Posted by 3 Beer Effect on June 18, 2002, at 11:08:28
In reply to Want to try stimulants, I need advice, posted by rainbowlight on June 17, 2002, at 23:23:23
"Bipolar disorder misdiagnosed as ADD & treated with stimulants can produce the same chaos & rapid cycling state as antidepressants can in bipolar disorder." (Stahl, Essential Psychopharmacology of Depression & Bipolar Disorder).
Obviously, ADD stimulants could push you into overt mania as they are much more powerful than Caffeine. Insomnia, anxiety, & weight loss are common side effects of stimulants & are often the reason for their discontinuation, but the anxiety & insomnia side effects can be treated with Klonopin (a 2nd line anti-manic agent benzodiazepine) in the day & Ambien at bedtime, or perhaps even with the non-addictive anticonvulsant Neurontin. They are not sure if Neurontin is a mood-stabilizer or not yet. As far as mood-stablilizers go, I believe that among the newer ones Lamictal & then Neurontin cause the least mental impairment while Topomax can cause quite a significant amount of mental impairment.
Usually, if someone had Bipolar II & ADD they would try Wellbutrin SR first before they started a psychostimulant since Wellbutrin SR, Paxil CR, & Remeron are the antidepressants with less tendency to cause mania.
Wellbutrin SR can be effective for ADD, more so in Adult ADD than in children but still is only effective in about 1/3 of ADD patients. The tricyclic Desipramine (NORPRAMIN) especially, & sometimes Nortriptyline (PAMELOR) are often effective for Adult ADD (they are not used in children for safety reasons).
Provigil (Modafinil) was rejected by the FDA for the indication of ADD because of lack of efficacy in clinical trials.
Ritalin & its refined/improved version Focalin are probably less likely to induce mania than Adderall or Dexedrine since Ritalin/Focalin only last about 3.5 hours at the most, are mostly a mental & not as much a general/appetite suppressing/physically "activating" stimulant, & seem to cause more inhibition of spontaneous behavior than Adderall or Dexedrine. Ritalin definitely causes anxiety in many & in rats causes behavioral inhibition and decreased social interaction. Generic versions of Ritalin such as methylphenidate have shown to be inferior (1/2 hour less in duration) & are best avoided.
Concerta may work since it is a long acting, smoother version of Ritalin, but it is probably more likely to cause insomnia & stomach upset & does not work for some people (I responded well to 20 mg Ritalin 2x per day but had little response to a trial of Concerta 56 mg qd.)
Sometimes people are misdiagnosed with as Bipolar II when they really have ADD or vice versa since the symptoms for both disorders are very similar (ADHD resembles the symptoms of Bipolar mania). I guess the only way to tell is by the patients reaction to a trial of a few mood stablilizers & if that is not successful then a trial of an ADD psychostimulant.
They thought I was Bipolar II since I couldn't tolerate the insomnia from the SSRIs (eventually became manic from Zoloft 100 mg) & could not tolerate Effexor XR or Remeron. But after negative responses to Neurontin & Lamictal but with positive responses to Ritalin & Dexedrine (with no stimulant induced mania) they decided that I have ADD-inattentive type with severe depression & social phobia.
3 Beers......................
poster:3 Beer Effect
thread:110187
URL: http://www.dr-bob.org/babble/20020617/msgs/110212.html