Ritalin Keeps Me on the Manic Side
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Q:  Ritalin Keeps Me on the Manic Side

i was diagnosed bipolar 2 years ago, but the treatments were not even beginning to work.  So my doc decided to try the add route.  At first with the ritalin I was wired beyond belief and refused to take it.  AS I also have panic anxiety disorder.  She startd me on stratera and it was like taking a suger pill.  So I gave the ritalin another chance.  Basically what it does is keep me on the manic side.  I feel the depression on the inside but the speed won't let it out.  I also take 10 mg valium 4 times a day and seroquel 300mg at bedtime.  I have a very high tolerance for med's.  I want to know if it is helpful to keep me manic with ritalin?  Without it I don't get out of bed, or I just sit and cry.

I have taken nearly every antidepressant out there. Paxil cr has worked the best.  Mood stabilizers are the same story. I feel like a lab rat- destined for the mental institution!  I was recently hospitalizewd a month ago, to play with my meds.  It was a complete failure and I couldn't get out of the place.  The only good thing I got out of it was group therapy.  And group therapy is not offered to outpatients.  This is a short term care facility (about 2 weeks).  Then they move you to the state hospital.  I have just changed counselors, hoping I could connect better.  I truly am trying. 

Dear Jodie --
Here's the thought that crossed my mind after reading your letter, though of course where you're at is not your fault: "Hey Jodie, when you've taken nearly every mood stabilizer there is out there, write back". If the emphasis in your treatment has been on targeting and preventing depression -- as opposed to targeting the cessation of cycling -- then the good news is, there's good reason to hope things could be better as far as medication treatments go.

Now, to start over, but with that as the emphasis: Mood stabilizers obviously haven't worked as you've hoped. Usually after going through them one at a time, assuming you really did have trials of all medications listed in the left hand column of the Mood Stabilizer table from my website, the next step is to go through combinations of them.

And though you don't have to be off antidepressants or Ritalin while you do this, if you find a mood stabilizer that seems to help some, then the next step, in my view, is to begin a very slow taper of the antidepressant (or perhaps in your case, Ritalin), taking 4-6 months to gradually remove it, in the smallest, smoothest set of steps down you can create. While you're doing that you can focus on maximizing the antidepressant potential of your mood stabilizers, which means getting all the mileage possible (highest tolerable dose, as long as it clearly adds some improvement) out of lithium and lamotrigine, and perhaps (according to some newer small studies) even omega-3 fatty acids. You can read about each of these in more detail from that Table linked above.

That's a general strategy you can review with your doctors, to see what they think. Good luck to you and them.

Dr. Phelps

Published November, 2003 


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