Posted by lpslpslpslpslpslps on June 5, 2010, at 20:12:04
Hi all,
I was hoping that if I described my particular matrix of symptoms and issues, someone else with a similar experience might be able to suggest ways I could improve my current treatment plan.
I am Bipolar Type II, and the presentation is anergic. I sleep sometimes 12 hours a day, and its almost impossible for me to motivate myself to do essential tasks. My apartment has at least 10 bags worth of trash scattered about. Very often I have to be somewhere, I'm 15-20 minutes late, because that's how long it takes to motivate myself to get going after the time I actually need to leave.
I am also severely ADHD, both inattentive and hyperactive. I frequently get hyperfocus, especially when I'm on my stimulant, but the hyperfocus is never directed toward something I really need to get done. I'm a phd student and I'm behind on my studies -- I have a few incompletes and I can't seem to focus for long enough to finish them. I take a psychostimulant, but I've become very tolerant to its effects and so it is much less helpful than it could be.
I'm also cripplingly sad right now -- my dear beloved cat died a month ago, I still weep every couple of days. He was five; his brother and litter-mate is still alive. Sometimes when I'm playing with my cat, I get so overwhelmed by some emotion that I can't do anything until the feeling starts to pass.
I am male, 28 years old, 150 pounds. My thyroid levels are normal, and though my resting heart rate and blood pressure are higher than they could be, they are within the normal range.
I currently take the following medications and supplements, in addition to weekly psychotherapy:
Morning:
Lamotrigine - 150 mg
Buspirone - 15 mg
Lisdexamphetamine - 70 mgFish oil - 2 grams of EPA/DHA
SAMe - 400 mg
Tyrosine - 6 grams
caffeine - 90 mgEvening:
Quetiapine - 100 mg
Mirtazapine - 30 mg
Buspirone - 15 mgFish oil - 2 grams of EPA/DHA
phosphatylserine - 100 mg
melatonin - 5 mg
L-Theanine - 200 mg
Multivitamin
Any and all advice would be much appreciated. One thing I was thinking about was adding something potentially energizing like Venlafaxine or Reboxetine or, alternatively, dropping the mirtazapine and taking Parnate, perhaps also lowering my stimulant dose. Also, I was thinking of dropping the buspar b/c I hate the multiple dosing, I sometimes forget in the morning, and of all my problems anxiety isn't really bothering me anymore. In fact, I almost wish I was a little more anxious so I wouldn't be so apathetic.Also, what about something like amisulpride or tianeptine?
My psychiatrist is great, always willing to work with me and accommodate suggestions about possible treatment options. He often seems less familiar with the current research about psych meds than I am (I subscribe to the abstracts in my rss feed of all the current biological psychiatry and psychopharmacology journals, and I usually read the full studies about medicines that I am currently taking (luckily have access through the university). Every medicine I'm currently taking is something I've proposed -- empowering, but also a little daunting if I screw up, since ceteris paribus I would prefer that everyone with imput to my treatment have some sort of expertise. I know a whole lot about the science of these medicines, but I'll clearly never be a physician or have that kind of expertise.
poster:lpslpslpslpslpslps
thread:950034
URL: http://www.dr-bob.org/babble/20100604/msgs/950034.html