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Urgh! Could use some help.


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Ok, to catch anyone up/remind anyone of my issues and med history:

Bipolar, rapid cycler, tend to spend more time in mania-land than depressed, paranoid as all get out, and delusional. OCD, pretty well split between the O and the C. BPD and ADHD, inattentive type and PTSD. We've been focusing on CBT to deal wth most issues, primary focus has been on BP and BPD. OCD, PTSD and ADHD just haven't been priorities in stabilizing. BPD, nearly extinct (I was a borderline borderline anyway - ha!), stabilizing on BP front - last 5 months or so. As a result, have been able to deal with some OCD and PTSD issues, OCD starting to minimize. Some therapeutic results with ADHD CBT activities (setting timers, creating lists, focusing on one thing at a time).

Current meds: 50mg Topamax, 150mg Lamictal, 10mg Lexapro. It's become evident that I'm a low metabolizer (as if you couldn't tell by listed dosages). This med regimine has been working out very well. Lexapro has been a constant at 10mg.

Previous med attempts:

Topamax - up and down the dosing spectrum - as high as 200 at one point, but that made me dumber than a box of rocks - couldn't remember words, sometimes even my name.

Lamictal - up and down the dosing spectrum - as high as 250 at one point...I don't remember the issue with the increased dosage but we've hit my sweet spot at 150.

Depakote ER 250mg - disaster - depressive tailspin. Only one other depressive episode worse than when I was on this medication. Threatened pdoc with murder - we quit this one. (in place of lamictal in current med regime)

Generic Wellbutrin 150mg - I can't remember if we started me at lower doses and worked up to 150 or not - I became increasingly manic on this drug and eventually had to quit it. (in place of lamictal and lexapro in current med regime)

Seroquel 50mg - utterly and completely zombified me - I couldn't even complete a thought pattern, let alone a sentence. Lost all concentration efforts and wanted to sleep constantly. (in place of topamax and lamictal in current med regime)

Strattera 40mg - prescribed bc my pdoc as a result of conversations where I'd told her that I've TRIED to become addicted to things but it just doesn't stick. I don't like taking recreational drugs to get high - I just don't enjoy it and speed has no effect on me (um, duh, that's one clue that I have ADHD). I basically told her that I'd been trying to self medicate for years, but was not having any success. She was concerned about giving me Adderall. Anyway, the Strattera sent me into an instanteous manic fit, pretty much immediately.

So here's the issue...the ADHD is driving me nuts...docs wanted to stabilize the BP to make sure it was truly ADHD and not symptoms of BP causing my issues. Clearly, we've isolated what's what and determined a clear diagnosis. I've been expermenting with varying doses of caffeine. Here's where it gets weird: when I was younger, mega doses of caffeine (ie: coffee, diet pills, mountain dew) used to send me through the roof - jittery, stomach problems, headaches - I was so sick, I don't really know if it helped with concentration or not. When I was in college, a bf gave me some Ritalin and it worked wonders for me - I was able to cram for a final for hours and did well on the exam the next morning, even though I crashed and slept for 2 of the 3 hours alotted for the test (I didn't complain about my B+ considering I'd never cracked the book before that night - gotta love that Ritalin!).

Fast forward to now - coffee, green tea, energy drinks - they set me on fire! In a good way though - I don't feel sick and I can accomplish mountains of work - and I'm happy to do it! I can stay on task, focused and productive. I can actually be that person that I've always known I can be. I feel accomplished and HAPPY.

So I tell pdoc this at our last appointment and ask him how we are going to deal with this moving forward. I advise that I'm not quite ready to start messing with my meds again yet, because I've been enjoying my relatively short period of stabilization and I don't feel like rocking the boat...but that at some point, I definitely want to deal with it. His advice? Keep drinking caffeine. I was dumbfounded.

I asked him if he was serious and told him that I've spent my entire life eliminating caffeine from my diet, as adviced by just about every sound dietary principal known to man (at this point in time, who knows what the medical establishment will come up with next) and his reply was that caffeine is not as strong a stimulant as ADD drugs. When I argued the point that the dosing was regulated and the side effect profile was lower, he suggest that I not drink coffee and drink green tea instead.

I spoke to my tdoc about this...and told him that I felt it was time to start looking for a new pdoc (again!)...bc clearly this guy was nuts (there were other red flags during our session as well). Tdoc felt that his less than scientific approach in advising copious amounts of unregulated caffeine consumption was highly irregular and gave me some advice about taking OTC caffeine pills (which I'm really against, but willing to experiment).

I'm really at a loss here and looking for some advice. I've sifted through the forums here and am not positive, but think that maybe my Strattera dose may have been too high to start with and that an 18mg dosage might have suited me better, given that I'm a poor metabolizer. Tdoc thinks Strattera was a poor choice as it's not a stimulant and given my med profile/history, Adderall would've been a better choice for me.

Thoughts? Comments? Suggestions? The suggestions would be awesome. Thanks gang ;)

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I asked him if he was serious and told him that I've spent my entire life eliminating caffeine from my diet, as adviced by just about every sound dietary principal known to man (at this point in time, who knows what the medical establishment will come up with next) and his reply was that caffeine is not as strong a stimulant as ADD drugs. When I argued the point that the dosing was regulated and the side effect profile was lower, he suggest that I not drink coffee and drink green tea instead.

Thoughts? Comments? Suggestions? The suggestions would be awesome. Thanks gang :)

The "energy drinks" on the market that aren't loaded with sugar may have enough other stuff that can screw with bipolar that you should be a bit cautious.

However, coffee, cocoa, green tea, black tea are all loaded with antioxidants and other groovy stuff, and could actually be healthy for you. While caffeine, theobromine, and theophylline may not be neurchemical-releasing stimulants like the prescription meds for ADHD, they're still quite useful. And quite tasty. As a gamer would say: they're made of win. ;)

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Hi DG!! I missed you! I couldn't take Strattera. I'm also Borderline Borderline. funny. ha ha. I can't take any stims.. because of anxiety. I am hopeless when it comes to my adhd. But, it usually gets swallowed by my BP. What fun. I'm glad you are doing better. About the caffeine. Beware the unlucky person who tries to tell me not to drink caffeine! No, no, no! you will not take away my diet coke. Hugs, Melissa

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When I argued the point that the dosing was regulated and the side effect profile was lower

Why don't you try using regulated caffeine then? You can buy caffeine pills cheaper than you can buy a soda or energy drink. If you could purchase an extended release formulation of caffeine, I would probably take it regularly. Caffeine certainly helps me, but I don't like the crash that comes with it.

Caffeine probably has fewer side effects than most stimulants. If I OD, I'll get jittery though. Bupropion on the other hand, made caffeine look like candy. During the first month, it was virtually impossible for me to sit still. It gave me all of the typical stimulant side effects, but the only reason I stayed on it was because even the SR version doesn't make me crash.

A lot of people do take caffeine regularly as directed by their doc. I guess it's often a good solution for chronic fatigue.

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