Posted by zane on February 21, 2004, at 14:30:47
Hello, I'd really appreciate some advice, and would love to hear from anyone that has been down a similar path.
This is my first post here, so we warned. I promise not to ramble on like this again.
I'm concerned my new doctor is prescribing medications that might not work well together. I’m pdoc to went to school for a long time, and I didn’t, but I’ve had other pdoc’s, some good, some borderline quacks, that have cycled me through dozens of therapies, medicines and combinations thereof, and I’ve always felt like a human guinea pig.
I've been repeatedly diagnosed as BP1, or BP2 depending on the pdoc over the past two decades. I was also diagnosed with ADD as a teenager, but I stopped taking it after ritalin came under attack by the press. When I recently changed insurance, my new pdoc and several others in his practice again diagnosed me as having “acute” ADD in conjunction with BP1. All of the males in my family, including all cousins, for the past two generations have been artistic, creative, moody mensa members. Everyone except my grandfather has either been diagnosed as ADD, BP, or both, with a total of eleven guys who either haven’t amounted to anything, or committed suicide.
We've (my father, uncle(s) and brother) have all tried just about every med that has been on the market for bp over the past twenty years. We have a dark family history of suicide, and a long list of relatives that are bipolar/add. Last year I had a bad series of cyclic of up/down mania, in conjunction with the suicide of a close bipolar friend, and the suicide of one of my uncle’s.
These recent events have, some what, opened my eyes to the fact that that the wonderful euphoric creative highs, are probably not be worth the risks when the pendulum swings the other way.
Before this new insurance carrier, I was on Wellbutrin and Lithium, but stopped taking both after going without insurance for an extended period.
My new pdoc initially put me back on bupropion, but added trileptal and ritalin. He put me on the trilep because it worked for my father, and generic ritalin because it had helped my brother.
After the first month we changed to concerta.
The trilep worked great for me at first, and helped me sleep and stopped the historical manic "highs" which consisted of insomnia for two to three days.After my repeated complaints that I'd been constantly sleepy, and an extended deep dark depression in which I look an unscheduled week off of work I was switched to lamictal.
The lamictal worked at first to snap me out of the depression, but now the dose has been raised to 50mg, once in the early morning and once after a late lunch.
After I also kept complaining that the bupropion seems to be corresponding to a anxious, but hazy, groggy, sleepy period starting about thirty minutes after I took 100mg (twice a day), he reluctantly agreed that I could stop taking the bupropion.The concerta still seems to be having an anti-stimulant effect, and actually calms me down, but also makes me sleepy. I can't really tell that the lamictal does anything for me or not, other than I haven't had any of my historical manic insomnia for the past two months.
The concerta does wonders for my concentration, but I still constantly feel the need to take a nap. I've always been known as a person who loves to take naps, and this tendency towards sleepiness doesn’t correspond to being depressed. It’s just something that’s part of me that I’ve learned to life with.
Although I’m doing logarithmically better overall with the concerta, taking, or I should say NOT taking it scares me silly. My pdoc said that it was ok if I gave my brain "a break" from it at first, and not take it on the weekends, if I wanted. Now that decision has been reversed after we noticed that when I didn't take it, I was jolted into an immediate manic depression that goes away immediately after resuming the concerta. The depression from the concerta withdrawal symptoms on Sunday, after skipping the Saturday and Sunday done, were horrid.Now I feel that I'm forced, almost addicted to the concerta, and actually scared of missing a dose. I've traveled extensively over the years, and had my luggage lost several times, or left my meds at home or lost them, etc. But I've never related missing a day or two of medications to a corresponding and predictable manic down swing into a borderline suicidal depression.
My father is still on the trilep but recently added modafinil to help with the associated sleepiness that have always caused him problems at work. This was because my brother urged him to check it out, because he’s had luck with a combination of lithium and modafinil, when both ritalin, and adderall stopped working.
Based on my fear of concerta, and but dad’s and brothers luck with modafinil, I’d like give modafinil a shot. Since my pdoc hates adderall, and it only worked for my brother for four years, I don’t think that it will ever be an option. My pdoc also doesn’t want to try modafinil, without giving a reason, but I get the impression that it isn’t on the HMO’s (the German K’s) list of approved meds for ADD.
Other that changing carriers, which I can’t do until next year, are there any options, references or any supporting material confirming that a modafinil and lamictal combination is effective for bp/add ?
Has anyone else had any luck treating BP1/ADD ?
poster:zane
thread:316358
URL: http://www.dr-bob.org/babble/20040218/msgs/316358.html