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Acute adult ADHD together with Bipolar one Disorder request for Fentanyl

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Hello
I'm Paul I suffer acute adult ADHD together with bi polar one and various mood disorders but if it takes all the money in the world to get to dr"s, I'm lazy down agitated even after 15mg Diazipam and take it NOTHING I can do I screw up and get more agitated.
Current meds

Fentanyl 75mcg 10 x patch(2 boxes)
Diazipam, 10 mg 3 times a day but prn after re booing
Gabipentine 300mg
Venlafaxine I'm on 75mg want increase back to 150 mg felt much better
Once the partner of the practice said top up and
Zolpidem 10mg nite x 1 prn
Sodium valproate 1200mg nitex4
Olanzapine changed from quatiapine
But the meds are showing clear side effects whilst rotting in my house and dog I'm after telling them to shuff their chemicals where the sun don't shine you are treated like a criminal the fact your on cd"s but fentanyl has been a life saver to me and pain level and I'm asking for fentora pills costs big bucks but then I won't have the benefit waking up in pain, so pain management I THOUGHT INSTEAD OF 10 75mcg patches and prn the rest for when neededr


Category: Family Physician-GP

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Category: Sexologist
Dr. Srikanth Reddy is online now

Expert:  Dr. Srikanth Reddy replied 4 Days.

Hello,

Thank you for your query at DoctorSpring. I have gone through your query in detail and I can understand what you are going through.

A diagnosis od adult ADHD with Bipolar mood disorder is certainly difficult to live with but then you should strive to live the best possible life with medications.

I have gone through your medications and you certainly needthe pain killers for you chronic pain and fentanyl patches seem to be working well for you.
Regarding your antidepressant, your dose of venlafaxine (75mg) is too low and you certainly need to increase the dose to atleast 150mg.

Olanazpine is a good anti psychotic as well as amood stabilizer and works on depression as well. Its good that you are on olanzapine.

Regarding your diazepam, the dose seems to be slightly high and with time you may get addicted to it. Zolpidem is a good choice in this context and 10 mg at night should give you a good sleep.

Along with all these medication you should consider adding some psychotherapies in your treatment plan. Cognitive behavioural therapy will be apt for you and you should give a serious thought for it.

Hope that helps, please feel free to discuss further.
Wish you good health
Regards
Dr. Srikanth Reddy


Patient replied :

Hi Dr Reddy
I agree with the need to raise my venlafaxine at least to 150mg but speaking to my case worker, they try and keep the venlafaxine down incase it brings on mania because of the bi polar, but i do know what 150mg feels like and i feel it should be ajusted, but i will chat to my consultant in a few weeks, it might be that i have to order and pay for myself.
About the Acute adult adhd, would you ever consider using ritalin for this disorder and what dose to start ? i was offered it at one point but nothing came to it.
can you think of a very quick onset pain medication that when im out and in terrible pain close to tears i could take, the dihydrocodeine 60mg works, but NOT when i have made the odd night out, i find i have to leave very early and its ruining my social life, any names and doses would be great. thanks again Paul


Expert:  Dr. Srikanth Reddy replied 3 Days.

Hello,

Thanks for the follow up query.

Among bipolar mood disorder as well if you are on mood stabilizer then you need not worry about 150 mg of venlafaxine. Many patients in my clinic are on 150 mg venlafaxine without any problem.

Coming to the use of ritalin in adults, its not one of the preferred drugs in adults.

Regardin your query about painkillers , in india we use a lot of diclofenac for sos pain relief and is very effective in the dosage of 50 mg. However I wont be able prescribe you diclofenac on email without physically examining you.

Regards
Dr. Srikanth Reddy MD


Dr. Srikanth Reddy
Category: Sexologist
Experience: 
Doctor of Medicine (MD), Psychiatry Residency Program,2001 – 2012
M.B.B.S,Mahatma Gandhi Institute Of Medical Sciences, Sevagram

Certificate Course in sex Therapy and Counselling, Sexology and Counselling, A
Sexology,Medikon Sexual Sciences, Mumbai

Training in Advanced Neurology at a leading corporate hospital (CARE hospital) in Hyderabad

Child Psychiatry Training in National Institute of Mental Health and Neuro-Sciences, Bangalore

Sex Therapy and Counsellingat MEDIKON Sexual Sciences, Mumbai.
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