28 replies to this topic

[Mind_Paralysis]

Yeah... I'm rather confused around this, and would like your input on this.

 

SO... am I Bipolar - Of Otherwise Unspecified Variety - aka, highly irregular and atypical - a rare variant which is not significantly described in the litterature.

 

I went to the psyche E.R yesterday, and waited the obligatory 2 hours before I got to meet a Dr - I described my unending problems with non-restful sleep, and how I have had problems with waking up while sleeping, ever since I got burnout.

 

The Dr. noted my various receded and cleared depressions, and the fact that I have such fractured sleep, and suggested that perhaps I have been misdiagnosed - that I don't really have ADHD-PI or SCT with accompanying anxiety, OCD and depression, but rather, I just have Bipolar with Autism on top. (the two masking each others symptoms)

 

What do you say, gentlemen and gentlewomen? Am I bipolar or not?

 

Because of what Jack_Black jokingly noted once, and some choice observations of my own, I'm actually not as unconvinced as I would have expected myself to be...

 

I do write in a curious and jovial way, sometimes indicating mania, and I do have an unstable mood. However, there are a few things which I feel makes this less plausible... Namely my response to medications.

 

Let's have a look:

 

600 mg Bupropion - Trialed this for about 5-6 days (can't recall quite how long...), and I did not go manic. In fact, I gained significant cognitive issues from the anti-nicotinic effects. 300 mg IR, first day of dosing, however, did turn me productive, sociable, less anxious, and reaction-time was spun up to the DOUBLE. One could see this as hypo-mania. This effect did not appear on second day of 300 mg IR, so I did not pursue it again - most likely honey-moon effect.

 

200 mg Sertraline - NOW we're talkin'! This should turn litterally ANY bipolar manic, without a mood-stabilizer, which I did not have access to - but I did not. In fact, I turned incredibly mellow and calm - every worry was gone - I was literally free of anxiety and OCD. PERFECT. It interfered with my Methylphenidate at such doses though, so I quit it. Was on it for at least three weeks.

 

70 mg Lisdexamphetamine - This is the maximum regularly recommended dosage - I were on this dose for around two weeks, then I gave up on it - didn't seem to help any more than 50 mg. Vyvanse has triggered this sort of efficiency honey-moon effect at least three times - once on 20 mg, once on 40 mg, and once on 70 mg. However, it was similar to Bupropion IR 300 mg, in that, to me, it did not continue for more than the initial dose. It has always given me sleep issues however.

 

 

I have also, in order to figure this out, not taken either Tianeptine, NSI-189 or Vyvanse today, and am, as a result, absolutely dead tired right now.

 

 

My sleep has been abnormal since I was around 11 years old, and was initially present as impenetrable insomnia - I could sometimes be awake until 5 am in the morning, which was incredibly long for a young child. I then went to sleep however - I never ever did NOT go to sleep. This then corrected itself in time, and I had stable sleep for some time.

 

I've always been morning-tired though, only exception EVER, was when I tried 25 mg Agomelatine for the first time - PERFECT sleep! And an incredibly energy and GREAT mood upon waking in the morning.

 

This effect was however not repeated on second dosing... honey-moon effect, perhaps.

 

 

So... all of you here who have followed me, my writing, my stories, my journey into various substances - what is your judgment? Do I have Bipolar, or not?
 

 

It should be noted that I NEED quick response, because I have, as a result of suspecting this, dropped nearly every medication, even melatonin, only sparing MagLT, because I need to test out the effects of QUETIAPINE - which the Dr. prescribed to me.

 

It is, however, not exactly the worlds most popular medication, for a number of reasons, so I need to know if I should take it or not.

Edited by Stinkorninjor, 20 October 2016 - 07:04 PM.

[PeaceAndProsperity]

The only thing bipolar about you are your diagnoses.

[jack black]

This is a tough one. I didn't know about the sleep issues. I thought it was just recently. With the added info it doesn't look like bipolar, but I'm not a psychiatrist.

Did you try the screening tests online?

Edited by jack black, 20 October 2016 - 10:36 PM.

[Mind_Paralysis]

@RBU: Haha! You know, you've got one weird sense of humour, dude! : D I wish it was that simple though...

 

 

This is a tough one. I didn't know about the sleep issues. I thought it was just recently. With the added info it doesn't look like bipolar, but I'm not a psychiatrist.

Did you try the screening tests online?

 

I tried 50 mg Quetiapine last night, and it did seem to make me sleep somewhat better, didn't wake up once I got to sleep - but, it also wasn't very sedating at all - I'd say Mirtazapine beats it pound for pound when it comes to sleep-potency. I have read that any mood-stabilizing or antipsychotic effects do not occur until you go pass 100 mg though.

 

Actually seems to have had some slight effect on my anxiety and OCD as well - which may imply a deep connection to my sleeping-issues - non-restful sleep is a beast.

I did not feel all that rested when I woke up though... I've been checking the litterature, and there is SOME evidence that it has SWS-increasing effects, but they seem to be weaker than other atypical antipsychotics.

 

Right, I'm going to do the BPII questionaire now, see what the results say.

Attached Files

•  BSDS_21_10_16_.pdf   568.27KB   0 downloads

[Mind_Paralysis]

Right, I've done both the MDQ and the BSDS, and they have some conflicting results - MDQ shows a risk, but BSDS doesn't show enough of a result, imho.

 

You can have a look at my BSDS in the PDF I've attached.

BSDS: 7 (minimum of 10-16)

 

MDQ: 7 (minimum of 7)

 

 

Could my recent problems simply be related to my medications, and the EXTREME stress I was under? What is the result of living a stressful life, like I have? Raised by NPD-parent, stressed because of slow cognition... would this then lead to such extreme changes in mood?

 

I hear this CAN be the case for regular ADHD, but I'm not regular ADHD...

 

 

 BSDS_21_10_16_.pdf   568.27KB   7 downloads

[jack black]

There is no question chronic stress will give you depression and burnout, especially when coupled with poor diet and alcohol. It happens all the time and it happened to me too when I was in university. Some people are more susceptible. I think COMT polymorphism is associated with this.

I guess you could also have disregulated sleep cycle and/or SAD (being in Scandinavia, what's yours vit d3 level BTW?).

My wife has problems with sleep cycle, but gets up early. I even bought a light box, but it didn't do much for her.

[OneScrewLoose]

I don't think your bipolar, I think you have terrible insomnia. If you've been an insomniac long enough, like I was for over ten year, you know being awake for a long time can cause hypomania.

 

What if I told you I might have your silver bullet?

I used to have the most unimaginable insomnia? It would take me a good 3-4 hours of laying down to fall asleep, if I could lay down at all. I'll name just some of the medications I tried to get to sleep: temazepam, mirtazapine, 3 tricyclics, trazodone, benadryl, ativan...there's more and more. First year of college I was up for 40 hours at a time and down for 15. Sometimes after being up for 40 hours, it still took me over an hour to get to sleep. It was miserable. I eventually landed on a combo of Seroquel and Zyprexa, two antipsychotics to get to sleep, they only worked 50% of the time, and made it so it took 3 hours for me to wake up. And then something happened. I developed this tic. I wasn't sure what was going on, I even thought it might be latent Tourette's or something. Thankfully it turned out to be a nervous tic, psychogenic. But I was prescribed clonidine for it. And with that, I started to fall asleep. As my dose went up, because the tic was resistant, so did the quickness in which I fell asleep. By the time I was at 0.6mg, I couldn't even stay awake if I wanted to, I would nod off at my computer. I couldn't believe I had found a solution.

And it made sense. Clonidine agonizes the alpha 2 adrenergic receptor, which reduces the release of norepinephrine. That made sense, it's reducing my mind's and body's activity and forcing me to sleep. Serendipity. But I also wondering why beta blockers weren't more effective in putting me to sleep then. Probably an alpha receptor thing I thought. But what was really strange was the fact that I was finally gaining weight. For 7 years I was 5'11" and would hover around 140lbs. I would force, see myself gain a few pounds, only to watch them disappear again. I become very self-conscious about this, and felt very boyish. There was still a lot of unanswered questions here, but I explained them away as coincidence or placebo. I was just fucking happy to be sleeping and off the anti-psychotics. And anything that was ever an H2 antagonist always left me feeling like shit in the morning. For once I didn’t have to take one!

Over the next 1-2 years the clonidine never lost its effect. It worked 99% of the time, with insomnia 1% of the time. I also finally beefed up to a nice 175 pounds, without trying to hard. I guess I was just at that age to finally gain weight. The brutal insomnia was truly gone.

Well, one day I was doing my usual pubmed crawl and I found something incredible happened. I found a study that showed that, during sleep deprivation (and not normally), the lateral hypothalamus displays alpha-2 receptors! This explained everything! Well, the lateral hypothalamus is the sole location of orexin-producing neurons, one of the macro-regulators of sleep, and a major wakefulness agent of the mind (what modafinil works on). It also controls appetite and weight gain. If these a2 receptors are activated during sleep deprivation, as the clonidine would do, the lateral hypothalamus is shut down, thus shutting down orexin production and knocking me out, as well as changing the dynamics of my weight and appetite.

 

I had a complete explanation at last. Unfortunately, after looking for a while, I could not find the study. I highly recommend giving clonidine a shot if nothing else as worked. Just monitor your blood pressure with each dose increase.

 

[jack black]

Very interesting story. i don't have any sleep issues, but my wife has. she swears by Ambien. i have tons of Clonidine, i bought for ADHD, but didn't work, made me sleepy and tired.

 

now, i thought sleep deprivation makes weight gain (impulsive eating)?

[Mind_Paralysis]

I don't think your bipolar, I think you have terrible insomnia. If you've been an insomniac long enough, like I was for over ten year, you know being awake for a long time can cause hypomania.

 

What if I told you I might have your silver bullet?

I used to have the most unimaginable insomnia? It would take me a good 3-4 hours of laying down to fall asleep, if I could lay down at all. I'll name just some of the medications I tried to get to sleep: temazepam, mirtazapine, 3 tricyclics, trazodone, benadryl, ativan...there's more and more. First year of college I was up for 40 hours at a time and down for 15. Sometimes after being up for 40 hours, it still took me over an hour to get to sleep. It was miserable. I eventually landed on a combo of Seroquel and Zyprexa, two antipsychotics to get to sleep, they only worked 50% of the time, and made it so it took 3 hours for me to wake up. And then something happened. I developed this tic. I wasn't sure what was going on, I even thought it might be latent Tourette's or something. Thankfully it turned out to be a nervous tic, psychogenic. But I was prescribed clonidine for it. And with that, I started to fall asleep. As my dose went up, because the tic was resistant, so did the quickness in which I fell asleep. By the time I was at 0.6mg, I couldn't even stay awake if I wanted to, I would nod off at my computer. I couldn't believe I had found a solution.

And it made sense. Clonidine agonizes the alpha 2 adrenergic receptor, which reduces the release of norepinephrine. That made sense, it's reducing my mind's and body's activity and forcing me to sleep. Serendipity. But I also wondering why beta blockers weren't more effective in putting me to sleep then. Probably an alpha receptor thing I thought. But what was really strange was the fact that I was finally gaining weight. For 7 years I was 5'11" and would hover around 140lbs. I would force, see myself gain a few pounds, only to watch them disappear again. I become very self-conscious about this, and felt very boyish. There was still a lot of unanswered questions here, but I explained them away as coincidence or placebo. I was just fucking happy to be sleeping and off the anti-psychotics. And anything that was ever an H2 antagonist always left me feeling like shit in the morning. For once I didn’t have to take one!

Over the next 1-2 years the clonidine never lost its effect. It worked 99% of the time, with insomnia 1% of the time. I also finally beefed up to a nice 175 pounds, without trying to hard. I guess I was just at that age to finally gain weight. The brutal insomnia was truly gone.

Well, one day I was doing my usual pubmed crawl and I found something incredible happened. I found a study that showed that, during sleep deprivation (and not normally), the lateral hypothalamus displays alpha-2 receptors! This explained everything! Well, the lateral hypothalamus is the sole location of orexin-producing neurons, one of the macro-regulators of sleep, and a major wakefulness agent of the mind (what modafinil works on). It also controls appetite and weight gain. If these a2 receptors are activated during sleep deprivation, as the clonidine would do, the lateral hypothalamus is shut down, thus shutting down orexin production and knocking me out, as well as changing the dynamics of my weight and appetite.

 

I had a complete explanation at last. Unfortunately, after looking for a while, I could not find the study. I highly recommend giving clonidine a shot if nothing else as worked. Just monitor your blood pressure with each dose increase.

 

Cool find! = D Especially because I FOUND THOSE STUDIES A FEW WEEKS AGO...!

 

I noticed my old friend - Intuniv, the drug I never tried, in that study, along with Clonidine. I got so caught up with the list of known SWS-drugs in the review which came to the conclusion that it's SWS-drugs that truly treat insomnia - by making it so that your QUALITY of sleep is enhanced, not the time spent.

 

But what you're saying make a lot of sense... And I've wanted to try Intuniv for YEARS.

 

I guess it's time to try this stuff out... And hey, it's more legal than Gabapentin or Pregabalin!

 

I have enclosed the two studies in this post, for those who may be interested in having a closer look at this stuff. One of the new perks of my course...! Getting straight pass the pay-walls - legit and everything!

 

 

Big cheers for reminding me of this, mate.

 

Neuronal ensembles sufficient for recovery sleep and the sedative actions of a2 adrenergic agonists_nn.3957.pdf

http://www.filedropp...cagonistsnn3957

Attached Files

•  Enhancement of Slow Wave Sleep Implications for Insomnia _jcsm.5.2S.S27.pdf   513KB   3 downloads

[PeaceAndProsperity]

Have you tried lithium orotate and seen how you respond to it?

[Mind_Paralysis]

Very interesting story. i don't have any sleep issues, but my wife has. she swears by Ambien. i have tons of Clonidine, i bought for ADHD, but didn't work, made me sleepy and tired.

 

now, i thought sleep deprivation makes weight gain (impulsive eating)?

 

Not necessarily - sleep-deprivation means hormonal imbalance and cognitive impairment - that can mean weight-loss as well as weight-gain. I was actually a lot like our fellow forumer OneScrewLoose in the past - I had very low body-fat and could never gain weight.

I also had varying degrees of this insomnia-rubbish since the age of 11, which, now that I think about it... was the last time, PRE-antidepressants which I actually had weight-gain, of fat that is.

 

I'm currently undergoing some very uncharacteristic weight-gain, first brought about by Mirtazapine-use 4 years ago, which then resided, but returned big-time following my mirtazapine-use after the burnout.

 

I haven't been sleeping right for close to 20 years, yet only had weight-gain recently.

 

Goes to show, that yeah, it definitely alters weight and hormones, but the end-result depends on your genetic make-up to begin with. My father was the same as me - hardly any body-fat at all.

[Mind_Paralysis]

Have you tried lithium orotate and seen how you respond to it?

 

Haven't tried it, no. Might be an idea for the future though - I'll keep it in mind, cheers for the tip.

 

I'm going to be trying an Alpha-2-Agonist first though - supposedly, I might actually be a PRIME candidate - sleeping issues, AND attention-deficit...! PERFECT!! ^^
 

[Mind_Paralysis]

Very interesting story. i don't have any sleep issues, but my wife has. she swears by Ambien. i have tons of Clonidine, i bought for ADHD, but didn't work, made me sleepy and tired.

 

now, i thought sleep deprivation makes weight gain (impulsive eating)?

 

Can I have some? I'm willing to pay, of course. Clonidine is well-known for causing daytime-somnolence - but less so when combined with AMPHETAMINE! : D

Or even better, if my Dr. finally grants it - Modafinil.

[psychejunkie]

Hi,

I don't think you're bipolar;

you are suffering from long-term insomnia from youth which certainly has changed your neural development for worse.

5HT2A antagonism may help you a lot; but, frankly,  I am not really sure! you can try an OTC drug like Hydroxyzine to find out, but the real deal is Niaprazine.

 

I think you should explain this to your Dr and tell him/her what you really need for better sleep and increasing REM to reverse or repair the damaged neural development.

Also you can try some psychoanalytic therapies (like "active imagination") to find out what had caused your insomnia in young age.

 

good luck

[Godof Smallthings]

I have no opinion regarding diagnosis, just leaving this info for reference about lithium:

Lithium has been shown to stimulate the growth of dendritic spines, which are generally irregular and/or missing in bipolar disorder.

( http://www.sciencema...ental-illnesses )

 

http://www.nature.co...mp2016184a.html

I'm currently trying low dose lithium orotate (5 mg daily of elemental lithium) for a month to see if it seems beneficial.

[Finn]

Decided to put my reply on this thread, don't want to hijack that thread with my post

http://www.longecity...in/#entry798657

 

You certainly gave *me* something to think about here with this as well - could you by chance have a look at my case as well?

--

 

How the h*ll am I going to solve this...? I need both Modafinil, Gabapentin and especially Atomoxetine to function - but they are reluctant to give me ample treatment.

 

Should I just accept their idea that I'm bipolar NOS and try to live as a sick-pensioner for the rest of my life? Because honestly, Quetiapine doesn't help - in any way.

(it should be noted that the evaluation for affective disorders have barely started, I've merely done the first basic essay)

 

On addforums.com there seems to be plenty of ADDers with bipolar II on Strattera or stimulant, even occasional bipolar I on stimulant, so with bipolar NOS, I would imagine that amoxetine can be added back at some point, once proper bipolar medication has been found.

 

 

 

Some of the common sleep aide mechanism are don't seem to do anything for your actual circadian clock, for example antihistamines' H1 antagonism doesn't  seem to do anything to your clock. 

 

 

http://journals.plos...al.pone.0144694

On the Role of Histamine Receptors in the Regulation of Circadian Rhythms

 

The aim of this study was to examine whether histamine mediates its effects on the circadian system through Hrh1 or Hrh3 receptors. We assessed both diurnal and free-running locomotor activity rhythms of Hrh1-/- and Hrh3-/- mice. We also determined the expression of Per1, Per2 and Bmal1 genes in the suprachiasmatic nuclei, several areas of the cerebral cortex and striatum under symmetric 24 h light-dark cycle at zeitgeber times 14 and 6 by using radioactive in situ hybridization. We found no differences between Hrh1-/- and wild type mice in the length, amplitude and mesor of diurnal and free-running activity rhythms as well as in expression of Per1, Per2 and Bmal1 genes in any of the examined brain structures. 

 

 

 

 

Insomnia drugs that don't do anything to your circadian clock might be useful for insomnia where anxiety messes up your sleep but your circadian clock is doing just fine. But if your sleep disorder is of more circadian by origin, then these kind of insomnia drugs are of little value. 

 

 

In lithium we have a true circadian heavy weight contestant

 

https://ahro.austin..../1/15850501.pdf

Low doses of lithium carbonate reduce melatonin light sensitivity in healthy volunteers

 

 

Sensitivity of the pineal hormone melatonin to bright light at night has been posited as a putative marker of affective disorders. Research demonstrates melatonin supersensitivity to light in bipolar disorder, however the role that lithium carbonate plays in this response is unclear. This study assessed the effect of lithium on nocturnal melatonin secretion and sensitivity to light in healthy adults. Ten participants, tested on two nights, had blood samples drawn between 20:00 and 02:30 hours. On testing nights participants were exposed to 200 lux of light between 24:00 and 01:00 hours. Participants took 250 mg of lithium daily for 5 d between testing nights. The results indicated that lithium had a significant effect on sensitivity to light but not on overall melatonin synthesis. This finding has implications on the true magnitude of the melatonin light response in people with bipolar disorder and may elucidate possible mechanisms of action of lithium.

 

Before lithium treatment, melatonin levels collapsed from pre-light to post-light by 55%, after 5 day lithium treatment, melatonin levels didn't collapse, they actually increased by almost 4%, like they usually do at that time of night.

 

 

 250 mg is pretty low dose, considering that apparently most bipolar I patients start on 900 mg or so and some of them go up to 1800 mg, also I think it would take more than 5 days to get to maximum concentration, more like 7, but since they measured lithium blood levels, from research point it was perfectly fine for them to hurry up, but in effect same results might have been achieved with just like 220 mg and longer build up time, so this dose was really small compared to usual bipolar I dose. The 300 mg lithium carbonate tablet is usually round, which probably makes it pretty pill cutter friendly. You could try to get prescription for sub-BPI dose lithium carbonate, and see if that does anything. 

 

Lithium also increases slow wave sleep.

 

http://www.fil.ion.u... wave sleep.pdf

 

 

 

Also sodium valproate seems to have similar effect in this light experiment.

 

http://www.nature.co...l/1300739a.html

Effect of sodium valproate on nocturnal melatonin sensitivity to light in healthy volunteers

 

 

 

 

Overall, especially compared to some other bipolar medication, quetiapine doesn't seem to be really circadian bipolar medication by it's profile. It's affinity on 5-HT2C receptors is rather weak compared to other receptors etc. 

 

 

https://en.wikipedia...ne#Pharmacology

 

 

http://www.sciencedi...028390894900779

 

http://www.sciencedi...00689939800746X

 

 

 

 

http://www.longecity...158#entry798281

 

 

 

  I take melatonin at 21.00 hours, along with Mirtazapine, but it doesn't seem to be enough...

 

I'm thinking I need to start taking melatonin EVEN earlier...! Perhaps take blue-light filtering to the next level, and get some glasses. Some SCT-ers on ADDforums have reported relief from sleep-issues if, and ONLY, if, they go to sleep BEFORE 21.00 hours! Apparently there's something wrong with our circadian rhytms, on a fundamental level - if we don't sleep before these hours, then it doesn't matter if we sleep 10-11 hours - we STILL won't enter deep-sleep...!

 

It's truly aggravating this... Hopefully my Gabapentin shows up soon, because I'm at my wits end with this. In theory, it should do the trick... but in theory, so should Clonidine have, and it wasn't enough! I actually woke up a LOT on that one...! In theory, Alpha-2-agonists are SWS-enhancing, but apparently not enough. (in theory, so is Mirtazapine, but it's not enough for me - higher dosages actually seem to wake me up MORE, from Alpha-2-ANTagonism, d'oh!)
 

 

 

 

Early evening melatonin taken around  5-7 pm supposedly stimulates pineal gland's own melatonin production much more than melatonin taken before sleep 

 

Article in Finnish, though Chrome's English translation seems understandable, also some English articles listed at the end of that article.

 

http://www.etlehti.f...ohtavat-harhaan

 

For me, taking melatonin between 5-7 pm then also before sleep worked at first really well, then I think I got some Advanced Sleep Phase issues from it, though I kept increasing the dose as part of my experiment to see if larger dose would have made things even better, so it could have been the dose increase that messed thing up, not the 5-7 pm time necessarily, maybe if I had kept the early evening dose at 0.5 - 1 mg, things would have been better, or maybe skipping the before bed dose would have prevented those issues, not sure. But individual response varies, so I'm sure plenty of people can do early evening melatonin without issues. You could try that also.

 

http://www.sciencedi...031938496800072

 

Clonidine shortens circadian period in both constant light and constant darkness

 

This one was on rats just like the next lithium one was.

 

http://www.sciencedi...024320580900910

Lithium slows rat circadian activity rhythms

 

https://www.research...53637538ef1.pdf

 

Lithium lengthens circadian period in a diurnal primate, Saimiri sciureus

 

 

http://journals.lww....riod_of.42.aspx

Lithium lengthens the circadian period of individual suprachiasmatic nucleus neurons

 

 

http://www.nature.co...l/1300764a.html

 

Lithium- and Valproate-Induced Alterations in Circadian Locomotor Behavior in Drosophila

 

lithium and valproate share effects on the circadian locomotor activity of Drosophila: they lengthen the period of circadian rhythms

 

 

So in this aspect, bipolar meds lithium and valproate are kinda opposite to clonidine, so clonidine not giving desired results or even being worse than nothing might be expected for bipolar.

 

 

Edited by Finn, 19 December 2016 - 06:50 PM.

[Lia-chan]

Don't you think, that both of us have the same problems with sleeping, just because we live so close to polar cicle?

Even now, in St. Petersburg sun goes up just for a few hours, before it becomes just as dark as b4

And btw I was also thinking, that I might have BD II, but I've never slept less than 8 hours, and I need at least 8 hours to feel kinda normal. In our region, I think that we just have a severe SAD. 

I've found this combo to work for me Sertraline 200mg - Strattera 2x40mg - Bupropion SR 450mg as I've seen, every kind of this drug seems to help you, so I hope you would find this combo useful. I also take a hell a lot of other drugs, but I don't think that they interfere a lot with my meds, anyway (Memantine 3x10mg, Roflumilast, Galantamine Extended Release 16mg,)

Edited by Lia-chan, 19 December 2016 - 09:44 PM.

[Mind_Paralysis]

Decided to put my reply on this thread, don't want to hijack that thread with my post

http://www.longecity...in/#entry798657

 

You certainly gave *me* something to think about here with this as well - could you by chance have a look at my case as well?

--

 

How the h*ll am I going to solve this...? I need both Modafinil, Gabapentin and especially Atomoxetine to function - but they are reluctant to give me ample treatment.

 

Should I just accept their idea that I'm bipolar NOS and try to live as a sick-pensioner for the rest of my life? Because honestly, Quetiapine doesn't help - in any way.

(it should be noted that the evaluation for affective disorders have barely started, I've merely done the first basic essay)

 

On addforums.com there seems to be plenty of ADDers with bipolar II on Strattera or stimulant, even occasional bipolar I on stimulant, so with bipolar NOS, I would imagine that amoxetine can be added back at some point, once proper bipolar medication has been found.

 

 

 

Some of the common sleep aide mechanism are don't seem to do anything for your actual circadian clock, for example antihistamines' H1 antagonism doesn't  seem to do anything to your clock. 

 

 

http://journals.plos...al.pone.0144694

On the Role of Histamine Receptors in the Regulation of Circadian Rhythms

 

The aim of this study was to examine whether histamine mediates its effects on the circadian system through Hrh1 or Hrh3 receptors. We assessed both diurnal and free-running locomotor activity rhythms of Hrh1-/- and Hrh3-/- mice. We also determined the expression of Per1, Per2 and Bmal1 genes in the suprachiasmatic nuclei, several areas of the cerebral cortex and striatum under symmetric 24 h light-dark cycle at zeitgeber times 14 and 6 by using radioactive in situ hybridization. We found no differences between Hrh1-/- and wild type mice in the length, amplitude and mesor of diurnal and free-running activity rhythms as well as in expression of Per1, Per2 and Bmal1 genes in any of the examined brain structures. 

 

 

 

 

Insomnia drugs that don't do anything to your circadian clock might be useful for insomnia where anxiety messes up your sleep but your circadian clock is doing just fine. But if your sleep disorder is of more circadian by origin, then these kind of insomnia drugs are of little value. 

 

 

In lithium we have a true circadian heavy weight contestant

 

https://ahro.austin..../1/15850501.pdf

Low doses of lithium carbonate reduce melatonin light sensitivity in healthy volunteers

 

 

Sensitivity of the pineal hormone melatonin to bright light at night has been posited as a putative marker of affective disorders. Research demonstrates melatonin supersensitivity to light in bipolar disorder, however the role that lithium carbonate plays in this response is unclear. This study assessed the effect of lithium on nocturnal melatonin secretion and sensitivity to light in healthy adults. Ten participants, tested on two nights, had blood samples drawn between 20:00 and 02:30 hours. On testing nights participants were exposed to 200 lux of light between 24:00 and 01:00 hours. Participants took 250 mg of lithium daily for 5 d between testing nights. The results indicated that lithium had a significant effect on sensitivity to light but not on overall melatonin synthesis. This finding has implications on the true magnitude of the melatonin light response in people with bipolar disorder and may elucidate possible mechanisms of action of lithium.

 

Before lithium treatment, melatonin levels collapsed from pre-light to post-light by 55%, after 5 day lithium treatment, melatonin levels didn't collapse, they actually increased by almost 4%, like they usually do at that time of night.

 

 

 250 mg is pretty low dose, considering that apparently most bipolar I patients start on 900 mg or so and some of them go up to 1800 mg, also I think it would take more than 5 days to get to maximum concentration, more like 7, but since they measured lithium blood levels, from research point it was perfectly fine for them to hurry up, but in effect same results might have been achieved with just like 220 mg and longer build up time, so this dose was really small compared to usual bipolar I dose. The 300 mg lithium carbonate tablet is usually round, which probably makes it pretty pill cutter friendly. You could try to get prescription for sub-BPI dose lithium carbonate, and see if that does anything. 

 

Lithium also increases slow wave sleep.

 

http://www.fil.ion.u... wave sleep.pdf

 

 

 

Also sodium valproate seems to have similar effect in this light experiment.

 

http://www.nature.co...l/1300739a.html

Effect of sodium valproate on nocturnal melatonin sensitivity to light in healthy volunteers

 

 

 

 

Overall, especially compared to some other bipolar medication, quetiapine doesn't seem to be really circadian bipolar medication by it's profile. It's affinity on 5-HT2C receptors is rather weak compared to other receptors etc. 

 

 

https://en.wikipedia...ne#Pharmacology

 

 

http://www.sciencedi...028390894900779

 

http://www.sciencedi...00689939800746X

 

 

 

 

http://www.longecity...158#entry798281

 

 

 

  I take melatonin at 21.00 hours, along with Mirtazapine, but it doesn't seem to be enough...

 

I'm thinking I need to start taking melatonin EVEN earlier...! Perhaps take blue-light filtering to the next level, and get some glasses. Some SCT-ers on ADDforums have reported relief from sleep-issues if, and ONLY, if, they go to sleep BEFORE 21.00 hours! Apparently there's something wrong with our circadian rhytms, on a fundamental level - if we don't sleep before these hours, then it doesn't matter if we sleep 10-11 hours - we STILL won't enter deep-sleep...!

 

It's truly aggravating this... Hopefully my Gabapentin shows up soon, because I'm at my wits end with this. In theory, it should do the trick... but in theory, so should Clonidine have, and it wasn't enough! I actually woke up a LOT on that one...! In theory, Alpha-2-agonists are SWS-enhancing, but apparently not enough. (in theory, so is Mirtazapine, but it's not enough for me - higher dosages actually seem to wake me up MORE, from Alpha-2-ANTagonism, d'oh!)
 

 

 

 

Early evening melatonin taken around  5-7 pm supposedly stimulates pineal gland's own melatonin production much more than melatonin taken before sleep 

 

Article in Finnish, though Chrome's English translation seems understandable, also some English articles listed at the end of that article.

 

http://www.etlehti.f...ohtavat-harhaan

 

For me, taking melatonin between 5-7 pm then also before sleep worked at first really well, then I think I got some Advanced Sleep Phase issues from it, though I kept increasing the dose as part of my experiment to see if larger dose would have made things even better, so it could have been the dose increase that messed thing up, not the 5-7 pm time necessarily, maybe if I had kept the early evening dose at 0.5 - 1 mg, things would have been better, or maybe skipping the before bed dose would have prevented those issues, not sure. But individual response varies, so I'm sure plenty of people can do early evening melatonin without issues. You could try that also.

 

http://www.sciencedi...031938496800072

 

Clonidine shortens circadian period in both constant light and constant darkness

 

This one was on rats just like the next lithium one was.

 

http://www.sciencedi...024320580900910

Lithium slows rat circadian activity rhythms

 

https://www.research...53637538ef1.pdf

 

Lithium lengthens circadian period in a diurnal primate, Saimiri sciureus

 

 

http://journals.lww....riod_of.42.aspx

Lithium lengthens the circadian period of individual suprachiasmatic nucleus neurons

 

 

http://www.nature.co...l/1300764a.html

 

Lithium- and Valproate-Induced Alterations in Circadian Locomotor Behavior in Drosophila

 

lithium and valproate share effects on the circadian locomotor activity of Drosophila: they lengthen the period of circadian rhythms

 

 

So in this aspect, bipolar meds lithium and valproate are kinda opposite to clonidine, so clonidine not giving desired results or even being worse than nothing might be expected for bipolar.

 

Thank you for making this post, and taking your time to reply to my post.

 

I have come to the conclusion that it may be best to simply play this game with the pyschiatric care unit and will be trying to suggest a shift towards Olanzapine instead of Quetiapine for my sleep-issues - unlike Quetiapine it's actually got some more significant 5ht2a-antagonistic properties, and have been proven to increase SWS.

 

(since I have become utterly non-functional since the removal of vyvanse and atomoxetine however, I am going to start illegal sources of both Modafinil and ATX soon though! ; ) )

 

I do have some further questions though, which I'd love to hear your thoughts on - do you have any thoughts on my response to antidepressants? The fact that I don't become manic from such high dosages is what makes the BP NOS-diagnosis implausible to me.

 

I am also curious what you think about my response to Mirtazapine? It supposedly partially works oppositely compared to Clonidine, what with the Alpha-2-Antagonism - which is something I definitely noticed when taking dosages higher than 15 mg - I wake up more on Mirtazapine then.

 

How does that add up with your note regarding the potentially circadian-weakening effects of clonidine? Logically, a Alpha-2-antagonist should then strengthen CR, but it seems to be doing the opposite, actually.

 

EDIT:

 

I forgot to mention this - but I've actually tried Mirtazapine before! A few years back I trialled it for insomnia and depression, and I did not notice any increased wakenings when taken - I slept the entire night through.

However, I still woke up with non-restful sleep - I was still dead tired during the day, just less so.

 

The Non-restful sleep is an issue which I've had for a long, long time, it's just been manageable in the past - the burnout worsened it significantly somehow, though.

Edited by Stinkorninjor, 19 December 2016 - 10:19 PM.

[Lia-chan]

You can find Valdoxan (Agomelatine) more useful, than melatonin.

Trazadone AFAIK also works for a hell a lot of people.

Sometimes, when I have mild paranoia, that maybe I have sort of BP-NOS, I just take 200 mg of carbamazepine.

A long time ago, I've also tried Lamotrigine, it just made me feel like my head is somewhere floating away from my body, it's also didn't work for me, I've been on it for 8 weeks. And... I also have Benzodiazepine withdrawal after I've been on medazepam for a month, and memantine is very helpful with it.

Edited by Lia-chan, 19 December 2016 - 10:31 PM.

[Heisok]

Stinkorninjor and Lia-chan for that matter. (Slipping this in before Finn answers your post.)

 

I highly recommend a bright light type therapy for Seasonal Affective Disorder if either of you feel effected by it. Over the last 20 years or so, I have periodically used them as needed. Great help when antidepressants stop working as well in the Winter. I have used 3, and they all have worked. 1 was a philips GoLITE BLU which is a narrow spectrum. I think that one is best served by a white light version. You can search for 10,000 lux white light devices shipped to your area. I think that the ones I used might be discontinued, but if so there would surely be replacements. I used a SunTouch Plus, and an Apollo BriteLITE 6. I still use the Apollo for additional morning light in my work area. Good luck to both of you!

 

 

Edited by Heisok, 19 December 2016 - 10:37 PM.

[gamesguru]

re: insomnia

 

I offer up a study and a quote at 11:30pm, as a pledge of my loyalty.

 

The heights by great men reached and kept were not attained by sudden flight, but they, while their companions slept, were toiling upward in the night. Henry Wadsworth Longfellow
 

Signs of Insomnia in Borderline Personality Disorder Individuals

https://www.ncbi.nlm...les/PMC2576314/

[Mind_Paralysis]

You can find Valdoxan (Agomelatine) more useful, than melatonin.

Trazadone AFAIK also works for a hell a lot of people.

Sometimes, when I have mild paranoia, that maybe I have sort of BP-NOS, I just take 200 mg of carbamazepine.

A long time ago, I've also tried Lamotrigine, it just made me feel like my head is somewhere floating away from my body, it's also didn't work for me, I've been on it for 8 weeks. And... I also have Benzodiazepine withdrawal after I've been on medazepam for a month, and memantine is very helpful with it.

 

I've actually used Agomelatine in the past - I even have a chart here at home. Might try it in a while, since I just ran out of Tianeptine.

I can't really start NSI-189 until I have the needed materials to optimize the effects:

 

Modafinil

Magnesium

Omega-3

 

Oh, and ATX would be lovely too, but Modafinil might be enough to get a good experience, since that was the case in the past. : )

 

BTW, SAD is of course a possibility... but I'm not entirely convinced, I'm not really traditionally depressed, am I? I've got more anxiety and OCD really, which are signs of maladjustment, which is logical if I have SCT - the fact that Atomoxetine helps AT ALL is a sign towards that.

 

It should be noted, that while on ATX, my OCD and Anxiety both saw significant drops, I had at least a 25% improvement in but a few days! That's consistent with other reports from maladjusted SCT and ADHD -individuals, regarding the response to medications.
 

 

I'm at heart a fairly social guy, but feeling the way I feel now, with this crushing fatigue, I just haven't had it in me to be as social as usual - more that I withdraw - a pattern from my childhood.

 

But every time I have forced myself to socialize I notice a definite improvement in mood - positive thinking goes up, and ruminative thoughts go down - in an environment wherein I can just be myself, without demands, I am not as sad, nor as anxious, nor as ruminative.
 

Doesn't sound like Bipolar to me!

Edited by Stinkorninjor, 20 December 2016 - 12:35 PM.

[Mind_Paralysis]

 

re: insomnia

 

I offer up a study and a quote at 11:30pm, as a pledge of my loyalty.

 

The heights by great men reached and kept were not attained by sudden flight, but they, while their companions slept, were toiling upward in the night. Henry Wadsworth Longfellow
 

Signs of Insomnia in Borderline Personality Disorder Individuals

https://www.ncbi.nlm...les/PMC2576314/

 

 

Borderline??

Well, sorry, but that's out of the question - I'm far too stable, and I find the behaviour of the BPD-girls I have been in relations with, utterly inexplicable - I don't understand it, other than on a intellectual level, after a good deal of studies on the subject.

 

Anyways, the study you reported is interesting - because it says, that at least in laboratory-settings, it seems as if BPD-ers actually get MORE Slow-Wave-Sleep than the Paradoxically or typically insomniac patients.

 

That alone, would single me out as not being BPD, don't you think?

 

Still, it brings up the definitive need to do a somnography! We need data on what happens when I sleep.

Something which my partners have brought up, is that I make small twitches, jerky movements when I sleep... I have also noticed this, as I seem to do them when I dream as well - basically, I dream that I get stuck in a pit-fall with one foot, or some such, or perhaps I get a punch to the FACE and I clench my teeth extremely hard - the muscular contraction can in such cases be SO HARD, that it wakes me up.

 

Often I used to fall right back asleep though.

 

Another thing to note - mostly when I wake up during the night, I am dreaming, and I can recall some memories from the dream when I wake.

 

Is there a pattern of some kind of micro-seizures here, or something?

 

 

I've started using 300 mg Gabapentin now - moved up from 150 mg - but it still doesn't seem to be enough... the study which proved that Gaba-P improves SWS also mentioned 600 mg, so starting this evening, I am going to be trying 600 mg Gabapentin as add-on to my regular regimen.

 

I think I might be trying Quetiapine as the primary falling-asleep aid this evening... on the other hand, I should probably stick with Mirtazapine, as otherwise I won't quite know what part does it, if it actually turns out to work.

[Lia-chan]

 

You can find Valdoxan (Agomelatine) more useful, than melatonin.

Trazadone AFAIK also works for a hell a lot of people.

Sometimes, when I have mild paranoia, that maybe I have sort of BP-NOS, I just take 200 mg of carbamazepine.

A long time ago, I've also tried Lamotrigine, it just made me feel like my head is somewhere floating away from my body, it's also didn't work for me, I've been on it for 8 weeks. And... I also have Benzodiazepine withdrawal after I've been on medazepam for a month, and memantine is very helpful with it.

 

I've actually used Agomelatine in the past - I even have a chart here at home. Might try it in a while, since I just ran out of Tianeptine.

I can't really start NSI-189 until I have the needed materials to optimize the effects:

 

Modafinil

Magnesium

Omega-3

 

Oh, and ATX would be lovely too, but Modafinil might be enough to get a good experience, since that was the case in the past. : )

 

BTW, SAD is of course a possibility... but I'm not entirely convinced, I'm not really traditionally depressed, am I? I've got more anxiety and OCD really, which are signs of maladjustment, which is logical if I have SCT - the fact that Atomoxetine helps AT ALL is a sign towards that.

 

It should be noted, that while on ATX, my OCD and Anxiety both saw significant drops, I had at least a 25% improvement in but a few days! That's consistent with other reports from maladjusted SCT and ADHD -individuals, regarding the response to medications.
 

 

I'm at heart a fairly social guy, but feeling the way I feel now, with this crushing fatigue, I just haven't had it in me to be as social as usual - more that I withdraw - a pattern from my childhood.

 

But every time I have forced myself to socialize I notice a definite improvement in mood - positive thinking goes up, and ruminative thoughts go down - in an environment wherein I can just be myself, without demands, I am not as sad, nor as anxious, nor as ruminative.
 

Doesn't sound like Bipolar to me!

 

For me, atx took a few weeks, just to start working and I had almost classic feeling, like the time just have stopped for me, so I'm able to do a hell a lot more things every day and now I'm able to do a lot more work everyday. I know, how that feels to withdraw from the society, because of fatigue. I also recommend you to try Lamotrigine for a few days or maybe weeks, so you can be sure, that you don't have BP-II. There is a thing, called Bipolar Anxiety, it's absolutely diffrent feeling than just classic GAD, so by doing this you'll able to kill two rabbits at once. And I also have the same jerky movements and teeth grinding, that my parents and my bf can notice while I sleep, but I rather blame my RLS that causes me a lot of problem. 

I also think that Quetiapine is a death sentence for someone, who has ADHD.

I've tried Tiapridal once and my impulsivity went sky-rocket and I couldn't concentrate on anything, that was a VERY traumatizing event, even now after half-a-year I still have severe flashbacks that give me a lot of cold chills.

[Mind_Paralysis]

Success!! : D I tried 600 mg Gabapentin this evening, and I did NOT wake up even once!

 

However, I didn't feel all that rested and energetic when I got up... but that may be from Mirtazapine, which always makes me tired anyway. It'll be very interesting to use this combo with Modafinil, when I get it (hopefully today!) and ATX.

 

What would everyone suggest as a sleep-onset-aid instead of Mirtazapine btw? I'm thinking Guanfacine, personally.

[Finn]

 

 

I do have some further questions though, which I'd love to hear your thoughts on - do you have any thoughts on my response to antidepressants? The fact that I don't become manic from such high dosages is what makes the BP NOS-diagnosis implausible to me.

 

I am also curious what you think about my response to Mirtazapine? It supposedly partially works oppositely compared to Clonidine, what with the Alpha-2-Antagonism - which is something I definitely noticed when taking dosages higher than 15 mg - I wake up more on Mirtazapine then.

 

How does that add up with your note regarding the potentially circadian-weakening effects of clonidine? Logically, a Alpha-2-antagonist should then strengthen CR, but it seems to be doing the opposite, actually.

 

EDIT:

 

I forgot to mention this - but I've actually tried Mirtazapine before! A few years back I trialled it for insomnia and depression, and I did not notice any increased wakenings when taken - I slept the entire night through.

However, I still woke up with non-restful sleep - I was still dead tired during the day, just less so.

 

The Non-restful sleep is an issue which I've had for a long, long time, it's just been manageable in the past - the burnout worsened it significantly somehow, though.

 

 

Stahl's Essential Psychopharmacology (4th edition May 2013, so maybe now there are more than 8 sub types ) lists 8 different sub types of Bipolar NOS, of those 8, only 2 go up to mania easily. Apparently plenty of people on bipolar spectrum don't get up to mania easily, some don't get even up to hypomania but peak somewhere between normal and hypomania,  etc.

 

I couldn't find any article of mirtazapine's or any other alpha 2 antagonists effect on circadian cycle length, so not sure about that.

 

In circadian disorder articles, generally pretty much the only three pharmaceutical solutions are mentioned, melatonin, other melatonin agonists and lithium, so while plenty of substances might have some little effect, those three seem to be in their own league.

 

When it comes to waking up and falling a sleep again, I think knowledge of 8 hour continuous sleep being unnatural anyway, made falling asleep again easier for me. "First and second sleep" pattern didn't get eradicated until 18th century. Now if I wake up, rather than thinking of how my sleep was ruined by discontinuity, I try to think that now I have opportunity to have first and second sleep that is as good if not better than continuous sleep, and fall asleep again more easily.

http://www.bbc.com/n...gazine-16964783

Edited by Finn, 21 December 2016 - 09:50 PM.

[Finn]

It should have been 19th century rather than 18th century in that previous post. 

 

Anyway, 200 years ago majority of people were still sleeping in some kind of "first sleep and second sleep" pattern rather than continuous sleep. 

[Mind_Paralysis]

It should have been 19th century rather than 18th century in that previous post. 

 

Anyway, 200 years ago majority of people were still sleeping in some kind of "first sleep and second sleep" pattern rather than continuous sleep. 

 

I gotta' thank you for finally getting me to check out Stahl's Essential Psychopharmacology! I've known about it for at least a year, but I have as of yet not bothered to check it out - definitely a great tool for learning psychiatry.

 

However, looking at the various forms of BP Stahl describes, I find myself somewhat skeptical about some of the forms... specifically BP 3.5 wherein substance-abuse is used to trigger mania - seems a bit of an oxymoron, since nearly everyone becomes manic from abused substances like cocaine or alcohol.

 

Anyways, the form of BP Stahl describes which I identify with, is... BIPOLAR 6!

Bipolar disorder in the presence of... Dementia.

 

 

Another subcategory within the bipolar spectrum may be “bipolarity in the setting of dementia,” termed bipolar VI. Mood instability here begins late in life, followed by impaired attention, irritability, reduced drive, and disrupted sleep. The presentation may initially appear to be attributable to dementia or be considered unipolar depression, but it is likely to be exacerbated by antidepressants and may respond to mood stabilizers.

 

 

My mood became unstable in recent years, my drive became reduced, and my sleep became more disrupted than ever.

 

However... it doesn't seem plausible that I have dementia - I'm just way too young! Of course, it could be Alzheimers Early-Onset, but the only dementia we have in our family, on my fathers side, is FTD - fronto-temporal Dementia, and my Grandmother, who was struck with the disease, did not show symptoms well into her late 60's.

And as I understand it, although 20% of all of the early-onset dementia is caused by FTD, the disease has never been recorded in anyone below the age of 40 - which is interesting, because even though Alzheimers accounts for not as many early onsets, it HAS been recorded below the age of 40.

 

 

Btw, I've read that article regarding sleep being partitioned into two sections in historic life, but I was never quite convinced... it mentions mostly agricultural life, and that isn't necessarily a NATURAL way of life for humans - we are, after all, hunter-gatherers at heart, NOT farmers - however, you have convinced me that I should not focus too much on if I wake up once during the night, but about how rested I feel when I wake up - feeling rested upon waking should be the focus.

 

And I actually think I might be feeling more rested thanks to Gabapentin! Still, it's early, so we'll see how it goes - it might be placebo right now - as well as MODAFINIL - I woke up feeling rested this morning, after three days of using 100 mg Modafinil! : D It's certainly more of a notch towards me having some form of arousal-disorder, since that appears to be a key-feature of many cases of Idiopathic Hypersomnia, or "sub-treshold" Narcolepsy - they never feel rested even though they sleep excessively.

 

 

Edited by Stinkorninjor, 25 December 2016 - 01:56 PM.

[pecanpie]

A lot of Doctors think of Bipolar disorder as a spectrum disorder although that is not the official stance of the committee that complied the DSM-V. However, if you buy the concept then the question since you've been treated for depression should be "how bipolar are you?" 

 

This page tries to answer that question, 100 point scale developed at Harvard.

http://psycheducatio...ty-index-table/

 

And this page goes deep into the concept of bipolar as a spectrum disorder.http://psycheducation.org/