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Rapid Cycling + ADHD

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I'm diagnosed with Bipolar (probably type I) with rapid cycling and ADHD. I've heard this specific combination is very hard to treat. I'm in the middle of a major depressive episode, and I can't really take antidepressants since that speeds up my rapid cycling, according to pdoc. I don't know what to do, seems like it's impossible to find a working cocktail. Also, it's like the depression blocks the positive effects of Concerta. I can't feel it working at all.

I'm currently on:

Lithium Sulfate 126 mg (sounds like a low dose, but since it's sulfate it's actually quite high)

Lamictal 50 mg (titrating up)

Fluanxol 5 mg

Concerta 72 mg

Nothing seems to be working right now.

Anyone with this specific flavour of MI? What do you take and is it helping?

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I don't have bp but I've seen some articles dealing with this subject when researching my own ADD.  I'll likely be doing a writeup on the topic sooner or later. 

Once the bp is stabilized, ie no major ups or downs for several months, it's likely safe to treat the ADD with any of the normal stimulants.  You just need to start with a baby dose and work your way up slowly, stopping immediately if you start cycling again. 

Some ideas for you to research:

Wellbutrin (buproperin), Strattera (atoximine), and Ednorax (reboxitine) are some ADs that might be safe for you to try. 

Provigil has a pretty good track record with bp folks around here. 

Some meds that could serve as a mood stabilizer that might also be stimulating are tegretol (made my attention worse, FWIW), Keppra, and Abilify.

Lamictal is an AC often used for bp that also has a decent anti-depressant effect.

Many rapid-cyclers around here swear by topomax as a mood stabilizer, FWIW. 

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Just my take on it...I would wait until you titrate more on the Lamictal. I had a lot of mixed episodes titrating to my current dose of 200mg. I really took it slow,starting in May. Since it's a bottom up MS, it really works wonders for some of us. I have read several places that 200mg is supposed to be the magic dose, and so far I have to agree.

I take Strattera for my ADD. It has worked pretty well so far. Worried about the pooping out.

I really feel for you. BPI or BPII, with ADD and of course the paranoia and anxiety that accompany both. The mixed episodes are the worst of all.

Keep asking questions and learning about all these crazy meds. You'll get it right, or close to it!

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You might want to try adding some choline

This study examined choline augmentation of lithium for rapid-cycling bipolar disorder. Choline bitartrate was given openly to 6 consecutive lithium-treated outpatients with rapid-cycling bipolar disorder. Five patients also underwent brain proton magnetic resonance spectroscopy. Five of 6 rapid-cycling patients had a substantial reduction in manic symptoms, and 4 patients had a marked reduction in all mood symptoms during choline therapy. The patients who responded to choline all exhibited a substantial rise in the basal ganglia concentration of choline-containing compounds. Choline was well tolerated in all cases. Choline, in the presence of lithium, was a safe and effective treatment for 4 of 6 rapid-cycling patients in our series. A hypothesis is suggested to explain both lithium refractoriness in patients with bipolar disorder and the action of choline in mania, which involves the interaction between phosphatidylinositol and phosphatidylcholine second-messenger systems


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The Lamictal finally kicked in and as the depression faded the Concerta started working again. Took me a hospital visit that lasted a week to sort things out, but that's another story.

Feeling much better, thanks for all the replies! ;)

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I'm Bipolar I, ultra rapid cyling with ADD. After trying about 30 different combinations, I seem to have hit on a winner.

For my maintenance meds I take:

Lamictal 400MG (you can go up as high as 500MG on this so don't be shy, it WORKS!)

Neurontin 2400MG

Geodon 60MG

Adderall XR 40MG (just went up on that, helped a lot)

I also take Ativan and Klonopin for anxiety and Ambien for sleep.

I see you take Concerta and I hope it works for you, but it made me totally manic and anxious and left me feeling shitty when it wore off. I switched to Adderall XR and it's been great.

Just my bit of experience for ya'. Everyone's chemistry is as different as their thumbprints, so what works for some, won't for others.


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