I do have a pdoc appointment coming up in the far future (since scheduling sucks), but I've been doing some research on my own, trying to figure out what might work for me, and at least have some pertinent questions to ask rather than just sitting there like a lump while he tries to pull solutions out of thin air.

I'm a rapid-cycling Bipolar II.

Meds currently taking and why:

Keppra    (anti-seizure, I'm epileptic)
Klonopin  (PTSD and anxiety)
Lamictal  (bipolar)
Multivitamin
Fish Oil (for the Omega-3's)

In the past there was also the occasional Ambien CR which doesn't do much other than put me to sleep for 4 hours and stop working (I'm a chronic insomniac).

I *was* also on Cymbalta (an anti-depressant) in addition to the Lamictal, but anti-depressants are by-and-large contraindicated for bipolar treatment as tests have shown them to be only as effective as placebo in preventing depressive episodes in bipolars, and as agents that can cause rapid cycling and mixed episodes in bipolar patients, so I'm (thankfully) off that now, and can truthfully say, apart from no more mixed episodes, I haven't noticed any difference.

Been on Abilify before -- it is pure evil.

I've tried 5-HTP, now that I'm not on the SSRI's anymore but found that in the long term, it can cause problems not only with serotonin, but can deplete dopamine and norepinephrine. (see link below)

Here's the whole quote since I'll reference it again later: (from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415362/)
To make things more confusing, I've now read that not all depression is caused by faults with the serotonin or its receptors -- some catecholamine neurotransmitter levels influence depression.  Well that's spiffy. (Page 4 of above link)  Here's the quote:

...believe that depression is due to serotonin dysfunction, depression may also be associated with catecholamine dysfunction, including dopamine and/or norepinephrine, or a combination of serotonin and catecholamine dysfunction.

How the hell can you tell if your catecholamine/dopamine/norepinephrine might be a problem instead-of or as-well-as the hallowed serotonin?  ARGH!  Any specialists on here willing to add their insights to that little gem? Seems like depression's just getting more complicated all the time. Grrr. (pouts)

... Moving on...
The problem I'm experiencing at the moment is that while the wild up and downs are well controlled with the Lamictal, I'm still getting the depressive side of things, which is no fun at all.  Lots of people take something else along with their Lamictal, and have had great success, so I was wondering that if that sounds like you, what worked for kicking out the rest of the depressive symptoms?  I've heard Seroquel might be the way to go, and any feedback for that or on any possible treatment would be great!

And yes, I'll talk it over with my pdoc before I do anything or make any changes; and no, I won't take it as medical advice (even if you are a medical professional), or sue you or anything heinous.  It's really sad we need these disclaimers isn't it?  I also promise not to cross the Grand Canyon on a tightrope.

 Hello,

I've been getting panic attacks after having started taking 25 mg's of Topamax a couple of days ago.  Panic attacks are not listed as a common side effect for Topamax.  Has anyone had experience with this? 

Hey all....

Hi, my name is Jess.

i have bipolar I, ADHD-combined type, OCD, and panic disorder with associated agoraphobia.

let's see..............

up until a year ago i was unmedicated and undiagnosed.  i thought i had PPD after my 2nd child was born.  little did i know, right??? they put me on Wellbutrin to help the post-partum depression and it shot me out of a cannon in 24 hours i was INSANE.

4 months later.....

i began a 6 month long psychotic break that i am just now pulling out of.  So my pdoc, therapist, and i have decided to focus on getting the bipolar under control, then the panic disorder, and finally dealing with the OCD and ADHD.

so far i have been on:

Bipolar: Lithium, Lamictal, Geodon, Celexa, Neurontin, Abilify - all of varying dosages

panic: Ativan, Klonopin, Xanax and Xanax ER, and Valium

and Vistaril to help me sleep since all of the above have nasty side effects when i use them for sleeping meds. plus it helps with my allergies *lol*

Currently i am on:

Lamictal 300mg, Geodon 120mg, Vistaril 50mg (i think?), Valium 5mg as needed (normally i dont have any Valium around the house since i have a history of abusing it but i got the Rx because i am traveling on Sunday and airports are a massive agoraphobic panic trigger for me)

someday i would like to get my ADHD under control as well - it and the OCD tie in together and make it impossible for me to do anything, especially when i am manic.  But, currently, no meds for the ADHD or the OCD.

and that's it!

i feel like a guinea pig, i swear.  i cant seem to get the dosages or med combos right.  this one is OK but i really think he is going to up my Geodon again...


***i wanted to mention and forgot a bit ago when i originally posted this that i had a psychotic break about 10 years ago as well, and i was *THIS* close to committing suicide but managed to yank myself out of it after over a year of hell. never thought of it after that, though. wanted it out of my head***

anyway HI :D

Well its been 100mg Wellbutrin, 10mg Celexa, and 1mg ativan. And it is not working.  Im Diagnosed  Borderline personality disorder, with PTSD and Panic disorder. I have been on those three drugs for about three months now and no improvement whatsoever. I need something that will get my moods normal and make me feel stable not like at any moment I might hurt myself. Fuck I hate all this medication I just want to give up.

So last week was finals, so I didn't take my meds part of the nights, because they would have made me too sleepy to study. This was partially good, becuase it let me have Seroquel until Friday. I was seeing my pdoc Monday and was on such a tiny dose (thanks to a horrible reaction to low dose Abilify) that I didn't think anything off it. I had trouble sleeping over the weekend taking just the Valium and Lamictal, but I just thought this was due to not having the seroquel which was terribly sedating the first couple weeks I was on it (it was still knocking me out, but I could function during the day). Anways, Monday came and we doubled the Seroquel and exchanged Klonopin for the valium (becuase she thought I was taking the Valium too often). Now I really can't sleep. It takes me forever to fall asleep then I keep waking up. Is this just my body adjusting to not having a constant level of valium? I'm not soppoused to be taking the klonopin unless I really need it (which is how the valium was during the day at first - it worried her that I would still be panicky for days on end even when taking the valium to help with sleep. I shouldn't feel like I'm about to have a panic attack when I just took valium a few hours previously). I would usually just give this a few more days, but my pdoc is going to be out of office as of Friday. Am I just being stupid? Does anyone else have experience switching with these meds kind of like this?

I'm pretty sure that doesn't make any sense. Stupid brain.

(Short background: I take 20 mg of Paxil/daily and .25 of Xanax prn for panic disorder, ptsd, and social anxiety. I quit smoking on Thursday morning (my last cigarette was at 11 a.m)).

Up until today I was doing fairly well with the whole 'not smoking' thing. I wasn't happy, exactly, but I didn't feel like shit and I was coping. Today, however, has been absolute hell. I really, really want a cigarette. I'm nervous and jumpy and twitchy and really overly emotional; I'm inclined to burst out into tears and scream, both at very little provocation.

I don't want to abuse my xanax, but this has been going on for a while and nothing I know to do to help is touching it. Does anyone think it would be a huge problem if I took one and hoped like hell it knocked the edge of this off far enough for me to be able to cope? Or is that just asking to replace one addiction with another?

wow! I've been in love with crazymeds forever; I never knew there was an LJ group!

Mm, I'm currently unmedicated. My diagnoses are bipolar II, ed-nos, (insert drug here) dependence/abuse, borderline personality disorder, and ADD.

The most effective medication I've tried is Lamictal. Adderall is nice but it makes me too crazy. I have also been prescribed, at various times, lithium, prozac, trazodone, and trileptal.

I guess all this is pretty tame compared to a lot of you... Anyway, I'm thinking about getting back on meds and into therapy because I want to be happy and successful, and to do that I can't be... however it is I am. I would like to try Wellbutrin for ADD... especially because nobody's going to prescribe me adderall or ritalin (ew, I don't want ritalin anyway) or anything else like that anymore. I guess they're not supposed to give Wellbutrin to people with EDs, but apparently nobody takes EDs seriously until you've grown fur.

But, antidepressants alone can fuck up bipolar people (I was misdiagnosed with depression for a long time. they had my on prozac and adderall. I was a nut). So I was thinking about getting back on Lamictal. Unfortunately, as another member recently posted, it interferes with my motor skills and coordination, which is not too good since I'm into art. I really don't want to get on a zombie drug like lithium, and I WON'T take anything that makes you fat. WILL NOT.

Then again, my behavioral health has improved a lot, which makes me wonder... what if I did just go on Wellbutrin? Is it worth the risk?

Also, I've been having a lot worse anxiety lately, and these panic attacks that feel like I'm going to have a stroke or a heart attack. It's getting a -little- better, and I have to wonder if some of it is just from this terrible mushroom trip I had back in August. Not that I don't have other stress in my life... The panickiness started a few months before the bad trip, and it's settling back down into the way it was just before the trip. Probably the extra anxiety was just like any other time you have a horrifying experience. Takes a while to get over it. Anyway, it's kind of the same situation as with ADD meds. Nobody's going to believe that I won't abuse my prescription. And PS: I've never abused drugs that were actually prescribed to me! Damn!

Recommend anything?

So, my compy decided that when I hit backspace I wanted to go back a page rather than edit text, so I'm going to try to rewrite this mess.

Anyways, this shall serve as a bit of an introduction, which is going to lead to a question. I think. So, yeah. I have GAD, panicky fun attacks, and some sort of depressive thing. Pdoc thinks its a variation on major depressive disorder. Hippie Therapist Lady (HTL) thinks that its a form of bipolar. Whatever,I care more about being able to function than having a concrete dagnosis. Anyways... Let's see. My current  med combo is 300mg Lamictal with 10mg diazepam to sleep and up to another 10mg as needed. I really try to avoid this because it makes me dizzy, clumsy, and disoriented. Its like I've a) had way too much to drink  or b) been up for about 60 hours. Not that I can drink with it, which is a bit annoying at times (ugh, lowered tolerance + possibility for reducing respitory abilities). Whatever. My pdoc seems very idk something with her prescribing habits. I had to down an entire bottle of hydroxyzine and experiement with a friend's xanax (not at the same time) before I was able to get the valium. So yeah, HTL thinks she is extremely conservative in terms of what I get...Which means she hasn't always like the material that she was given...

Anyways, I was functioning fairly well on that combo for awhile. My major issue had been the anxiety, because SSRIs make me more depressed and suicidal (what the fuckery?), and pdoc wouldn't give me something else. That's okay now, becuase baseline anxiety disappeared a few weeks ago for a some unknown reason. Whatever. So yeah, the lamictal and I were getting along fine until a few weeks ago when lo and behold I start doing rapid cycling - kind of - I guess.

Now to the question part. This morning I met with pdoc and was all like I can't fucking deal with up and down and I really can't have another day where I crash so hard that I almost down an entire bottle of valium. This whole conversation was crazy because I could barely think straight enough and kept going elsewhere and yeah. This was backed up by a couple of calls from HTL. So pdoc was all, hmm.. three options.

1. Up the lamictal (this is what we did with zoloft untill I got so bad that I never left the house, took enough excederin to kill a horse, wrote words like fail in my arms with a knife, stopped making apointments and eventually wnt off it simply becuase I ran out of pills). This has the problem though that while Lamictal is good at keeping me from crashing usually, it won't get me  down to a point of functioning when I end up sing-songy at work. Yeah... We'll just leave it the same for now.

2. Lithium. Fun blood work. Plus, side effects and all that jazz.

3. Some other mood stabilizer. She first suggested seroquel (sp?), then switched to abilify on the grounds that drowzy is bad. Fewer,different side effects.

Yeah, we went with option 3 for now at a dose of 2.5mgs of Abilify daily with the possibilty of switching if need be. My quick googling showed side effects of anxiety and insomnia with the abilify though. I could deal with the insomnia by taking it in themorning. Maybe it coul replace my semiusual NoDoz. I guess. I only get about 5 hours of sleep though, so I need all the sleep I can get.

The anxiety freaks me out alot more. Seriously...seriously. I can't fucking get back to the point when I'm too anxious to leave the house/library/park. Yeah, those are the big three. Just becuase I can make As and Bs while submitting 90% of assignments online with extensions, I'm much happier making those grades while going to class 90% of the time.

Long story short: The question or I guess its going to be questions.

Should I be concerned about the anxiety? Is this dose too low for it to be a major factor? Something along those lines?

Would you have gone with the lithium or the Abilify?

I've been taking 20 mg. of Paxil and Xanax (.125 mg) PRN for slightly more than 2 months, for panic disorder. It works. It works well. I rarely if ever take the Xanax and in general I feel as though I've been given my life back.

The issue I am having is that I had to have my mother make the inital appointment and come with me. The doctor she chose was a GP she is personally familiar with (she's a nurse and he treats other members of my family). Obviously he did a perfectly good job since I feel human for the first time in a decade. The issue is that he's also 2+ hours from my home and may or may not be covered under my husband's new insurance plan.

Ideally I would like to find someone locally and definitely covered by insurance. My fear is that if I try to go in, even with medical records, they're going to start playing the medication roulette game with me. Does anyone have any experience with this? If I go are they likely to try to 'second guess' what my doctor and I have found that works, or will they take the damn records, give me my refills and leave me in peace? Is the fact that the doctor who diagnosed me is a GP going to make that more likely, if I see a psychatrist now?

I really, really don't want to get on that merry-go-round, but I'm perfectly willing to accept that I may be worrying about nothing. I also need to find a therapist for CBT. Does anyone know a good resource to check out their reputations? Or even advice on how to access if they're a good fit for me, once I'm there? I've never seen a therapist before, and while I want to now, I'm pretty danged clueless.

Have any of you had enormous difficulties getting your GP to work with you regarding psych problems and psych meds?  My doctor, for instance, insists on prescribing me steroid inhalers, despite my telling him I'll never take them because they aggravate my anxiety and panic attacks.  He also tells me I'm wrong when I say I can't take Flexaril because it works like a tricyclic antidepressant, and I cannot take antidepressants, and that antiinflammatories won't affect my lithium level.  Huh?  Never mind the medical journals you should be reading, have you ever heard of Google?  Of course, the part of my brain that imagines conspiracy theories likes to think that if he had just given me some damn ativan a few years ago when I started having panic attacks, I may never have gotten on the med go round (as it was, he prescribed me hydrocodone syrup for a cough, and told me he didn't want to prescribe anything "heavy" for anxiety). 

Any advice?  Does anyone have a vetting procedure they use for general practicioners to find out how open they are to working with psychiatric problems?