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Hi, my therapist is going to evaluate me next week for ADD, and I'm pretty sure its going to be + for ADD. I already am diagnosed as Bipolar II because of my anxiety and depression.

I take Lamictal 200mg, Zoloft 50mg, Effexor XR 150mgs. I take Klonopin PRN but thats very rarely because it makes me too stupid. :)

Sooooooooooooooooooooooooo what are the options for ADD medications besides Wellbutrin and Stratera? Whats the difference between Adderal and Ritalin?

K thanks! ;)

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Guest lmmmnop

Pretty much anything with a stimulant effect can be used for ADD. This includes the classic Ritalin (and its isomer, Focalin), Adderall, Provigil, Cylert, and Dexedrine, as well as any other medication noted to be stimulating without necessarily being a "real" stimulant, like Wellbutrin. Caffeine is the cheapskate's OTC stim. Strattera is different from the rest of these in that it's not a stimulant. It affects norepinephrine, which is a neurotransmitter associated with impulsivity and inattention. There are probably more meds that I'm not thinking of. This isn't my area of expertise. I just have ADD and a keyboard and I'm waiting for a download over dialup.

Check the CNS stimulant forum for more information on the meds listed above, including many user experiences. Run searches for old stuff. There's some chemical shit posted there, too.

With a bipolar diagnosis, a lot of pdocs will not want to give you a stim, ADD or no. Strattera is currently favored as a first-line ADD med for bipolars because it will not make you manic (though it might aggravate existing cycling). With treating comorbid ADD and bipolar, the million-dollar question is "how stable are you?" If your cycling isn't under control, taking ANY of the medications known to impact ADD could send you on the express route to hell, whether manic, mixed, or rapid-cycling. You don't want that. We don't want that. Once you're quite sure your BP is under control, though, adding a med for the ADD can be a wonderful idea. I am not disposed to dig up links now, but VE posted a link (in this forum) several months ago to a study abstract in which bipolar ADD kids were tried on Adderall, with good results -- after their bipolar had been stabilized on other medications. Controlling BP first is paramount.

(Edited to add my great big moddy stamp of approval now that I'm logged in.)

lmnopplanet.jpg

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hi again. well *sigh* my bipolar has NEVER been under control for more than 3 mos... so I don't know what to think. I do know that I slept all day yesterday.. woke up for an hour or two between going back to bed, then slept all night too. I'm very... unmotivated and tired all the time. So, as for cycling, who the hell knows... I'm very very prone to being depressed, and if i take antidepressants i tend to get anxiety... there's just no treatment for me that would allow me to live normally. now wheres that link about feeling suicidal

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Hi VelvetElvis, this is the short version as to how I know as I need to go have a bath, anyways I was dx with ADHD in 97 and put on Ritalin until roughly 2000 when I was told 'adults cant have ADHD yaka crap yaka' ended up in a theraputic community in 2001-2002 and asked to be reasseed for ADHD and got dx with ADHD combind type yet again and put back on this time Ritalin SR,. came back to leeds (uk) and decided that well after a long debate with psych decided stimulants arent a good idea for me, (long story i wont go into) so asked what alternatives there were, and was told Rispiridone or Effexor .. I was also told and given literature which I have somewhere that say Serequal can help as well, with the more impulsive side of things..................

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Hi VelvetElvis, this is the short version as to how I know as I need to go have a bath, anyways I was dx with ADHD in 97 and put on Ritalin until roughly 2000 when I was told 'adults cant have ADHD yaka crap yaka' ended up in a theraputic community in 2001-2002 and asked to be reasseed for ADHD and got dx with ADHD combind type yet again and put back on this time Ritalin SR,. came back to leeds (uk) and decided that well after a long debate with psych decided stimulants arent a good idea for me, (long story i wont go into) so asked what alternatives there were, and was told Rispiridone or Effexor .. I was also told and given literature which I have somewhere that say Serequal can help as well, with the more impulsive side of things..................

OK. You're in the UK. 'nuff said. Pdocs there seem to be at odds with the rest of the world about a lot of stuff.

Does it help?

If not, the SNRIs and wellbutrin are again worth a look here.

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hi again. well *sigh* my bipolar has NEVER been under control for more than 3 mos... so I don't know what to think. I do know that I slept all day yesterday.. woke up for an hour or two between going back to bed, then slept all night too. I'm very... unmotivated and tired all the time. So, as for cycling, who the hell knows... I'm very very prone to being depressed, and if i take antidepressants i tend to get anxiety... there's just no treatment for me that would allow me to live normally. now wheres that link about feeling suicidal

OK. You're on zoloft. and effexor. and bipolar. and your pdoc want you to go up on the zoloft.

I'm not an expert. You have more of a medical background than I do. I'm a dropout philosophy student. That said, if I were you I would drop the effexor and the zoloft and the pdoc.

That's a potentialy fatal combo to begin with. It's also one which could make your symptoms worse and not better.

Um.

God.

I'm going to refer both of your threads to a couple of the bipoar mods and make sure they have seen all the pieces but this sounds really fucked up to me.

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Velvet Elvis, you probably have more experience with the medical stuff than me. I didn't have much schooling on the psych meds, and anyhow, the research on this crap is pretty lame. You've been mod-ing this board for a long time, so really I take your suggestions quite to heart. The thing about Effexor and Lamictal is that I've had great success with it for atleast 6 mos, I've held a job, a relationship, and haven't had the need to try and off myself, which to me... is great progress.

Initially my pdoc wanted to up the effexor dose. Do you think that might be worth another try?

You know... all of this may be due to my current relationship problems...

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Well, if your main problem is depression, then I see the reasoning behind it. If it works, then there's probably nothing wrong with the combo.

If I had to choose I'd think increasing Effexor may make more sense because some of its neurotransmitter profile is related to ADHD (increasing noradrenalin and dopamine in higher doses), while Zoloft works just on serotonin, tweaking which doesn't help with ADHD symptoms directly. Zoloft didn't do crap for my ADHD, but nothing else did either (we have no stimulants or Strattera in this country, and ADHD is only diagnosed in kids, phew). It didn't even help me with depression and/or anxiety.

On the other hand, increasing Zoloft may slow down the metabolism of Effexor and increase its blood levels, so I wouldn't be surprised if it helped. Also, some indirect mechanism may play some role ("increasing serotonin here may increase noradrenalin there"). You never know.

*BUT* if your Effexor&Lamictal combo worked, and adding Zoloft only made things worse, then one could guess that increasing Effexor (to the level when it starts being a multiple reuptake inhibitor) may be a better idea than adding/increasing Zoloft.

Also, keep in mind that stress related to life events/relationship/whatever may increase symptoms of depression, anxiety, ADHD, herpes, acne and other things. When stress resolves, your memory/concentration will improve, sooner or later.

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Velvet Elvis-

I'm on Lamictal 200mg, Effexor XR 150mg, Zoloft 100mg, and Risperdal 1mg. I'm bipolar II and this combination has been a Godsend. I know that the psychiatric profession has been steering away from using antidepressants on bipolars but I've been stable for 2 years on this combination. I love, love, love this cocktail. So Ammity and I are on pretty similar meds. My bipolar primarily manifested itself as anxiety and depression, also. For some reason that combination works for me, but it doesn't work for Ammity.

I don't know how long she/he has been going to this particular pdoc but it took me a little over a year to come up with this particular combination that works for me. My point being it is possible that her pdoc isn't fucked up. Then again, maybe he/she is. Not getting the right meds sucks.

I'm also ADHD and since I've been stable for several years I'm going to look into help with the those symptoms.

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I'm on Lamictal 200mg, Effexor XR 150mg, Zoloft 100mg, and Risperdal 1mg. I'm bipolar II and this combination has been a Godsend. I know that the psychiatric profession has been steering away from using antidepressants on bipolars but I've been stable for 2 years on this combination. I love, love, love this cocktail. So Ammity and I are on pretty similar meds. My bipolar primarily manifested itself as anxiety and depression, also. For some reason that combination works for me, but it doesn't work for Ammity.

Depending on other conditions, phase of the moon, etc. cranking up serotonin by adding Zoloft can be

a bad idea for bipolar patients and pretty miserable for some ADHD+depression folks... But as

herpie rightly pointed out, Zoloft is one of the the ADs that plays with inhibits liver enzymes.

The net effect may be to slow down Effexor clearance and/or increase buildup until you've got MUCH

more active Effexor metabolites in your bloodstream than otherwise, without cranking up the dosage.

Maybe it's a way of increasing the effective dosage without increasing the side effects from the

parent compound so much?

The combination can be deadly because you can end up with much, much more serotonin reuptake

inhibition than is safe (YMWV), but I guess it works if not pushed up too hard and too quickly and

if you cycle mostly on the "fuckit, just kill me now" side of the seesaw anyway.

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