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  #1  
Old 06-23-07, 02:18 AM
youngChelovek youngChelovek is offline
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Bipolar and ADHD Meds Together? Is It Possible?!!!

Hello all. I was diagnosed with Bipolar Type I along with ADHD, predominantly inattentive type. I currently take -- only for my Bipolar Disorder -- Lamictal, Seroquel, Lithium, Abilify, and Effexor for depression. My doctor keeps putting me on anti-depressants for my ADHD (such as Wellbutrin). Well, they're not working. My question is, is it still possible for me to go back on a stimulant while taking these bipolar meds? My moods are 100% controlled on the med cocktail I currently represent. If it's possible to take stimulants with bipolar meds, which stimulant would be the best? Has anyone tried Strattera with bipolar meds? I heard Strattera is almost as effective as Ritalin in treating ADHD in children. Is this true?

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Old 06-23-07, 10:34 AM
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Naturally everybody is different and naturally we cannot give medical advice . What we can do is tell you what we manage on.

I cannot truly speak for BPI since I have BPII, but this is what I take:

Lamictal
Abilify
Atarax
Dexedrine

I know there are others here who manage to take stimulants with BP meds, and others who do not. Its always a balancing act when you take meds for ADHD and BP at the same time.

In short, you really have to ask your doctor. I am personally totally unfamiliar with Effexor, Lithium and Seroquel. I hope that some more members of the Cycling Team show up and give you some more input .
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Old 06-25-07, 10:29 AM
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CF is correct...there are so combo's we all take here. I am not as familiar with the Bipolar I either. Just experiences with my Aunt.
So this is another list of meds from a Very Rapid Cycling Bipolar II/ Inattentive ADDer. I will also tell you my 15 year old is Bipolar II / ADD as well.

My list.
Lamictal 150mg
Risperdal .05mg to 1mg during the week for sleep/also as needed for psycho PMDD days.
Adderall XR 20mg, everyday....

My son has exactly the same meds except instead of Risperdal he is on Seroquel 150mg. He over rode the Risperdal for sleep, and tends to be a little more aggressive / aggitated/anxious than me, apparently Seroquel seems to work better for these symptoms, especially in hard to medicate teens.

I can tell you that I had to be on my Lamictal for a little over 2 months, when I was up to 100mgs , before my doc would let me start the Adderall XR. And I went with the lowest dosage. 20mg. Down from my normal (pre BPII dx) of 40mg. I have had no issues with it causing continual manic/hypomanic episodes. I do have to watch how late I take them, or they do mess with my sleep cycle, and of course that can cause the hypomania to kick in.
I also am familiar with my triggers, and when "more extreme" stages of hypomania will occur, like after a huge stressful/ chaotic/ traumatic event..Then I don't take it for a couple of days until I feel leveled out.
Other than that, it seems to work well with the Lamictal & Riserdal. In fact feel much more level on both, and get much more done on both.

I can tell you, as I have said to others. I don't see a lot of good reactions with the Strattera and Bipolars. Although it might be different with the BPI..but not sure. And as far as the Wellbutrin, my understanding is that it's NOT recommended for Bipolars? It can cause Hypomania..and from what I have seen here for the other's it has caused that and extreme anxiety and mood swings...So I would def research that...Jeaniebug had some bad experiences with it.
See her threads http://www.addforums.com/forums/show...1&page=3&pp=15
She has reference to the same info I researched. Antidepressants and Bipolar II don't often work well together. If you scroll through the thread you can see the succession of issues, and some "research" info and sites...

And of course Eyeforgot...had some issues going on the Strattera.
See her post.
http://www.addforums.com/forums/showthread.php?t=40737

Again, what works for one doesn't work for others. And I don't know much about the BPI's...

Here are some useful sites I have used.
Both to research my Bipolar, and also medications.

www.helpguide.org
www.medicalnewstoday.com/sections/bipolar
www.nimh.nih.gov (national institute of mental health, I use this one alot)
www.nami.org (and this one, which is national alliance on Mental Illness

Med site
www.pdrhealth.com


Hope this helps in your medication journey!
Welcome to the cycling club!


Hope
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Old 07-01-07, 11:48 AM
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Hey, young C!


Hope is right, I personally had a very bad experience with Effexor. It made me incredibly manic, and as a BP II, I am sometimes hypomanic, but the only time my mania was significant was on Effexor. I had a pdoc who I kept telling, "its not working" for the depression and he kept upping my dose. I made some very bad choices on Effexor. Very out of character for me (but hey, that's the wonderful world of bipolar!)

However, everyone is different, and it works well for some people. I personally see it prescribed a lot for cancer patients (women) to reduce hot flashes related to menopause brought on by chemotherapy. Those gals seem to like it. One patient went from 8 hot flashes a day to 4 per week (I do clinical cancer research). Of course, these ladies have not been diagnosed with bipolar and/or ADHD, to my knowledge.

I am inattentive as well. I was prescribed Wellbutrin in January by a quack of a pdoc because I have had treatment -resistant depression for like 15 years, and I had never tried Wellbutrin. This was before my diagnosis of bipolar/ADHD. (And the depression was the primary manifestation of my bipolar II, which is fairly common, it turns out). Wellbutrin made me alternately weepy, bursting into tears at the drop of a hat, and aggitated or angry/hostile. I mean hostile for me, which meant I was short with people and my patience was non-existant. When I first took it I thought it was wonderful, and in hindsite, I know it induced mania. (or hypomania) Which I suspected, but it felt so good, I was in denial. For about two weeks I thought it was the most wonderful drug ever invented. Then it was the anger/sad thing, and my depression only got worse from there. I had switched pdocs after that when I was getting tested and officially diagnosed with BP and ADHD, and I begged doc #2 to go off it. He said no problem, and I threw away every last one of those!

Strattera is wonderful for some people here on the forum, you can search for it and find more information. My pdoc said he has never found anyone who did well on it, but he often tries it for the first med, since it is a non-stim. I was prescribed it, but I have to confess I did not take it because I was too afraid to take it -- mainly because I had been around an 11 year old who took it last fall -- I was working with hearing impaired boys, and there was one in particular who had ADHD. He was put on Strattera and I saw a big increase in really bad behavior anger, aggression, and hitting. Finally after about 2 months he was switched back to stims and he was no longer trying to inflict deadly harm on the younger boys. It was a hairy experience, and it caused me a lot of anxiety. He had to be watched 100% of the time, and he still managed to hit/hurt a 7 year old several times. I had to take at least one xanax to get through 6 hours of working around him.

{{I have to continue this on the next post, it won't let me post the whole thing here. Sorry this is so long}}
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Old 07-01-07, 11:55 AM
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I read up about it at the time, and found lots of info about SNRI's - Strattera, Effexor, and Cymbalta (and others) are antidepressants of the selective norepinephrine reuptake inhibitor (SNRI) class. I found the following information on a site for lawyers who represent people harmed by Strattera. And of course, it only talks about the bad side effects which are only a percentage of those taking it.


Quote:

On Thursday, September 29, 2005, the Food and Drug Administration (FDA) issued a warning to the public about suicide risk associated with Strattera. Strattera, manufactured by Eli Lilly, is prescribed in cases of attention deficit hyperactivity disorder (ADHD). Strattera (atomoxetine HCl), is a selective norepinephrine reuptake inhibitor (SNRI) approved for the treatment of attention-deficit/hyperactivity disorder.

Concerns about a suicide-related side effect of Strattera emerged more than a year prior to the warning issued. In the journal Pediatrics (PEDIATRICS Vol. 114 No. 3 September 2004, pp. 895-896) physicians documented that within a pool of 153 patients (10.5 3.74 years old) treated with atomoxetine in outpatient settings in Denver, Colorado, and North Branch, Minnesota, extreme irritability, aggression, mania, or hypomania induction were observed in 51 cases (33%).

According to the drug's label insert, the clinical trials prior to Strattera's FDA approval showed between 2% and 5% of patients experienced mood swings, with 8% experiencing irritability and another 1% who discontinued the trials due to aggression or irritability. Until the Sept 2004 study release many clinicians were anecdotally aware of increased hostility, aggression and mania exhibited by some atomoxetine patients.




{{I still have to add a bit, copying and pasting from Word seems to be a problem, dang! So to be continued.... }}
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Old 07-01-07, 12:01 PM
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Since I do clinical trials, although for cancer treatment, I can tell you that 33% of patients experiencing these kinds of negative side effects is quite a red flag for me. I think it is particularly important for someone with bipolar to be really careful around Strattera, because to me, it appears that it sometimes can trigger mania in addition to hostility. And I wonder if, in the clinical trial, if the kids who did have the irritable/hostile side effects also had undiagnosed bipolar in addition to ADHD. It would be interesting to find out if any of them went on to be diagnosed with bipolar.

All of this may mean absolutely nothing in your case. I am not a doctor, so I have not had much experience with these drugs, except to say that I have taken two kinds of SNRI's and they were both really bad experiences for me. And we are all different, and you really need to talk with your doctor. But knowledge is a powerful thing.

So what are your observations about taking Effexor, and/or Wellbutrin? If you tolerate them and they help, maybe Strattera would be right for you. I had read that when you are starting out on a mood stabilizer, you might not want to add an antidepressant right away, because it can cancel out the effects of the mood stabilizer and you might not be getting to experience the "true" effect of the mood stabilizer itself. I think I read that on psycheducation.org. Have you done that -- i.e. Lamictal, Seroquel, Lithium, Abilify w/o an SNRI? Of course, talk to your doctor, I am not recommending this, I just wondered.

I do not have depression on the mood stablizer (Lamictal) alone. I will be very reluctant to add any anti-depressant to my mix of Lamictal and Adderall, because antidepressants have not helped me. What they did do was increase my anxiety, cause me weight gain, and I became more anti-social. I know that stims can trigger mania, but so can SNRI's, or SSRI's. Like Hope said, you might do OK on a fairly low dose of stims. Like her, I also take 20 mg of Adderall. I did have to suggest that to my pdoc before he prescribed it, but I also had to suggest the Lamictal, which he hadn't been prescribing because of the rash side effect. Like Hope, I am getting more done, and my depression has lifted. I do still cycle some, and I do still have anxiety. I may try abilify or risperdal at some point.

Good luck to you! Let us know what happens!
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Old 07-10-07, 07:25 PM
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I am a bipolar I who took Strattera during the 2004 elections and my third day on it I was a 'candidate'. A stimulant works well for some but if you do well on an antidepressant of a similar nature (I go manic on all of them) then straterra may help.
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Old 10-10-10, 09:32 PM
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Re: Bipolar and ADHD Meds Together? Is It Possible?!!!

Quote:
Originally Posted by youngChelovek View Post
Hello all. I was diagnosed with Bipolar Type I along with ADHD, predominantly inattentive type. I currently take -- only for my Bipolar Disorder -- Lamictal, Seroquel, Lithium, Abilify, and Effexor for depression. My doctor keeps putting me on anti-depressants for my ADHD (such as Wellbutrin). Well, they're not working. My question is, is it still possible for me to go back on a stimulant while taking these bipolar meds? My moods are 100% controlled on the med cocktail I currently represent. If it's possible to take stimulants with bipolar meds, which stimulant would be the best? Has anyone tried Strattera with bipolar meds? I heard Strattera is almost as effective as Ritalin in treating ADHD in children. Is this true?

Thanks,
youngChelovek
I know alot of bipolar perople who take ritalin and amphs like dex and it does not make them manic..it lessens their mania. I've seen mania and I mean hardcore mania from people on effexor which you're on so I'd be more worried about that med.
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Old 11-15-10, 06:41 AM
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Re: Bipolar and ADHD Meds Together? Is It Possible?!!!

Mostly children don't seem to do too well with Strattera.

I have been on Lamictal for about 6wks (tapering) and Strattera for 4 wks. I'd caution you with starting the latter since most (not all but by far most) report some sort of affect on their libido.

In terms of mmod - the point of starting the bp med first is to create that ceiling/floor to enable you to seek treatment for other conditions. So yes, you can seek ADD meds. Be wary that your pdoc will likely be reluctant towrds stimulants but if you're very intent on starting those (e.g. Concerta, Adderall) you could offer to start on a lower dose
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Old 12-27-10, 01:45 PM
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Re: Bipolar and ADHD Meds Together? Is It Possible?!!!

Okay, so I have been ADHD since elem school (ritalin) I seemed able to control most of my symtoms as I got through my late teens and early 20's, (I thought anyways, others disagreed) I talk excessively, interrupt others, fidget, have angry outbursts, and random mood swing. There are other symtoms, but you get the point i'm sure. My new DR says I am ADHD BPII, with a mood disorder and prescribed Adderall XR 20 mg(which I have been on and off of for several years at 40mg dosing) along with depakote500mg 2 x aday. The depakote is making me very ill, but it does wonders for my mood swings (and keeping my family from wanting to strangle me) but I have thrown up so much in the few days I have been on it I am not sure I can tolerate it much longer. I have even lower my dosing to half in am half in pm but even that and some phenergan to control the nausea doesn't help.(I do eat before I take the meds also) Oh and I sleep like crap....all the time, can't sleep can't fall asleep....HELP??? I know your not DR's but please give me some advise?
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Old 01-18-11, 02:12 PM
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Re: Bipolar and ADHD Meds Together? Is It Possible?!!!

Hi I have adhd combo type along with bipolar type II with bunch of other stuff but the first med my doctor started me on was lamictal. After I was titrated up to the correct dose she started me on some adhd medication. I've tried adderall IR 10mg and the BD problems didn't seem to peek out from the adderall so we were in the clear but I needed something extended release so I can be able to work full time and continue being a full time student (which sucks but only 1 semester left till I graduate so it's worth it) due to my financial need to work. So she switched me to vyvanse and it has been good even though we're still trying to find the correct dose. I haven't tried any other BD medications so I won't be able to help you with that but this combination has been great for me. I do think people with BD can also be on a stimulant if it is correct for them. Good luck!

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Old 01-24-11, 09:19 PM
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Re: Bipolar and ADHD Meds Together? Is It Possible?!!!

I would be cautious if your moods are controlled. Generally, the effect for me is that one counter indicates the other and they pretty much cancel each other out. I didn't know if you could have both.
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Old 01-25-11, 09:11 PM
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Re: Bipolar and ADHD Meds Together? Is It Possible?!!!

I am diagnosed with depression,bipolar,anxiety & ADHD.I take Paxil,Abilify,Xanax & Dexedrine & this has been a really good combination of drugs for me.I haven't any side effects & no mania with the Dexedrine.

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Old 01-26-11, 12:38 AM
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Re: Bipolar and ADHD Meds Together? Is It Possible?!!!

Quote:
Originally Posted by jeaniebug View Post
I read up about it at the time, and found lots of info about SNRI's - Strattera, Effexor, and Cymbalta (and others) are antidepressants of the selective norepinephrine reuptake inhibitor (SNRI) class. I found the following information on a site for lawyers who represent people harmed by Strattera. And of course, it only talks about the bad side effects which are only a percentage of those taking it.






{{I still have to add a bit, copying and pasting from Word seems to be a problem, dang! So to be continued.... }}
I have BP 1, and I believe Strattera made me manic...but not just irritable like normal, no no... it was absolute rage, to the point where I wanted to harm people. It was scary.

Anyway, I take 70mg of Vyvanse with an adderall or dex booster along with Geodon and Wellbutrin. My pdoc has always been more concerned with the Wellbutrin than the stims. He said that in his experience, as long as I'm on the Geodon (since I'm on a high dose), the Vyvanse isn't as worrisome, especially because it isn't 24/7 like an antidepressant.
When I leave his office, he commonly says "Watch the Wellbutrin, call me if you start to become manic"....and I've been on it for like 6 months at this point.
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Old 01-26-11, 01:15 AM
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Re: Bipolar and ADHD Meds Together? Is It Possible?!!!

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When I leave his office, he commonly says "Watch the Wellbutrin, call me if you start to become manic"....and I've been on it for like 6 months at this point.
He should be more worried about the stimulant and the lack of a mood stabilizer in your cocktail. Wellbutrin is probably the least likely anti-depressant to induce mania or mixed states.
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