Mental Health Does anyone know what this Bipolar treatment is? Should I bother?

[CSM25]

My mistake if this is in the wrong section,

I have ADHD and (many signs point to it) possibly Bipolar Disorder (many signs point to it), maybe more hypomania - or BPD II.

I am against taking most drugs, despite previous use of a lot at times. In any case, the point is, despite intelligence - there's a severe
organizational, structural, and focus issue coupled with insomnia, and disconnected thoughts... sometimes feeling "high" with no sleep and
no stimulants.

ON the one hand, I rush and complete school work last minute (since I was a kid). On the other hand, I am eccentric.

Its hard separating what is ADHD, and mania, versus not.

*More troubling is, risky behaviors, some addictions, and not being in control at times.
Also, I ruined my life many years ago as I was treated on anxiety meds --- it was ADHD masquerading as generalized anxiety disorder, in a way.

Definite mania, alcoholism, drug use, risk-taking, and mania, and much worsened judgment, shady friends followed. I had to leave the country... it was a whole thing.

Anyways, hence, I'm reluctant to rest things. And I feel if my life is on track, maybe some hypomania can be prevented by trying my hardest to sleep properly.



I have seen some expert differential diagnostic doctor, my psychologist, and my referring psychiatrist (who specializes in ADHD and child disorders I think, I'm not a child but there are few ADHD doctors nearby).

He believes that there are strong reasons to believe I have BP II. My psychologist (phD thinks hypomania here or there), the md psychiatrist ... I mainly talk about school and career, cognitive, medicine stuff there.

The treatment --- is something to do with enzymes in the brain and has brain imaging to see improvements in connections of certain areas of the brain.
I am not sure what it is... and it is similar to some diabetes treatment.

It is some new treatment, has anyone done this? And do they know possible side effects?

Thanks.

 

[cj]

Do you know the name of the treatment?

 

[paranoid android]

Enzymes in the brain? As far as i know there are no actual treatments for Bipolar or anything else that touch on that at all really. Well maybe a few for Alzheimer or other forms of Dementia but even those treatments are still very experimental to the best of my knowledge.

what is the name of this treatment anyway? Although none of us here are doctors and thus certainly can't be like "Okay take this with this and you will get better" as none of us are doctors and even if some of us where we couldn't diagnose a patient we haven't met face to face we can tell you what has worked for us for starters thus giving you a idea of what medications are generally seen as being say a first choice treatment for whatever illness.

 

[SixBuckets]

There is research around enzymes related to mania and hypomania, but I'm not aware of any treatments coming out of this research yet. Is your doctor suggesting you enroll in a clinical trial? You might want to find out if this is an approved, on market treatment or a novel, exploratory treatment.

The only treatment I know of that relies on brain imaging is transcranial magnetic stimulation, which involves using magnetic coils to stimulate bits of the brain. The changes are monitored on neuroimagery. I have NFI how effective it is, but it's definitely not first line therapy for bipolar.

 

[paranoid android]

There is research around enzymes related to mania and hypomania, but I'm not aware of any treatments coming out of this research yet. Is your doctor suggesting you enroll in a clinical trial? You might want to find out if this is an approved, on market treatment or a novel, exploratory treatment.

The only treatment I know of that relies on brain imaging is transcranial magnetic stimulation, which involves using magnetic coils to stimulate bits of the brain. The changes are monitored on neuroimagery. I have NFI how effective it is, but it's definitely not first line therapy for bipolar.

I would be very wary of any exploratory treatment without any real clinical trials to back it up. Messing with established and long used medications as a new treatment for say Bipolar depression such as Ketamine or Scopolamine is one thing but messing around with brain enzyme therapy is quite another. I would certainly suggest trying mood stabilizers as a first line therapy especially if you have Bipolar 2 disorder and not Bipolar 1.

I have heard of TMS but like you haven't the slightest idea as to how effective it is or if it's even effective at all. It has to be more effective then some of the more barbaric treatments such as ECT but then again that's kinda like saying it's more effective then huffing glue or hooking jumper cables up to someones head 8)

 

[CSM25]

My God, I'm not sure if it was lack of sleep or time-outs as well, I wrote the phrase in the brackets twice, and mania twice as well in a later sentence.

In any case, I suppose I was in too much of a rush, and somewhat under slept (plus the doctor had to go fast, its in a hospital), and I am not sure exactly what he said.
I remember saying, how I'd definitely rather not take any SNRI/SSRI, or mood stabilizers if they too, take a long time to build up and leave the system. Then he mentioned how it's some protein / or enzyme related treatment, that also has applications in diabetes. My bad, that's probably not very useful - it was a fast appointment, and I have had a lot going on with school and other things. Otherwise, ideally I'd write and ask questions beforehand, and try and take my add medication so I could stay on point at his office.

Anyways, yeah I know - even doctors can't tell me for sure. It seems to me, that it may be a clinical trial.
There were three med students in the room, all female. And I was trying to answer one of their sets of questions - and obviously I was difficult to follow, then I tried to slow down and make more sense to the Doctor. I guess perhaps it was to see if I am strongly symptomatic enough for some clinical trial.

I went there because I mentioned some things to the ADHD treatment doctor that I have. Another person (a few) mentioned to me, that they think perhaps I may be manic depressive (I know that's mostly not helpful, but one was a doctor or health care practitioner, who sees high risk patients all the time). That kind of freaked me out. 8 months later, I had an appointment.

I don't know... I wrote the admin. assistant, I guess I'll wait to hear back - before I know what the treatment is called, if its "in trials", etc.
Seems pretty extreme, if they can see brain imaging changes within four weeks (although that may not mean anything at all).

Thx all for the answers. He seemed to be concerned with my disconnected thoughts - and seemingly having a different conversation than the one he was having with me. But maybe that's just severe ADHD (which is no picnic either... Both (assuming they're actual things),that would be an uphill battle.)

Perhaps I just need to take melatonin more and a change of environment. I'm in my mid-to late twenties. The last time, I consistently was out of control, in very bad ways was 19... So even if I have what can be termed hypomania, it seems to be pretty well controlled (relatively speaking).

He was concerned mostly with my disconnected thoughts, difficulty having "the same conversation" as him... easily could be ADHD things.
Even as a kid, I'd write 2000 words for a paper, so of course I'm late, keyed up, doing multiple things at once in higher education -- that doesn't mean I'm manic. Even if so........... Going on ADHD meds and Bipolar meds, seems extreme, when the tests are largely qualitative.

I guess "Never trouble trouble, til trouble troubles you." Sleep problems definitely affect me. However, failing out school or not having options later, to be a little more stable, is not worth it to me. As silly as that may sound. That's why I refused Effexor when offered as a non stimulant for ADHD (after my exp before, of c not).

 

[CSM25]

paranoid android and SixBuckets.

Definitely won't risk that... I need to get 100's occasionally at school (which is hard in analytical courses that are taught poorly, with me not learning in class anyways) to balance out my lateness/ too long of assignments, issues with the faculty/ department.....
So TCM, or crazy drugs that may make me actually crazier and worsen my performance...

I'd say helllll no.

I thought I had brain damage after Effexor, mostly because of working memory issues and a fall that I had. I'm sure it was ADHD all along now, and that set something off (the SNRI), plus the destructive fake-friends (users). I mean if I can't remember the path to a place I walk all the time, it makes sense that I couldn't see everything occurring... I just of course never want any of that to ever happen again. I'm far wiser now, and distrusting. Its just that I felt relief - some along with despair, when I finally had several confirmations of ADHD a couple years ago... if even that is wrong... like 6 years later, then that would really get to me. I'm sure it will be fine soon enough, I just need to change my routine... and do things that have been long delayed (career, relationships, etc).

I guess - it's only worth doing if my disconnectedness, difficulty in certain milestones, and severe disorganization, and distractibility would go down, or risk-taking behavior, without horrid side effects. Not likely, I don't think. I've taken responsibility and worked really really hard the last 4-5 years, and most of the time before that... so things should improve anyways. Part of me thinks they never will, until I go somewhere else, achieve something, get some "worry" off my mind.

 

[SixBuckets]

I would be very wary of any exploratory treatment without any real clinical trials to back it up. Messing with established and long used medications as a new treatment for say Bipolar depression such as Ketamine or Scopolamine is one thing but messing around with brain enzyme therapy is quite another. I would certainly suggest trying mood stabilizers as a first line therapy especially if you have Bipolar 2 disorder and not Bipolar 1.

I have heard of TMS but like you haven't the slightest idea as to how effective it is or if it's even effective at all. It has to be more effective then some of the more barbaric treatments such as ECT but then again that's kinda like saying it's more effective then huffing glue or hooking jumper cables up to someones head 8)

People are too harsh on ECT. It's nowhere near as rough as it used to be. Despite its reputation, it has really good outcomes in treatment resistant depression. I know a few people who've had it and their experience is nothing like the horror stories from the 50s. I was considering it myself when I was first treated - the only reason I didn't go for it is that my psychiatrist thought I'd find it too distressing because I'm afraid of needles.

 

[paranoid android]

People are too harsh on ECT. It's nowhere near as rough as it used to be. Despite its reputation, it has really good outcomes in treatment resistant depression. I know a few people who've had it and their experience is nothing like the horror stories from the 50s. I was considering it myself when I was first treated - the only reason I didn't go for it is that my psychiatrist thought I'd find it too distressing because I'm afraid of needles.

Considering i have a friend who was in hospital with someone who had it and the person ended up jumping off a bridge a week later after they had fried her brain with the ECT i wouldn't recommend it to anyone. She couldn't even recognize her kids ffs they cooked her brain so much. But for some reason this hospital used higher voltages and she had a seizure that they didn't even treat afterwards that lasted long enough to be considered Status Epilepticus. I've heard nothing but bad from the few people i know that actually had it done.

 

[Kittycat5]

CSM25, could this treatment involve inositol or one of its analogues?

 

[SixBuckets]

Considering i have a friend who was in hospital with someone who had it and the person ended up jumping off a bridge a week later after they had fried her brain with the ECT i wouldn't recommend it to anyone.

I have no idea about the specific circumstances with your friend, but I'd guess it's really hard to determine whether the suicide was caused by the ECT or the severe depression she would have been experiencing to be recommended for it. I'm sorry for your loss - that's a horrible thing to happen.

She couldn't even recognize her kids ffs they cooked her brain so much.

The memory loss from ECT is largely temporary, but it can be super distressing while it's happening. It's bullshit if the hospital didn't manage this appropriately and caused her further distress.

 

[CSM25]

Kittycat5, It may have been inositol.

I have read and my PhD Pyschologist (who assumed I knew I had AD, when I first saw her for CBT for anxiety), mentioned a couple of times that some things I describe do sound like Mania/ more likely hypomania.

She and one or two sources I've read online (not great sources) state that "Manic Symptoms on an antidepressant - SSRI/ (others like trycyclical or atypicals too perhaps?)" is a sign of Bipolar...

Basically, on a 17 question test (or 200 for that matter), I score like 16 or 17 out of 17 (or 190-195+ / 200) for ADHD type behaviors and symptoms.
Perhaps, in part because I don't explain myself well, without serious effort and writing down what to say before... I come across Bipolar or very anxious to random doctors as well.
(I truly don't care what most of them think, as I conquered a hell of a lot -- medical, psychological, and more - with my own tactics and handwork and not blindly listening to anyone).

The thing is ADHD (or the syndrome or set of symptoms that the DSM calls "ADHD") is definitely not a joke for me... and if its actually Bipolar and ADHD...
Well I don't want more drugs. And more side effects, but I don't want to ruin my life again either.

I've quit coke, alcohol (98% down at least, sometimes a couple or more mo with none), lost 70lb, lost 30lb after regaining them on effexor! I've argued well over an entire year's worth of course grades (and won). So I don't want to risk things.

I do have some screwed up thoughts at times, but I don't believe that I am insane lol. MOST would say if you are Bipolar and ADHD, treating the Bipolar part is most important.

In short, I fit criteria for both in many ways. What keeps me up at night?
Mostly work that I begin late and need to do. I write 5000 words of notes for a 1000 word document, or 2000 words or 40 pages for a 15 page assignment then have to shorten it.

I have definitely since childhood, shunned sleep (changing a bit. Its better when I workout and eat very well).

Risky behaviours, etc... People not understanding me, talking, writing fast... those could all be ADHD and or Bipolar.

But , the manic and horrible situation that arose at 19-20, that caused me to leave the country, caused major financial loss, and mental stress, actually my drug use STARTED at that time too).If that could be nicely explained by Bipolar... that would be great and horrible at the same time for me, I think.

***In reality... If I lied (and was drug seeking), I could likely convince them I have any such condition... I wouldn't do that - because indeed mental suffering is very REAL. However, the DSM not having any physical tests, my ever-worsening diagnoses... the whole "neurotransmitter" hypothesis behind ever mental condition --- doesn't make me more confident in their ability to successfully alleviate any seriously impairing symptom of any mental, learning, cognitive disability.

I hope IFF (if and only if) I am Bipolar II or whatever the case may be, that
A. ADHD wasn't completely wrong (I doubt it was.... chronic underperformance since childhood, despite good grades).
B. I don't choose to medicate ADHD at the detriment of my mood/mental stability and face an early exit as a result.

I was pretty depressed - maybe 1.5-2 years.
Unable to leave the bed without being dragged 2 months, after coming to terms with that effexor-debacle and what happened back then (betrayed by friends, school, life seemingly thrown away). Faked it to make it a year or so... then started exercising and school again - but while I looked healthier and more productive, I still had SOME issue with academics. Not knowing where my rooms are, what are the expectations for a course, how to schedule time.
-->Good thing I was pretty smart as a kid, otherwise I'd probably had failed grade school. I skipped much of high school to learn faster at home and also play "catch-up", writing massive essays and handing them in late and getting 97's seemed better than sitting in class for a long long time.

And a few years after here and there.

I tried effexor, zoloft, prozac when I thought I had Anxiety predominantly and before I knew for sure I had ADHD.

Marijuana makes me feel manic... I didn't realize at 20 . Also I used to wander hours on end. I get lost a lot... When I was fixing my academic stuff up, and before I could sit in class, while I was trying to set things straight again after moving, it took some serious time to act normal and to (sleep, eat, exercise, take care of myself).

I did better at school, but probably skipped classes until 3 years ago.

I've done like 60... and am getting a 40 course degree only...... I don't know wtf.
I feel like my first major changed --- due to untreated ADHD and anxiety/depression. Later issues were due to the substances/ manipulative friends, and probably mania too.


So there's a lot of stuff I'd like to avoid. I'm trying to make up for lost time and just make my future bright --- get what I want without never reaching my potential. To see my dreams come true.... and live well as the best revenge.

I feel like ADHD and ALL the 4-5-6-? factors get in my way of studying... But I do crazy things as well. I constantly tell myself not to dangerously cross the street like this, not to study only the day before, not to do this risky thing, etc.

Worrying/ depression/ hyper focus waste a lot of time in addition to major disorganization (physically and mentally).





Too long didn't read:

My life was completely fucked up. I was fucked up in various ways. People around me were. I fixed that. Then I still had problems. Fixed the alcoholism. Then the (other) substance abuse. Then got some help for anxiety again (no medication!). Then pre-graduating from my previous program inquired rigorously and was found to be ADHD. Now, completing some additions to that program -- I am running into trouble. I was up maybe 5-6 days much of Feb to March (job interviews, I had like 14 in a couple weeks.... and I got offers, but changed my mind on the industry a little bit).

Then similar in summer, with several courses.

Now, I just want to make sure that things don't get destroyed again -- by medication, or by my theorized or actual craziness.
Likely, I'll take my chances and just treat ADHD, regardless what I find out (hopefully soon).

I just want to have my career, physical, and mental health on track. And have nice, trusting, longer term relationships.
That means performance (for that money, looks, self-care, travel, etc) counts... for me more than being 10-20% "more stable", as I explained to my counsellor, months ago regarding such a future dual / differential diagnosis of both conditions.


-Maybe it was inosotil -- the named popped out to me, in a list of meds for bipolar.

 

[CSM25]

Also, Reddit R/ BiPolar and R/ADHD (was a member) seemed to both think there's a good chance I was Bipolar. (not that this means anything).
I thought about this and everything literally before..... Mainly it came up early this year when I was testing for STI's (it was fine thank God.. I'm usually careful).

Someone at the clinic, was concerned with my mental health.Mannerisms, speed of talking, mentioning I had drank, history, school, insomnia ---\
the person working there sees sex workers, clients, basically "at risk" types of all kinds there. And she told me - she worries that I may have a serious mental disorder, that isn't being treated. That day made me ask my MD and PHD and.... finally I had a referral to an expert a couple weeks ago. Anyways.

I go back and forth on a LOT of things --- but, whatever executive impairments I have --- I and experts around me, tend to attribute to what is termed "ADHD". Probably planning, working memory, EF deficits (as per Russel Barkley's work). Sorry for such a long post. I mostly believe, most the time that it is true that I have ADHD.

However, I don't have marvelous improvements like many examples seem to.... Then again I am overworked and don't really care at this point. Grad school / getting in, and work I will care much more. The meds help... but likely fuel no sleep. Slight changes in diet or things like caffeine seem to take me from (meds working ) to (meds not working / performance worsened, and sleepless nights that may be hypomania). Maybe its motivation mostly. I tried to study at home since I was a child, I got by only under extreme time pressure.

 

[paranoid android]

I have no idea about the specific circumstances with your friend, but I'd guess it's really hard to determine whether the suicide was caused by the ECT or the severe depression she would have been experiencing to be recommended for it. I'm sorry for your loss - that's a horrible thing to happen.



The memory loss from ECT is largely temporary, but it can be super distressing while it's happening. It's bullshit if the hospital didn't manage this appropriately and caused her further distress.

The hospital in question id notorious for it's barbaric treatment of patients. For one thing for some reason they use a far higher voltage with ECT then other hospitals and they also didn't give her any anti-convulsants afterwards despite having seizures. When she finally had the major seizure which lasted well over 5 minutes by my friends count they refuse to give her a shot of Lorazepam, Valium or even Phenobarbital which would have stopped the seizure. Instead they shot her up with Haldol which cause seizures in it's own right and it made her worse. According to my friend who was in the same psych ward as her at first they said she was just acting out and refused to even look at her. So between the extremely high voltage ECT and the numerous ECT treatments they gave her over the course of a few weeks combined with the Status Epilepticus her brain was pretty much fried and turned her into a even more depressed zombie with no memory at all really.

IMO ECT if it is to be tried at all should be used as a last resort after every medication from SSRi's to TCA's to Atypical and even typical anti-psychotics to MAOI's and even Amphetamines and more experimental treatments have been tried such as Ketamine. But the medical establishment is very conservative as a whole and they are very reluctant to try new treatments or even anything outside of SSRI's and SNRI's. Hell some won't even prescribe Tricyclics which helped me through a few rough patches let alone MAOI's.

 

[SixBuckets]

The hospital in question id notorious for it's barbaric treatment of patients. For one thing for some reason they use a far higher voltage with ECT then other hospitals and they also didn't give her any anti-convulsants afterwards despite having seizures. When she finally had the major seizure which lasted well over 5 minutes by my friends count they refuse to give her a shot of Lorazepam, Valium or even Phenobarbital which would have stopped the seizure. Instead they shot her up with Haldol which cause seizures in it's own right and it made her worse. According to my friend who was in the same psych ward as her at first they said she was just acting out and refused to even look at her. So between the extremely high voltage ECT and the numerous ECT treatments they gave her over the course of a few weeks combined with the Status Epilepticus her brain was pretty much fried and turned her into a even more depressed zombie with no memory at all really.

Aw that's so awful. It's places like this that give the treatment such a bad rep.

IMO ECT if it is to be tried at all should be used as a last resort after every medication from SSRi's to TCA's to Atypical and even typical anti-psychotics to MAOI's and even Amphetamines and more experimental treatments have been tried such as Ketamine. But the medical establishment is very conservative as a whole and they are very reluctant to try new treatments or even anything outside of SSRI's and SNRI's. Hell some won't even prescribe Tricyclics which helped me through a few rough patches let alone MAOI's.

I don't know about where you are, but that's exactly how it is used in Australia - after first line treatments have been exhausted and for treatment resistant depression only.

 

[CSM25]

Anyone know how much "more stable" i.e. , how constant someone's emotional level should be with ADHD, versus if they have both?

I've had lots of stress lately and know some things will go away as I solve some issues. One a surgery, one just getting full time work, and another deciding about law school etc... But I can't do any of those immediately, because I'm upgrading my degree at school - with various issues arising there (handing in things late).

People have often told me - "you need more structure". Now that I have my own place, pay most of my bills, know how to get good jobs, and know what I don't want to do... I feel at times I have more of this "structure". On the other hand I'm not sure what "structure" even means.

It makes sense for someone with ADHD to feel sad or anxious all the time when they're constantly underperforming and have 20 things on the plate... that doesn't necessarily mean they have a "mood disorder".

Anyone ever have most symptoms of Bipolar AND ADHD, decide to treat only the ADHD, and leave it at that... and eventually
end up... completing their goals and feeling less all over the place, prone to ups and downs?

I imagine bipolar makes structure quite difficult, same can be said about ADHD no doubt.

I don't want to screw up... get only alright marks, or go to Law school - when I want to do something creative instead (but go there, because its more "stable", structured, and easy to explain what it is you're doing). I also don't want to choose the artistic route and possibly lose my mind . I think I'll have far more confidence post surgery (eliminating a long term issue)... but who knows.

 

[CSM25]

Ok, so to be to the point.
The specialist at the hospital sent notes to my doctor (ADHD).

And its unclear whether I have BP2, but there's a strong indication. The more "new" technique... still need my doctor to follow up --its unclear, what I'm supposed to do there (probably not do anything at all).

-Perhaps a short trial of Lamictal (anti-convulsant, lamotrigine by GSK)
OR Latuda (riskier, antipsychotic -weight gain, dyskanesia --- "No thank you.")

Taking lamictal for a few weeks - any major risk?

 

[Kittycat5]

Make sure you titrate up to whatever is the dose that works. Overall, Lamictal is pretty safe but rare and very serious skin reactions (Stevens-Johnson syndrome or toxic epidermal necrolysis) can occur if you start too high or go up to fast. If you arent taking any other meds (primarily the mood stabilizers that are also antiepileptics) you should take 25mg a day for 2 weeks, then 50mg for 2 weeks the 100mg for 1 week and finally jump to 200mg. Of course if say 50mg is working, you dont need to go any higher, but generally 200mg is the target dose.

 

[CSM25]

Yes, after posting I immediately read about SJS...

I heard about it before, because I am planning an abdominoplasty ( I lost 70-80lb over 10 years ago - not a lot of excess skin, but affects my confidence).
I read about necrosis and all those things.

As someone with sensitive skin, planning a major surgery..... I think that kind of stuff matters more than any hypomania to me. I have to be very cautious esp with psyche drugs.

I don't know its scary. That year long manic episode on Effexor ruined my life. I now know that + ADHD, and being trapped with destructive friends... that was "mania" for sure. I don't want to mess with my skin at all. I was on accutane many years ago... I have hyperhidrosis, etc.


I have allergies, excema, am on a vasoconstriction causing stimulant (dexedrine). I think Lamictal works well for many with my symptoms, but that SJS is no joke at all.

Maybe screw it. Thanks for the reply, and I definitely agree about slow titration and for anyone taking a similar drug - slow titration off ​it as well (due to withdrawal).


My brother is a skin specialist (ENT/ Facial plastics surgeon). We disagree a lot... Unfortunately I can't ask him.
Thank you for answering me, Kittycat5, I really appreciate it. Good to know the target dose as well. Its a confusing time.

Do you think such a drug could lower one's IQ or make them ... worse in math, writing, or logical tests?

 

[SixBuckets]

Lamotrigine is an absolute wonder drug for me, and I've heard the same from most bipolar people I know who've tried it. I've been on a lot of different antidepressants and a fair few of them have relieved my symptoms and made me functional. Lamotrigine is the first thing I've been on where I just don't feel like I have bipolar at all. Practically no symptoms, practically no side effects, just being a regular human.