Posted by Ritch on December 30, 2004, at 11:11:23
In reply to Re: pstim for Bipolar II with comorbid ADHD? » Ritch, posted by Ron Hill on December 30, 2004, at 1:06:50
> Mitch,
>
> How have you been? I'm committed to a self-imposed one-year block from posting (ends in Feb '05), but I need to interrupt my block to ask you a couple quick questions.
>Hi Ron, haven't talked to you in quite some time!
> Please correct me if I'm wrong, but as I recall, your dx is Bipolar II with comorbid ADHD (or do I have your dx confused with that of cybercafe?). Also, wedged in the deep recesses of my cranial crevices is the remembrance that last year your cocktail included a low dosage (like 10 mg) of Adderall XR as an add-on to your moodstabilizer for the purpose of treating your comorbid ADHD.
>
> Is my memory anywhere close, or am I off in left field? Here are my questions:
I was first diagnosed simply as manic-depressive (before it was called bipolar disorder). Later on when they split it up it was changed to bipolar II. Never argued with that. Latest pdoc looks at symptoms and doesn't fuss with dx much, and it would be more accurate to say that I have a lot of classic ADHD symptoms and some experimentation has happened to attempt to treat the ADHD as well as the bipolar symptoms. But, I've also got for real case of panic disorder and stimulants/WB aggravated the heck out of that and those meds have proven to be unusable for me. Bipolar+ADHD+panic disorder, what a mess, huh?
>
> 1) What was your dosage of Adderall, and how long were you on it?
The first time I tried Adderall was with Neurontin (only), and I had stopped taking an SSRI. I was on just 5mg with 600mg of Neurontin for about a couple of months. Starting getting panic big time. I attribute stopping the SSRI for that more than the Adderall, but it certainly didn't help the anxiety!>
> 2) What are your comments, opinions, and recommendations regarding the use of a low dosage of Adderall XR as an add-on to a moodstabilizer in a BP II patient for the purpose of treating atypical depression (via the dopamine and norepinephrine reuptake inhibitor actions of Adderall)?
IF you don't have a clear-cut anxiety disorder I would give it a try. When I'm taking a stimulant it does seem to exert an anticyclic effect. Look for an anticyclic effect. If things start getting worse-get off the stuff. None of the usual depressive symptoms happened while I was on it. Whether that's treating my bipolar or treating "ADHD", I'm not sure. I would watch the dosage and watch for tolerance (needing to increase the dose), and also watch for reverse tolerance (which is what I think happened in my case). I did try Depakote+Effexor (lowdose)+Adderall 5mg with much better success at a later time. Should I try a stimulant again.. I would need a serotonergic med to counter the anxiety. But, I would prefer not to have the anxiety to counter in the first place :) It is also possible that the stimulant simply removed the depressive phases, and changed the expression of mania from euphoria/dysphoria to panic anxiety. It also could have changed the expression of depression to simple boredom!
>
> 3) What are your observations and/or opinions regarding the likelihood of eventual pstim poop-out if Adderall were to be used on a long-term basis in the manner described directly above in question #2?
I would be definitely be concerned about it. However, other meds poopout as well, so perhaps it is just an individual thing? I've heard about some people with ADHD who take a steady moderate dose over time and it continues to help with attentiveness, but they can sometimes get depressed..... Maybe the stimulant would best be used for a seasonal bout of bipolar depression only (something that is predictable), and get off after it would normally subside (a few weeks)?
>
> 4) Finally, what prompted you to discontinue the add-on Adderall tx?ANXIETY! Yuck. Just hate being jittery, nauseous, and overfocused. Great for work though.
>
> Thanks much Mitch!
>
> -- Ron
>
>
You're welcome!
poster:Ritch
thread:435006
URL: http://www.dr-bob.org/babble/20041228/msgs/435691.html