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I Need a Med Change


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Hi,

I took Prozac and Adderall for many years for Depression and ADD. Last year I got a new Pdoc who says I really have BPII (mixed stated), and the meds have possibly done more harm than good (great).

Now I take 100mg. Lamictal and 60mg. Cymbalta, and I have Klonopin that I take occasionally for anxiety. I don't feel any better. I have no motivation. I want to stay in bed all day, watch TV and eat carbs. My self-esteem is below zero. I'm not actively suicidal, but I have frequent thoughts of "what's the point, If this is as good as it gets."

I obviously need to try a med adjustment. Any ideas? I'll try what my Pdoc gives me, but I'm not sure about him right now, so I would love to get some imput from others who 'know.'

Thank you,

-- Bee

Oh yeah -- I'm female, 44.

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Now I take 100mg. Lamictal and 60mg. Cymbalta, and I have Klonopin that I take occasionally for anxiety. I don't feel any better. I have no motivation. I want to stay in bed all day, watch TV and eat carbs. My self-esteem is below zero. I'm not actively suicidal, but I have frequent thoughts of "what's the point, If this is as good as it gets."

I obviously need to try a med adjustment. Any ideas? I'll try what my Pdoc gives me, but I'm not sure about him right now, so I would love to get some imput from others who 'know.'

But it can get better than that. I get impatient with med changes every time something doesn't work, but I always try remembering that my pdoc can't say ahead of time what might help; it's just one of those trial-and-error processes, unfortunately. Lamictal helps me and I found Cymbalta to be hell in a pill, but not the same symptoms you're having -- I was having more self-destructive thoughts than ever and my head felt full of angry bees, to put it briefly. One thing I will say is that, of the antidepressants I tried, Wellbutrin helped me the most, but it made me feel agitated and I couldn't go above 150mg. I mean, there's no way to know how any med's going to work until you try, from what I've learned so far.

I hope you get some better answers than mine, and I hope it goes well for you with whatever med changes you end up making.

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Thanks, Nomi

(hey look, I think I managed to register!).

I'm sure that I'm not the only one who dreads med changes, even when I really need one. It's that whole 'here we go again' thing. . .

I agree about the Cymbalta -- I have never liked it. And if you forget a dose -- holy shit!

I need to muster some courage to deal with this new pdoc. He intimidates me, so I don't express myself very well with him (I walked all over my last pdoc, which probably was worse). The new guy's shtick is to prescribe with ultimate confidence, and when I go back and tell him that it's not working, he acts as if I am mistaken. That's why I have been dragging around on this current mix for too long.

Anyway, I have some questions specifically about Lamictal, so I guess I should go to the med section and look around there.

Thanks again

-- B

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prescribe with ultimate confidence, and when I go back and tell him that it's not working, he acts as if I am mistaken

thank you! i just now pinpointed that as my problem with my previous pdoc. you are strong, it is your body/mind and he needs to hear you past his wall of whatever. telling him straight up "i feel intimidated, i feel it's hurting my treatment, i think we should work on this" seems perfectly fair to the situation.

--thoughts from someone who didn't share

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You could try upping the Lamictal.. many people are on 200mg. If the Cymbalta isn't working you could also substitute Effexor. When you miss your dose do you just feel bad, or does your emotional state change? With me, 48 hours without it & I sunk into a really foul mood.. just one way to know if it's working. I would probably try the above changes before switching meds around.. (Effexor and Cymbalta are closely related). Then, since it's BP, you'd probably want to play around with the other mood stabilizers and perhaps add a small SSRI or AAP for serotonin, etc.. That's what I'd do.

Edit: Also - Effexor's effect on norepinephrine tends to be more stimulating than Cymbalta. So that may help with the ADD.

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thank you! i just now pinpointed that as my problem with my previous pdoc. you are strong, it is your body/mind and he needs to hear you past his wall of whatever. telling him straight up "i feel intimidated, i feel it's hurting my treatment, i think we should work on this" seems perfectly fair to the situation.

--thoughts from someone who didn't share

Yeah, I think he likes to be a fancy tdoc/pdoc. It's like he is trying to psych me out, but what I need is a straight shooter with my meds. I will step up at my next appointment, because I am desperate (but that bothers me, too, because why can I be clear headed then, and not other times (OMG, is my pdoc doing this for this purpose. . .? Damn!. . .)

You could try upping the Lamictal.. many people are on 200mg. If the Cymbalta isn't working you could also substitute Effexor. When you miss your dose do you just feel bad, or does your emotional state change? With me, 48 hours without it & I sunk into a really foul mood.. just one way to know if it's working. I would probably try the above changes before switching meds around.. (Effexor and Cymbalta are closely related). Then, since it's BP, you'd probably want to play around with the other mood stabilizers and perhaps add a small SSRI or AAP for serotonin, etc.. That's what I'd do.

Edit: Also - Effexor's effect on norepinephrine tends to be more stimulating than Cymbalta. So that may help with the ADD.

I'm thinking that upping the Lamictal will be the course, since 200 seems to be a normal dose.

I have never gone two days without Cymbalta, because of the brain zaps I get after one day, so I don't know -- it's an interesting point. One thing I have trouble with, though, is pinning down my reactions with my med changes -- sometimes I feel like I'm not in touch with my mind/body as much as other people. And then there's my 'cycle'. . .

Effexor. . .hmmm. . I hear it's tough like Cymbalta, but I like the idea of it being more stimulating. . . I left another post on the AD section -- It's about why BP'rs are prescribed AD's when many think that AD's make BP worse? I am confused.

-- B

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Hi,

I took Prozac and Adderall for many years for Depression and ADD. Last year I got a new Pdoc who says I really have BPII (mixed stated), and the meds have possibly done more harm than good (great).

Now I take 100mg. Lamictal and 60mg. Cymbalta, and I have Klonopin that I take occasionally for anxiety. I don't feel any better. I have no motivation. I want to stay in bed all day, watch TV and eat carbs. My self-esteem is below zero. I'm not actively suicidal, but I have frequent thoughts of "what's the point, If this is as good as it gets."

I obviously need to try a med adjustment. Any ideas? I'll try what my Pdoc gives me, but I'm not sure about him right now, so I would love to get some imput from others who 'know.'

Just know that ADD and BP are not mutually exclusive. In fact, having one increases the chance that you'll have the other. It's complicated because they can also be easily mistaken for each other. You might want to keep that in mind if this course of treatment doesn't pan out. If you don't have an accurate diagnosis you can end up trying med after med and never get better because you're not being treated for the right things.

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If you don't have an accurate diagnosis you can end up trying med after med and never get better because you're not being treated for the right things.

Believe me, I live in constant fear of this. It seems to be the story of my life.

After a while, a person gets weary. . .

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Did you feel better on the previous medication, which I stemmed from your previous diagnosis? If so, that's definitely something to tell your pdoc. It's a sign he's on the wrong course.

What you describe now sounds like you are dealing with some serious depression (I know it well). Let him know.

I am not smart enough to suggest medications for you, but there are many people on this board who are very smart and very experienced. Try doing some searches about your symptoms or meds. I've found that helpful.

Lots of bipolar II/ADHD stuff can overlap. It can be confusing and heartbreaking, I know. Hang in there.

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Did you feel better on the previous medication, which I stemmed from your previous diagnosis? If so, that's definitely something to tell your pdoc. It's a sign he's on the wrong course.

This seems to be a very valid point to me.

However:

When I was first diagnosed with depression 15 years ago I was put on Prozac and had apparently terrible side effects (ie., I fell in love, got married, started and ran a successful art gallery, had a healthy self esteem, etc. . .)

I would think that it would be reasonable to go back there somehow, but my pdoc, says, no, I am much too ill for such normalcy. I was "suffering" from hypomania, which has now been replaced with hellish mixed states. He wants me to lower my expectations(WTF?)

So, you see, even my past medication history isn't making much sense to me right now. When I ask new pdoc if I can just expect to be on a downward slide from here on out, he kind of shrugs. . . Nice.

-- B

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I'm thinking that upping the Lamictal will be the course, since 200 seems to be a normal dose.

I have never gone two days without Cymbalta, because of the brain zaps I get after one day, so I don't know -- it's an interesting point. One thing I have trouble with, though, is pinning down my reactions with my med changes -- sometimes I feel like I'm not in touch with my mind/body as much as other people. And then there's my 'cycle'. . .

Effexor. . .hmmm. . I hear it's tough like Cymbalta, but I like the idea of it being more stimulating. . . I left another post on the AD section -- It's about why BP'rs are prescribed AD's when many think that AD's make BP worse? I am confused.

Yeah, 200 is normal.. hopefully that works out well for you. I'd think it'd make some difference if it's working on your depression at all - which it's supposed to. Effexor actually has the tendency to have worse withdrawal than Cymbalta.. but it's mostly the brain zaps. So the fact that you get those now.. It'd probably be about the same. Overall, Effexor tends to work well.

As for rx'ing AD's; it's for the depression side of the BP. Sometimes the mood stabilizers and AP's stop the manias but not the downs. It's not that you wouldn't respond to a strong AD like an SSRI.. it's that you could respond too well & get a manic episode. For that reason, AD's are usually used in small doses or as a last resort with the aid of another stabilizing med to keep you from getting too high. Cymbalta & Effexor can trigger you too, but they tend to do better than the plain SSRI's.

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Did you feel better on the previous medication, which I stemmed from your previous diagnosis? If so, that's definitely something to tell your pdoc. It's a sign he's on the wrong course.

This seems to be a very valid point to me.

However:

When I was first diagnosed with depression 15 years ago I was put on Prozac and had apparently terrible side effects (ie., I fell in love, got married, started and ran a successful art gallery, had a healthy self esteem, etc. . .)

I would think that it would be reasonable to go back there somehow, but my pdoc, says, no, I am much too ill for such normalcy. I was "suffering" from hypomania, which has now been replaced with hellish mixed states. He wants me to lower my expectations(WTF?)

So, you see, even my past medication history isn't making much sense to me right now. When I ask new pdoc if I can just expect to be on a downward slide from here on out, he kind of shrugs. . . Nice.

-- B

Um... Obviously I don't know your whole story, but judging from this, I'd look into getting a second opinion. Even if your pdoc's correct in his new dx, there's no reason for him to be telling you to be lowering your expectations for the rest of your life in this kind of way. He's not doing a great job with your meds, or of listening to you, or of educating you about BP.

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Just switched to Cymbalta a few weeks ago myself cause I needed a change. For reference, I've been medicated for BP2 for 10 years now and been on lotsa stuff. What I've learned:

1. Sometimes you DO need a change.

2. Let your pdoc make that call with your input.

3. Sometimes new stuff jacks you up bad (suicidal stuff included), so see your pdoc frequently when making a change (for me that's weekly).

4. Everything takes time.

5. If you ever get that feeling like you're gonna crawl outta your skin or that making nooses with rope seems a little too interesting--stop and call pdoc or 911 IMMEDIATELY. Seriously...

6. Oh yeah--I went from a lean mean triathlete this suimmer to a pudgy couch potato on Cymbalta. Sucks to lose the 6 pack, but I'll trade above ground and breathing for 10-20 lbs of lard ANY and EVERY DAY OF THE WEEK. ;-)

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Just switched to Cymbalta a few weeks ago myself cause I needed a change. For reference, I've been medicated for BP2 for 10 years now and been on lotsa stuff. What I've learned:

1. Sometimes you DO need a change.

2. Let your pdoc make that call with your input.

3. Sometimes new stuff jacks you up bad (suicidal stuff included), so see your pdoc frequently when making a change (for me that's weekly).

4. Everything takes time.

5. If you ever get that feeling like you're gonna crawl outta your skin or that making nooses with rope seems a little too interesting--stop and call pdoc or 911 IMMEDIATELY. Seriously...

6. Oh yeah--I went from a lean mean triathlete this suimmer to a pudgy couch potato on Cymbalta. Sucks to lose the 6 pack, but I'll trade above ground and breathing for 10-20 lbs of lard ANY and EVERY DAY OF THE WEEK. ;-)

Thanks, Ninotores

Yes, I need a change. And I am dreading it, because I hate the way it can make me feel. Plus, as I'm sure you know, it's always a crap shoot, and one never knows if the new med will be worth anything. I've gone from really bad to way worse with wrong med guesses in the past. And to make matters worse, I'm still ambivalent about the fairly recent BPII diagnosis (no pun intended).

Man, I'm really on a downer, tonight!

Anyway, I'm glad the Cymbalta is doing the job for you. Just don't skip a dose (brain zaps are only fun the first time).

-- B

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Um... Obviously I don't know your whole story, but judging from this, I'd look into getting a second opinion

. Even if your pdoc's correct in his new dx, there's no reason for him to be telling you to be lowering your expectations for the rest of your life in this kind of way. He's not doing a great job with your meds, or of listening to you, or of educating you about BP.

Yeah, I need to have a sit down with this doctor and find out where he is coming from. He's this hot-shit pdoc and people think he walks on water around here, but maybe he's finally met the nut he can't crack (pun intended that time).

-- B

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Now I take 100mg. Lamictal and 60mg. Cymbalta, and I have Klonopin that I take occasionally for anxiety. I don't feel any better. I have no motivation. I want to stay in bed all day, watch TV and eat carbs. My self-esteem is below zero. I'm not actively suicidal, but I have frequent thoughts of "what's the point, If this is as good as it gets."

If either of us gave a damn, we could high five and say "Hell Yeah" about this. ;)

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