Jump to content
CrazyBoards.org

ADHD + BPII: Replace Lamictal?


Recommended Posts

Hi there. I'm a male, late twenties. I was diagnosed (correctly) with ADHD a few years ago. I take dexedrine on and off (mostly on during school or work - but I take breaks).

Many years ago I was prescribed Effexor XR (eventually Seroquel, Zoloft). I didn't realize at the time but (first time) I eventually became seriously Manic, and destroyed everything around me. That was my second year of university. That and untreated ADHD, and a lot of other bad things (that made me have to leave the country) happened - and it was really bad. I was dx G.A.D. then and later swore off all psyche meds ever. I got a lot better in some ways. Lost 30lb I gained, got better in sobriety, worked my ass off... BUT it was a major struggle. And quitting alcohol, later drugs, and smoking, and trying to piece together my life, and force myself not to be depressed/anxious - did not work. ADHD meds later helped with motivation, etc, but it was kind of late.

I recently (1.2years ago or so) saw someone who is one of the "experts" on Bipolar Disorder Research, in North America. He diagnosed me or "strongly suspects" me of having Bipolar II. I got a prescription from my regular Pdoc for lamotrigine (that other expert is hard to see and is a research doc/lecturer mostly I think). It was the generic. I was scared to try it and waited 9 months. I gave up after a month due to swelling/ bloating. That was September. Now I tried Brand name (GSK) and I think its better, its been 17 or so days. But I may quit - for the same reasons and dry/irritated eyes. I'm very serious about fitness/ lifting weights and the bloat is sabotaging me there. And I really need a job and to apply myself to get into grad school sooner than later. I feel anxiety decreased dramatically and there are antidepressant effects in lamictal. And perhaps that and dex are a great combo... but I worry about side-effects and the fact that lamotrigine binds to melanin. My eyes felt like they were burning day 16-17 at times. I had "red -pen marks/ scratchy" like rashes a few days in week 2 on 25mg... But they just occurred a couple hours after taking the medication (around 10pm every night). 

This is probably the first medication or substance besides (alcohol, cocaine, original first time use of dexedrine/adderall) that "lifts" my depression. I wonder can I switch to something like Gabapentin? Is gabapentin good enough as a "mood leveler"? I usually can go out with people and be very fun to be around, for a while - but then I'm back on my own again. Like I did improv, was very funny, outgoing at different times in my teens and twenties --- but sustaining any relationships are HARD/ impossible for me. Agitation, impulsivity, anxiety, depression all seem to be reduced on Lamictal... Is there anything else that can do this and blend well with adhd meds?

 

I don't think I need any cocktail of meds like those often prescribed for Bipolar I. My therapist (PhD -psychology), and pdoc (Psychiatrist) see me more as ADHD. But, that serious depression is something they don't really see. At 16 I thought it was anxiety, then at 18-19 I treated that, ruined everything around 20-21... And rebuilt my life, the next 4-5 years. I was happy to be 40-50% functional on ADHD meds, but it doesn't seem enough. I will not go back on anything like Effexor... but maybe Wellbutrin or Gabapentin will help. Any insight into this? Thanks for reading.

 

Using only ADHD meds in my last university courses seemed to have helped -- but sometimes I was awake 3-4 days. This is kind of how I was during high school finals, job applications, two different universities - even without ADHD meds. BUT at least instead of taking lots of coffee and missing tests/ etc... I was alright. Getting B's and B+ on classes I hated at a school I hated... So that was OK, but now I'm off into the real world and need something more fast. I also think clearer, and such on lamictal. But it makes me fall asleep very late -- 9-10am... and while I sleep 8-9hours, its at the wrong time!!!!!

 

I am planning a major surgery, deciding for or against law school, and getting more work experience in this year.

 

TL,DR:

-I am ADHD and Bipolar II (more time spent in depression). 

-Lamictal seemed to be better as an antidepressant than I've ever experienced. I used generic 30days and brand name now 17 days.

-I'd like to quit and find something better, with less side effects. I'd like it not to mess with my ADHD treatment. 

 

Edited by MNK99
Clarification.
Link to comment
Share on other sites

1 hour ago, MNK99 said:

TL,DR:

-I am ADHD and Bipolar II (more time spent in depression). 

-Lamictal seemed to be better as an antidepressant than I've ever experienced. I used generic 30days and brand name now 17 days.

-I'd like to quit and find something better, with less side effects. I'd like it not to mess with my ADHD treatment. 

 

Hi MNK99 - Welcome to CB! I seem to have similar DX to you - I fall more on the major depression end, but have had poor results with SSRIs (Long ago, Zoloft made me manic) I've had 1-2 docs mention BP2 for me as well, along with probable ADD. I hope to go back on Ritalin for that, but started back up on a mood stabilizer last October which is working out really well.

I don't know how long you were on Lamictal 25mg, but most ppl experience similar side effects while ramping up on it. If you can, I would try to stick it out. The side effects end up being very mild compared to everything else I've been on (like 20 meds if you see my sig) !! I also had the extreme itchiness (got better), redness of skin, dry eyes (Visine helps), water retention, a couple headaches after increasing dosage. I always take it in the morning. It is neither sedating or activating for me. I'd say it is a very effective mood stabilizer. In the last several months, I have lost 8 pounds (no changes) I am already thin and like you, very active though.

I have not tried Gabapentin (since Lamictal works well for me) I have heard it is a more sedating med that works on Gaba receptors (ppl here can correct me if I'm wrong) I've also heard that most other mood stabilizers are more effective in stopping Mania (versus lifting Depression) Gabapentin is utilized more in ppl with comorbid Anxiety disorders. While Lamictal is supposedly the most effective of the class to lift depression (although most docs do not use it as monotherapy - they typically add some kind of antidepressant or anti-anxiety med dep on your issues)

Anyhow, I don't know if this is at all helpful, but just my experiences. Were the side effects really too bad to try Lamictal longer? The titration period is slow and a pain, but honestly, once you hit 100mg (and stay at this dose for several weeks) The med builds up in your system and initial side effects are minimized.

Edited by cloudmonger
Link to comment
Share on other sites

Hi Cloudmonger, thanks for the reply. I was thinking maybe my post was too long and random for replies. It seems on drugs.com both Gabapentin and Lamictal (separately) have really high ratings.

The side effects for Lamictal aren't so so bad. But, I am very conscious about my weight. I was obese as a kid. 250lb at 16 yrs old, 180lb at 18 years old (diet and exercise). I maintained a healthy weight for my height the next ten years except when on anxiety medication (Effexor and or seroquel - perhaps, they realized I was Manic... not sure why I was prescribed it as that school and psychiatrist are 2700 km away from where I moved). Any other time in the last decade + I've been 175-190lb (6ft). 

I mention all this because my mylan-lamotrigine trial saw me very bloated (water retention or edema perhaps) and my body recomposition stagnated. Like I was 180 then 185lb... (Like I was gaining strength and cutting bodyfat every week... and it slowed during this time). I quit, and immediately that water weight disappeared.

NOW: I have randomly lost weight just starting Lamictal. I was on mylan-ltg Sept 1 to Sept 30 and saw the effects to my physique (as vain and silly as that may sound) and quit it

This is important because since I lost 70-80lb and maintained it over ten years, I plan to surgically correct the tiny bit of excess skin (not that bad, but screws with my mind). I'm finally looking cut and defined more which is hard as a "formerly fat person" (no offense to anyone)... but its clearly better without the med.

If I am on a med to help depression and maintaining non-depression, that's good. But if it makes me look worse or interferes with that surgery... then its hard to stay on it. Now there's no weight gain per se... I was actually 169lb which I probably have never weighed since early teens... but I looked worse from the edema/retention. I dunno.

 

Re: "I also had the extreme itchiness (got better), redness of skin, dry eyes (Visine helps), water retention, a couple headaches after increasing dosage."

Did your water retention go away? I only have it in my stomach. I worked my ass off for a nearly flat stomach and now its bad. The only change was LTG. I wish it wasn't so... cuz I like it. I actually hate people less (can see the good in things too maybe?). Which would be amazing for relationships and motivational also. Just being skinny and forcing myself to go through the life motions using adhd meds may not be enough for me....

 

Things like that surgery, relationships, illness, tons of wasted opportunities, time running out don't mess with me nearly as much on LTG. 

Its good you had the patience for the trial and error of meds and stick it through. I don't think I can. I know no antipsychotics, nor (most if any) SSRI/SNRI's suit me, and I'm settled with ADHD meds at least... so I may almost be there. 

Edited by MNK99
Link to comment
Share on other sites

8 minutes ago, MNK99 said:

I was on generic 30ish days, on brand name 17-18 days right now... So only on 50mg a half week. It really does help but there's no explanation for actually losing weight without trying and simultaneously looking worse. As in now at 169-172lb I look worse than at 176 or so. It's water retention. Damn drugs!

I seem to respond better to the brand name also (not sure why??) I had initially started on the generic...

I totally get the water retention annoyance, I'm not sure how to fix it, other than drink more coffee since it is a diuretic ;-) I try to drink more water, but then have to pee constantly, sometimes 3 times within a period of 30 minutes! Like Niagra falls too. Lol.

Link to comment
Share on other sites

Thanks for the replies and all.

I think I do better on GSK dexedrine than say the generic adderall, vyvanse, ritalin etc. I would never chance it with some generic alternative of dexedrine. And felt very apprehensive about the IR tablets changing. But luckily in Canada we have that. I kind of don't like Pfizer - cuz of the Effexor ordeal (it wasn't just that... but my whole life was a mess then, it may have taken 5-6 years to piece together "why"). It was crazy being told I was ADHD. And then 1-2 years later, probably Bipolar. I had just spent all that time settling my mind on that... and then on the next thing. Some forum mentioned: hydrochlorothiazide as a diuretic for some psyche meds, but the less drugs the better. I already take inhalers, this, and dex.  

 

Also: generics can vary between 80-125% of the original patented drug's targeted dose. And excipients (lactose, whatever binders or inactive ingredients might be different), which you probably already know.

Edited by MNK99
Link to comment
Share on other sites

Here's my experience. I was able to wean down my lamictal to 75 mg and haven't had any significant depression. I'm also on Concerta. I had been on lamictal 300 mg but wanted off just on principle and because I questioned whether it helped. I found 75 mg controlled depression but I can't go lower. But I'm also on abilify for mania. I wonder if you would have the effect you want, minus what you hate, on a lower dose?  It was a slow downward titration and of course don't do it on your own.  I've never taken gabapentin, just had friends who found it severely sedating, so I would hope it's never offered to me. That's just my experience so may not be the answer for you. But I will say lamictal is the only med to control my depression this long, and that's saying a lot. 

Link to comment
Share on other sites

Hey there, thanks for the reply.

I only was on the generic 28-30 days, last September and the brand around 20-21 days now. I quit... and wanted to change it to the morning, then didn't take it two days, and restarted at 25mg. I was only on 50mg max. I think it helps even at a lower dose... but I think I may go up to 100mg or so and see. IF I can stand the bloating. 

Off it -two days (I know... I shouldn't quit meds randomly. BUT this is my first bipolar med ever, and I've had hella bad experiences back when I was misdiagnosed).

Interesting you are on Concerta and Lamictal. I am on Dex and Lam. I just switched to morning after quitting... and only 25mg. Hoping to get back up to 50mg in a  few days. I stepped it down, because I switched to 7am dosing rather than 10pm night. I look thin without lamictal but very fat suddenly on lamictal (bloated or whatever - no weight gain). Its odd.

Its very strange and I hope it goes away. I had (mild mild) rashes... and I don't think SJS (I know, its extremely serious), but they go away in 2 hours. Not today, but 4 or so times in the last 3 weeks. Maybe more... because I almost only ever accidentally saw them in the mirror. Seeing Pdoc today. I am not excited about alternate options - latuda, lithium, etc. I don't think I need depakote etc. 

I'm med sensitive it seems. And other options - are bad for bipolar (SSRIs, SNRIs) and ADHD often. Like prozac did nothing for me and is toxic to itself in a way, and makes things like adderall and dexedrine not work (due to " blocking the metabolic pathway of AMP's, 'CYP450 2D6'.

Reference:

http://www.corepsych.com/2008/12/add-adhd-medications-amphetamines-cyp-450-2d6-drug-interaction-update/

Edited by MNK99
Link to comment
Share on other sites

47 minutes ago, notloki said:

17 days is not enough time to properly evaluate a med and whether or not side effects will go away.

I agree. Also, Lamictal has a particularly slower titration than most meds - it really takes awhile to get to a balanced blood level to be able to assess what it will do for you. I stayed 2 weeks on each dose after increase (25mg for 2 weeks, 50mg for 2 weeks, 75mg for 2 weeks, etc)

I want to emphasize that I did have the worst side effects after each dose increase, but once I was on 100mg for a month side effects seemed to go away. All I have now is mild itching on legs, a bit of water retention but not really bloating (my clothes are bigger on me, also on my waist) I have increased my water consumption because i am a bit more thirsty and the more you drink, the quicker your body flushes out the water. I don't know what the water retention is due to, I've read that Lamictal works on Sodium channels so may effect sodium balance in some way?? I don't know....

Link to comment
Share on other sites

Thanks for the responses everyone.

I guess deep down, I know I should give it some more time.

A couple things: Should a mood stabilizer feel like a "warm cloud" around you, that keeps you "safe/stable". As in things that would upset you normally, seem less worrisome and you can just deal with them. I saw my Pdoc yesterday, he said to my surprise: "This is the most calm, I've ever seen you." And that was just with 25mg lamictal, 25mg dexedrine. I feel it could be very helpful in relationships.

Maybe some cosmetic worsening (water retention, minor) is ok temporarily...... if it gets me to where I desire to be (successful and happy).

I see mental speed, and calculations are easier when on a stable dose. Like I "forget" numbers less readily. Just on coffee or add meds I'd get 92-95 sometimes 100 on such a quiz. With lamotrigine in my system, I may be a tiny bit less fast at times - but I'm more accurate and surprisingly got 100 several times, when waking up at 3am. I test myself a lot on random things. 

-Is it possible this diagnosis and possibly helpful mood stabilizer may make my doctor reluctant to give ADD meds? He and another expert diagnosed me ADHD 2.5-3 years ago. And someone else, a bipolar expert dx me BPII ("quite possibly") last year sometime. -- I mean clearly my academic and lots of work functioning improve on ADHD med . maybe not all day every day... But that may be clear on this too. And I know BP is often not liked to give stimulants, plus lots of other docs may think "ADD is a kid's problem". 

-Also, I'm going to Mexico. Being from a developing country, I'd be worried to go there - with the sun and the food allergens I have, and such. I get sick... every time I go to Asia, etc. probably in Mexico too. But I'm only there 3 days. Doctor seemed to be reluctant to go above 25mg but agreed when I said 50mg should be fine if I start it in a couple days, rather than increasing in mexico. I just feel 50>25 and want to get titration over with.I definitely do not want to end up in a hospital over there. 

 

Edited by MNK99
Link to comment
Share on other sites

1 hour ago, MNK99 said:

Thanks for the responses everyone.

I guess deep down, I know I should give it some more time.

-Is it possible this diagnosis and possibly helpful mood stabilizer may make my doctor reluctant to give ADD meds? He and another expert diagnosed me ADHD 2.5-3 years ago. And someone else, a bipolar expert dx me BPII ("quite possibly") last year sometime. -- I mean clearly my academic and lots of work functioning improve on ADHD med . maybe not all day every day... But that may be clear on this too. And I know BP is often not liked to give stimulants, plus lots of other docs may think "ADD is a kid's problem".

 

Are you currently on ADD meds? I have experienced push-back from pdocs not wanting to prescribe stimulants. I've had a couple past pdocs say I "could be BP2" because I've reacted badly to antidepressants, I've done well on Lamictal. I will keep trying because I felt like ritalin really helped me in many ways - particularly as an adjunct med. I agree with what you have said, most pdocs I've seen think ADD is a kids problem & if you weren't officially diagnosed as ADD as a child, then it's unlikely you have it. It's been a huge problem for me & I'm currently looking for a new pdoc that will be open to putting me on a stimulant again because it worked for me in the past with no issue.

Link to comment
Share on other sites

Yes. But I really don't use too too much. I was dx with the ADHD first. And I've been good... The doc trusts me (as he should! lol).

I really was having trouble in university - and I got them towards the end of one program along with the ADHD diagnosis, we carefully tried a few different ones then titrated up to a more adequate dosage. He is not an expert in Bipolar, so he sent me for a differential diagnosis of sorts by "the guy" for bipolar in my city. I think he seems fine with me on stimulants. I go on and off but keep the prescription. Any real work, I take them (like university, job applications, work).

The thing is my PDOC, the one I see (versus the other one that diagnosed me at a special clinic in the hospital for BPII) says that if I don't have ADHD - that no one does. The PhD counsellor I see, says I'm "pretty much the poster-boy for ADHD" when I questioned it again and again

I don't think I've been misdiagnosed since after I was 22. I ignored most things and got healthy on my own till several years later, and only got help when I needed it. So I was not diagnosed before as a child because the possibility didn't enter my head nor my parent's head. Despite my issues, he had "good grades" and was relatively behaved... That all fell apart entering adulthood, but I think that's why.

In short: I value my mostly seen doctors - but I do believe someone more specialized in Bipolar vs someone more specialized in ADHD - would have different opinions of me. 

As would say a family doctor, or someone who doesn't believe in any of this. 

I have no doubts stimulants improved my life: By brute force, making class, working out, getting around my inability to keep a schedule.

As to whether its likely or not... I have been back and forth on it. But that's just me being indecisive - looking back it was ADHD and at my worst is was probably that, memory issues, blackouts, mixed states, alcoholism, crappy friends etc simultaneously (one terrible year). 

TL;DR:

-I always had profound Executive Function issues.  Focus and Concentration issues, and difficulty with time. I always felt like I was running out of time. "What? that's due today?!" "what pages is the test on? When is it?" I would ask my friends even as a 14 year old. I can't remember early childhood.... but I think things get harder and harder, so it was ignored.

-Raised very conservatively, I didn't know what ADD was really and thought I'd know or needed bad grades to have that. 

-It was mostly too little too late. I didn't speak up about difficulty in Grade 10 - because it was a very challenging school and my closest cousins and brother were always doing "perfect" in school. I only spoke up about changing my school afterwards. Plus I was super shy back then. If I had the right guidance (not at that elitist high school I went to briefly), someone would have checked up on me. 

Later, I was traumatized from other things too, so I never could figure it out, until I overcame a lot of other issues and could focus on "why am I underperforming my whole life." Additionally, now also: Can I be happy now before having all I want. To live for the journey, or for the ride, rather than only results - that I seldom get (depression etc)... and without the agitation, feeling on edge/high strung 24-7.

-Regardless what most docs think, I can convince them. Not because I'm a liar... but bc they and I know it isn't fully based on indisputable science. And I'm trying to do the best I can regardless of labels. They can change, or be more accurate... but just the label doesn't help that much.

Edited by MNK99
Link to comment
Share on other sites

*I think maybe its hyponatremia. Acc to google "hyponatremia": 

Hyponatremia is a condition that occurs when the level of sodium in your blood is abnormally low. Sodium is an electrolyte, and it helps regulate the amount of water that's in and around your cells.May 28, 2014

Hyponatremia - Mayo Clinic

 

Also this study shows lamotrigine on the list of drugs that cause this. 

https://www.researchgate.net/publication/5382315_A_Review_of_Drug-Induced_Hyponatremia

 

Cloudmonger said:

"All I have now is mild itching on legs, a bit of water retention ... I have increased my water consumption because i am a bit more thirsty and the more you drink, the quicker your body flushes out the water. I don't know what the water retention is due to, I've read that Lamictal works on Sodium channels so may effect sodium balance in some way??" 

I think you're right. I looked it up because today I counted maybe 18 side effects I've had in the last 23 days and I just noticed my eyes twitch. Closing one eye, my other eyelid flutters. Not sure if this is happening in each eye when they are both closed. The weight loss, shaking, eye twitching, and water retention --- that one that goes away when its not in my system, may be this. I tried drinking some electrolyte drinks but they did not have sodium and maybe that won't help much. I'll get some tests at the doctor one of these days. The twitching, somewhat blurred vision, dry skin - worsened excema, etc... maybe all related. 

Edited by MNK99
Link to comment
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

 Share

×
×
  • Create New...