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Bipolarity with ADHD by Lydia Godgedock - Mon, 27 Mar 2017 01:28:32 EST ID:/4+pDU+R No.278468 Ignore Report Quick Reply
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After looking at all the active threads, I have seen a few threads on ADHD, and a couple on smart drugs (and one on wakefulness promoting agents on the first page), but they did not quite pertain to my problem. I have bipolarity and comborbid ADHD. It sucks. My conundrum is as follows. I need something that treats the ADHD without pushing me into mania, and I am sensitive to medication. Any recommendations or ideas? I

've self-medicated with caffeine and nicotine the last ten years and this shit sucks. I was diagnosed quite young with the ADHD, and I took Ritalin for 12 years from 6-18. In college, I briefly took Concerta, Ritalin, and Vyvanse...I can't remember why I discontinued them, but Concerta was vile.

I know that there are non-stimulant options like Strattera, Intuniv, and Kapvay/Catapres, but ideally if anything I would use those in addition to the stimulant. I have ADHD quiet severely.
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Albert Saddlefield - Mon, 27 Mar 2017 13:36:52 EST ID:DO8Td1tQ No.278476 Ignore Report Quick Reply
just add depakote to whatever stimulant
for example ice + depakote
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TinyTrip !5pb17tfZto - Mon, 27 Mar 2017 16:57:00 EST ID:5R2en7Vc No.278480 Ignore Report Quick Reply
Depends. I'm assuming you mean BP 1 which would imply you've had atleast one manic episode, this would make it extremely difficult as PDocs will be afraid of inďucing manic symptoms.

While I had a diagnosis of BP 2 I complained about about lethargy, dysphoria, and anhedonia enough to get my team to agree to initially modafinil, divalproex sodium, and clonazepam. Oddly, modafinil made me more wired than any other stim I've tried so we settled on vyvanse 60mg.

With a history of mania or psychosis, I'm not sure many doctors would be willing to risk your health. If I were you I'd focus on how my ADHD has negatively impacted my quality of life to the extent it needs to be adressed properly and safely. Whether this means a cocktail of something like divalproex, quetiapine (under 250mg), and a dex based stimulant, or you may have to settle for the B league Weĺlbutrin etc.

We all have to come to realize limitations of our illnesses, with mine I can't consume alcohol and havent for years. I'm not too familiar with the treatment of comorbidity between ADHD and BP 1 but I'm aware of the stats and am sure there is some precedent
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Albert Hovingstone - Mon, 27 Mar 2017 20:27:41 EST ID:/4+pDU+R No.278484 Ignore Report Quick Reply
>>278480
Currently, all I take is Abilify 5mg once a day. Sometimes I will supplement with melatonin for sleep. In other words, I do not know what exact affective disorder I have.

So you think Provigil (modafinil)/Nuvigil(armomodafinil) would be too 'stimluating'? That's a concern of mine. I wish a stimulant existed without all the weird peripheral stuff. I just want concentration, motivation back, etc.

I took Ritalin as a kid and it did wonders.
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Lillian Baddlebury - Thu, 30 Mar 2017 17:10:11 EST ID:F79les0X No.278540 Ignore Report Quick Reply
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>>278468
I'm in that boat OP, and when it comes down to it I've chosen not to treat the ADD because mania is just not worth it (it also exacerbates anxiety, which is between the two in severity for me).

I can however offer you the following insights based on my experience:

-Ritalin (or focalin) would probably be your best option if you choose to be scripted stims, as I find when it's over, it's over (plus weed practically eliminates the comedown). It's got less of an edge to it than amp IMO, and I would consider it to be "safer" in respect to bipolar (in IR form). FUCK concerta though, I agree, the 12-hour slow release makes it an utterly different beast (tweaky, anxiety, panic...). Unfortunately, methylphenidate loses its useful effects rather quickly when taken on a regular basis.

-AVOID AVOID AVOID adderal; for me this actually causes worse side effects than meth, and it lingers for dayyyyys. Weed does not help so much with the comedown. I can definitively link it to kicking off at least one manic episode. If you're set on going the amphetamine route, I'd suggest dexedrine, though you're unlikely to get this Rx without having been tried on mixed amp salts first. Beware that this is really playing with fire though.

-Bupropion is a much more mild stimulant and less likely to trigger mania. I found it helpful for about a week; after that, all it generated was anxiety.

-Modafinil seemed pretty promising, though I didn't get to try it very long due to it causing a rash all over my body.

-Strattera did literally nothing except make it feel funny when I pissed.

Oddly enough, I've actually found gabapentin to be surprisingly helpful. Though this may have more to do with the anxiety piece getting in the way of actively handling other symptoms, I do in fact feel significantly stimulated from it. It becomes easier for me to take a step back and collect my thoughts to formulate a plan of action (though I do also tend to both multitask and get hyper-focused). It combines excellently with caffeine as well (and by extension nicotine). The fact that it has these unforeseen benefits when intended as an anxiolytic (for which it also helps) is perhaps the most fortuitous "side effect" I've ever experienced.

I'd highly recommend having seroquel available when trying any stims while bipolar, since it is one of the few things that can effectively cancel out of them and give you sleep should the situation start getting out of hand. All in all, I find it easier to handle ADD symptoms with managed bipolar, than I do to handle bipolar symptoms with managed ADD.

While YMMV, I hope this was helpful in some respect, and that you are able to find relief from the things you carry.
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Albert Cronkinshaw - Mon, 03 Apr 2017 04:12:53 EST ID:RX6CrARH No.278616 Ignore Report Quick Reply
Cbd sea beee dizzzzle
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William Gushwill - Mon, 03 Apr 2017 16:55:49 EST ID:TV5cKxPn No.278622 Ignore Report Quick Reply
What is bipolarity? It's clear you mean bipolar but given the strange way you're referring to it, I'm thinking you haven't had it diagnosed by anybody before. If you haven't, get diagnosed. ADHD and bipolar have some ridiculous overlap in symptoms. If you've got bipolar, stimulants present a risk of causing a bout of mania and should probably be avoided. if you're serious about having bipolar you need to talk to a professional about it; if you actually suffer from it, youre at risk for some seriously debilitating problems.

if you just think you have bipolar, chances are you don't have it. usually people with bipolar aren't aware they cycle through moods like they do and often have to have people force them to seek treatment. it's also a serious enough risk that stims will give you a manic episode that your life could get seriously fucked, so if you tolerate stims without much issue chances are you dont have bipolar either
>>
Beatrice Murdfoot - Sat, 08 Apr 2017 07:04:18 EST ID:/4+pDU+R No.278726 Ignore Report Quick Reply
>>278622 In short, I have no clear idea.
Here's some of my diagnostic and treatment history for you or anyone in the thread...I provide explanations where necessary. I think this bears repeating that diagnostic criteria, terminology, and treatment methodologies change really quite frequently, especially in the APA, which seems to cater to and be catered to by the pharmaceutical industry. But that's entirely a different conversation.

I think Bipolar Disorder is a clunky term. I prefer Manic-Depression, but it is outmoded. I picked up Bipolarity as a term after I heard Bipolar Disorder referred to it as such in British English.

Honestly, I am not sure. Here is what I know. I was diagnosed with ADHD w/ ODD (Oppositional Defiant Disorder) at around age 4 in 1991. Autism, retardation and other disorders were ruled out. Also, I had poor fine motor skills and a learning disability I began medication treatments at 5 or 6 with Ritalin ranging from 5mg-20mg anywhere from once-a-day to three-times-a-day. I never took Cylert or any of the amphetamine drugs growing up...Adderall may have been the only one available in the in the 90s/early 00s. I'm not sure when Desoxyn came out, but that was never put forth as an option. Ritalin did the trick though.

Fast forwarding...I stopped taking Ritalin my senior year of high school. This proved disastrous in college and my second semester of my senior year. You're probably scratching your head as to why I would do this, but there was this unmitigated optimism and frank idiocy in this period of medical history in which a commonly held belief amongst physicians was that 'LOL kids outgrow AD(H)D; throw that RItalin out". Adult ADHD was considered unlikely was what I was told. (I had older physicians use the term hyperkinesis in lieu of ADD or ADHD. I mean some of these people were just antiquated or misinformed)

I hated college for a wide variety of reasons. I drank like a fish and consumed caffeine and nicotine to quell my anxiety and my attention issues. Not surprising, I have been told that untreated ADHD is quite nasty. I think college proved that point to me and I can say now that inadequate treatment/no treatment was to blame for my failure and unhappiness. When I was 20, I suffered a pretty severe panic attack on my way to a different college--I was transferring. I had some pretty severe repressed memories come back. I experienced hallucinations (primarily tactile), delusions, anhedonia, psychomotor retardation, and crippling depression. Three weeks later I voluntarily committed myself to a psych ward with encouragement from my family. I had been taking only Zoloft at the time and had been on it maybe a month (a week on it prior to my panic attack). This was prescribed by my family doctor at the time. There was no psychiatrist, neurologist, or mental health specialist in my life at this time. Anyway, I spent two-to-three weeks in the psychward. It's hard to remember honestly and really quite unpleasant. I was diagnosed as Psychosis (NOS). I was given a wide ranging differential diagnosis that included psychotic depression, bipolar disorder, schizoaffective, schizophreniform, and a bunch of other diagnoses I can't remember.

I was discharged and put on Depakote and Risperdal disc melts. I was so avoidant, akathisia-afflicted, unsettled, and anxious I could barely function. My psychiatrist at the time was pretty useless. Eventually I saw a competent psychiatrist that was willing to change up meds and offer therapy. This helped tremendously. But in brief, I have always typically reacted poorly to SSRIs and SNRIs. My psychiatrist seemed to think that this was proof that it was not simple unipolar depression (or any of its variants e.g. depression with psychotic features, atypical, or melancholic) but that it was bipolar depression. He ruled out the schizophrenia-related disorders. By what criteria I am not sure. There was a lot of testing and medication trial-and-error (Cymbalta, Wellbutrin SR & XR, Aplenzin, Lamictal, Trileptal, Concerta, Vyvanse, methylphenidate, Lunesta, clonazepam, zolpidem tartrate & Ambien CR, etc.; etc.)

Anyway, there's more but I'm tired of writing and you're probably tired of reading. I think untreated ADHD may be the root of all of my evils. I think bottom-line that ADHD isn't the one-note/one-dimensional illness that I was sold as a child. It's definitely a multi-dimensional illness.

My most recent affective-related diagnosis was Mood Disorder NOS. I've also been diagnosed as having generalized anxiety disorder and adjustment disorder.
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Fuck Smallcocke - Sat, 08 Apr 2017 15:50:21 EST ID:KnhBZ9FM No.278729 Ignore Report Quick Reply
>>278622
ADHD and bipolar disorder have symptom overlap for the same reason depression and bipolar disorder have symptom overlap. They're genetically correlated. ADHD runs in bipolar families and bipolar runs in ADHD families. Many people have both at the same time, and the most common diagnosis for a bipolar in childhood to have is ADHD with ODD or conduct disorder (it's an absurd rate too, something like 90%).

Stims can trigger mania but it's not reliable an indicator as SSRI triggered mania. Some researchers have even forwarded using amphetamines to treat certain cases of mania because it stabilizes EEG spiking.


>>278726
Desoxyn has been available since the 1940's. There used to be a whole class of methamphetamine pharmaceuticals, the CSA killed almost all of them off save for desoxyn itself.

It's possible whatever 'psychotic features' of your illness were strictly related to the panic attack, which by itself can present with hallucinations. I would especially consider this notion if no positive symptoms made their presence known after this attack. Psychosis is very easy to misdiagnose, even for professionals. You don't type like you have an FtD, which is good prognosis regardless of my speculation.

>This helped tremendously. But in brief, I have always typically reacted poorly to SSRIs and SNRIs. My psychiatrist seemed to think that this was proof that it was not simple unipolar depression (or any of its variants e.g. depression with psychotic features, atypical, or melancholic) but that it was bipolar depression. He ruled out the schizophrenia-related disorders. By what criteria I am not sure.

This is kind of a recent push in psychology. The strict dichotomy between unipolar and bipolar illness is fading over time as we learn more about the etiology of mood disorder in general. The depressive non-responders, people who have no benefit from SSRIs or only short-term benefit with multiple drug trials, are a little bit closer to the bipolar side of the pendulum than the unipolar side by treatment response and familial history - even if you have no manic symptoms displayed. It ties heavily into innate temperament and interpersonal experiences during childhood. Some people are naturally more sunny and thus more predisposed to developing mania, some people are irritable and predisposed to mixed states, some people swing between sadness and happiness without their swings progressing to the level of a severe mental disorder. Sometimes the mania just hasn't revealed itself yet, or maybe you'll always just be sort of in between bipolarity and unipolarity, not quite setting your toes down in either category. Kraepelin himself states that there were as many divergent illness courses for mood disorder as there were individuals suffering from it.

To be fair, manic symptoms can be quite difficult to recognize in the self, especially milder non-psychotic forms. When depressed, they can arise as mixed state psychomotor agitation, irritability, and rage episodes along with goal-directed suicidal compulsions. When not depressed, they can be as insidious as a mild bump in self-esteem levels and energy for a week or two.
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Beatrice Murdfoot - Sat, 08 Apr 2017 17:19:37 EST ID:/4+pDU+R No.278730 Ignore Report Quick Reply
>>278540 OP here (sorry for the late response)
My diagnostic history is kind of wacky, and I referred to in an earlier post, but like you, I can say I definitely have an anxiety problem being diagnosed with GAD and the comborbid ADHD, which definitely has an anxiety component already built-in.

My mood is a little more tricky...the last word on my mood was Mood Disorder (NOS). I think I probably had First Episode Psychosis and I may have been misdiagnosed and as a result mistreated all this time. Fuck me if so.

The meds I'd be down for would be Focalin XR and Aptensio XR and Provigil. I'm a QD kind of man. I don't think all XR/ER/CR meds are bad...but Concerta was just awful. It was too much. The crash was dreadful. Vyvanse's crash was worse. It felt like I was dying a lot of the time at the end of the day. Maybe that gets better after time? I've heard that's not the case looking around the net in various forums. It might just be a trial-and-error thing.

In response to your post (thanks btw), I'm definitely leaning methylphenidate-formulation or atypical treatment ala modafinil (Provigil) or some other off-label option. I think I miss that 'feeling smart' sensation. I miss that 'oh shit that's why I had all As' or put another way that feeling of my brain being given a top-flight-top-grade tune up like an engine.

Wellbutrin also gave me anxiety and made me a little feisty. Also, I was horny all the time, but I was happier if not more hostile generally speaking lol.

Strattera also made me feisty and downright aggressive. I didn't care for it. It's a shit option. I hope the beta-blockers are better.

Thanks for the advice. You're right. Maybe I should try my bipolar features first...right now my treatment is pretty inadequate.

>>278616
CBD would be excellent and I might explore it. Medical weed is coming to my state soon, so maybe that will become a regular option. I can say marijuana helps with my anxiety and mood, but executive functioning and task saliency...I am unsure about that. I've also heard that marijuana can negatively affect bipolarity. I don't really smoke. I can actually count on both hands how many times I've blazed.
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Beatrice Murdfoot - Sat, 08 Apr 2017 17:44:31 EST ID:/4+pDU+R No.278731 Ignore Report Quick Reply
>>278729
Wow, thanks for the informative post. What is an FtD? Frontotemporal Dementia? I've never had an recurrent positive symptoms and it has been almost 10 years. What do you know or think about pharmacogenomics? I had a therapist mention it to me that there's testing out there to see what medication would be a 'good fit' based on my genetics.

I've heard it's very difficult to be prescribed Desoxyn. I'd probably rule it out as a possibility for myself if I were to ever tell a psychiatrist about my diagnostic history.
I haven't ruled out Intuniv or Kapvay, but if they're anything like Strattera...I'll be bummed.

I think you're right. I think it was First Episode Psychosis. Probably a one-and-done event. The competent psychiatrist's thinking was that I probably had a mild case of dysthymia in Jr. High that became rather clinical and pronounced in high school and it 'morphed' into bipolarity. I'm not sure if that's possible...it's just what he thought.

Not only did I not respond to SSRIs/SNRIs, I had negative outcomes and I couldn't get an erection, so it was very unpleasant.

Interesting. I think as an illness goes that mental illness certainly needs to be taken on a case-by-case basis. I think there's a little too much blanketing that goes on in psychiatry and clinical psychology these days. Emil was right.

The neurologist who diagnosed me said ADD within a few minutes of meeting me. The child psychiatrist I saw thereafter said that I was gifted/talented but that I had problems with rage as I had certain developmental setbacks...namely I had depreciated fine motor skills...issues with things like writing or using scissors or coloring, etc. I was clumsy and that has a name too like proprioreceptor (I made that up but it has proprio in there and maybe -re-), but otherwise no other gross motor impairments.

What's the gold-standard for bipolar treatment then? Lithium + Lamictal? Basically is there any medication that can address bipolar mania, bipolar depression, mixed episodes and work during maintenance?

Thanks for your time btw...really appreciate it.
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Phyllis Dunnerset - Thu, 20 Apr 2017 21:32:54 EST ID:/4+pDU+R No.278990 Ignore Report Quick Reply
An update--

I have an appointment with my Primary Care Physician here soon and I'll see a new psychiatrist thereafter.

I'm still thinking something (dex)methylphenidate based or modafinil. Probably a Focalin or Focalin XR with Intuniv to augment.

On the Manic-Depression side, I'm thinking of dropping Abilify (!) for better or worse. Antipsychotics are a potentially nasty class of drugs that can cause really nasty chronic conditions like tardive dyskinesia, metabolic syndrome/diabetes, obesity, etc. I'm thinking Lamictal XR and ideally Oxtellar XR (any variety of oxcarbazepine will work I think) for mood stabilization. We'll see what happens. I'd take LIthium if it weren't a monograph of nightmarish side effects.

Also I'm thinking about participating in a pharmacogenomics test, which will potentially offer greater insight into my ideal fit.
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Clara Trotfield - Fri, 21 Apr 2017 02:37:27 EST ID:XfeUcuQf No.278997 Ignore Report Quick Reply
>>278990
Be careful with Lamotragine/Lamictal. I've been on Zonegran, Keppra, Depakote, Lamictal, and a few others I cant remember and I'm presently on Lamictal 100XR right now. I take it at night time and I'm losing my hair and also my balance. It's better than the others I've been on but it's certainly a slippery slope.

I'd also lowered my dosage amount because it seems to do just the same for me back when I was on 500mg nightly.
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Clara Trotfield - Fri, 21 Apr 2017 02:39:47 EST ID:XfeUcuQf No.278998 Ignore Report Quick Reply
>>278990
Forgot to mention my mood stability. I don't really recall my mood changing because of Lamictal. I was a very hateful and violent person growing up and educating myself was how I grew out of it. If anything about my mood is being affected, it's my complacency. But that's probably my depression from being epileptic.
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The guy who knows nothing about everything - Sun, 23 Apr 2017 02:56:05 EST ID:c/sO2GEh No.279030 Ignore Report Quick Reply
Educate yourself and self medicate with substances you are comfortable with that logically will help the way your brain functions. I don't know if your in it for the short term like me or long term but use your past experiences to think about what's helped, for how long then look into why those substances helped with your problems and which ones did the best for the longest. From there it is just making sure your not messing your body up for the long term and refining what works for you so it last longer with less negative effects. You do you but pay attention to yourself every step of the way.


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