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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Just A Lurker on July 25, 2007, at 0:19:06
My current diagnosis (long story) is Bipolar-2 and ADD. I also have had insomnia for a year or two.
Current prescription meds:
Lamictal for Bi2
Provigil for ADD
Klonopin for sleep
Neurontin for sleep (maybe RLS)In addition...
Melatonin and Benadryl to help me sleepI want to... well, hell, I don't want to take so many meds if I don't have to. I certainly want to get off the sleeping meds. (Apparently I have apnea, but sleeping meds make it worse.) I'm trying to wean myself at least off the Benadryl, then (probably) the Klonopin.
In addition, the standard meds do just an OK job. The Lamictal doesn't always work like it should (currently up to 3x200mg a day.) The Provigil (200mg) does a decent job, in some ways worse than Adderall, in some ways better.
So, I want advice.
Do I try to get a second opinion?
Do I hit the Amen Clinic and get a SPECT scan to see if they can figure this all out?
Do I try some of the following suggested supplements...
- l-theanine (sleep)
- omega-3 (bi2)
- ginkgo (add)
- acetyl-l-carnitine (add)
- maybe something else?Sorry, I am very discouraged. Bi2 (recently diagnosed, and if correct) has caused me problems over the years, from lost relationships to having to leave a job (thankfully never fired.) ADD is a bitch. The insomnia, I hate having to take pills to sleep.
I just want this all to go away - no, not you-know-what, I just want to get as much fixed as possible.
OK, now that I've dumped, offer me suggestions! What has worked for you? What has failed?
Thankyakindly.
Posted by polarbear206 on July 25, 2007, at 8:02:57
In reply to Need some medication support, posted by Just A Lurker on July 25, 2007, at 0:19:06
> My current diagnosis (long story) is Bipolar-2 and ADD. I also have had insomnia for a year or two.
>
> Current prescription meds:
> Lamictal for Bi2
> Provigil for ADD
> Klonopin for sleep
> Neurontin for sleep (maybe RLS)
>
> In addition...
> Melatonin and Benadryl to help me sleep
>
> I want to... well, hell, I don't want to take so many meds if I don't have to. I certainly want to get off the sleeping meds. (Apparently I have apnea, but sleeping meds make it worse.) I'm trying to wean myself at least off the Benadryl, then (probably) the Klonopin.
>
> In addition, the standard meds do just an OK job. The Lamictal doesn't always work like it should (currently up to 3x200mg a day.) The Provigil (200mg) does a decent job, in some ways worse than Adderall, in some ways better.
>
> So, I want advice.
> Do I try to get a second opinion?
> Do I hit the Amen Clinic and get a SPECT scan to see if they can figure this all out?
> Do I try some of the following suggested supplements...
> - l-theanine (sleep)
> - omega-3 (bi2)
> - ginkgo (add)
> - acetyl-l-carnitine (add)
> - maybe something else?
>
> Sorry, I am very discouraged. Bi2 (recently diagnosed, and if correct) has caused me problems over the years, from lost relationships to having to leave a job (thankfully never fired.) ADD is a bitch. The insomnia, I hate having to take pills to sleep.
>
> I just want this all to go away - no, not you-know-what, I just want to get as much fixed as possible.
>
> OK, now that I've dumped, offer me suggestions! What has worked for you? What has failed?
>
> Thankyakindly
Are you having some lingering depression that might warrent an antidepressant? Many people with bipolar II need to be on an AD in combo with a mood stabilizer. This could be why you are having trouble sleeping. It's pretty tricky finding the right combination of drugs when you have a comorbid diagnosis, esp with ADD/bipolar.Polarbear
Posted by linkadge on July 25, 2007, at 9:51:33
In reply to Need some medication support, posted by Just A Lurker on July 25, 2007, at 0:19:06
Omega-3 might be a good option. You may find a low dose of remeron to help sleep without exaserbating sleep apnea. There will be some overlap between the effects of lamictal, gabapentin, and clonazepam. You may be able to reduce there.
Provigil is really not approved for AD/HD. Have you tried meds like dexedrine, or methylphenidate?
Linkadge
Posted by Just A Lurker on July 25, 2007, at 10:07:59
In reply to Re: Need some medication support, posted by linkadge on July 25, 2007, at 9:51:33
> Omega-3 might be a good option. You may find a low dose of remeron to help sleep without exaserbating sleep apnea. There will be some overlap between the effects of lamictal, gabapentin, and clonazepam. You may be able to reduce there.
I see it's an AD. (A suggestion made in the other response.)
I was on Lexapro, and was tapered off. I also used Trazodone and Doxepin for sleep at various points; neither was terrific, though I think the Trazodone worked better. I've heard of problems taking ADs if you are bipolar; is this not a problem if you are taking a mood stabilizer?
I'd like to reduce the Klonopin just because benzos can be addictive and they tend to stop working anyway.
> Provigil is really not approved for AD/HD. Have you tried meds like dexedrine, or methylphenidate?
I have some but haven't tried them yet. My new pdoc's theory is that (at least with the Adderall) it made my manic symptoms worse, notably the negative ones.
He also suspects that I may not really have ADD per se, but it could just be a mask for bipolar.
This pdoc is highly recommended (by some other doctors who are, frankly, tops in the area), but I'm frustrated that nobody knows what I have, how I feel, and how to fix it.
Posted by Phillipa on July 25, 2007, at 10:43:35
In reply to Re: Need some medication support » linkadge, posted by Just A Lurker on July 25, 2007, at 10:07:59
Wellbutrin as an ad? Maybe lunesta or ambien as a sleep med? Isn't there sometimes a crossover between ADD and bipolar later? What age bracket are you in? Love Phillipa
Posted by linkadge on July 25, 2007, at 11:46:08
In reply to Re: Need some medication support » linkadge, posted by Just A Lurker on July 25, 2007, at 10:07:59
>I was on Lexapro, and was tapered off. I also >used Trazodone and Doxepin for sleep at various >points; neither was terrific, though I think the >Trazodone worked better. I've heard of problems >taking ADs if you are bipolar; is this not a >problem if you are taking a mood stabilizer?Generally yes. Mood stabilizers can reduce the propensity of an antidepressant to cause destabilization. Remeron is probably less likely to cause destabilization than other AD's. Usually if the dose is kept low there aren't too many problems.
>I'd like to reduce the Klonopin just because >benzos can be addictive and they tend to stop >working anyway.
Yeah. It can sometimes cause depression. The addictiveness and loss off effectiveness of benzo's with time varies from person to person.
>I have some but haven't tried them yet. My new >pdoc's theory is that (at least with the >Adderall) it made my manic symptoms worse, >notably the negative ones.
This is always a possability. Provigil is an alertness promoting agent, not necessarily an attention promoting agent. If you can't concentrate for lack of alertness (ie from other meds or daytime fatique) it may help, but true ADHD is not really a lack of alertness.
You could always try another stimulant. Sometimes they don't mix well with anticonvulsants. Somtimes certain stimulants can acually improve stability in certain bipolars.
A high quality omega-3 product is always a good idea as there is evidence of efficacy in both bipolar and ADHD.
>He also suspects that I may not really have ADD >per se, but it could just be a mask for bipolar.
This is a possability too. It can go the other way around, ie bipolar symptoms can really be a result of severe ADHD. There is also high comorbidity between the two illnesses. Both illnesses seem to show deficits in prefrontal cortex activity.
>This pdoc is highly recommended (by some other >doctors who are, frankly, tops in the area), but >I'm frustrated that nobody knows what I have, >how I feel, and how to fix it.
It sucks. I am in kind of a grey area too. I personally didn't find lamotrigine to be of any use. It does't really have the same track record of other mood stabilizers.
Have you tried say lithium + omega-3 + low dose methlyphenidate?
Linkadge
Posted by Just A Lurker on July 26, 2007, at 0:14:18
In reply to Re: Need some medication support, posted by Phillipa on July 25, 2007, at 10:43:35
I tried Wellbutrin once, had a bad experience with it. Ambien works pretty well (even with the pretty hallucinations) but my sleepdoc thought it was making my apnea worse.
I'm in my mid-30s. I'm not sure when a crossover would be...
Posted by Just A Lurker on July 26, 2007, at 0:21:29
In reply to Re: Need some medication support, posted by linkadge on July 25, 2007, at 11:46:08
> Generally yes. Mood stabilizers can reduce the propensity of an antidepressant to cause destabilization. Remeron is probably less likely to cause destabilization than other AD's. Usually if the dose is kept low there aren't too many problems.
OK. I was on 10mg of Lexapro, maybe I need to ask my doctor about Remeron. (God, that sounds like a commercial.)
> >I'd like to reduce the Klonopin just because >benzos can be addictive and they tend to stop >working anyway.
>
> Yeah. It can sometimes cause depression. The addictiveness and loss off effectiveness of benzo's with time varies from person to person.Generally I haven't had much problem with withdrawal - ambien of course caused insomnia if I stopped cold turkey, paxil was (accidentally) cold turkey and a real pain, but everything else has been fine.
>
> >I have some but haven't tried them yet. My new >pdoc's theory is that (at least with the >Adderall) it made my manic symptoms worse, >notably the negative ones.
>
> This is always a possability. Provigil is an alertness promoting agent, not necessarily an attention promoting agent. If you can't concentrate for lack of alertness (ie from other meds or daytime fatique) it may help, but true ADHD is not really a lack of alertness.Well, that's a good question, maybe this is some sort of sleep-attention-bipolar interaction and who knows what is causing what. Lack of sleep would make attention worse and moodiness. But sometimes I am sharp as a tack, sometimes not (either unfocused, depressed, or a combination thereof.) One reason why I was thinking of a SPECT scan or something to see if it could give me something with a bit more... certainty may not be the right word, but you get the idea.
> You could always try another stimulant. Sometimes they don't mix well with anticonvulsants. Somtimes certain stimulants can acually improve stability in certain bipolars.
I do have some Ritalin (long story) I could try. I'm going to give the Provigil some time to see how it works.
> A high quality omega-3 product is always a good idea as there is evidence of efficacy in both bipolar and ADHD.
Excellent, thanks. My pdoc even said I should take it.
> >He also suspects that I may not really have ADD >per se, but it could just be a mask for bipolar.
>
> This is a possability too. It can go the other way around, ie bipolar symptoms can really be a result of severe ADHD. There is also high comorbidity between the two illnesses. Both illnesses seem to show deficits in prefrontal cortex activity.Yeah, I'm getting that impression. ADHD is no longer really such a bad word, thankfully, since everybody either has a kid with it or knows someone who does.
> >This pdoc is highly recommended (by some other >doctors who are, frankly, tops in the area), but >I'm frustrated that nobody knows what I have, >how I feel, and how to fix it.
>
> It sucks. I am in kind of a grey area too. I personally didn't find lamotrigine to be of any use. It does't really have the same track record of other mood stabilizers.
>
> Have you tried say lithium + omega-3 + low dose methlyphenidate?I haven't tried lithium yet, my pdoc was talking about trying a lithium + lamotrigine cocktail depending on how I was feeling. I think my mood HAS stabilized more since going up to 3 pills a day, judging from my mood chart, but that's my impression.
The worst part is that you really can't judge by yourself how you are doing, you have to ask others. Sigh.
>
>
>
> Linkadge
>
>
>
Posted by Phillipa on July 26, 2007, at 20:10:35
In reply to Re: Need some medication support » Phillipa, posted by Just A Lurker on July 26, 2007, at 0:14:18
Teen to adult I believe. Love Phillipa
Posted by annarborgirl on July 26, 2007, at 22:31:55
In reply to Need some medication support, posted by Just A Lurker on July 25, 2007, at 0:19:06
hi lurker. i am also on provigil, 200mg @ 7am and 200 mg @ 2pm (for fatigue). your statement: "The Provigil (200mg) does a decent job, in some ways worse than Adderall, in some ways better." has me wondering what your pros and cons are of the drug. im also on wellbutrin 150mg, emsam 6, lamictal 200.
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