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co-occurring bipolar & adhd: what meds/lifestyle/habits work for you?

H

hiddenpants

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Hi! I'm new to this forum and also new to the whole process of trying to find the meds that work for me. I've tried lots of different combos so far, but I think I'm on a path to finding what works. What I'm looking for here is just some shared experiences on how you've managed your bipolar/adhd combo with meds & other therapies/apps/habits/etc.

Right now, I'm treating bipolar 2/unspecified symptoms & adhd symptoms with a combo of lamictal (lamotrigine) at 25mg XR and 50mg XR (i take it at 2 different times of day, once in the AM and the other dose in the afternoon. I was recently prescribed strattera (atomoxetine) at 10mg to start/take in the morning with my first lamictal dose. I also take seroquel (quetiapine) at 12.5mg before bed (I cut the 25mg in half). So far, the strattera is helping me focus and have some energy in the day because I was feeling super low energy and unable to concentrate even though my mood has gotten so much more stable with the lamictal/seroquel combo and I'm actually sleeping.

It's taken me about 10 years to start getting what I feel like is proper treatment. First I was diagnosed with depression, put on an SSRI by a psych that didn't listen to me, but that was terrible for me so I went off and found a new psych. Tried trazodone, made me manic/mixed episodes which scared me. Went off that, and seroquel helped so much more for sleep. Tried guanfacine before the strattera because the guanfacine didn't work and made me so tired/dizzy. I also could never stand being on birth control because I'm so sensitive to meds/anything that messes with my brain chemicals. I also have a history of PTSD so that's a fun addition to this whole puzzle, and have used nicotine on and off for about 10 years but am really hoping to quit. I barely drink anymore--used to drink a lot I think to self-medicate, but I know how it affects me negatively now so I really try not to, and I think weirdly the meds I'm on help curb that desire to drink.

Does anyone have similar experiences? Just being sensitive to everything?

I do psychotherapy every 2 weeks, I see a dietician because food is difficult for me, and I sometimes struggle to stay physically active, but I really try. It's such an uphill battle, so I want to know if there are things that work for you that I might try in terms of lifestyle and helping my meds really work to support better habits that help mental health.

Thanks in advance for sharing your experiences/thoughts!
I am hoping to find some sense of community because my mental health journey has been really difficult so far!
 
Tawny

Tawny

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I have bipolar disorder and ADHD. I take Lamotrigine and Escitalopram. I increase and decrease those as necessary. I only take the antipsychotic when very unwell which is not often now.

My mum and dad did not like me taking the ADHD medication when younger. Now, i don't take anything for it.

Life is hard sometimes, but i manage. Rest, avoiding stress, eating well, omega fish oils,, multivitamins, taking things slow. I don't work and i don't drive anymore.

They are both difficult to deal with aren't they, and i cannot always tell the difference between the two disorders.
 
S

SFGuy

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Does anyone have similar experiences? Just being sensitive to everything?

I do psychotherapy every 2 weeks, I see a dietician because food is difficult for me, and I sometimes struggle to stay physically active, but I really try. It's such an uphill battle, so I want to know if there are things that work for you that I might try in terms of lifestyle and helping my meds really work to support better habits that help mental health.
If my life is too stressed or stimulating, I become "sensitive to everything." I get overwhelmed and/or hypomanic. Alternately, I can go numb and get depressed, especially when stressed.

Like you, I had bad treatment for decades (SSRI + Benzo). As I got older, my symptoms got worse and I finally found a pdoc who put the picture together and diagnosed me with Bipolar. It took another year or longer before she saw the ADHD.

On her advice and the advice of a cognitive therapist, I structured my life quite a bit. I plan eating times, write menus, cook everything I eat, go to bed at the same time every night, and even plan showers. The idea of structure sounded like hell to my free spirit, but I like it. When I break my self-imposed rules, I get symptoms.

My most important med is Depakote (it would be Lamotrigine, but I got side effects). Since I also have an anxiety disorder, I take Lyrica (I've been tapering off the Xanax for almost two years). I take Baclofen for sleep. For ADHD, I take Dexedrine 10 mg in the morning and the afternoon and Guanfacine twice a day. I am on thyroid hormone, which my pdoc says many patients with bipolar need. I take a custom compounded Ketamine nasal spray 3 times a day to prevent depression. Trazodone was prescribed by a neurologist decades ago to prevent migraine.

My meds are adjusted at least once a year to change dosages or add/drop meds.

Two GPs (and some people here) have told me I'm on too many drugs, but this mix is what keeps me functioning well now. My pdoc and her buddies in psychiatry believe in doing their best to help patients be the best they can, not just get by. I know many other pdocs prefer to hand out scrips for 1 mood stabilizer and 1 antipsychotic and be done with it.

My side effects are morning grogginess and severe constipation, but I can manage both.

Here's a website I've found useful since I'm "on the spectrum" but not exactly bipolar 1 or 2:
 
T

Traveler5

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On the Edge of Sanity
- Bipolar 2 - Risperdal 2mg and Lamictal 200mg
- Severe Generalized Anxiety Disorder - Cymbalta 200mg & Klonopin 1.5mg & Propranolol 120mg
- Minor-Moderate OCD - Cymbalta
- Moderate-Severe ADHD - Dextroamphetamine 30mg
- Trazodone 150mg for sleep as well as Remeron 15mg

I take the above and all is well -- for the most part.
 
LaFong

LaFong

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Prozac
Wellbutrin
Lamictal
Seroquel
Diazepam

My pdoc won't treat the ADHD because he's worried that a stimulant will trigger a huge manic episode (it has once before). For eight weeks according to my wife. I wish I could take the Adderall again; it made me feel significantly better.
 
S

SFGuy

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My pdoc won't treat the ADHD because he's worried that a stimulant will trigger a huge manic episode (it has once before). For eight weeks according to my wife. I wish I could take the Adderall again; it made me feel significantly better.
My pdoc is expert in ADHD and Bipolar. We tried all the amphetamine/stimulant drugs (not Desoxyn/Methamphetamine) at moderate doses to see which I liked. Dexedrine won by a nose with Ritalin lost. No mania.

She took me up slowly. I chose to stop at a fairly low dose (10mg twice a day). Anything higher makes me jittery. I've been on it for several years without mania, but I can see that a higher dose would provoke hypomanic symptoms.

I'm not sure what's in her secret sauce, but I think it's a combination of slow increases with careful observation. I think I saw her once a month or more when I was starting out on Dex. My usual schedule is 50 minutes every 3 months.
 
Wishbone

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On her advice and the advice of a cognitive therapist, I structured my life quite a bit. I plan eating times, write menus, cook everything I eat, go to bed at the same time every night, and even plan showers. The idea of structure sounded like hell to my free spirit, but I like it. When I break my self-imposed rules, I get symptoms.

Two GPs (and some people here) have told me I'm on too many drugs, but this mix is what keeps me functioning well now.
Scroll down to the part about "Social time cues and life events", it backs up your regime perfectly. https://onlinelibrary.wiley.com/doi/full/10.1111/pcn.12688

I have sleep and exercise set in stone and I'm working on meal times being set in stone too. I definitely agree with predictability being beneficial for a body that craves balance.

(Guilty! :itwasntme:) I actually think your medication makes sense. There's a lot going on, and I'm often against that, but I can see how yours works for you because you've got this comorbidity that certainly complicates the picture. I like how carefully managed yours has been too, I reckon the psych keeping a close watch is a good idea when starting up on meds and med combinations.
I think my major gripe is when I see Benzos as part of the picture and then meds that lift as well; that's just a clash I can't get on board with.
The Bipolar/ADHD picture is one that fascinates me, I must say.
 
S

SFGuy

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The Bipolar/ADHD picture is one that fascinates me, I must say.
It's a bumpy road! Before I was diagnosed with 3 disorders, I didn't know if I was up, down, or in between. There was a trigger, moving cities, that made my symptoms worse and more obvious to my pdoc in the new city.

Once I started learning about bipolar med cocktails, I was surprised at their complexity. The SSRI+Xanax combos my earlier pdocs prescribed were simple, but probably contributed to my mood instability, especially mixed states. "Anxious depression," they said. Much of that "anxiety" was mania, but I didn't know the difference between feeling anxious and being hypomanic then.

I don't know how long my current mix will hold, but I have faith in my pdoc to figure things out when I get symptoms since she pulled off a miracle once.
 
Wishbone

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Long may it continue. I guess that's the benefit of the American system versus ours. We don't have the constant monitoring and stewardship from pdocs unless things are still a total mess or you're going private and paying for it all yourself, which few people can do or want to do seeing as they're already paying into a health system (as bad as it is). As soon as it looks like you're well you can be discharged back to your GP's care and if you ever need to see a pdoc again it will almost certainly be a completely new one that doesn't know your history. The idea of having a professional that's in it with you and knows you appeals a lot.
 
S

SFGuy

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I love having a good pdoc who knows me. But in major cities like mine, we have to go private to get one. None of the good pdocs take insurance and all are expensive.

If we use insurance, we get youngsters or go to a clinic/hospital where we may not see the same pdoc for long. We also get generic/algorithmic treatment. Subtleties are lost on them.

That's if we're lucky. Even insurance-covered pdocs are hard to find.

My pdoc is a big expense for me, but I'm bonkers enough that I've made her a top priority. Most of my meds are covered by insurance. That's important since they cost even more than my pdoc does.
 
Wishbone

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I've got a good example actually. I mentioned still struggling with depression a while back to my GP and wanting to be referred back to a psych. My GP recommended antidepressants. I said no. When I got my appointment with the psych he also recommended antidepressants. I said no.
I know that neither doctor has read through my history because in it is a warning against giving me antidepressants and I know that because I have a copy of my records. That's scary stuff I think.
 
S

SFGuy

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That’s unacceptably bad, but so common. You’re depressed? My training says SSRI or SNRI. See you in 6 months.
 
F

Frankum35

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I have bipolar disorder and ADHD. I take Lamotrigine and Escitalopram. I increase and decrease those as necessary. I only take the antipsychotic when very unwell which is not often now.

My mum and dad did not like me taking the ADHD medication when younger. Now, i don't take anything for it.

Life is hard sometimes, but i manage. Rest, avoiding stress, eating well, omega fish oils,, multivitamins, taking things slow. I don't work and i don't drive anymore.

They are both difficult to deal with aren't they, and i cannot always tell the difference between the two disorders.
My same recipe!
 
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