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Med Cocktail for ADHD and Bipolar 2, mostly depressed side.


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Habing a hard time getting stabilized...  Was doing well on Wellbutrin, Zoloft, and Dexedrine but blood platelets bottomed out. Also was on Seroquel and Lamictal,

Stopped Zoloft and DEX (causing platelet issues) and also stopped Lamictal over the course of a year.

Started on Effexor 225 mg (which doesnt affect platelets) but I feel like Im becoming dysphoric, irritable, more anxious. Its making my anxiety worse. 

 

Anyone have good cocktail ideas? I'm thinking of going back on Lamictal, maybe wellbutrin and a tricyclic...I don't know (or Buspar)...The problem is I can't take anything with Seratonin (SSRI or AMPS)...Perhaps concerta next as it has no seratonin reuptake. 

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On 9/16/2016 at 11:49 PM, alivetoday said:

Habing a hard time getting stabilized...  Was doing well on Wellbutrin, Zoloft, and Dexedrine but blood platelets bottomed out. Also was on Seroquel and Lamictal,

Stopped Zoloft and DEX (causing platelet issues) and also stopped Lamictal over the course of a year.

Started on Effexor 225 mg (which doesnt affect platelets) but I feel like Im becoming dysphoric, irritable, more anxious. Its making my anxiety worse. 

 

Anyone have good cocktail ideas? I'm thinking of going back on Lamictal, maybe wellbutrin and a tricyclic...I don't know (or Buspar)...The problem is I can't take anything with Seratonin (SSRI or AMPS)...Perhaps concerta next as it has no seratonin reuptake. 

Are you sure you know which drug was affecting the platelet counts?

Why can't you take anything that affects serotonin? Are you aware that venlafaxine (Effexor) is a serotonin-norepinephrine reuptake inhibitor, with the same inherent risks as SSRIs and other serotonergic drugs? Amphetamines only minimally affect serotonin, but methylphenidate has even less of an action w.r.t. serotonin, so it's a good option to try...

On 9/18/2016 at 0:11 PM, nmk1226 said:

I have been given Vyvanse for BED.  I know that sounds crazy because it is typically an ADD med, but the FDA has done studies and has expanded its uses to BED. 

To be specific, the drug manufacturer conducted the studies, not the FDA. The way the drug indication approval process works in the US requires the drug manufacturer to fund and conduct studies, the FDA only reviews them and makes decisions based on the evidence (with some rare exceptions). Accuracy is important.

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  • 2 weeks later...

I'm bi polar with ADHD and PTSD. I've been on a mad cocktail since I was 15!

heres the breakdown:

litium 1050mg bedtime  mood stabilizer/ antidepressant augmentation/anti manic

nortriptyline 150mg bedtime  tricyclic antidepressant (SNRI)

bupropion 300mg mornings stimulant antidepressant (NDRI)

Abilify 5mg mornings antidepressant   augmentation and antimanic 

Methylphenidate SR 40mg (2x 20mg) morning   ADHD and antidepressant (DNRI)

thyroxine 100mcg morning replacement therapy and antidepressant augmentation 

HydroMorph Contin (12hour Hydromorphone CR) 30mg/day for pain

Gabapentin 1200mg/ day in 3 doses for neurological pain

nabilone 1mg twice a day or neurological pain and anxiety

diazepam 5-10mg twice a day as needed anxiety

hydromorphone 2-4mg three times a day as needed breakthrough pain

 

i included all my meds as some cross over  

everything seems to be working okay

im a depressed bipolar and only go manic very seldomly 

My ADHD is under control

my depression required a tricyclic cause nothing else seemed to work at all  lithium and nortriptyline is a very powerful combo according to psychiatrist and in the books/Internet 

the nortriptaline/bupropion/methylphenidate acts as a "triple reuptake inhibitor" and lithium Abilify thyroxine augments the cocktail . everything works synergistically but I find I get some anxiety as it's a powerful combo that I'm on diazepam short term till I get used to the combo. one benefit is bupropion and nortriptyline also helps the ADHD too . I'm usually very depressed as I'm paraplegic I broke my back during a suicide attempt (I jumped off a 5 floor building) this cocktail makes my face ache cause I'm smiling all the time. It's a bit euphoric at times from the stimulation which also counteracts the hydromorphone drowsiness and the methylphenidate also augments pain relief too.

I used to take a cocktail emphasizing serotonin reuptake (citalopram bupropion and Dexedrine with lithium) and was really messed up and it left me exhausted by the end of the day and felt really weird in the head. My current cocktail emphasizes norepinephrine and dopamine reuptake and a little direct serotonin involvement and I feel very clear energetic and focused. once the nortriptyline Kicked in I became very energetic and happy with some euphoria but not the speedy type of euphoria associated with Dexedrine that impairs judgement from overconfidence. I've never been happier and so focussed at the same time!

i hope this helps you. 

 

Edited by Freddy
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  • 2 weeks later...

Wow Freddy - that is a lot of meds to be on at one time!!  I'm Bipolar2 (predominantly depressed, previous diagnosis of major depression) Back on Lamictal which works well in mood stabilization, but I want to get back on a stimulant (was on Ritalin) to help with ADD symptoms and apathetic depression that will not go away. I've been on the gamut of SSRI's and SNRI's, even high-dose Wellbutrin.. They made me exhausted/numb yet sort of wired/restless at the same time. None of which really helped by depression/apathy and lack of focus.

***For those of you here that have both Bipolar and ADD - did you have a difficult time finding a pdoc that would prescribe you a Stimulant? Or is it just that you've been ADD for life and always on Stimulants since childhood? Ritalin really helped me but since I've run out (and moved far away, with a different doctor), no one will describe it. I've never had Mania, just some mood -cycling that happens from time to time which seems to be  corrected by the Lamictal.

Edited by cloudmonger
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  • 5 years later...
On 9/21/2016 at 1:49 AM, JustNuts said:

Are you sure you know which drug was affecting the platelet counts?

Why can't you take anything that affects serotonin? Are you aware that venlafaxine (Effexor) is a serotonin-norepinephrine reuptake inhibitor, with the same inherent risks as SSRIs and other serotonergic drugs? Amphetamines only minimally affect serotonin, but methylphenidate has even less of an action w.r.t. serotonin, so it's a good option to try...

To be specific, the drug manufacturer conducted the studies, not the FDA. The way the drug indication approval process works in the US requires the drug manufacturer to fund and conduct studies, the FDA only reviews them and makes decisions based on the evidence (with some rare exceptions). Accuracy is important.

 

On 9/21/2016 at 1:49 AM, JustNuts said:

Are you sure you know which drug was affecting the platelet counts?

Why can't you take anything that affects serotonin? Are you aware that venlafaxine (Effexor) is a serotonin-norepinephrine reuptake inhibitor, with the same inherent risks as SSRIs and other serotonergic drugs? Amphetamines only minimally affect serotonin, but methylphenidate has even less of an action w.r.t. serotonin, so it's a good option to try...

To be specific, the drug manufacturer conducted the studies, not the FDA. The way the drug indication approval process works in the US requires the drug manufacturer to fund and conduct studies, the FDA only reviews them and makes decisions based on the evidence (with some rare exceptions). Accuracy is important.

 

On 10/5/2016 at 12:07 PM, Freddy said:

I'm bi polar with ADHD and PTSD. I've been on a mad cocktail since I was 15!

heres the breakdown:

litium 1050mg bedtime  mood stabilizer/ antidepressant augmentation/anti manic

nortriptyline 150mg bedtime  tricyclic antidepressant (SNRI)

bupropion 300mg mornings stimulant antidepressant (NDRI)

Abilify 5mg mornings antidepressant   augmentation and antimanic 

Methylphenidate SR 40mg (2x 20mg) morning   ADHD and antidepressant (DNRI)

thyroxine 100mcg morning replacement therapy and antidepressant augmentation 

HydroMorph Contin (12hour Hydromorphone CR) 30mg/day for pain

Gabapentin 1200mg/ day in 3 doses for neurological pain

nabilone 1mg twice a day or neurological pain and anxiety

diazepam 5-10mg twice a day as needed anxiety

hydromorphone 2-4mg three times a day as needed breakthrough pain

 

i included all my meds as some cross over  

everything seems to be working okay

im a depressed bipolar and only go manic very seldomly 

My ADHD is under control

my depression required a tricyclic cause nothing else seemed to work at all  lithium and nortriptyline is a very powerful combo according to psychiatrist and in the books/Internet 

the nortriptaline/bupropion/methylphenidate acts as a "triple reuptake inhibitor" and lithium Abilify thyroxine augments the cocktail . everything works synergistically but I find I get some anxiety as it's a powerful combo that I'm on diazepam short term till I get used to the combo. one benefit is bupropion and nortriptyline also helps the ADHD too . I'm usually very depressed as I'm paraplegic I broke my back during a suicide attempt (I jumped off a 5 floor building) this cocktail makes my face ache cause I'm smiling all the time. It's a bit euphoric at times from the stimulation which also counteracts the hydromorphone drowsiness and the methylphenidate also augments pain relief too.

I used to take a cocktail emphasizing serotonin reuptake (citalopram bupropion and Dexedrine with lithium) and was really messed up and it left me exhausted by the end of the day and felt really weird in the head. My current cocktail emphasizes norepinephrine and dopamine reuptake and a little direct serotonin involvement and I feel very clear energetic and focused. once the nortriptyline Kicked in I became very energetic and happy with some euphoria but not the speedy type of euphoria associated with Dexedrine that impairs judgement from overconfidence. I've never been happier and so focussed at the same time!

i hope this helps you. 

 

Of course not medical doctor but I have bipolar 2 disorder and ADHD and I have struggled for years to get the right medication. The problem with bipolar 2 is there isn't many options for our depression that works. Many Drs prescribe medication for bipolar 1 depression such as vrylar and other SSRI antidepressants which do not work for us. In truth the only real medication that solved my depression and everything else was Seroquel. Trust me, I have tried every cocktail you can imagine to avoid taking Seroquel. Lamictal, topamax, Zoloft, every antidepressant in the world! Several anti- anxiety meds. However, there is a new antipsychotic med that treats bipolar 2 depression and I am going to try it. Weight gain doesn't appear nearly as bad. Caplyta.

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