Antidepressant or anti-anxiety to go with Adderall, diagnosed BP 2 and ADHD

[betterdays4all]

I've been on an SSRI called Lexapro 10 mg since 2014 and it helped me get through classes in grad school and work I didn't really want to do anymore, also was dealing with toxic relationship the entire time and maybe it blunted my judgment a bit because I haven't held a job since and been applying everywhere. I tried klonopin for anxiety instead and it was worse than lexapro and made me even more dumb for the last bar exam sitting.

My doc just says go back on the lexapro if i get anxiety off of it, but it's not that simple and I can't figure out why I seem dependent on Lexapro unless it's circumstantial and fighting out of a depressive situation (toxic gf left and maybe wasn't toxic? I stopped lexapro due to my family swearing I didn't need it and I was even more depressed after that but felt more normal in social situations oddly). I've tried vyvanse and was irritable, dexedrine spansules seem to work best for my adhd but right now for studying purposes, I asked for the adderall. Thanks in advance!

 

[Ozle]

What effects are you geting from the Adderall at the moment?

 

[betterdays4all]

What effects are you geting from the Adderall at the moment?

I can objectively make better decisions and actually focus on my bar exam studies with the instant release Adderall but more anxiety than time release adderall, but with the time-release I had less anxiety but also less focus for such a huge exam. Also on Lexapro 10 mg and Lithium Carbonate 900 mg (to control my mania if I was indeed ADHD and BP2 like new PCP says). The best adhd med I tried was the Dexedrine Spansules but I wasn't seeing as clear like I am on Adderall even, I still have this uncomfortability that something is off where my anxiety is still an issue. Either I'm becoming more hyper aware of my situation like I was my last job in 2014 over that summer in Washington on Adderall XR 25 mg and Lexapro 10 mg, but if it wasn't for adding Klonopin 0.5 mg to the mix, I prob would still have my ex-gf right now but she left me last August when I didn't have a job after my last fail for the bar exam in July, Feb 21st will be my third and final shot at this because I'm losing it.

She recently reached back out after keeping me on block when I wished her a happy birthday and my heart jumped and told myself play it cool and she did leave me when everything was going South, but I couldn't blame her at the time last year. She texted question marks and I left voicemail that day off of adderall and she never called back. Don't know why the two are so tied together, but this is insanity. If i didn't see me have any success that last summer in Washington, I may be less confused. Sorry for rambling, living in a broken home doesn't help. Thanks for listening

 

[sekio]

Adderall/Dexedrine and other amphetamines can cause or potentiate aniety, just FYI. Especially with the time release drugs. Amphetamine itself has a 12-14 hour half life in the body, you can imagine how persistent it must be with a 12-hour time release added on top of that.

Lexapro is actually indicated for management of nonspecific anxiety and is also known to cause rebound anxiety if suddenly stopped. If you are most functional on that then it's probably the drug you should stick to.

As for other ways to deal with anxiety, CBT seems to be the most popular and reliable means of treating it - pharmacological means tend to have a lot of side effects or simply low efficacy in any one specific patient. If you're finding that 0.5mg clonazepam makes you too stoned to function, maybe you should look into other nonbenzodiazepine drugs like, for instance, CBD, buspirone or friends.

 

[Ozle]

Amphetamine is probably one of the most anxiogenic substances that exists, and I'd say the fact that you're feeling a need to compensate with benzos and SSRIs is a sign that it might be worth re-examining at least the dose you're on. If you have a sympathetic doctor, I'd suggest sitting down and talking all of this over with him, and asking if he can suggest a solution that's more stable and sustainable over the long term.

SSRIs are also quite notorious more causing manic states in bipolar patients; although this is thankfully less of an issue in BP-2 than in BP-1, it's probably worth thinking about if you're also going to be taking it with Adderall.

 

[betterdays4all]

Thank you, I def. think my new PCP got the Bipolar 2 diagnosis right, as I feel more level-headed on Lithium Carbonate but without treating my ADHD, I don't get out of bed or function the way I want and maybe it's the mania I was missing and that's why I can't figure out why I know Lexapro doesn't make me smarter yet continue to take it everyday in a toxic broken home environment. I couldn't find a way to move out until I started Lexapro so I guess I figured go all in on it and find a way to move out then and treat my BP which def. took the lexapro agitation away but wreaked havoc on my sex drive and lost my social life in this past horror-show relationship. Dexedrine and D-Amp actually doesn't induce mania like Adderall and I need to find a psych and get an appoint to get on the spansules instead, Vyvanse made me irritable too not as good.

 

[aced126]

Amphetamine and derivatives are anxiogenic. As Sekio said, nonbenzodiazepine anxiolytics like buspirone might help.

 

[d1nach]

"Escitalopram, similarly to other SSRIs (with the exception of fluvoxamine), inhibits CYP2D6 and hence may increase plasma levels of a number of CYP2D6 substrates "

Ali Torkamani. "Selective Serotonin Reuptake Inhibitors and CYP2D6". Medscape.com. Retrieved 14 May 2015

"As escitalopram is only a weak inhibitor of CYP2D6"

Noehr-Jensen, L; Zwisler, ST; Larsen, F; Sindrup, SH; Damkier, P; Brosen, K (December 2009). "Escitalopram is a weak inhibitor of the CYP2D6-catalyzed O-demethylation of (+)-tramadol but does not reduce the hypoalgesic effect in experimental pain.". Clinical pharmacology and therapeutics. 86 (6): 626–33.

Dextroamphetamine is metabolized by p450 cyp 2d6.

"Adderall XR Prescribing Information" (PDF). United States Food and Drug Administration. Shire US Inc. December 2013. pp. 12–13. Retrieved 30 December 2013.

Weak inhibitor being one that causes at least a 1.25-fold but less than 2-fold increase in the plasma AUC values, or 20-50% decrease in clearance.

Flockhart DA (2007). "Drug Interactions: Cytochrome P450 Drug Interaction Table". Indiana University School of Medicine. Retrieved on July 2011


Therefore, one reason you might be experiencing things like anxiety from adderall may be due to lexapro weakly but significantly altering the peak and duration of adderall via inhibiting weakly the eprimary enzyme that breaks down dextroamphetamine cyp2d6 p450.

 

[Xzbtya]

Amphetamine is probably one of the most anxiogenic substances that exists, and I'd say the fact that you're feeling a need to compensate with benzos and SSRIs is a sign that it might be worth re-examining at least the dose you're on. If you have a sympathetic doctor, I'd suggest sitting down and talking all of this over with him, and asking if he can suggest a solution that's more stable and sustainable over the long term.

SSRIs are also quite notorious more causing manic states in bipolar patients; although this is thankfully less of an issue in BP-2 than in BP-1, it's probably worth thinking about if you're also going to be taking it with Adderall.

I can think of quite a few worse ones...DMAA, Yohimbine, ephedrine, etc. That being said, yes the combination could definitely through someone with BP1 or 2 into a manic episode. I don't understand why most docs seem to jump right to adderall over something like methylphenidate with a much shorter half-life and less dumping of monoamines into the brain.

 

[Woodburner]

Nothing to add, sorry, just posting so that I can find it again when I have more time to read it properly. 8)