Stimulant medication for Bipolar depressive

Greetings!

Some past history first. My first visit to the psych was due to a depression lasting for about 6 months. All along, I was sure (from my symptoms and self diagnosis) that an untreated Inattentive ADHD condition had led to a life situations which had triggered the depressive episodes.

Diagnosis 1 : Depression
Treatment 1 : Wellbutrin 150 mg
- Depression reduced but I still had racing thoughts, unable to focus, work was severely affected.

Diagnosis 2 : Major Depressive episode with a likely history of dysthemia
Treatment 2 : Cymbalta 60 mg, Adderall 10 mg
Cymbalta 60 mg - Depression lifted, I felt much better.
Adderall 10 mg - While at work, I would ruminate uncontrollably over marital problems. The stimulant gave me the choice to either work or waste time pondering.

I took Cymbalta for 6 months. I noticed brain zaps when I missed a dose or two. The zaps were like brain resets. Quite scary especially since since some people reported that the side effect could become permanent and which meant a lifetime of Cymbalta. I weaned off successfully. Yeah!!

Then I had a forced separation - (wife was not very sympathetic to my condition).

Diagnosis 3 : Bipolar depressive (History of bipolar in family - paternal grandmother, father and sister - all Bipolar type 2 hyper)
Treatment 3 : Lamictal (100 mg) and Amisulpride (100 mg).

I don't think I have ever had a mania or hyper episode in my life. The wife and me would argue and yell at each other but I don't think that counts as hyper.

This combo just hit the spot. I felt much better. Now I don't wake up sad and gloomy. Besides the occasional sad hour or two, I am ok for the most part.

I still have issues concentrating and focusing. The mind drifts within 15 minutes of work. I resorted to smoking (nicotine) to keep up with work. I went from a quitter to 10 cigarettes per day.

I brought this up with the doc. I mentioned that the smoking was therapeutic for me. Its either a stimulant or smoke. I am in a place where Adderall is not kosher and the only option is Ritalin. My doc, afraid of triggering a hyper has prescribed 10 mg Ritalin per day.

The 10 mg is far from adequate. I skip a dose every now and then so that I can take 2 doses on the same day. On the other days, I still smoke 10 cigs.

The doc is reluctant to increase the Ritalin to 20 mg as the stimulant might trigger a hyper episode.

For me, the stimulant dose even though a 20 mg dose , truly makes me feel "normal". I can get the work done, choose when to get distracted. It makes a big difference.

I am just curious to know
1) if there are bipolar depressive out there who have never had a mania / hyper episode
2) any bipolars who have been prescribed stimulants (dexedrine, adderall or ritalin).

Amz wrote:1) if there are bipolar depressive out there who have never had a mania / hyper episode

No. To be diagnosed bipolar a person MUST have had atleast 1 hypomanic or manic episode. A person that has never had atleast 1 form of manic episode is NOT bipolar. Could be some form of depressive. I however have only had 2 hypomanic episodes in my life (41 years old), and they were very clearly episodes as they were 100% opposite of my normal personality.

The company that comes out with a bipolar drug thats will keep us awake and stable instead of dragging a-- and feeling tired most the times will get rich . I cant wait for that day.

I think you shouldn't worry so much about the label but worry about how you're feeling. A label is just a doctor's opinion, not fact anyways. If the lamictal and Amisulpride is working for you then that's all that matters. I would agree that without the manic episode you're not bipolar, and I would bring that up with your doctor, (ask him to take out the DSM and look it up even) Perhaps after you point this out to him he won't feel so hesitant about upping the ritalin.

Help me out here ...

Are these hyper symptoms

Symptom 1
I have nights of feeling hyper sexual or making some grand life plans, lying awake, and then sleeping in till late and waking up tired. This happens at least once a fortnight

Symptom 2
Intense thoughts of hurting my wife for what she did to me . These feeling would affect how I behaved with her and things just got worse. That she was passive aggressive was not made up, but i my response was full on passive aggressive and verbally abusive during conflicts ).

Symptom 3
I did a lot of retrospection during the depression. Upon which, I realized how much the manipulative and destructive behavior of my father had wreaked havoc on my family. I would get these intense anger rages then, just wanting to beat the life out of that sob m0!&3r f@#%3r. I would just twist and turn with rage, silently screaming on the inside. During these intense times, I don't think I acted out of character but messed up royally at work due to my condition.

Symptom 1 and 2 combined with the family history led to the diagnosis. I never mentioned symptom 3 to the doc which might have been a hyper episode.

Anyways, thanks for your responses. The help is appreciated.

Hello!


I myself am bipolar 2. Recently diagnosed 2 years ago, since then have realized its been apart of my entire life. I had have diagnosis of depression etc. since 16 (now 34).

Bipolar is each person's disease, as to how it effects you and how you react. With the symptoms you describe it sounds very familiar how i have felt in the past, what really led me to a psychiatrist was my anger, I would get in a rage over the stupidest things that i wouldn't even normally notice, and usually during that that time I felt others were doing things just to piss me off (delusional)(this would go on for weeks). Which eventually just turned into a downward spiral of a deep depression and I would start realizing what i had done, because before, it all just felt like that's how I'm "supposed" to feel.

It took me a lot of counseling to figure out that I was indeed the problem it just took time to see things from other points of view. I had many years (my whole life) of distorted thinking and situations that became very complicated from an illness i didn't even know I had.

Any way getting to the medications. Meds can be wonderful, finding the right ones can be very frustrating, as you want relief of the symptoms you have, and then some of the meds add their own symptoms.

So my "official" dx is Bipolar 2, Panic disorder, and ADD

I take:
Lamictal 200mg a day,for mood stabilization
Prozac 60mg helps my depression/rage.
Methilyn XR (Ritalin extended release) 10mg 2 times a day, extended release helps so much to last all the time.
Klonopin 1mg 2 times a day, helps my irritability and to stay calm and potential "situations"

This mix of meds has changed my life! I'll admit that I had a hard time taking them all the time as i was in denial for a long time. Now I take them regularly and I feel better then I have in many many years. I can think and my emotions feel "normal".

I'd just like to add that what i think was important was the order i started taking these mesds, i stated with Lamictal (which is also has a great anti-depressant effect)for a few months with the Klonopin, once mood was in check and I stayed calm, added the Prozac so i was unlikely to trigger any mania as mood was under control, to deal with depression. Finally i still couldn't think straight, distractablity, unable to concentrate for any period of time, so the Methilyn XR (Ritalin extended release) was added.

I hope this helps. Feel free to contact me if you have more questions. I am not a doctor so definatley talk to someone who is qualified. All the meds i am on was working with a Psychiatrist. Don't forget therapy/consoling is almost just as important as meds!

Take Care

Hey there!

I know how you feel... I'm also bp2 with a mix of adhd and anxiety. That combo is hard to treat. I had been treated for depression and anxiety for most of my life, but then I noticed that my ups and downs were getting more severe...I'm also in my early 20's. When I went to my general practitioner about concentration problems (thinking this may have to do with anxiety, which partially it does), he prescribed me stimulants... those made me feel great for about a week and then I'd crash into a really bad depression. I finally sought out a psychiatrist who diagnosed me as what I mentioned above. I'm currently on celexa and topamax at night and I take abilify in the morning. I take a small amount of dexedrine and klonopin during the day, which really helps. I had been on all of these before seeing the doc except for the abilify and the kllonopin. The dexedrine really does help my depression and the abilify seems to give it a little kick without making me out of control. The klonopin keeps my anxiety at bay, but I'm thinking the abilify is also helping a little since my moods are not as all over the place.... I haven't even been on the abilify for 2 weeks yet and I love it. I want to get stuff done in a relaxed, non-manic way, and I just feel more organized. This combo seems to help all my issues so far. I do believe if you're slightly ADD, stimulating drugs help with depression, but you need to be on a proper mood stabilizer, so you don't get manic. Hope this helps!