Q. I’m a 50 year old woman diagnosed with both Bipolar II and ADHD. I was first diagnosed as bipolar 11 years ago, after years of being diagnosed with treatment resistant major depression. Although adding a mood stabilizer to my meds seemed to be a promising start, within a year I was assigned to a different psychiatrist, who decided that all of my hypomanic episodes had been medication related, and that I was not truly bipolar. So it was back to treatment resistant major depression, and 6 years of varying combinations of pretty much every non-MAOI antidepressant on the market. During those years, I was impaired enough that I was unable to work, and had trouble functioning at all. This culminated in my children being removed from my custody and my becoming homeless, followed shortly by a serious suicide attempt resulting in hospitalization. Luckily the doctor at the hospital recognized my mixed state for what it was and started me on a regimen of Wellbutrin and Lamictal. Aside from occasional seasonal lows, with some dosage adjustment my moods have been stable since, and I now have custody of my youngest child and work full time.
I have also struggled with anxiety issues and PTSD in the past, though neither is a huge factor in my life right now. I also have ADHD, however, which is fairly well managed with Adderall XR. In addition I take Topomax for migraine prevention. My one ongoing problem is insomnia/daytime drowsiness. My sleep has pretty much always been disordered, and even with my other concerns under control my life is fairly severely impacted by this.
I have tried removing all stimulating medications from my regimen and replacing them with less activating ones (Strattera, various SSRIs), which only leaves me more tired, more symptomatic, and still unable to sleep. I have not responded to Ambien, Lunesta, or Rozerem, and will not take sedating anti-psychotics or tricyclics, as they cause me excessive weight gain and mental dullness. Because I am more likely to feel awake at night and sleepy during the day I currently work third shift, but this is an imperfect solution at best, and I still have periods of 36-48 hours of sleeplessness most weeks, followed by massive drowsiness for 24-36 hours. At its most regular, my sleep cycle rarely includes more than 4 hours of uninterrupted sleep, and it takes hours to get to sleep in the first place.
I don’t believe my mental health issues can be said to be truly under control unless I am finally able to actually sleep on a regular schedule, but the only meds that really work for me are benzos (Xanax in particular), and my prescriber has a policy against prescribing them, even though I have no history of substance abuse. What is going on with me, and what can be done? Do I need better control of my bipolar disorder, or is this a separate and potentially incurable problem?
A. I would suggest, as I do for most people who take medication as their only form of treatment for their mental health issues, that you consider therapy. Medications can be a blessing for many people but rarely is medicine alone found to be a fully comprehensive treatment. Therapy can be extremely effective in decreasing your symptoms of ADHD as well bipolar disorder.
With regard to your disturbed sleep, medication may be part of the reason why you don’t sleep well. It might also be that your psychological conditions are not under control, as you suspected and that may partly explain your sleep disturbance. Hypnosis, under the treatment of a trained and skilled professional, is one method you can try to improve your sleep. It might also help with aspects of your bipolar disorder.
The task for you is to expand your treatment options. Medication-only usually is not very effective and counseling needs to be considered.
Thanks for your question.
Last reviewed: By John M. Grohol, Psy.D. on 20 Oct 2008
Randle, K. (2008). Bipolar Disorder Need Controlled or Separate Problem?. Psych Central. Retrieved on March 11, 2014, from http://psychcentral.com/ask-the-therapist/2008/10/20/bipolar-disorder-need-controlled-or-separate-problem/