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Mental Health Bipolar disorder and the medications I use to treat it.

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comptech92

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Nov 18, 2015
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Hello All,

About two years ago I was diagnosed as bipolar. I was prescribed 100mg of Zoloft as well as Klonopin 1 mg. I also use caffeine in high quantities as well as adderall IR 10 mg at least 4 times a day. Not long after starting the concoction (if you will) my depressive symptoms went away and I feel like I was more on the hypomanic side of things. I was super productive and didn't sleep for days. But now, it's gotten to the point of rapid cycling where in the morning and through the early afternoon I am as described above but when I get home, I get very lethargic and don't want to move and don't have the motivation to do anything. I've tried switching it up and taking half in the morning and half in the afternoon with absolutely no success. Can anyone tell me what I can do to get back on track? I really hate the depressive bull that I deal with on the daily.
 
Welcome to bluelight. I am moving your thread to the mental health forum from NASADD.

Talk to a doctor or medical professional about medications. Also, if you are taking Adderall 4X or more a day and drinking a lot of caffeine that's why you're more manic and unable to sleep.
 
If I had to take a guess, I would say that taking Adderall IR 10mg "at least 4 times a day" had masked your symptoms with dopamine release and the like for a couple weeks or so but at the end of the day its only increased your mood cycles as your tolerance to it has risen and its effects have decreased. I'm not to sure on the contraindications of taking Zoloft With Adderall. As far as what to do to get back on track, MY opinion would be to taper off or down to a lower dose of the Adderall and see what that does for you. Also, I cant see that taking it at staggered doses throughout the day would help a mood cycle.
 
I'm bipolar, and I once responded to Zoloft. Eventually, however, it ceased to be effective at all. My two cents is that your Adderall use isn't helping, and you should be on a mood stabilizer of some kind. Are you bipolar I or II? That can make a lot of difference in finding effective treatment. I'm kind of surprised at the Zoloft/Klonopin combo that your doctor prescribed. SSRI's can help prevent major depressive episodes, but don't do shit to control cycling, and there are other meds that will be better long-term for bipolar than benzos. Were you prescribed this by a psychiatrist or a GP?

My advice is to quit the Adderall and cut down on your caffeine, and then talk with your doc about finding a better med combo. If you're only seeing a GP, find a psychiatrist to take over the treatment.
 
I'm Bipolar II. I have never had a severe manic episode, however, I do get severely depressed in which case it's hard to think or move or function as an adult. My GP prescribed them to me with the advice of a psychiatrist. I have really bad anxiety as well. When your zoloft stopped working, what did you have to go to, to help with your situation?
 
I'm bipolar II as well. My situation was complicated by an onset of severe fibromyalgia, which added heavy chronic pain and strong sleep disturbances to the picture. In retrospect, the Zoloft was never effective at managing my bipolar symptoms, but it prevented them from tipping over into a major depressive episode, which was progress at the time. It helped enough that I was able to stay consistently strong in grad school (a considerable improvement from undergrad), but I was still experiencing enough cycling to interfere with the social and professional aspects of my life, and I was pretty useless in relationships. Then fibro cancelled out all of Zoloft's effectiveness.

Seroquel was effective at one point when I was having an panic attack-heavy major episode about a decade ago. It stabilized my sleep, intensified my dreams, and over a few months, got me back to stable. But when we tried it again recently (post-fibro), it wasn't effective anymore - the sleep disturbances from my fibro overpowered Seroquel's drowsiness. I was able to stay asleep, but my sleep cycles were still being constantly interrupted. Eventually, we found a combo of Cymbalta/Remeron/Seroquel XR. Cymbalta is approved for fibro treatment - it's helped keep the pain out of my legs, but never did shit for me as an antidepressant. Remeron is for my sleep - it's been the only thing we've tried that successfully controls the sleep disturbances. Seroquel XR is the mood stabilizer - it never worked while the sleep disturbances were going on, but once Remeron stabilized those, it started to work as it should, and it's been terrific. If fibro wasn't in the picture, it's likely that Seroquel XR would be enough on its own.

It's good that you've got a psychiatrist advising, but I would still skip the GP and go straight to them for treatment. They'll be much more intuitive at adjusting your treatment as necessary.
 
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Thank you for your perspective on this. I have very vivid dreams, when I sleep. My GC has already told me that he didn't want to put me on a mood stabilizer because it would make me a zombie. I probably should have the psychiatrist doing all of the treatment but was trying to keep everyone in the loop and try to get second opinions. I work in I.T. and I am very good at what I do. (Most Days) and I don't want things to make me less productive at work, it's just when I get home that I struggle so much. I guess the phrase "What goes up, must come down" is probably relevant here. I guess what my biggest fear is, is that I will start taking a regimen and it will take away my outgoing personality and affect my overall work performance. However, the depression bullshit is starting to get kinda old. Thanks again Silverwheel!
 
You're welcome. The "mood stabilizers turn you into a zombie" opinion is a signal that your primary doctor should not be administering your treatment in this area. Emotional blunting is certainly a side effect to watch for, but the right med for you will not have this side effect. The "zombie" thing is a shallow cliche, and a psychiatrist will approach this treatment with considerably more subtlety and genuine knowledge.
 
silverwheel said:
I'm bipolar II as well. My situation was complicated by an onset of severe fibromyalgia, which added heavy chronic pain and strong sleep disturbances to the picture. In retrospect, the Zoloft was never effective at managing my bipolar symptoms, but it prevented them from tipping over into a major depressive episode, which was progress at the time. It helped enough that I was able to stay consistently strong in grad school (a considerable improvement from undergrad), but I was still experiencing enough cycling to interfere with the social and professional aspects of my life, and I was pretty useless in relationships.

Seroquel was effective at one point when I was having an panic attack-heavy major episode about a decade ago. It stabilized my sleep, intensified my dreams, and over a few months, got me back to stable. But when we tried it again recently, it wasn't effective anymore - the sleep disturbances from my fibro were too heavy for it to manage. Eventually, we found a combo of Cymbalta/Remeron/Seroquel XR. Cymbalta is approved for fibro treatment - it's helped keep the pain out of my legs, but never did shit for me as an antidepressant. Remeron is for my sleep - it's been the only thing we've tried that successfully controls the sleep disturbances. Seroquel XR is the mood stabilizer - it never worked while the sleep disturbances were going on, but once Remeron stabilized those, it started to work as it should, and it's been terrific. If fibro wasn't in the picture, it's likely that Seroquel XR would be enough on its own.

It's good that you've got a psychiatrist advising, but I would still skip the GP and go straight to them for treatment. They'll be much more intuitive at adjusting your treatment as necessary.
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I'm sorry to hear about your fibromyalgia.
I tried Zoloft many years ago. Then moved on to Remeron which made me feel better about my depressing phase.

It's all too tricky when a doctor has to diagnose bipolar or other mental conditions when on those who take opiates and/or other mood altering substances on a daily basis as symptoms seems to be a little alike in some cases.

I've been reading about these false-positives. Not you, but it happens a lot.

Take care and all the best!
 
Well, my bipolar was diagnosed about 12 years before the fibro came along. Fibro just made it a hell of a lot harder to treat effectively as well as being a bear in its own right. I'm prescribed Percocet for the pain, which isn't ideal, but I'm severely allergic to Neurontin (which also rules out Lyrica because the molecules are so similar), and I've never responded to Tramadol or Hydrocodone products. On the whole, Percocet has improved my quality of life considerably, and the side effects I experience from it are much less severe than the consequences of my pain going uncontrolled.
 
I too am sorry that you have to go through all of that. My dad had end stage COPD before he died in April. He was prescribed Neurotin which basically made him drool on himself most of the time. I finally was able to get him to a doctor that would prescribe him prescription narcotics (so we didn't have to spend so much to by them off the street). I have vascular issues with one of my legs that causes tingling and pain and I couldn't imagine how bad you have it. I used to use opioids all of the time and truth is, is I love them but I have to look out for me and my life. I know that if I became addicted to them, that would be the end of my career and would end up causing more problems long term. I know that fibro. doesn't really get better, but I hope for the sake of your sanity that the pain lessens! Thanks for your help Silverwheel!
 
I heard lithium has bad side effects. I would probably lean more towards seraquil or an alternative
 
How old are you? I ask because bipolar II's often have their symptoms evolve as they get older. One of the things my doctor shared with me is that as bipolar II's get into their 30's, the "up" parts of the cycle often become much more agitated and angry instead of happy or euphoric, which was fit with what I was experiencing.
 
oh boy. why is a bipolar taking speed? do you want to be a speed addict? as much as you love speed, it ain't worth it in the long run. I know this for a fact, I been there. You should be taking lithium, not speed. oops I forgot the rules But make him give you lithium. I found that the lithium helped me become not as crazy during the highs
 
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Lamotrgine may be a good choice. It works, is well tolerated, and wont zombify you nearly as much. Lithium is probably still the best option, and sure it has side effects but so do all drugs. Your doctor can actually measure the levels of Lithium in your blood unlike many others, keeping you in a range that is therapeutic and minimizes adverse reactions.

And a psychiatrist really should be consulted. Their non-pharmacological methods would be quite valuable and should be more well versed in diagnosing and treating mental disease. Lots of conditions have overlapping symptoms and best if you relay them directly to the person deciding on your care, rather an intermediate. And Adderall seems like a bad idea to me as well. Besides aggrevating hypomanic episodes, it can worsen anxiety and the way you describe it sounds typical of amphetamine crash. Maybe you have a legitimate need for Adderall but it sure doesnt seem very useful right now.
 
In response to the comment about lithium: it's a very serious drug, not one about which you say "why aren't you on it???". People either swear by it or hate it. Rarely a middle ground. Weight gain, frequent peeing, severe hand tremors, mental fog, etc are all likely side effects. For some it works wonders, and for some it does nothing. And you need regular blood tests to avoid toxic levels.

In response to the OP: the thing about adderall is that, especially with instant release, there's a strong comedown effect. It usually works for about 3-5 hours, and then you feel exhausted, immobile, sad, hopeless, until you take the next one or go to sleep. Especially if you have a mood disorder like bipolar. I bet that's a huge part of your problem. Either talk to your doc about adderall XR, (you might still have a comedown in the evening), or consider weaning off of it. It can really contribute to unstable mood. Good luck!
 
Are Zoloft, Adderall, and Klonopin less serious? The blood tests are a good thing in my eyes because of strong correlation between the plasma level and therapeutic and toxic effects.
 
I have bipolar I and I'm on Latuda 80mg and lithium 1200mg. I find no side effects from either but balance in my brain. The lithium wiped out depression I had in sept and besides regular blood tests, no problem. I'm also on Kolonopin 1mg x3 day and it keeps the panic attacks away. I do drink a lot of coffee also which I shouldn't but it's not bc I'm a zombie or anything. I have tried other meds and they turned me into a zombie for sure. It really is trial by error process. Good luck to you
 
A lot of people I know(and here on bl) really dislike seroquil, it was nightmare drug for me and did make me into a Zombie with a capital Z. I'd stay away from that if at all possible. The lithium has waaaaay to many awful side effects and many shrinks seem to be shying away from it lately ime and scripting the ssri's instead(which are also terrible lol)
There's just not a lot of good options IMO/ime. The adderall isn't helping your situation at night but I bet it sure helps during the day lol. Do what u gotta do to find happyness no matter what! Only u know what works for u.
 
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