Posted by ed_uk2010 on February 15, 2015, at 13:09:26
In reply to Re: Depression vs. 'negative' psychotic symptoms » ed_uk2010, posted by Tomatheus on February 14, 2015, at 21:52:11
Hi Tom,
>I was initially wary of taking vitamin D3 because I had noticed what seemed to be a worsening of my psychotic symptoms when I tried taking it previously when I wasn't taking any antipsychotics.
Do you think it was related? Side effects seem possible if you were taking doses which were grossly in excess of normal physiological requirements over a prolonged period of time, but that doesn't appear to be the case. The body can manufacture thousands of units of D3 per day when adequate areas of skin are exposed to the summer sun... or at other times of year near the equator.
>So, I've been taking vitamin D3 (which doesn't worsen my psychosis when taken with Abilify) consistently now for a little more than a year, although I've only been at my current dose of 3,600 IU for what I'd guess to be three to four months.
Although it's impossible to be certain without a blood test, your regimen is consistent with what is likely to be an adequate replacement dose for the treatment of proven deficiency. Do you know how severe your deficiency was?
Recently, several D3 products have been officially approved in the UK. Doctors can prescribe these medicines to treat deficiency. Prior to this, unlicensed vitamin supplements were prescribed, and such products are still widely purchased of course. (None of the popular over-the-counter vitamin D products are approved/licensed medicines, they are exempt as food supplements).
The approved capsules have the following official dosage recommendations for treating biochemically proven deficiency states in adults:
3200 units daily for up to 12 weeks, followed by a maintenance dose, if appropriate.
2 x 20 000 unit capsules (total 40 000 units) WEEKLY for 7 weeks, followed by a maintenance dose...... (This is equivalent to taking around 5000-6000 units per day for 7 weeks).
The suggested maintenance dose depends on the product, but for all products is between 800 units and 2000 units per day. I suppose a few people may require more than 2000 units/day for maintenance after full correction, but presumably not many.
There is a tendency to prescribe 800 units per day for people who are not deficient, but where it's important to protect against deficiency eg. in osteoporosis. Higher maintenance doses eg. 1600 units to 2000 units per day are more likely to be chosen for those with recent severe deficiency which has been corrected.
I believe the vitamin D council suggests 5000 units/day on a long term basis. This seems a lot for routine use. I find it difficult to imagine that most people would require so much for maintenance treatment. For sure, you can use high doses to treat deficiency, including huge 'one off' doses, but once the blood level is normal, smaller amounts should normally keep it that way. D3 appears to be well absorbed orally, especially when taken with something fatty. Very high oral doses may sometimes be needed in those with disorders causing fat malabsorption eg. cystic fibrosis.
So, if you can get a blood test from your doctor, I would definitely do so and adjust your dose accordingly. If you can't, maybe reduce to a lower maintenance dose when your current pack runs out. Maximum improvement due the D3 has probably occurred. If possible, get at CBC etc at the same time.
>I was 20 when my depressive symptoms first surfaced and 27 when the psychosis and likely mania emerged.
In men, schizophrenia with severe negative symptoms and a bad prognosis usually has an earlier onset, with psychosis well before 27. Women often have a later onset. Psychosis with a later onset, like yours, usually has a better prognosis and mild/moderate negative symptoms. This doesn't make it any less distressing, unfortunately. Those with severe mood disturbances during psychosis (eg. schizoaffective disorder) may be very agitated while unwell, but even so, the prognosis is generally somewhat better than schizophrenia without affective disturbance. In schizoaffective-type illness, the response to 'mood stabilisers' is usually poor when compared to bipolar disorder, but the response to APs is often good... and may be better than in schizophrenia. I think you do right to continue low-dose Abilify. You seem to have found a dose which provides good control of psychosis and relapse prevention without too many side effects. Although you have some residual psychosis-like phenomena, attempts to suppress these with higher doses of APs might lead to more side effects rather than any great benefit. Furthermore, it doesn't appear that these symptoms are very problematic in comparison to your depressive-like amotivational symptoms.
>As far as the extent to which my psychosis might drug-induced is concerned, I was taking tranylcypromine with SAM-e
I don't know whether SAM-e or aminoguanidine would truly represent the problem, but tranylcypromine is dopaminergic and as a result, I assume it presents a risk of inducing psychosis, mainly in those who are biochemically predisposed to it. Others on p-babble have reported psychosis on MAOIs. I think you should avoid all dopaminergic drugs and stimulants based on your past history. They may produce a brief period of stimulation, but this could be followed by a psychotic relapse.
>Toxoplasma gondii infections.
Are you seropositive for toxoplasma antibodies? And have you had a cat? Mind you, a very high percentage of the US population show serological evidence of past infection, so such tests may not be very revealing.
>I'm avoiding taking more SNRIs and TCAs because Cymbalta and Anafranil left me feeling quite agitated and irritable.
Was Cymbalta very different to the SSRIs for you? How long did you take it for?
>I experienced extreme rage and aggression following ingestion of a single dose of mirtazapine and did not take any more of the stuff.
A yohimbine-like agitation.
>I suspect that it might be the NRI actions of Anafranil and Cymbalta that led to the agitation and irritability that I experienced on those medications
It certainly could be. It's difficult to assess. Your reaction to SSRIs suggests they can produce mood instability... I don't know whether the NRI effect of Cymbalta was a problem in its own right, or whether its combination with the SRI property was bad for you. Anafranil is more complex because it hits so many different receptors.
Was your response to Anafranil very similar to your response to Cymbalta, or different?
>but desipramine might be something to consider
Cautiously, perhaps. You're well aware of the possibility of side effects. NRIs can produce a 'start up' agitation in some people, which tends to pass as the brain adapts and the resulting AD effects begin. The agitation may be less likely to pass in those with bipolar tendencies, but Abilify might keep you stable. I'd mainly be concerned about you trying anything likely to induce psychosis, especially in the absence of an AP. I don't think desipramine is a huge risk in that respect, unless it induced mania. I would be more concerned if you experienced a worsening of psychosis on Anafranil or Cymbalta. You've not mentioned that though. It's awful to feel agitated though, so I fully understand why you feel wary.
>I've responded differently to fish oil during different stages of my illness.I think many of the possible benefits would not occur until you'd been taking it for several months. Perhaps you could consider a balanced EPA/DHA formulation, and spread the doses out across the day, with meals, rather than taking loads at once? I've started to spread my doses out to try and mimic a natural high-fish diet.
Take care.
poster:ed_uk2010
thread:1076218
URL: http://www.dr-bob.org/babble/20150129/msgs/1076669.html