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gazelle

New here and would love to hear your thoughts on med change

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Hi all I'm new here first diagnosed with ADHD I and now with bipolar 2 and anxiety. 

I'm having some trouble with the meds that I'm on. I'm taking between 25 and 50 mg of Vyvanse daily. It helps with my depression, ADHD, and binge eating, but even though I'm a big girl I'm very sensitive to meds in general so my dose is fairly low. Since I was just diagnosed with bipolar in April, the psychiatrist added a mood stabilizer which is Lamictal. It is making me super sleepy but I'm not sleeping well at night. I already know that I don't do well with anticonvulsants because I can't even take 25 mg of Topiramate without being zombie like tired all day. Also my Promethease test shows that I have a gene for processing anticonvulsants less efficiently than other people. 

Lamictal seems to be doing the same thing that topiramate does to me, at least to some extent. I am also on 60 mg ER of propranolol at bedtime for a fast pulse and anxiety. I'm averaging about 5 hours of sleep right now and that is not working well for me.

I am really wanting to request doing something different than this Lamictal. I'm definitely feeling more stable, but I cannot function as a zombie with a four-year-old. What would you suggest that I talk with my pdoc about when I go back, if anything? I've made it up to 75 mg of Lamictal and it's killer. My only option I'm thinking is to quit taking it in the morning and try it at night, but that never helped with Topiramate either.

I will say that I struggle more with depression than hypomania but I do have hypomanic episodes--at least a few year with the seasonal changes and sometimes I wonder if I don't rapid cycle as well. I will also add that a concern for me would be weight gain because I'm already in the obese category, though I am losing weight--only with the help of the Vyvanse and dealing with the binge eating and ADHD for the last couple of years since I was diagnosed.

Thanks!

 

 

 

 

 

Edited by gazelle
Left out info

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15 minutes ago, gazelle said:

Hi all I'm new here first diagnosed with ADHD I and now with bipolar 2 and anxiety. 

I'm having some trouble with the meds that I'm on. I'm taking between 25 and 50 mg of Vyvanse daily. It helps with my depression, ADHD, and binge eating, but even though I'm a big girl I'm very sensitive to meds in general so my dose is fairly low. Since I was just diagnosed with bipolar in April, the psychiatrist added a mood stabilizer which is Lamictal. It is making me super sleepy but I'm not sleeping well at night. I already know that I don't do well with anticonvulsants because I can't even take 25 mg of Topiramate without being zombie like tired all day. Also my Promethease test shows that I have a gene for processing anticonvulsants less efficiently than other people. 

Lamictal seems to be doing the same thing that topiramate does to me, at least to some extent. I am also on 60 mg ER of propranolol at bedtime for a fast pulse and anxiety. I'm averaging about 5 hours of sleep right now and that is not working well for me.

I am really wanting to request doing something different than this Lamictal. I'm definitely feeling more stable, but I cannot function as a zombie with a four-year-old. What would you suggest that I talk with my pdoc about when I go back, if anything? I've made it up to 75 mg of Lamictal and it's killer. My only option I'm thinking is to quit taking it in the morning and try it at night, but that never helped with Topiramate either.

I will say that I struggle more with depression than hypomania but I do have hypomanic episodes--at least a few year with the seasonal changes and sometimes I wonder if I don't rapid cycle as well. I will also add that a concern for me would be weight gain because I'm already in the obese category, though I am losing weight--only with the help of the Vyvanse and dealing with the binge eating and ADHD for the last couple of years since I was diagnosed.

Thanks!

 

 

 

 

 

lithium- great for depression, anxiety, the tried and true standard

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Second lithium. But it can affect amphetamine based meds although my adderall with lithium is still more effective than any other type of stim. Some take stabilizing antipsychotics like abilify too which can be a crapshoot but can help both depression and hypomania 

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19 hours ago, gazelle said:

I am also on 60 mg ER of propranolol at bedtime for a fast pulse and anxiety. I'm averaging about 5 hours of sleep right now and that is not working well for me.

You may want to consider talking with the prescriber who prescribed the propranolol about taking it in the morning, because propranolol, being a beta-blocker, can suppress the production of melatonin, which can cause problems with sleep.

19 hours ago, gazelle said:

I am really wanting to request doing something different than this Lamictal. I'm definitely feeling more stable, but I cannot function as a zombie with a four-year-old. What would you suggest that I talk with my pdoc about when I go back, if anything? I've made it up to 75 mg of Lamictal and it's killer. My only option I'm thinking is to quit taking it in the morning and try it at night, but that never helped with Topiramate either.

If you don't do well with lamotrigine, ask your pdoc what s/he thinks about either an atypical antipsychotic or lithium. Both have advantages and disadvantages.

Lithium has been around forever and is tried and true, but will mess with your Vyvanse's effectiveness, and depending on the dose (if given in relatively high doses), can mess with your thyroid (sometimes permanently causing hypothyroidism) and kidneys and can cause weight gain as well. Lithium does show effectiveness in depression and suicidality for some patients, but for others (me included), it can actually exacerbate or induce depression. I'm not speaking merely out of my own experience, these were words of caution from my pdoc. For the most part, lithium is better for mania and hypomania than depression. One very interesting thing in particular about lithium is that it's extremely neuroprotective. I think I read somewhere that it has the potential to disrupt the development of amyloid plaques, which are what are responsible for the development of neurodegenerative diseases like Alzheimer's disease. It's also helpful for anxiety, if I'm not mistaken, for some people who are taking it, and it has been shown to decrease aggression.

Atypical antipsychotics are newer, but have a myriad of mechanisms of action that are effective against mania/hypomania, mixed episodes, and depressive episodes, as well as improving cognitive symptoms, improving sleep, anxiety, etc.; however, many of them do this at the cost of causing unwanted sedation, weight gain, metabolic disturbances (high cholesterol, high triglycerides, hyperprolactinemia, and elevated blood sugar which could lead to type 2 diabetes), neurological disturbances (extrapyramidal symptoms like pseudoparkinsonism, akathisia, tremors, and rarely, the sometimes irreversible tardive dyskinesia), as well as other side effects. Side effects like weight gain, metabolic disturbances, and neurological disturbances can be mitigated by choice of antipsychotic... e.g.: Zyprexa, Clozaril (reserved as a last resort medicine anyway), and Seroquel usually the most frequent offenders of sedation and weight gain (sometimes Saphris); Zyprexa the most frequent offender of diabetes; Risperdal and sometimes Invega the most frequent offenders of hyperprolactinemia; Abilify, Geodon, and Latuda the most frequent offenders of akathisia, yet they are usually the most weight neutral... But if you are going for weight neutral, Abilify, Geodon, Rexulti, Vraylar, and Latuda are usually the most weight neutral. They may or may not interfere with Vyvanse. The dopamine partial agonists, Vraylar, Rexulti, and Abilify, actually may enhance the effect of stimulants. Abilify, for me, does just that.

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Seventy-five mgs of Lamictal is not that much, and LTG is known for making you feel worse before you feel better. It’s weight-neutral and good for depression, which is why it’s a preferred choice for BP ll.

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The suggestion is to try at at 200 before giving up. Obviously that's not always practical, but just saying doses less than 200 (or at least 100 depending on other meds) aren't always super helpful 

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Well it ended up being a no-go because I got really terrible, painful glandular swelling that is listed as one of the more serious side effects and quit it. By that point I was feeling terrible anyway so it's going to be back to the drawing board as far as adding something else in besides Vyvanse and Propranolol but I do really feel that I need something since my mood tends to stay around irritable and mostly depressed these days. 

We are also looking at borderline personality disorder as a possibility since the more reading I did on it the more it actually seemed like that might be my issue in addition to or instead of bipolar 2. I have at least seven out of the 9 traits in the DSM and noticed that while most of the bipolar 2 folks were having moods every few days or a couple of weeks I seem to have several moods a day at least. My best friend is also bipolar and she said there is definitely something that is really different about the two of us and that I do not easily let anything go as far as a slight or when I feel hurt by someone. In other words meaning of my mood changes seem to be linked to interpersonal dealings. Thanks you guys for all of the feedback!

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Are you on Extended Release?  If so, perhaps you could switch to regular release and take it at night?

i also wondered if it is possibly your Vyvanse wearing off.  

Your Lamictal dosage is low, if you are titrating to a therapeutic dose...the sleepiness may go away.  

Lithium worked but I gained forty pounds and had numerous side effects.  I took it to pull out of,a severe mixed episode (with Lamictal, too), but I went off Lithium afterwards.  I know it works well for many people.  

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There are some really great responses in this thread.  Really good information.

I'm on 100 mg Lamictal going up to probaby 300 mg.  Strange but I have no side effects whatsoever from it and it doesn't make me sleepy.  I started taking it first thing in the morning and don't notice anything.  I just stopped lithium for fear of kidney issues later on but it didn't seem to affect me at all.

Everyone is so different in how meds affect them.  It's trial error really but do not be afraid to express your experiences with your doctors.  Too many of us put up with unbelievable stuff with meds.  There's too many options out there to settle for crazy side effects. 

Edited by Distorted Me
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Just wanted to update. I ended up getting switched to Latuda. Started at 10mg since I'm really med sensitive. I like it so far--suicidal l thoughts stopped with the first dose and I'm happier and not as grumpy. Going to move to 20 mg tomorrow.

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1 hour ago, gazelle said:

Just wanted to update. I ended up getting switched to Latuda. Started at 10mg since I'm really med sensitive. I like it so far--suicidal l thoughts stopped with the first dose and I'm happier and not as grumpy. Going to move to 20 mg tomorrow.

That's great! Hope it continues, fingers crossed! :) 

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