Mental Health
Have mental health questions? Ask a psychiatrist online
Connect one-on-one with {0} who will answer your question
Answered in 38 minutes by:
12/10/2011
MN Psychiatrist, Psychiatrist
Category: Mental Health
Satisfied Customers: 792
Experience: Physician for 17 years, adult psychiatrist for 13 years working with a wide variety of patients.
VerifiedHello, I am a psychiatrist.
To answer your question, it is really hard to say if you should be on all of these medications or not, without having assessed you face-to-face and without knowing more of your history. I can tell you, though, that you are on a fair amount of medications, and Adderall and Cymbalta may contribute to mania.
Could you tell me more about how well this regimen of medications has worked for you? How well satisfied with it have you been?
To answer your question, it is really hard to say if you should be on all of these medications or not, without having assessed you face-to-face and without knowing more of your history. I can tell you, though, that you are on a fair amount of medications, and Adderall and Cymbalta may contribute to mania.
Could you tell me more about how well this regimen of medications has worked for you? How well satisfied with it have you been?
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2,350
Experience: MBBS ; M.D Psychiatry, MS. Health Informatics
VerifiedHello sruffy,
You have mentioned that your diagnosis is ADHD and Bipolar disorder.
Both Cymbalta or any other antidepressant when given in a patient suffering from Bipolar disorder may cause switching of depressive state to hypomanic / manic state or may aggravate / worsen the manic episode. Same is the case with Adderall also. You have also mentioned that "My mania has been horrible over the last year"
Now your psychiatrist wants to add Bupropion too and in my personal view, you are on too many medicines currently. Two antidepressant in a patient of Bipolar disorder should be avoided.
For Bipolar depression usually Lamotrigine is enough in most cases and the dose range is from 100 to 200 mg per day. You are currently on 100 mg so if your depressive symptoms are not under control the dose can be further increased if needed. Lamotrigine is very effective for treating Bipolar depression as well as in prophylaxis of both manic and depressive episodes.
The dosing of Quetiapine is appropriate in my view.
Regarding the antidepressants, as I mentioned earlier, since Cymbalta is an dual acting antidepressant, it can worsen the mania symptoms in a Bipolar patients. Your doctor want to add Wellbutrin (Bupropion) too to this regimen but in my view, instead of both these medicines, Bupropion alone is an better alternative in cases of Bipolar disorder if an antidepressant is needed at all.
So if your doctor agrees to taper down Cymbalta and replace it with Bupropion this should help in both depressive symptoms as well as ADHD symptoms.
To summarize, Seroquel is a good choice, Dose of Lamotrigine can be increased first before adding any other antidepressant in your case and Cymbalta can be replaced with Bupropion if possible.
Clonazepam (Klonopin) is a benzodiazepine and can cause dependence on it if taken for long time (more than 4-12 weeks) so if you are taking this medicine for a long time, the dose can be taper down and stopped. It can be taken on as and when needed to control the anxiety symptoms and help in sleep if needed.
Best wishes,
Vikas
Please feel free to ask if you need clarification/more information. Kindly click the GREEN ACCEPT BUTTON if you are satisfied with the answer. POSITIVE FEEDBACK and BONUS are warmly appreciated
You have mentioned that your diagnosis is ADHD and Bipolar disorder.
Both Cymbalta or any other antidepressant when given in a patient suffering from Bipolar disorder may cause switching of depressive state to hypomanic / manic state or may aggravate / worsen the manic episode. Same is the case with Adderall also. You have also mentioned that "My mania has been horrible over the last year"
Now your psychiatrist wants to add Bupropion too and in my personal view, you are on too many medicines currently. Two antidepressant in a patient of Bipolar disorder should be avoided.
For Bipolar depression usually Lamotrigine is enough in most cases and the dose range is from 100 to 200 mg per day. You are currently on 100 mg so if your depressive symptoms are not under control the dose can be further increased if needed. Lamotrigine is very effective for treating Bipolar depression as well as in prophylaxis of both manic and depressive episodes.
The dosing of Quetiapine is appropriate in my view.
Regarding the antidepressants, as I mentioned earlier, since Cymbalta is an dual acting antidepressant, it can worsen the mania symptoms in a Bipolar patients. Your doctor want to add Wellbutrin (Bupropion) too to this regimen but in my view, instead of both these medicines, Bupropion alone is an better alternative in cases of Bipolar disorder if an antidepressant is needed at all.
So if your doctor agrees to taper down Cymbalta and replace it with Bupropion this should help in both depressive symptoms as well as ADHD symptoms.
To summarize, Seroquel is a good choice, Dose of Lamotrigine can be increased first before adding any other antidepressant in your case and Cymbalta can be replaced with Bupropion if possible.
Clonazepam (Klonopin) is a benzodiazepine and can cause dependence on it if taken for long time (more than 4-12 weeks) so if you are taking this medicine for a long time, the dose can be taper down and stopped. It can be taken on as and when needed to control the anxiety symptoms and help in sleep if needed.
Best wishes,
Vikas
Please feel free to ask if you need clarification/more information. Kindly click the GREEN ACCEPT BUTTON if you are satisfied with the answer. POSITIVE FEEDBACK and BONUS are warmly appreciated
Thanks for your reply John.
Usual dosage range of Quetiapine is from 400 -800 mg per day and you are currently on 600 mg per day so if your doctor does not want to add any other mood stabilizer or switch you over to another one, a good idea would be to increase the dose up to 800 mg and see the effect.
Otherwise, Valproate preparations such as Depakote, Depakote ER, Depakene and Lithium are the first line mood stabilizers and we personally prefer Valproate preparations over lithium because of comparatively lesser side effects. So any preparation of Valproate could be a good option in your case.
Other possible options as a mood stabilizer can be Olanzapine and Aripiprazole (Abilify).
Lamotrigine (Lamictal) is the first line treatment option for Bipolar depression. It is also effective in prophylaxis of bipolar mania and bipolar depression. The dose of Lamotrigine should be reduced if given along with Valproate.
Since you are already on Seroquel and Lamictal but still not responding adequately, so combination of Valproate and Lamotrigine could be a good combination in your case.
Wellbutrin (Bupropion) can be a good option for both Bipolar depression as well as ADHD symptoms in your case and can be added to the current combination of Seroquel + Lamictal + Wellbutrin or if your doctor want you to switch over to Valproate than Valproate + Lamictal + Wellbutrin.
Adderall should not be taken with Wellbutrin as there are significant interaction reported between these two medicines and close monitoring is required if they are both given in combination so if possible, Adderall can be discontinued by your doctor in my view. Also adderall may worsen or aggravate the manic symptoms as I mentioned earlier.
If your doctor plan to add Wellbutrin, Cymbalta can be stopped as there is no sense in giving two antidepressants at the same time in a patient suffering from Bipolar disorder and this combination may further worsen the mania symptoms.
Regarding Klonopin (Clonazepam), as I mentioned earlier, it should not be taken for such a long time and should be taper down in your case.
Please don't stop any medicine by yourself. Nearly all of these medicines should be taper down slowly under your doctor supervision.
You can discuss with your doctor about the changes I have suggested and hopefully they may be useful in your case.
In any case, your doctor is the the best judge to decide whether or not to change / replace any medicine.
Best wishes,
Vikas
Please feel free to ask if you need clarification/more information. Kindly click the GREEN ACCEPT BUTTON if you are satisfied with the answer. POSITIVE FEEDBACK and BONUS are warmly appreciated
Usual dosage range of Quetiapine is from 400 -800 mg per day and you are currently on 600 mg per day so if your doctor does not want to add any other mood stabilizer or switch you over to another one, a good idea would be to increase the dose up to 800 mg and see the effect.
Otherwise, Valproate preparations such as Depakote, Depakote ER, Depakene and Lithium are the first line mood stabilizers and we personally prefer Valproate preparations over lithium because of comparatively lesser side effects. So any preparation of Valproate could be a good option in your case.
Other possible options as a mood stabilizer can be Olanzapine and Aripiprazole (Abilify).
Lamotrigine (Lamictal) is the first line treatment option for Bipolar depression. It is also effective in prophylaxis of bipolar mania and bipolar depression. The dose of Lamotrigine should be reduced if given along with Valproate.
Since you are already on Seroquel and Lamictal but still not responding adequately, so combination of Valproate and Lamotrigine could be a good combination in your case.
Wellbutrin (Bupropion) can be a good option for both Bipolar depression as well as ADHD symptoms in your case and can be added to the current combination of Seroquel + Lamictal + Wellbutrin or if your doctor want you to switch over to Valproate than Valproate + Lamictal + Wellbutrin.
Adderall should not be taken with Wellbutrin as there are significant interaction reported between these two medicines and close monitoring is required if they are both given in combination so if possible, Adderall can be discontinued by your doctor in my view. Also adderall may worsen or aggravate the manic symptoms as I mentioned earlier.
If your doctor plan to add Wellbutrin, Cymbalta can be stopped as there is no sense in giving two antidepressants at the same time in a patient suffering from Bipolar disorder and this combination may further worsen the mania symptoms.
Regarding Klonopin (Clonazepam), as I mentioned earlier, it should not be taken for such a long time and should be taper down in your case.
Please don't stop any medicine by yourself. Nearly all of these medicines should be taper down slowly under your doctor supervision.
You can discuss with your doctor about the changes I have suggested and hopefully they may be useful in your case.
In any case, your doctor is the the best judge to decide whether or not to change / replace any medicine.
Best wishes,
Vikas
Please feel free to ask if you need clarification/more information. Kindly click the GREEN ACCEPT BUTTON if you are satisfied with the answer. POSITIVE FEEDBACK and BONUS are warmly appreciated
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2,350
Experience: MBBS ; M.D Psychiatry, MS. Health Informatics
VerifiedDr. Vikas and 87 other Mental Health Specialists are ready to help you
How JustAnswer works
Describe your issueThe assistant will guide you
Chat 1:1 with a mental health professionalLicensed Experts are available 24/7
100% satisfaction guaranteeGet all the answers you need
Related Mental Health Questions
Something needs to be adjusted with my -polar medications.
Something needs to be adjusted with my bi-polar medications. I've been trying to find a new psychiatrist but time has run out and I'll have to see when her highness can fit me in. I guess I'll see if … read more
Dr. Kaushik
PSYCHIATRIST ( MD Psychiatry)
Doctoral Degree
5,047 satisfied customers
A close friend of mine has been prescribed the following
A close friend of mine has been prescribed the following medication. She told me she was diagnosed as bipolar. Im wondering if taking all these meds all together is safe. They are: Sertraline 100mg - … read more
Ask Eleanor
Psychotherapist Family Therapist Author
Master's Degree
1,377 satisfied customers
For many years I've been treated with various combinations
For many years I've been treated with various combinations of medications to control clinical depression and anxiety which I have likely inherited from my father's side of the family. For the past few… read more
Dr. Vikas
Psychiatrist
M.D (Psychiatry)
2,350 satisfied customers
I have been recently been diagnosed with having a very
Hello, My name is***** have been recently been diagnosed with having a very difficult to handle obsessive/compulsive disorder. I have recently been taking a large number of meds for what was first bel… read more
Dr. Kaushik
PSYCHIATRIST ( MD Psychiatry)
Doctoral Degree
5,047 satisfied customers
I am -polar and also have OCD disorder. My mania is probably
Hello, My name is***** am bi-polar and also have OCD disorder. My mania is probably the result of my OCD, in which I dwell on certain thoughts on a constant basis. My physician has placed me on Cymbal… read more
Dr. Vikas
Psychiatrist
M.D (Psychiatry)
2,350 satisfied customers
I am -Polar. I am on a number of different medications to
Hello, My name is***** am Bi-Polar. I am on a number of different medications to control my symptoms. After speaking to one of your other psychiatrists a few day's ago, he believed that I am over medi… read more
Dr. Ed Wilfong
Psychologist
Doctoral Degree
1,524 satisfied customers
I'm 24yrs/Female who has schizoaffective disorder- polar
Hi, I'm 24yrs/Female who has schizoaffective disorder-bi polar type. I suffer from practicially all the symptoms of schizophrenia, ADD and bi polar disorder. Medicine only seems to work for a couple o… read more
MN Psychiatrist
Psychiatrist
792 satisfied customers
I have a nephew who has polar he is taking lithium 300 mg 2
I have a nephew who has bi polar he is taking lithium 300 mg 2 a day and also abilify 1 in am. He is still very anxious restless and has a hard time concentrating. ADHD and Bo polar run on our family.… read more
Selah R, M.S. LPC
Licensed Professional Counselor
Master's Degree
519 satisfied customers
I have great psychiatrist and treated successfully for
I have great psychiatrist and treated successfully for bi-polar with Lamictal for a few years but I am unable to find a successful med that treats ADHD. We have gone through all, inc. Strattera, Adder… read more
MN Psychiatrist
Psychiatrist
792 satisfied customers
My wife has been diagnosed with -Polar Disorder I. What is
My wife has been diagnosed with Bi-Polar Disorder I. What is the standard treatment for this disorder and why normally is a neuroleptic drug prescribed along with a mood stabilizer for it? What are th… read more
Carol Kryder LMFT
Private Practice
Master's Degree
802 satisfied customers
I am bipolar and am on medication Lamictal 200mg and
I am bipolar and am on medication Lamictal 200mg and welbuterin 100mg daily, but I still have my manic anger episodes. How can I avoid this??… read more
Dr. Kaushik
PSYCHIATRIST ( MD Psychiatry)
Doctoral Degree
5,047 satisfied customers
My son was diagnosed with -polar disorder, after a manic
My son was diagnosed with bi-polar disorder, after a manic episode with psychotic features. He is on lithium, seroquel and lamictal. It has been 3 years. What type of functionality can we expect? Is t… read more
Dr. Kaushik
PSYCHIATRIST ( MD Psychiatry)
Doctoral Degree
5,047 satisfied customers
I am taking seroquel xr, klonpin 6 mg zoloft 200mg ambien
I am taking seroquel xr, klonpin 6 mg zoloft 200mg ambien 1mg for bi-polar disease Is this too many drugs FOR ME? ALSO 3 OTHER DOCTORS SAY I am not bi-polar I have trouble sleeping at night so my doct… read more
Dr. Kaushik
PSYCHIATRIST ( MD Psychiatry)
Doctoral Degree
5,047 satisfied customers
I have been on wellbutrin 300 mg xl, lexapro 30 mg, and
I have been on wellbutrin 300 mg xl, lexapro 30 mg, and depakote ER 1200 mg. All taken once a day. Recently, I told my doctor that I wasn't satisfied with my drugs to help rid me of my depreesion so I… read more
Carol Kryder LMFT
Private Practice
Master's Degree
802 satisfied customers
Thanks Dr. Kaushik! i want to ask you another question- the
thanks Dr. Kaushik! i want to ask you another question- the quetiapine which i take is 150mg but if i increase the dose to beyond 200mg i get severe dry mouth and leg cramps. They also tried Seroquel … read more
Dr. Kaushik
PSYCHIATRIST ( MD Psychiatry)
Doctoral Degree
5,047 satisfied customers
I currently am dual diagnosed ADHD Type III ( Overfocused )
I currently am dual diagnosed ADHD Type III ( Overfocused ) and Bi-Polar I. I haven't had a manic episode in years only hypomanic. I have experienced Strattera, Vyvanse, Focalin, Concerta with minimal… read more
Dr. Kaushik
PSYCHIATRIST ( MD Psychiatry)
Doctoral Degree
5,047 satisfied customers
BACKGROUND INFO: 24 year old female. I have -Polar 1
BACKGROUND INFO: 24 year old female. I have Bi-Polar 1 (diagnosed at 13 years old), depression (suicide attempt at age 11), PTSD(childhood abuse/flashbacks) and more recently severe disabling anxiety(… read more
Ralph LMHC
Psychotherapist
Master's Degree
872 satisfied customers
BACKGROUND INFO: 24 year old female. I have -Polar 1
BACKGROUND INFO: 24 year old female. I have Bi-Polar 1 (diagnosed at 13 years old), depression (suicide attempt at age 11), PTSD(childhood abuse/flashbacks) and more recently severe disabling anxiety(… read more
Nancy
Psychotherapist
MS, PhD can.
492 satisfied customers
Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. Posts are for general information, are not intended to substitute for informed professional advice (medical, legal, veterinary, financial, etc.), or to establish a professional-client relationship. The site and services are provided "as is" with no warranty or representations by JustAnswer regarding the qualifications of Experts. To see what credentials have been verified by a third-party service, please click on the "Verified" symbol in some Experts' profiles. JustAnswer is not intended or designed for EMERGENCY questions which should be directed immediately by telephone or in-person to qualified professionals.
JustAnswer in the News:
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
What Customers are Saying:
I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much
Pretoria, South Africa
I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well!
Albuquerque, NM
Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion.
Beaverton, OR
Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
Tracy, CA
I feel better already! Thank you.
Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem.
Lockesburg, AR
You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions.
Tucson, AZ
I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!!
Phoenix, AZ
< Previous | Next >
Meet the Experts:
Dr. Keane
Therapist
1,379 satisfied customers
Clinical Psychology PhD, Licensed Professional Counselor with experience in marriage/family, teens and child psychology.
TherapistMaryAnn
Therapist
4,259 satisfied customers
Over 20 years experience specializing in anxiety, depression, drug and alcohol, and relationship issues.
Dr. Olsen
Psychologist
2,336 satisfied customers
PsyD Psychologist
Norman M.
Principal psychotherapist in private practice. Newspaper contributor, over 2000 satisfied clients on JA
2,246 satisfied customers
ADHP(NC), DEHP(NC), ECP, UKCP Registered.
Steven Olsen
Therapist
1,728 satisfied customers
More than twenty years of expertise in counseling, psychological diagnosis and education
Anna
Mental Health Professional
1,656 satisfied customers
Licensed Clinical Social Worker with 29 years in addictions and mental health.
Dr. Ed Wilfong
Psychologist
1,524 satisfied customers
Twenty-five years treating all ages; Specialities: psychopharmacology & diagnosis, MMPI-2, testing.
< Previous | Next >
Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. Posts are for general information, are not intended to substitute for informed professional advice (medical, legal, veterinary, financial, etc.), or to establish a professional-client relationship. The site and services are provided "as is" with no warranty or representations by JustAnswer regarding the qualifications of Experts. To see what credentials have been verified by a third-party service, please click on the "Verified" symbol in some Experts' profiles. JustAnswer is not intended or designed for EMERGENCY questions which should be directed immediately by telephone or in-person to qualified professionals.
