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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Peter on March 27, 2002, at 2:41:56
Hi everyone:
Well, I've been on Neurontin (300mg tid), adderall (20mgXR in a.m. + 10mg regular early p.m.), and klonopin(1.5mg daily), all for a few months. Because of some emotional instability and a desire to simplify my medication regime, my pdoc and I have decided that I taper off adderall and start lithium (Eskalith) 300mg each night, rising up to 600mg in 3 days. After I'm stable on eskalith, I might also taper off the neurontin, or keep using a small amount of it with the lithium. To tell you the truth, I'm freaked out (what else is new?). I find that I really like the adderall; I'm so used to feeling motivated and focused with the first dose, and my evening 10mg dose makes me feel calm, focused, and often a bit euphoric. Even though I'm tapering off slowly, I'm just not looking forward to coming off of it. I never went over my prescribed dose, so I haven't abused it, but I guess I'm addicted by this time. On the other hand, my more sensible half tells me that it's alot better for me, with my addiction background, to be on a less 'psychoactive' medication (eskalith) that I can take once-daily to stabilize me. In doing this I can pay more attention to the important things in life-my relationships, spirituality, etc...but I'm just apprehensive about stopping the adderall! My p-doc was even going to up my dose of the stimulant, but we decided to try the lithium. He's diagnosed me with mild bipolar II/SP/possible ADD. Though I love the adderall, it sometimes creates a bit of instability & irritability in me, and my high heart rate would have required the addition of a beta-blocker, which I wouldn't have felt comfortable with. I'm hoping that the Lithium will finally be the one drug that can keep me stable. I've tried just about everything else, and I want to just settle on something and stay, and it sounds like Lithium's the best bet. But I'm nervous. Sorry-I just needed to vent.
Peter
Posted by JohnX2 on March 27, 2002, at 3:03:18
In reply to time to taper adderall and add lithium-DARN!, posted by Peter on March 27, 2002, at 2:41:56
Hi Peter,I'm going on to try the Lithium train too after a LOOOONG hold out.
I loved Adderall also but it made me a bit too frantic. I understand your feelings.Wish us luck!
Regards,
John> Hi everyone:
> Well, I've been on Neurontin (300mg tid), adderall (20mgXR in a.m. + 10mg regular early p.m.), and klonopin(1.5mg daily), all for a few months. Because of some emotional instability and a desire to simplify my medication regime, my pdoc and I have decided that I taper off adderall and start lithium (Eskalith) 300mg each night, rising up to 600mg in 3 days. After I'm stable on eskalith, I might also taper off the neurontin, or keep using a small amount of it with the lithium. To tell you the truth, I'm freaked out (what else is new?). I find that I really like the adderall; I'm so used to feeling motivated and focused with the first dose, and my evening 10mg dose makes me feel calm, focused, and often a bit euphoric. Even though I'm tapering off slowly, I'm just not looking forward to coming off of it. I never went over my prescribed dose, so I haven't abused it, but I guess I'm addicted by this time. On the other hand, my more sensible half tells me that it's alot better for me, with my addiction background, to be on a less 'psychoactive' medication (eskalith) that I can take once-daily to stabilize me. In doing this I can pay more attention to the important things in life-my relationships, spirituality, etc...but I'm just apprehensive about stopping the adderall! My p-doc was even going to up my dose of the stimulant, but we decided to try the lithium. He's diagnosed me with mild bipolar II/SP/possible ADD. Though I love the adderall, it sometimes creates a bit of instability & irritability in me, and my high heart rate would have required the addition of a beta-blocker, which I wouldn't have felt comfortable with. I'm hoping that the Lithium will finally be the one drug that can keep me stable. I've tried just about everything else, and I want to just settle on something and stay, and it sounds like Lithium's the best bet. But I'm nervous. Sorry-I just needed to vent.
> Peter
Posted by Zo on March 27, 2002, at 4:53:19
In reply to time to taper adderall and add lithium-DARN!, posted by Peter on March 27, 2002, at 2:41:56
I gotta say, I kind of disagree. In principal and in practice: If a med is working for you, the idea is to augment it with something appropriate to tone down the anxiety, or help with sleep or whatever.
Isn't it possible that what you're sensing is your body saying, Adderall works for me?!
I am BPII, and the pstims have never added any instability, quite the opposite, esp Dex.
And why lithium? Why not Lamictal?
Zo
Posted by fachad on March 27, 2002, at 6:49:40
In reply to time to taper adderall and add lithium-DARN!, posted by Peter on March 27, 2002, at 2:41:56
If Adderall is helping, but causing side effects, why not try a differet pstim?
For me, Adderall was completely intolerable. It gave me dry mouth, racing heart, high blood pressure, and a constatnt stressed out feeling.
Dex is much less jittery, and Ritalin is by far the most gentle in terms of side effects, and the most potent in terms of anti-depressant effects of the three (for me anyway).
The only caveat with Ritalin is that is wears off quickly, so Concerta is the best way to take it. For me Concerta is just so smooth, I can hardly tell I am taking anything, until I notice the benefits.
Posted by Ritch on March 27, 2002, at 9:57:01
In reply to time to taper adderall and add lithium-DARN!, posted by Peter on March 27, 2002, at 2:41:56
> Hi everyone:
> Well, I've been on Neurontin (300mg tid), adderall (20mgXR in a.m. + 10mg regular early p.m.), and klonopin(1.5mg daily), all for a few months. Because of some emotional instability and a desire to simplify my medication regime, my pdoc and I have decided that I taper off adderall and start lithium (Eskalith) 300mg each night, rising up to 600mg in 3 days. After I'm stable on eskalith, I might also taper off the neurontin, or keep using a small amount of it with the lithium. To tell you the truth, I'm freaked out (what else is new?). I find that I really like the adderall; I'm so used to feeling motivated and focused with the first dose, and my evening 10mg dose makes me feel calm, focused, and often a bit euphoric. Even though I'm tapering off slowly, I'm just not looking forward to coming off of it. I never went over my prescribed dose, so I haven't abused it, but I guess I'm addicted by this time. On the other hand, my more sensible half tells me that it's alot better for me, with my addiction background, to be on a less 'psychoactive' medication (eskalith) that I can take once-daily to stabilize me. In doing this I can pay more attention to the important things in life-my relationships, spirituality, etc...but I'm just apprehensive about stopping the adderall! My p-doc was even going to up my dose of the stimulant, but we decided to try the lithium. He's diagnosed me with mild bipolar II/SP/possible ADD. Though I love the adderall, it sometimes creates a bit of instability & irritability in me, and my high heart rate would have required the addition of a beta-blocker, which I wouldn't have felt comfortable with. I'm hoping that the Lithium will finally be the one drug that can keep me stable. I've tried just about everything else, and I want to just settle on something and stay, and it sounds like Lithium's the best bet. But I'm nervous. Sorry-I just needed to vent.
> Peter
Peter,Why can't your pdoc just start up the lithium and get you stabilized at a low therapeutic blood level *first*-then start an Adderall taper (or switch pstims)? I mean, how is he going to be able to tell what's working for you if he changes two things at once?
Mitch
Posted by Peter on March 27, 2002, at 11:39:34
In reply to Re: time to taper adderall and add lithium-DARN! » Peter, posted by Zo on March 27, 2002, at 4:53:19
> I gotta say, I kind of disagree. In principal and in practice: If a med is working for you, the idea is to augment it with something appropriate to tone down the anxiety, or help with sleep or whatever.
> Already, I'm on Neurontin and klonopin to tone down anxiety and help with sleep. I guess I'm sort of sick of constantly augmenting one drug with another for the last seven years and still never being stable enough on any given cocktail, no matter how complex.
> Isn't it possible that what you're sensing is your body saying, Adderall works for me?!
> Adderall is an amphetamine and I'm an ex-cocaine and heroin addict. Even if it produced profound instability in me, I'm sure my body would still be saying 'Adderall works for me.' (-: No, but I see what you're saying; but I think that when weighing the pros and cons, though adderall has it's good sides for me, the cons win. On the whole, I'm only feeling good when the adderall is working on me, and I don't like the fact that I have to plan every day around when I'm taking it-that's why I know deep down it's better for me at this point to turn to something that can stabilize me with one daily dose. That's not to mention the physical side-effects: freezing hands (bad for a pianist like myself), dry mouth, high heart-rate.
> I am BPII, and the pstims have never added any instability, quite the opposite, esp Dex.
> Well, Dex is something I've looked into and discussed with my pdoc. He said once we stabilize on lithium, if I need a pstim again, we'll go right to dex.
> And why lithium? Why not Lamictal?
> I think my natural proneness to excessive anxiety is exacerbated by the thought of certain medications, and Lamictal is certainly one of them. I actually tried it once, but couldn't get the thought of the rash out of my head, so we stopped it. I realize Lithium has it's dangers also, but all in all I've learned it's alot safer and less 'heavy-duty' than people have thought over the years-it just gained a bad rep as a heavy, dangerous drug from all those years of it being used only for severe, hospitalized BP1 patients, before anticonvulsants were even thought of as possible beneficial drugs for BP. It's true it has a better track record for severe BP1, but it has also proven effective for mild BP cases and even unipolar depression. As long as I make sure I'm hydrated and get the proper blood-tests, my pdoc has assured me I will be ok. Unlike the anticonvulsants, it supposedly has no sedating effects, and I like the idea that it's just a mineral that prevents your mood from swinging too far one way or the other.
>Peter
Posted by Peter on March 27, 2002, at 11:43:56
In reply to Re: time to taper adderall and add lithium-DARN! » Peter, posted by fachad on March 27, 2002, at 6:49:40
> If Adderall is helping, but causing side effects, why not try a differet pstim?
> I've tried Concerta and I really didn't like it. It made me anti-social and apprehensive.
> For me, Adderall was completely intolerable. It gave me dry mouth, racing heart, high blood pressure, and a constatnt stressed out feeling.
> Same here, but for me the stress has not been constant-it has come in waves.
> Dex is much less jittery, and Ritalin is by far the most gentle in terms of side effects, and the most potent in terms of anti-depressant effects of the three (for me anyway).
> I've spoken about dex with my pdoc, and he said once I stabilize on lithium, if I need a pstim again we'll go right to dex.
Peter
Posted by Peter on March 27, 2002, at 11:48:07
In reply to Re: time to taper adderall and add lithium-DARN! » Peter, posted by Ritch on March 27, 2002, at 9:57:01
> Peter,
>
> Why can't your pdoc just start up the lithium and get you stabilized at a low therapeutic blood level *first*-then start an Adderall taper (or switch pstims)? I mean, how is he going to be able to tell what's working for you if he changes two things at once?
> Hi Mitch:
That's a great point. I'm going to ask him. Thanks.
Peter
Posted by Peter on March 27, 2002, at 22:41:26
In reply to Re: time to taper adderall and add lithium-DARN! » Ritch, posted by Peter on March 27, 2002, at 11:48:07
Hi all:
Last night was my first night on eskalith 300mg. Throughout the day today I've had dizzy spells, extreme irritability, and terrible stomach pains. I know the lithium doesn't start affecting the mood for weeks, but can these physical side-effects be from the 300mg dose I took last night? I've previously shared all my thoughts regarding the pros and cons of making the switch to Lithium or adjusting my current regimen of Neurontin, adderall, and klonopin. I just get so confused and anxious whenever I do a med switch, but these side-effects were not imagined. I'm still confused; part of me wants to follow doctor's orders and taper the adderall while adding Lithium, thereby simplifying the medication regime and hopefully stabilizing my mood. But another part of me just wants to keep the current regime, maybe making little adjustments here and there. On the one hand, switching to Lithium COULD do wonders-and I'm afraid of being addicted to adderall anyway, with one doctor telling me I have ADD and another telling me I don't; on the other hand, I'm mild bipolar, not severe BP1, and I have alot of anxiety about Lithium, no matter how much my pdoc tells me it's safe and effective. I'm so sick of these mental gymnastics. I don't know what to do, and I realize alot of you have given me great advice-but I just keep worrying. That's the story of my life, not to mention my chronic indecisiveness. I'm fed up.
Peter
Posted by Ritch on March 28, 2002, at 0:06:55
In reply to SIDE-EFFECTS ALREADY?!?!?, posted by Peter on March 27, 2002, at 22:41:26
> Hi all:
> Last night was my first night on eskalith 300mg. Throughout the day today I've had dizzy spells, extreme irritability, and terrible stomach pains. I know the lithium doesn't start affecting the mood for weeks, but can these physical side-effects be from the 300mg dose I took last night? I've previously shared all my thoughts regarding the pros and cons of making the switch to Lithium or adjusting my current regimen of Neurontin, adderall, and klonopin. I just get so confused and anxious whenever I do a med switch, but these side-effects were not imagined. I'm still confused; part of me wants to follow doctor's orders and taper the adderall while adding Lithium, thereby simplifying the medication regime and hopefully stabilizing my mood. But another part of me just wants to keep the current regime, maybe making little adjustments here and there. On the one hand, switching to Lithium COULD do wonders-and I'm afraid of being addicted to adderall anyway, with one doctor telling me I have ADD and another telling me I don't; on the other hand, I'm mild bipolar, not severe BP1, and I have alot of anxiety about Lithium, no matter how much my pdoc tells me it's safe and effective. I'm so sick of these mental gymnastics. I don't know what to do, and I realize alot of you have given me great advice-but I just keep worrying. That's the story of my life, not to mention my chronic indecisiveness. I'm fed up.
> Peter
Hi Peter,Well, I never got *irritable* on lithium :-) but, I can't hack the stuff due to cramps and diarrhea (IBS sfx). It usually takes about 2-3 days of taking it for those symptoms to kick back up again. There is some nerve that is hooked into my gut in a certain spot (I know the spot!), and it begins with a dull ache that increases to a spasm and makes me miserable. Geez, do you think he would let you take 250mg of Depakote instead of the lithium (for a first trial of a 1st line mood stablizer)?? The Dep. can cause some GI troubles, but nothing compared to lithium (if you have that sort of sensitivity). SSRI AD's do me in (gut-wise) in a similar way, but they are more predictable post-dosing, whereas lithium cramps would kick in just about anytime. Oh yeah, there is lithium citrate which is supposed to be easier on your GI tract. It got mentioned in one visit, but I never tried it. Has anybody out there found lithium citrate not to cause the GI probs that lithium carbonate can cause? Is it still available?
Mitch
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