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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Stacey fu on April 21, 2003, at 1:14:09
Hi everyone!
I have been recently diagnosed with Bipolar I and ADHD. I'm on 100 mg. of Zoloft, 200 mg. Topamax and 40 mg. of Strattera. I am basically a zombie. I know I need to manage my symptoms, but do I really have to live like this? I'm going to call my psychiatrist tomorrow to see if he will switch me to Effexor, since I heard it's less sedating than Zoloft. The only problem is, Strattera is a norepinephrine reuptake inhibitor, and Effexor is acting on serotonin AND norepinephrine. Isn't that somewhat of a dangerous combo? Or am I mistaken? (I should mention that I also smoke a pack a day.) I'm a little uneasy about starting a new medication, but I don't want to drag myself around anymore, either. Can anybody give me advice?
Posted by zeugma on April 21, 2003, at 9:54:34
In reply to Bipolar and ADHD (HELP!), posted by Stacey fu on April 21, 2003, at 1:14:09
The Strattera and Effexor together should not be a problem. I'm also currently on a medication that acts on NE (Pamelor), and Strattera is basically my only option if I want a specifically ADD med (for reasons I went into in another post). My doctor assured me the combination is safe- it isn't norepinephrine agonism that is dangerous, but cardiotoxicity, and Strattera is not cardiotoxic. So it is safe to combine even with meds that share some of its actions.
Posted by cybercafe on April 21, 2003, at 18:15:28
In reply to Bipolar and ADHD (HELP!), posted by Stacey fu on April 21, 2003, at 1:14:09
> Hi everyone!
>
> I have been recently diagnosed with Bipolar I and ADHD. I'm on 100 mg. of Zoloft, 200 mg. Topamax and 40 mg. of Strattera. I am basically a zombie. I know I need to manage my symptoms, but do I really have to live like this? I'm going to call my psychiatrist tomorrow to see if he will switch me to Effexor, since I heard it's less sedating than Zoloft. The only problem is, Strattera is a norepinephrine reuptake inhibitor, and Effexor is acting on serotonin AND norepinephrine. Isn't that somewhat of a dangerous combo? Or am I mistaken? (I should mention that I also smoke a pack a day.) I'm a little uneasy about starting a new medication, but I don't want to drag myself around anymore, either. Can anybody give me advice?are you sure it's the zoloft and not the topamax that is making you sedated?
Posted by Stacey fu on April 22, 2003, at 2:28:12
In reply to Re: Bipolar and ADHD (HELP!), posted by cybercafe on April 21, 2003, at 18:15:28
> > Hi everyone!
> >
> > I have been recently diagnosed with Bipolar I and ADHD. I'm on 100 mg. of Zoloft, 200 mg. Topamax and 40 mg. of Strattera. I am basically a zombie. I know I need to manage my symptoms, but do I really have to live like this? I'm going to call my psychiatrist tomorrow to see if he will switch me to Effexor, since I heard it's less sedating than Zoloft. The only problem is, Strattera is a norepinephrine reuptake inhibitor, and Effexor is acting on serotonin AND norepinephrine. Isn't that somewhat of a dangerous combo? Or am I mistaken? (I should mention that I also smoke a pack a day.) I'm a little uneasy about starting a new medication, but I don't want to drag myself around anymore, either. Can anybody give me advice?
>
> are you sure it's the zoloft and not the topamax that is making you sedated?
>
>Yes, because when I was just on the Topamax by itself, it didn't really sedate me much at all. The side effects I noticed where a decrease in appetite, slight dizziness, eye strain, and difficulty with coordination. If it made me tired at all, it wasn't much, although it is possible that the effects are potentiated by the Zoloft.
Posted by Stacey fu on April 22, 2003, at 2:31:29
In reply to Re: Bipolar and ADHD (HELP!), posted by zeugma on April 21, 2003, at 9:54:34
> The Strattera and Effexor together should not be a problem. I'm also currently on a medication that acts on NE (Pamelor), and Strattera is basically my only option if I want a specifically ADD med (for reasons I went into in another post). My doctor assured me the combination is safe- it isn't norepinephrine agonism that is dangerous, but cardiotoxicity, and Strattera is not cardiotoxic. So it is safe to combine even with meds that share some of its actions.
Thanks for your help Zeugma. :) How is Pamelor working for you?
Posted by zeugma on April 22, 2003, at 10:34:25
In reply to Re: Bipolar and ADHD (HELP!), posted by Stacey fu on April 22, 2003, at 2:31:29
Pamelor has been very helpful in reducing anxiety, depression, and some ADD symptoms. It's especially good in helping me have a regular sleep schedule and keeping my appetite up even when my mood isn't so good. There are a lot of side effects, but to be honest, they are mostly start-up; when I raise the dose I'm always hit by something (like fatigue or dry mouth), but then I get used to it and the effects go away.
I asked my doctor about what, specifically, the difference would be between Strattera and Pamelor, besides Strattera's being more selective for norepinephrine. He said Strattera might act on dopamine in some way not fully understood yet. How is Strattera working for you? Is it helping your focus and motivation? Have you taken Ritalin or any other ADD meds and if so, how does it compare?
Posted by Stacey fu on April 22, 2003, at 13:00:45
In reply to Re: Bipolar and ADHD (HELP!), posted by zeugma on April 22, 2003, at 10:34:25
> Pamelor has been very helpful in reducing anxiety, depression, and some ADD symptoms. It's especially good in helping me have a regular sleep schedule and keeping my appetite up even when my mood isn't so good. There are a lot of side effects, but to be honest, they are mostly start-up; when I raise the dose I'm always hit by something (like fatigue or dry mouth), but then I get used to it and the effects go away.
I know what you mean about side effects on start up. It is now day 8 on all 3 meds, and I am not nearly as fatigued and "stoned" as the first few days. I didn't sleep all night last night, falling asleep at around 9:00 in the morning, only to wake up at 10 minutes past 11:00! So I guess I'm staying up all day now. Ooops! Sorry! I don't know what I did to the rest of your message. Actually, I got diagnosed with ADHD on April 15th 2003. I got diagnosed with Bipolar in December 2002. So I am totally new to this. I am so relieved that I'm really not stupid or lazy like I thought. The hyperactivity has winded down so far, but I'm not sure if that's from the Strattera or from fatigue from all this medication pdoc has got me on. I can't really see an improvement in attention or focus, but I did put away groceries and rearrange my refriderator today, something that I was actually enthused, not overwhelmed to do. Maybe it is working a little so far. I think the dosage might be a bit too low (40 mg) what do you think?
Stacey :)
Posted by zeugma on April 23, 2003, at 8:24:37
In reply to Re: Bipolar and ADHD (HELP!), posted by Stacey fu on April 22, 2003, at 13:00:45
> > Pamelor has been very helpful in reducing anxiety, depression, and some ADD symptoms. It's especially good in helping me have a regular sleep schedule and keeping my appetite up even when my mood isn't so good. There are a lot of side effects, but to be honest, they are mostly start-up; when I raise the dose I'm always hit by something (like fatigue or dry mouth), but then I get used to it and the effects go away.
>
>
>
> I know what you mean about side effects on start up. It is now day 8 on all 3 meds, and I am not nearly as fatigued and "stoned" as the first few days. I didn't sleep all night last night, falling asleep at around 9:00 in the morning, only to wake up at 10 minutes past 11:00! So I guess I'm staying up all day now. Ooops! Sorry! I don't know what I did to the rest of your message. Actually, I got diagnosed with ADHD on April 15th 2003. I got diagnosed with Bipolar in December 2002. So I am totally new to this.I was first diagnosed with ADHD about 15 years ago. I went back on Pamelor last August as it was the only AD or ADHD med I ever tolerated.
I am so relieved that I'm really not stupid or lazy like I thought. The hyperactivity has winded down so far, but I'm not sure if that's from the Strattera or from fatigue from all this medication pdoc has got me on. I can't really see an improvement in attention or focus, but I did put away groceries and rearrange my refriderator today, something that I was actually enthused, not overwhelmed to do. Maybe it is working a little so far. I think the dosage might be a bit too low (40 mg) what do you think?
>
> Stacey :)
>Everyone is different as far as dosage needed to benefit. Have you switched from Zoloft to Effexor yet? I would think that with Strattera and Effexor together, you could take a lower dose of either or both of those meds.
z
>
Posted by Stacey fu on April 23, 2003, at 13:18:30
In reply to Re: Bipolar and ADHD (HELP!), posted by zeugma on April 23, 2003, at 8:24:37
> I am so relieved that I'm really not stupid or lazy like I thought. The hyperactivity has winded down so far, but I'm not sure if that's from the Strattera or from fatigue from all this medication pdoc has got me on. I can't really see an improvement in attention or focus, but I did put away groceries and rearrange my refriderator today, something that I was actually enthused, not overwhelmed to do. Maybe it is working a little so far. I think the dosage might be a bit too low (40 mg) what do you think?
Stacey :)
> Everyone is different as far as dosage needed to benefit. Have you switched from Zoloft to Effexor yet? I would think that with Strattera and Effexor together, you could take a lower dose of either or both of those meds.I have my prescription for Effexor XR 75 mg. right now. It's from my medical doctor. I called my pdoc, and left a message with his receptionist telling her I wanted to get switched and for him to call me back. Then, SHE called me back again telling me he wanted me to stay on the Zoloft as prescribed, but to take it at night if it was making me drowsy. So, angily, I called my medical doc and gave him the scoop, and he filled the Effexor over the phone. The reason I haven taken it yet is for two reasons. 1) I don't want pdoc to get mad at me for going behind his back, and 2) I heard there's significantly uncomfortable withdrawl effects from Effexor. Have you ever heard about the withdrawl? And should I be concerned?
Thanks!
Stacey
Posted by zeugma on April 23, 2003, at 20:55:14
In reply to Re: Bipolar and ADHD (HELP!), posted by Stacey fu on April 23, 2003, at 13:18:30
There are lots of stories about Effexor withdrawals all over the net, including this board. Effexor seems to be effective, as its name implies, at treating anxiety and depression. It's not something to be taken lightly. The issue with your pdoc is of concern. With mine, I try hard not to do anything that might piss him off, like increasing the dosage without asking him first (though he must feel he earns every cent of his office fee). I figure that way he might be more receptive to any suggestions I make.
It does seem from reading messages here that there are a lot of pros and cons with Effexor. It has more of a potential downside than most medications even though it's also more likely to work. In your situation I guess I'd hang on to the Effexor script and at the next appt lay out the problem with Zoloft and that it's not the right med for you. If he's still not receptive I'd be in the market for another pdoc anyway so you'd have nothing to lose by filling the script. That's just my view, and I tend to be an inveterately cautious person. Hope this helps,
z
Posted by Stacey fu on April 24, 2003, at 2:22:35
In reply to Re: Bipolar and ADHD (HELP!), posted by zeugma on April 23, 2003, at 20:55:14
Thanks Z. I appreciate all your help! :)
Posted by jrbecker on April 24, 2003, at 16:57:06
In reply to Re: Bipolar and ADHD (HELP!), posted by Stacey fu on April 24, 2003, at 2:22:35
An Open Trial of Bupropion for the Treatment of Adults with Attention Deficit Hyperactivity Disorder and Bipolar Disorder
Timothy E. Wilens, Jefferson B. Prince, Thomas Spencer, Stephanie L. Van Patten, Robert Doyle, Kristine Girard, Paul Hammerness, Sarah Goldman, Sarah Brown and Joseph Biederman
Accepted 8/26/2002Abstract
Background: Despite the increasing recognition of comorbid Attention Deficit Hyperactivity Disorder (ADHD) and Bipolar Disorder (BPD) in adults, there are no prospective trials of pharmacological agents to treat ADHD in these patients. Given the efficacy of bupropion for ADHD in adults, as well as its use in the management of bipolar depression, we studied the tolerability and efficacy of sustained-release bupropion in adults with ADHD plus BPD.Methods: This was an open, prospective, six-week trial of bupropion SR (up to 200 mg BID) in adults with DSM IV ADHD plus historical BPD I (10%) or BPD II (90%). Adults receiving adjunct anti-manic agents (mood stabilizers and antipsychotics) at baseline were included in the study. We used standardized psychiatric instruments for diagnosis and outcome. Efficacy was based primarily on Clinical Global Impression (CGI) for ADHD and the ADHD symptom checklist.
Results: Of 36 patients entered (75% male, mean age 34 years), 30 patients completed the protocol (83%). At endpoint (LOCF), compared to baseline, treatment with bupropion SR resulted in significant reductions in the ADHD symptom checklist (-55%, z=5.63, p<0.001) and CGI severity of ADHD (-40%, z=6.285, p<0.001). Bupropion was associated with reductions in ratings of mania and depression.
Conclusions: The results from this open study of adults with ADHD plus BPD suggest that sustained-release bupropion may be effective in treating ADHD in the context of a lifetime diagnosis of BPD without significant activation of mania. Further controlled trials are warranted.
Posted by Stacey fu on April 25, 2003, at 0:25:18
In reply to Re: Bipolar and ADHD (HELP!), posted by jrbecker on April 24, 2003, at 16:57:06
> An Open Trial of Bupropion for the Treatment of Adults with Attention Deficit Hyperactivity Disorder and Bipolar Disorder
> Timothy E. Wilens, Jefferson B. Prince, Thomas Spencer, Stephanie L. Van Patten, Robert Doyle, Kristine Girard, Paul Hammerness, Sarah Goldman, Sarah Brown and Joseph Biederman
> Accepted 8/26/2002
>
> Abstract
> Background: Despite the increasing recognition of comorbid Attention Deficit Hyperactivity Disorder (ADHD) and Bipolar Disorder (BPD) in adults, there are no prospective trials of pharmacological agents to treat ADHD in these patients. Given the efficacy of bupropion for ADHD in adults, as well as its use in the management of bipolar depression, we studied the tolerability and efficacy of sustained-release bupropion in adults with ADHD plus BPD.
>
> Methods: This was an open, prospective, six-week trial of bupropion SR (up to 200 mg BID) in adults with DSM IV ADHD plus historical BPD I (10%) or BPD II (90%). Adults receiving adjunct anti-manic agents (mood stabilizers and antipsychotics) at baseline were included in the study. We used standardized psychiatric instruments for diagnosis and outcome. Efficacy was based primarily on Clinical Global Impression (CGI) for ADHD and the ADHD symptom checklist.
>
> Results: Of 36 patients entered (75% male, mean age 34 years), 30 patients completed the protocol (83%). At endpoint (LOCF), compared to baseline, treatment with bupropion SR resulted in significant reductions in the ADHD symptom checklist (-55%, z=5.63, p<0.001) and CGI severity of ADHD (-40%, z=6.285, p<0.001). Bupropion was associated with reductions in ratings of mania and depression.
>
> Conclusions: The results from this open study of adults with ADHD plus BPD suggest that sustained-release bupropion may be effective in treating ADHD in the context of a lifetime diagnosis of BPD without significant activation of mania. Further controlled trials are warranted.
Thanks a lot for the thought, but there are 2 reasons why Wellbutrin (bupropion) didn't work for me. I was taking 300 g. 150 Sr b.i.d. and by day four I was very manic. When I wasn't manic I was in the middle of a panic attack or a crying spell. It seemed to just drive me crazy. I had a very bad experience with it. I went on it to quit smoking. It didn't work. I discontinued after 6 days. I couldn't take it anymore.Sherree
Posted by Marc Webb on August 16, 2004, at 4:11:35
In reply to Re: Bipolar and ADHD (HELP!), posted by Stacey fu on April 23, 2003, at 13:18:30
> > I am so relieved that I'm really not stupid or lazy like I thought. The hyperactivity has winded down so far, but I'm not sure if that's from the Strattera or from fatigue from all this medication pdoc has got me on. I can't really see an improvement in attention or focus, but I did put away groceries and rearrange my refriderator today, something that I was actually enthused, not overwhelmed to do. Maybe it is working a little so far. I think the dosage might be a bit too low (40 mg) what do you think?
>
> Stacey :)
>
>
> > Everyone is different as far as dosage needed to benefit. Have you switched from Zoloft to Effexor yet? I would think that with Strattera and Effexor together, you could take a lower dose of either or both of those meds.
>
>
>
> I have my prescription for Effexor XR 75 mg. right now. It's from my medical doctor. I called my pdoc, and left a message with his receptionist telling her I wanted to get switched and for him to call me back. Then, SHE called me back again telling me he wanted me to stay on the Zoloft as prescribed, but to take it at night if it was making me drowsy. So, angily, I called my medical doc and gave him the scoop, and he filled the Effexor over the phone. The reason I haven taken it yet is for two reasons. 1) I don't want pdoc to get mad at me for going behind his back, and 2) I heard there's significantly uncomfortable withdrawl effects from Effexor. Have you ever heard about the withdrawl? And should I be concerned?
>
> Thanks!
>
> Stacey
>
>
>
>
>I am a 35 yrd old male and I am on Effexor 75 mg and Strattera 40 mg. I have had great results from these meds. I have increased many new things in my life. I have been through 9 yrs of therapy.I also did my own research to find out what was the matter with myself. I took me to find the answers.
The doctors were no help.
I had to take control of the doctors I was seeing due to many are doing this with out looking at your brain. I read a book that makes more sense. This book is called. (HEALING ADD , The breakthrough program that allows you to see and heal the 6 types of ADD.) by Daniel g. Amen M.D.
This book shows the many brain scans of normal brains and the areas needed helped. I has helped me clear my thoughts on feeling better.
The medicine I spoke about has help with ADD and Depression and Anxiety. People ask now why am I so happy now. I just told tell I found myself in the fog I was living.Hope you find the right dose or med for your..
I will pray for you.Marc
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