Med Advice For Cyclothemia (like bipolar)

[KikiNik]

Just found this forum looking for answers to my medication questions for co-morbid adhd & cyclothemia. I am wondering if it is ok to take prozac, wellbutrin, and also a stimulant. I basically figured out myself through research, that I had these two conditions. I had started taking phentermine years ago to lose weight, but found myself staying on it after I had lost enough weight. I realized I was self medicating myself for adhd, and it also helped with depression. I thought I was bipolar, but now believe it to be cyclothemia. I went to a doctor who prescribed me prozac for the depression. I kept taking phentermine with his knowledge (from other doc), and it has seemed to be the perfect combo for both conditions. He has now prescribed Wellbutrin to me, since I still get tired at times from the prozac. He said it may be better for me then the phentermine, and would help give me some energy. Now, I have read that some people take wellbutrin, as well as a stimulant for adhd. Some say wellbutrin seems to not be as effective for adhd. So I am wondering what would be the best combination of these meds for me: Prozac, Wellbutrin, Phentermine (or other stimulant like dextroamphetimine). Is the combo of the three ok? If not, what combination would help me the most for hypomania, depression, and adhd? Also interested in dosage that would be best. I now take 20mg Prozac 2x a day, 30mg phentermine 3x day. Supposed to start 100mg wellbutrin 2x a day (deleting phentermine). Just wanted some answers before I switch or just add the wellbutrin. Oh, I also have hypothyroidism & take synthroid 88-100mg 1x a day. Any help regarding my meds is very much appreciated, from any of you who have suggestions. Thanks

[Gregster]

People do take a multitude of drugs for ADD and it's probably not uncommon to take Prozac, Wellbutrin and a stimulant together but I would not rush into anything - If I were you I would do as your Dr suggests and switch from the phentermine to the Wellbutrin and give it time to take effect. Many people take Wellbutrin for ADHD and it works very well for lots of them - every person is different. Phentermine is a stimulant but it is not used for ADHD to the best of my knowledge - it is likely not as effective for ADHD as the other stimulants, but I don't know that for sure.
There are a lot of variables in your situation - uncertainty about your diagnosis, the possiblility of bipolar disorder, the hypothyroidism - so going slow and not taking too many drugs at once, would seem a prudent thing to do. You want to give the Wellbutrin time to work, you want to see if it alone is helping, and you want to see how your body reacts to it - Wellbutrin has stimulant effects (You could say it's something like a cross between a stimulant and an anti-depressant) so it might increase your blood pressure, affect your sleep, etc. Given these variables, I wouldn't want to take Wellbutrin and phentermine together until I had a better idea how they will react together in your brain. As far as dosage goes, it's difficult to say what the right amount is - trial and error usually determines that eventually. Trust your Dr - he knows all your particulars (age, weight, BP, medical conditions, etc) - and will be best able to judge what's safe for you.
Good luck,
Greg

[Lafnalot]

I have always been taught that for typical bipolar stims were a no no----but for cyclothymia I am unsure. I am however concerned about the act of taking meds that your doctor is unaware of and unable to check you on. That along with medical issues is very touchy. Hypothyroidism also has an effect on emotion. I strongly urge you to seek the help of a good endocrynologist, or discuss your meds with your doc of choice. He or she needs to know all suppliments and chemicals you are placing in your system in order to gain a balance for you.

Hugs and welcome to our little adhd home away from home.

[1civdiv]

I have ADHD and Bipolar II and I take Wellbutrin and Lamictal with good results. I was on Stratera for the ADHD, but found that I did not like some of the side effects. As far as stims, i used to drink 10-15 cups of coffee a day(very black). I really think that if you give the wellbutrin a chance to work you will be happy with the results.

[KikiNik]

I am mostly concerned with Wellbutrin, because I read about people getting seizures & tics. I know that with the prozac & phentermine (stimulant) I have been fine. As far as cyclothemia and medications, I have found the info below on a couple of sites, and can relate to it. Stimulants have been great as a mood stabilizer. I now sleep every 12-24 hours, instead of staying up 2-3 days straight. Prozac has been amazing, in getting rid of my depression. I don't always go by what the doctor says, since I do my own research. In the beginning he prescribed me "geodon" to use as a mood stabilizer. I read up on it, and never took it once. Found it could be a problem with my thyroid meds, and would make me very sleepy. I let him know it wasn't for me, and then he prescribed the wellbutrin with the prozac.

Cyclothemia & Medication:

* Stimulants
For years, the dogma was that stimulants should be avoided for bipolar patients because they will cause mania. Although mood charting sometimes reveals that stimulants will promote cycling, they may occasionally be quite effective in bipolar depression as an adjunct to a mood stabilizer regimen. Some patients, perhaps especially those with comorbid ADD, will in fact have a mood stabilizing effect from stimulants; there are cases in the literature of acute mania responding to stimulants extremely rapidly. More often, a bipolar II patient with prominent depression will benefit from the addition of a stimulant with diminished anergy; of course, monitoring for a destabilizing effect is necessary, and mood charting here will be useful. Careful and close follow-up of response to stimulants is clearly warranted, but they should not be absolutely shunned, either in depressed or manic phases.

* Methylphenidate Dosage Range 10-60 mg/d. Primary drug of choice for chronic hypomania and for excessive daytime sleepiness (hypovigilance). May be added to antidepressant
drug regimen in rapidly cycling manic-depressive disease (or cyclothymia).

Cyclothymic Disorder Explained:

Less severe hypomanic and mini-depressive periods follow an irregular course, with each period lasting a few days. Cyclothymic disorder is commonly a precursor of bipolar II disorder. But it can also occur as extreme moodiness without being complicated by major mood disorders. In such cases, brief cycles of retarded depression accompanied by low self-confidence and increased sleep alternate with elation or increased enthusiasm and shortened sleep. In another form, low-grade depressive features predominate; the bipolar tendency is shown primarily by how easily elation or irritability is induced by antidepressants. In chronic hypomania, a form rarely seen clinically, elated periods predominate, with habitual reduction of sleep to < 6 h. Persons with this form are constantly overcheerful, self-assured, overenergetic, full of plans, improvident, overinvolved, and meddlesome; they rush off with restless impulses and accost people. Although cyclothymic and chronic hypomanic dispositions contribute to success in business, leadership, achievement, and artistic creativity in some persons, they more often have serious detrimental interpersonal and social sequelae. Cyclothymic instability is particularly likely to be manifested in an uneven work and schooling history; impulsive, frequent changes of residence; repeated romantic or marital breakups; and an episodic pattern of alcohol and drug abuse. Treatment: Patients should be taught how to live with the extremes of their temperamental inclinations, although living with cyclothymic disorder is not easy because of the resulting stormy interpersonal relations. Jobs with flexible hours are preferred. Patients with artistic inclinations should be encouraged to pursue such careers because the excesses and fragility of cyclothymia are better tolerated in such circles. The decision to use a mood stabilizer depends on the balance between the functional impairment produced by unpredictable mood swings and the social benefits or creative spurts the patient may receive from hypomanic swings. Divalproex 500 to 1000 mg/day is better tolerated than equivalent doses of lithium. Antidepressants should be avoided because of the risk of switching and rapid cycling.
http://www.merck.com/pubs/mmanual/se...er189/189e.htm

[Lafnalot]

I understand what you are saying, Im just saying your med doc really needs the info of what goes into your body, even if its just to be conciderate and cover his butt. he has aa nightmare of legal obligation.

[Gregster]

I really wouldn't worry about seizures or tics - if the stimulant you take hasn''t given them to you, the Wellbutrin isn't likely to either!
Tics are a more common a side effects for stimulants than for Wellbutrin.
Regards,
Greg

[KikiNik]

Thanks for the advice!!!
I've been taking my phentermine stimulant still,
with the wellbutrin and prozac. It seems to going
fine. I have a doc appointment in 2 weeks, so will
discuss this with him. I felt that I really needed
more of a stimulant, since I was still getting tired
and spacy throughout the day. I will either stay
on this prescription, or have the doctor prescribe
me a stronger stimulant, and then go off the
wellbutrin and the phentermine.

[BackAgain]

You would think that being a Pharmacist would protect you from self medicating. But so be it. (Actually the reason I'm so intreged by your posting is that you "stimulant" of choice is something we have in common) When it comes to your questions about medications and what you should do. I have thoroughly researched the topic since I was diagnosed about 2 years. To keep it short if I could ask you one question it would be why did you seek treatment and what is the time frame from which you started legit. prescriptions and when you found yourself taking Fastin. (Adipex is only available as 37.5mg and Ionamin is a different long actin resin of phentermine.) Blue and Yellow capsules I think are the generic that is going around now. But anyway I would very much enjoy talking to others who are in this same situations.

As a side not taking an antidepressant and having your mood increase in anything less than 3-4 weeks is bad. Antidepressants can unmask cyclothymic, bipolar and related diseases by sending one into a manic or hypomanic state.