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Bipolar Type II

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Dr,

I am Bi-Polar Type II as currently diagnosed.

I have a history in young adult life, without knowing current diagnosis, of substance abuse. Recurrent pattern: Illicit substances used in college – Cocaine, MDMA, Marijuana, alcohol. Minor use (only a few times) of psychedelics (LSD, Psilocybin).

Overcame illicit drug use in early 20s. Alcohol has been a common thread for self medicating since age 19.

Exposed to Oxycontin at age 29 during hip surgery. Before surgery for hip replacement (avascular necrosis) required exceptional amounts of oxycontin for relief of pain. After surgery, awoke to extreme pain. Doctors had to insert an epidural to relieve pain and screaming. Also had to unlock restrictions on auto-medicating button/system while in recovery.

Anesthesiologist watched over me at night after surgery and informed me before surgery that he had never “given a patient as much narcotic medication” before a surgery before. This was at Mayo Clinic in Minnesota.

Cocaine and MDMA, used recreationaly, had very sudden termination of desired effects. One friend, after I complained that the MDMA had not effected me, after two doses, said after taking the same pills the next day “I was rolling after one. Seriously, you need to see a doctor, I’m worried about you.”

I have a history of my body developing quick and extreme tolerance to medications.

Please review history and question that follows.

Personal Stats:

Male, 34, 175 lbs.

Presented with major depression in late adolescence.

Sought help over two decades for relief from depression. (1996 to 2012)

SSRIs including Prozac, Celexa, Lexapro, Paxil, Zoloft. All caused manic episodes. Definitely allergic to serotonin enhancers.

In 2003 had a doctor investigate depression, ADD/ADHD and bi-polar.

Treated with Ritalin – caused agitation after some time. No mood enhancement.

Treated with Lithium – Serum levels never increased to therapeutic levels. No mood enhancement or stability at that time, although treatment was within a small window.

Left treatment (during college in Hawaii) with major psychological disturbance (totally abnormal) – major panic attacks. Debilitating anxiety beyond anything I have ever experienced. An example: unable to study for a simple reading of a homework assignment in a quiet library with no one else present – cried for at least 30 minutes in the corner of a closed room.

Window of unsuccessful treatments from 2002 to 2013.

Found a doctor that is working with me on Bipolar Type II (2013 to present).

I am convinced based on personal history, reflection of friends, reflections of wife that this is a correct diagnosis.

Important information: I do not suffer from manic episodes. Life feels mostly normal except for rapid-cycling and stress induced depression. I have a very low “low,” and a very limited “high” on my manic spectrum.

I finished college. I completed a Masters. I strive when working so long as I am not extremely stressed. I am happily married. I have two children.

Past and present I self medicate with alcohol. In the past I have heavily used alcohol (relative judgment – excessive high mark never exceeded 300 ml or so of 40% alcohol (vodka).

Usage at that level in the past, not present. – 6 years ago at least.

Current alcohol consumption limited to 750 ml at 13% a night – 1 bottle of Saki a night at most. Buy a bottle at the market once a day so no more is in the house at a time.

Current regimen and vector for treatment:

History with this doctor:

4 months with Lithium – no noticeable efficacy beyond first week of treatment (apparent mood enhancement at onset of treatment, rapidly disappeared). Serum levels at low end of therapeutic levels without noticeable effect.

Current: 100mg Lamictal (Lamotragine) x 2 per day (200mg total). Serum levels 2.0 on scale of 4.0 – 18.0 mcg/mL.

Planned medication: increase to 300mg/day (100mg AM, 200mg PM) for 3 days, increase to 300mg. 2x day after.

2nd medication – this is the center of my concern:

My father died May 5th unexpectedly, healthy and young (68). I am adopted, so family history is non-existent.

During this period, I was prescribed (before death of father; unrelated) adderall (amphetamine salts). At first, there was an increase in mood and motivation. Overnight it seemed like I had found the correct solution to my problems. Working dose was 20mg x 2 per day taken either twice a day, or all at once.

Started out at 10mg x 2 per day with little effect.

During this time (1 month window around father’s death) I was able and interested in doing things I hadn’t done for years… maybe over a decade. I cleaned the house regularly, planned and packed for a move out of our house to prepare for a move into a new one, took walks with my wife (I never had the drive to exercise or go on walks with my wife, despite the internal logical desire to), took care of lawn maintenance, etc.

After about a month long window on 100mg x2 a day Lamictal, and 20 x 2 a day on adderall, everything went back to normal.

Doctor prescribed a change from adderall to D-Amphetamine (a component in adderall). I went from 40mg/day adderall to 10mg x4 days, to 20 mg x 4 days, to 30mg of D-amphetamine.

I have not noticed any change either in mood or energy beyond being able to get out of bed in the AM.

I have, without my doctors permission, added 1 pill of adderall to the 30mg of D-amphetamine without impact. A few days during the window of the death of my father, I increased my adderall does to 60 or 80mg in a day.

My current experience with the stimulant medication is that it now barely works. Where it works with with energy, but not with mood. I had, for some time, a desire to do things I had never had the ability to do – I desired to go for a walk with my wife, and had the energy and joy to do so, etc.

For a fleeting moment, I experienced joy and interest in the mundane.

Now, with 30mg of D-amphetamine and 20mg of Adderall in the AM, I experience very little. I have been without the medication on occasion and replaced the same effect with caffeine from espresso.

I am reluctant to increase the dosage not because I am afraid I will appear as though I want to get high (I have been there, and left that far in the past), but because not only do I believe it will not reach the bar set with the initial month of exposure, but because I know such an extreme titration with or without my doctors consent might alienate me based on taking matters of dosing into my own hands.

My question: What is it about my physiology that creates an extreme tolerance to chemical substances? The same tolerance helped me to stop taking illicit drugs in my youth, but now seems to be thwarting my desire for treatment.

I am largely open with my doctor, but I do not want to burn the bridge I have established over a window of taking the dosage into my own hands based on personal experience with the medication.

I am so weary over trying to find a solution. I had one within my reach, and then it disappeared. I know by nature amphetamines tolerance builds quickly, but this occurred over a month without abuse.

We are planning on increasing the Lamictal which never increased my ability to find joy in the mundane. I understand and desire this, but don’t know what to do about the medication that brought actual, acute relief to the problem of emotion and joy.

Please, what are your thoughts about the pharmacology involved?

-Kevin

  • Odile Lee
    Dex-from my experience and study ( prescribed use of Dex -A 2 yrs, study, 1.5 yrs ) as a Chronic Depressive with ADHD ( ADHD diagnosed 4x/Psychiatrists, 3x GP, 2x Psychologist and originally, self diagnosed which led to seeking official MD diagnosis. Bi-Polar, 2x diagnosis Psychiatrist. Note: the Hyperactivity component of ADHD can resemble Hypermania in BP, also associated mood swings, most usually caused by issues stemming from difficulties with ADHD and same with Depression. ) Dex is not a MOOD regulator per se. It works on ( in ADHD and ADD ) "dumbing" down the signals of the brain, to allow focus. There is no component that would work on mood, as it does not work on Seratonin or Dopamine, or other Neurotransmitters. It can cause a lift in mood, as the concurrent fixing of attention related disorders often is so marked that natural mood regulates due to success. To expect Mood regulation from Dex is like expecting, well ( by analogy ) coffee to make you tranquil/stable instead of alert. Your use of alcohol/drugs will affect any medications you take, often to the negation of better effects. It is also a well know factor, that alcohol is to be avoided in Bi-polar as it is a depressant. You may feel ok while tidily, generally it will contribute to more depression troughs. From my teaching, from a nurse with BP- the prime factors of BP regulation is sleep, avoidance of alcohol, regulating and adjusting your supplements ( esp. high powered antioxidants which can compliment your prescribed meds. ) To be honest, BiPolar is something that Ive been taught - is always going to be there. Like ADHD. It can't be medicated away ( as Manic episodes usually occur with Anti-depressants. I suffer hyper mania myself, with them. ) Ive studied many things on both conditions, in great detail. Im no doctor ( although I have 27 years of autodidact self teaching, due to prior inability to attend Uni ) but I have a talent for extremely deep and intuitive research, at great speed ( last 2 years!). The best advice the nurse could offer ( 12 years nursing ) was- " Depression just has to waited out, like Burroughs said. It sucks, but thats all you can do. You may not find a chemical regulator for your mood, except to prevent mania( I myself take Epilim, which also helps extreme Hyper episodes and insomnia ) and extremes of mood. I myself, after 40 or so years of terrible abuse/lost prospects/extreme depression/worse etc- can tell you this- even after the Prime Key of finding Dex of for main symptoms ( focus and its like getting glasses) - there is no like answer for me, to deal with crippling depression. Much of mine comes from the unfairness of it all. We all understand this. And suffer. Happiness is overrated, and over pushed. Some people are happy, I wish I could be. But Im not. Until and if you find a substance that helps your obviously, terrible feeling ( and I do sympathise- my best friend the nurse, thru him I now understand that even my worst, is usually his daily helping ) - there have been many great people who have felt such. And still pushed on. You are one of the unsung heroes. Consider from me to you, The Honour of the Tin Man, for the loyalty, courage, and true deep feeling that Bi-Polar in its uniqueness confers. From the Order of the Scarecrow ( these are The Wizard of Oz references by the way )- inside a multi-layed. multi-talented, many faceted genius intelligence which I cannot communicate very well , I know.
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Please post this question in Doctox thread on the hub forum or SR2 forum, get the details from here:

DoctorX “Ask a Drug Expert Physician” Thread – Now on The Hub Forums!

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