![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by LouisianaSportsman on May 1, 2014, at 2:13:32
TL;DR:
_________________________________________________
I've posted my massive combo of meds before:Brintellix (vortioxetine) 20mg
Desoxyn (methamphetamine) 30mg.
**Lamictal XR (lamotrigine) 200mg.
Latuda (lurasidone) 60mg.
**Gralise (gabapentin) 1,800mg.
**Nuvigil (armodafinil) 300mg
Trodenki XR (topiramate) 200mg.
**Xanax XR (alprazolam) 1.5mg.I prefer going every two weeks. She also doesn't feel comfortable getting the Desoxyn script filled. These are the changes we're making:
Brintellix (vortioxetine) 20mg
Dexedrine (dexamphetamine) 60mg.
Latuda (lurasidone) 60mg.
Trodenki XR (topiramate) 200mg.
Klonopin (clonazepan) 1.5mg.We spent about an hour and determined that it would be best to have one mood stabilizer (never noticed Lamictal do anything) so we're going with Topamax XR that augments well with weight gaining AAP, Latuda 60mg. Thanks to this mood stabilization, it allows the addition of an antidepressant, Brintellix. We have to change the Desoxyn back to Dexedrine as my stimulant (insurance letter), and we decided that the Nuvigil high dose was overkill per insurance company. She said that I will be able to augment medications in the future depending on how they react with my current medications, such as desipramine.
BASICALLY! The insurance company sent a letter to her advising her to monitor all of my medications more closely and that they would do their own independent evaluation if changes were not made. I think it has something to do with the Desoxyn. The insurance company also has a signed note by a professional PDOC.
__________________________________________________My PDOC is open to me trying any AAP in place of Latuda because want to find the best one. The only other AAP I've been on is Abilify, and I thought it was OK.
I was thinking:
Sapris (heard lots of good things about it)
Zyprexa Zydis (hopefully be less weight heavy and I won't gain weight since I'm on Topamax and Adderall. Belviq is always an option if it super effective)
Clozaril (how dangerous is it? I don't think my PDOC would let me go get blood tests so it wouldn't be a hassle)
Invega
Thoughts?
Posted by Louisiana Sportsman on May 1, 2014, at 3:35:16
In reply to Reducing meds. PDOC advise trial of any AAP Ideas?, posted by LouisianaSportsman on May 1, 2014, at 2:13:32
Since, I was admitably a fan of Abilify (turned into a Latuda fanboy when I switched). My PDOC mentioned this injection of 400/300mg./month. She told me that she would be able to administer it herself.
I've done a lot of digging around and I truly believe no doubt that Latuda is the best monotherapy or add on to a mood stabilizer for BP patients not taking an antidepressants. Hands down.
However, I think Abilify might boost the Brintellux more. And, I'm back down to a healthy weight and I think I could prevent aripiprazole's weight gain with topiramate and high dose dexamphetamine. If it comes down to it, I will get Belviq.
But, I've always said Latuda was missing something that Abilify had, that's why I said 80% in terms of symptoms, but I always strongly suggested Latuda because it's much, much more healthy.
Are there any benefits to an injection over an oral pill?
Posted by Louisiana Sportsman on May 1, 2014, at 6:17:28
In reply to Reducing meds. PDOC advise trial of any AAP Ideas?, posted by LouisianaSportsman on May 1, 2014, at 2:13:32
I read the article in my Essentials of Clinical Pharmacology book and the side effects of clozapine are just too much. :O
Highly suggest the book. You can get it from $100 used to $140 new I believe. Stahl has good books from $45-$130. I think my copy of the old edition was about $80.
Posted by Phillipa on May 1, 2014, at 9:31:12
In reply to Nvm to clozapine, posted by Louisiana Sportsman on May 1, 2014, at 6:17:28
First the insurance letter is this one of the new ways the government is taking control over what they consider to be unnecessary meds? Second I didn't know you were bipolar. Do you tend toward depression or mania? Also the advantage of an injection over a pill is that it is in your system and one less thing to remember to take. Phillipa
Posted by Louisiana Sportsman on May 1, 2014, at 12:38:00
In reply to Re: Nvm to clozapine » Louisiana Sportsman, posted by Phillipa on May 1, 2014, at 9:31:12
> First the insurance letter is this one of the new ways the government is taking control over what they consider to be unnecessary meds? Second I didn't know you were bipolar. Do you tend toward depression or mania? Also the advantage of an injection over a pill is that it is in your system and one less thing to remember to take. Phillipa
Yes, the insurance letter was very interesting. I believe the DEA is monitoring my Desoxyn scripts and Xanax XR. The letter said I was on too many sympathetic agents and redundant medications.
We plan on defying the letter. She is changing my Xanax XR r to Klonopin 0.5 3X a day next time she advised.
My PDOC suggested Oxtellar XR as well as Sunovion, the makers of Latuda, own Aptiom. Oxtellar XR is time-released oxcarbamazepine. Aptiom is eslizcarbazepine, which is a metabolite of the oxcarbamazepine.
Tegretol/Equetro --> Trileptal --> Oxtellar XR --> Aptiom.
We're cutting Lamictal. I thought Aptiom may be a good choice for a mood stabilizer-- the target dose is 800mg./daily and they make a 800mg. pill. ++ I think they did a great job with Latuda lol.
I imagine my combo will be something this 80% sure. See, it's not nine different meds anymore! It's "cleaner" now IMO. I am thinking about about adding Kapvay and memantine and desipramine to make it nine again, but the whole letter messed it up. I might just leave if as if is...
Dexedrine IR (dexamphetamine) 60mg.; [#180 10mg.]
Aptiom (eslicarbazepine) 800mg. QPM
Brintellix (vortioxetine) 10mg.; QAM
Latuda (lurasidone) 60mg..; QHS
Troendki XR (topiramate) 200mg. QHS
Klonopin (clozapam) [#90 0.5mg.] PRN
Posted by Louisiana Sportsman on May 1, 2014, at 12:45:30
In reply to Re: Nvm to clozapine, posted by Louisiana Sportsman on May 1, 2014, at 12:38:00
HOW DID I FORGET ALL THESE TIMES
I GOT #30 OLEPTRO 300mg.
FINALLY
RIGHT NOW
mind blank
add that
--- seven meds
Posted by Louisiana Sportsman on May 1, 2014, at 12:51:35
In reply to FORGOT I GOT OLEPTRO 300MG. Lol, posted by Louisiana Sportsman on May 1, 2014, at 12:45:30
> HOW DID I FORGET ALL THESE TIMES
>
> I GOT #30 OLEPTRO 300mg.
>
> FINALLY
>
> RIGHT NOW
>
> mind blank
>
> add that
>
Brintellix (vortioxetine) 20mg
Dexedrine (dexamphetamine) 60mg.
Latuda (lurasidone) 60mg.
Oleptro ER (trazadone) 300mg.
Trodenki XR (topiramate) 200mg.
Klonopin (clonazepan) 1.5mg.---- in two weeks I'll be getting Aptiom 800mg. Unless any one stops me (Erick SLS ed Klein there's more) and I can pick any AAP
Posted by klein on May 1, 2014, at 14:09:24
In reply to Reducing meds. PDOC advise trial of any AAP Ideas?, posted by LouisianaSportsman on May 1, 2014, at 2:13:32
Hey L.,
What are the symptoms you currently want to treat?
Most depot injections don't keep the drug's levels as steady as regular dosing. Depots are useful for noncompliant patients or stabilized patients with severe disorders that have reached some level of remission and have a daily outpatient routine (those who do monthly checkups etc). In most cases, I''d think that the only advantage is to save you from the hassle of taking an extra pill.
All that aside, it could be worth a try if you've already taken Abilify at a steady dose for several months with good results. Otherwise... personally, I wouldn't go for it, as my experience with Abilify ranged from miraculous to disastrous. Due to it's "modulating" effect, my dose had to be tweaked constantly, ranging from 1mg to 25mg and then back down to 4, later back up to 10 etc etc.
You may know that I'm a mirta/mianserin fan, lol so I've gotta say: Definitely consider giving Saphris a try. YMMV of course but I think it's a wonderful med. It knocks me out cold for 5-8 hours (dose dependent) of deep, restful sleep and I wake up feeling motivated and energetic. It basically feels like a tetracyclic, it inherited a big chunk of their pharmacology, but without the heavy sedation and weight gain (weight loss is common on this drug). *sigh* Organon is sorely missed =/ If you decide to try it, do ask for the black cherry flavored pill, the regular one tastes horrible.
Depending on your symptoms, maybe you shouldn't rule out clozapine. It could be very helpful. I've noticed this trend where the first med of a new generation of drugs is usually much maligned. Imipramine, fluoxetine (I know, not technically the 1st SSRI but in "pop" culture at least), clozapine, Thorazine, Valium (again, not tecnhically), venlafaxine (again) and so on. Clozapine does have heavy-handed side effects and risks, but so do all psychotropics on the market. regular tests should put you at ease.
HTH, warm regards.
Posted by klein on May 1, 2014, at 14:11:38
In reply to Reducing meds. PDOC advise trial of any AAP Ideas?, posted by LouisianaSportsman on May 1, 2014, at 2:13:32
Posted by Louisiana Sportsman on May 1, 2014, at 14:11:57
In reply to Re: FORGOT I GOT OLEPTRO 300MG. Lol, posted by Louisiana Sportsman on May 1, 2014, at 12:51:35
I will prolly stay on Latuda (she has Saphris samples too) Brintellix and Trokendi XR as I HAVE never had to pay for them. She keeps all the samples in a separate locked closet in her office and always tells me she can get more some because she "likes me; smartest patient in her career". She just doesn't want me addicted to benzodiazepines, AKA Lyrica Part Two, but we know it may be inevitable except I haven't exceeded my dose. She was down to write Gabitril, but that letter halted that.
Posted by Louisiana Sportsman on May 1, 2014, at 14:14:40
In reply to ziprasidone is a good one too! (nm) » LouisianaSportsman, posted by klein on May 1, 2014, at 14:11:38
ziprasidone is really cheap anything under $50 or so ain't a big deal, I just don't like it as much because it seems "dirty" if that makes sense. I just might halt the Latuda train for a trial of it.
Posted by Louisiana Sportsman on May 1, 2014, at 14:17:40
In reply to Re: Reducing meds. PDOC advise trial of any AAP Ideas? » LouisianaSportsman, posted by klein on May 1, 2014, at 14:09:24
AWESOME POST dentist appointment at 3:00. Gotta leave work And drive, but I'll try to use my phone. Perfect.
Posted by phidippus on May 1, 2014, at 14:34:01
In reply to Reducing meds. PDOC advise trial of any AAP Ideas?, posted by LouisianaSportsman on May 1, 2014, at 2:13:32
Clozaril can kill all your white cells and/or give you a heart attack. Blood tests are mandatory and you're put on a registry. This would be overkill anyway.
I would recommend Invega.
Eric
Posted by klein on May 1, 2014, at 14:57:34
In reply to Reducing meds. PDOC advise trial of any AAP Ideas?, posted by LouisianaSportsman on May 1, 2014, at 2:13:32
> Brintellix (vortioxetine) 20mg
> Desoxyn (methamphetamine) 30mg.
> **Lamictal XR (lamotrigine) 200mg.
> Latuda (lurasidone) 60mg.
> **Gralise (gabapentin) 1,800mg.
> **Nuvigil (armodafinil) 300mg
> Trodenki XR (topiramate) 200mg.
> **Xanax XR (alprazolam) 1.5mg.That's a bunch of meds, but it's hardly an alarming selection...
More than the Desoxyn, maybe they found the Lamictal, Topamax, Gralise and, to a certain extent, the Xanax combination a bit strange, as they're all pretty similar (not really but you know what I mean).
Did she contact the insurance co. to find out what exactly caught their attention?
Posted by Louisiana Sportsman on May 1, 2014, at 15:05:46
In reply to Re: Reducing meds. PDOC advise trial of any AAP Ideas? » LouisianaSportsman, posted by phidippus on May 1, 2014, at 14:34:01
> I would recommend Invega.
>
> Eric(In the dentist waiting room lol)
I put a lot of weight on your thoughts, Eric.
Yeah, I like it too, my PDOC writes it often with success. I've wanted to try it; well, I want to try them all. Kind of a hobby., e.g. I wouldn't want to be on clozapine long-term, but it'd be interesting to evaluate.
Latuda. Abilify, Saphris, Invega, Geodon those are the ones I take seriously, and I just want to see what's so great about Zyprexa, that's all. No desire to mess with Seroquel. Risperidone is respectable.
I'll change to Invega if she has samples. If she has samples of Saphris, I may try it.
I will post more soon.
Posted by LouisianaSportsman on May 1, 2014, at 19:40:04
In reply to Re: Reducing meds. PDOC advise trial of any AAP Ideas? » LouisianaSportsman, posted by klein on May 1, 2014, at 14:09:24
Hey, Klein! You're now on SLS (been inactive lately) and Eric status to me. Sorry if I was rude to you on that SSRI empathy thread.
Well, I've admitted this deep in this forum before, but I guess I'll admit it again-- I just really enjoy changing up, reading up and trying different medications as my hobby.
I can say that I do not know much about depot injections. I thought that it might have offered metabolic benefits even, but I was kinda skeptical about that. I figured it was just exclusively for non-compliant patients or people who didn't seem so eager to be taking their medication.
I was on Abilify at 5mg. to augment sertraline (Zoloft) at the time and noticed that it was a sugar pill so I raised the dosage to 10mg. which was something my old PDOC seemed very reluctant to do. (Thank God I have my current PDOC) I noticed about three days later that I had a definitive positive effects from Abilify that were not placebo at 10mg. and I stuck with it. It made me gain weight so bad. I was on Abilify when I switched to my new, awesome PDOC and she switched me to Latuda per my request (very tough choice to switch since I thought Abilify did work) and added Topamax for weight and mood.
Very much so want to try Saphris! I might trial it for a month and see what happens. It might be better than Latuda! If I do good at Abilify 10mg./ Latuda 40/60mg.-- what dosage of Saphris should I try? I'm pretty for real about switching. I'm pretty for real about Invega too. :/ But Saphris just looks more appealing. It's my third favorite AAP.
Olanzapine looks like a nice, safer sequel to clozapine if I was going to try that right route, and I've always wanted to see what the hype is about. The Zydis form seems to cause less weight gain.
I'm going to basically ask my PDOC, who I know who is a fan of Saphris, Invega, and Zyprexa what she thinks would be best to try out for a month. I'm pretty positive she'd be down to let me try something different, and if I like it better-- I'll stick with it.
The insurance letter said to cut back down on the medications used for stimulation, CNS depressants, and concomitant usages. I'm not sure why they sent that-- they're still continuing to pay. I believe the Gralise, Xanax XR and the Desoxyn raised a red flag in someone's department. The letter did state that narcolepsy was no associated with the Nuvigil script and it exceeded the quantity dispensed limit of #30 (I was getting #60 for 500mg. armodafinil ~600mg. modafinil). The letter stated that shingles was not associated with the Gralise. The Lamictal XR was singled out due to the fact that I am already on an extended-release anticonvulsant. The Desoxyn was mentioned as being for narcolepsy and while approved for ADHD, anyone prescriber who prescribes Desoxyn is under a monthly review process.
Basically, in the future, I guess we're going to have to stay on-label. I think we could still get away with some stuff however as it was just was just an "Advisement" and not a warning or anything, but my PDOC still took it seriously.
I tried the Oleptro ER 300mg. last night and didn't experience much next-day sedation or even nightly sedation with my clonazepam, but I do miss the armodafinil a lot. That's why I'm thinking may be desipramine for energy. I'm also thinking about mirtazapine at night, but I'm scared of weight now that I no longer have the Nuvigil on board. I'm not sure what to think about the Oleptro just yet.
I go back in two weeks, I have in mind: desipramine, mirtazapine, and what else?
Posted by LouisianaSportsman on May 1, 2014, at 20:11:56
In reply to Re: Reducing meds. PDOC advise trial of any AAP Ideas?, posted by LouisianaSportsman on May 1, 2014, at 19:40:04
What do you guys think with the Aptiom? I really like the single pill maintenance dosage of 800mg., the same makers of Latuda, and it's a form of oxcarbamazepine that is the newest (its metabolite) (April 2014) I've always been wanting to try Oxtellar XR, actually, and this is a superior version with a dosage I like.
Also, really not sure about Oleptro ER (trazadone). I think my PDOC just went for it because I printed out that damn paper I wrote where I compared it to Abilify and she asked if I wanted to try it for sleep at night. I didn't have to the nerve to make the case for nortriptyline/desipramine.
Notriptyline probably at 75mg. since that is a suggested dosage target, I'm sure my PDOC would go ahead and just write #30 75mg. and I would take it at night. I have a high drug tolerance to everything. The guidelines say start desipramine at 75mg., but the smallest maintenance dosage is 100mg. so I'm sure she'd write #30 100mg. I think one of these two would compliment the Brintellix well.
Who knows the Oleptro XR might be amazing? What if it provides good rest and a minor antidepressant effect? Would it cause serotonin syndrome if combined with Brintellix and Nort/Desi? Lower the dose to 150mg.?
Example Regiment:
Aptiom (eslicarbazepine) 800mg.
Brintellix (vortioxetine) 20mg
Dexedrine (dexamphetamine) 60mg.
Latuda (lurasidone) 60mg.
(Pamelor (notriptyline) 75mg./ Desipramine 100mg.)
((Oleptro ER (trazadone) 300mg.))
Trodenki XR (topiramate) 200mg.
Klonopin (clonazepan) 1.5mg.
Posted by LouisianaSportsman on May 1, 2014, at 21:13:50
In reply to ^^ Above Post is for Klein-- this is about Aptiom, posted by LouisianaSportsman on May 1, 2014, at 20:11:56
Ah! Forgot about mirtazapine!
Let's see which ones work with which assuming that Brintellix stays no matter what.
Aptiom (eslicarbazepine) 800mg.
Brintellix (vortioxetine) 20mg
Dexedrine (dexamphetamine) 60mg.
Latuda (lurasidone) 60mg.
(Pamelor (notriptyline) 75mg./ Desipramine 100mg.)
(Remeron (mirtazapine 45mg.)
((Oleptro ER (trazadone) 300mg.))
Trodenki XR (topiramate) 200mg.
Klonopin (clonazepan) 1.5mg.We have it built around
Brintellix (vortioxetine):
Serotonin reuptake inhibitor = 1.6 nM
NET blocker = 113 nM
5-HT1A receptor near-full agonist = 15 nM
5-HT1B receptor partial agonist Ki = 33 nM
5-HT1D receptor antagonist Ki = 54 nM
5-HT3A receptor antagonist Ki = 3.7 nM
5-HT7 receptor antagonist Ki = 19 nMMirtazapine:
SERT: no appreciable affinity
5-HT1A receptor= 18 nM
5-HT2A receptor= 69 nM
5-HT2C receptor= 39 nM(inverse agonist)Desipramine:
SERT Inhibtion: 179 nM
NET: 2.27 nMNortriptyline:
SERT: 16.5 nM
NET: 1.65 nM
5-HT2A: 43 nM
5-HT2C: 8.5 nMTrazadone:
SERT: 367.3 nM
5-HT2A: 35.8 nM
5-HT2B: 78.4 nMBased on my analysis, nortriptyline looks risky to add to Brintellix and Trazadone whereas desipramine and mirtazapine, in particular, would not be likely to cause issues and would go very good with the MOA of the trazadone.
Posted by LouisianaSportsman on May 2, 2014, at 12:43:58
In reply to Re: ^^ Above Post is for Klein-- this is about Aptiom, posted by LouisianaSportsman on May 1, 2014, at 21:13:50
Friday and Saturday after administering Oleptro ER the night before I woke up the next feeling the best I have felt in a LONG TIME.
Friday morning was decent, I'd say it was about 5/10 on the sluggishness scale which is pretty good since most days are 7-9's.
Today was a 3/10 on the sluggishness. I got out of bed within 2 minutes! I can't remember the last time I've done that.
Effects of trazodone on the sleep of depressed subjects a polygraphic study
Clinical improvement, as assessed by a reduction of more than 60% in MADRS scale scores, was accompanied by evidence of the definitely beneficial effects of trazodone on the disturbed sleep of these depressed patients. From the beginning of treatment, there was a hypnotic-like effect (increase in total duration of sleep and stage II, decrease in sleep latency and intrasleep awakenings). In addition, records at the end of the study showed an increase in delta sleep and an increase in REM latency, an effect classically associated with an antidepressant action. These particularly valuable effects of trazodone on sleep would suggest that this drug should especially be given in cases of depression with major insomnia.
----------------Discontinuing it and using it as a sleep aid.
Latuda and Brintellix basically do everything trazadone does:
Relevant actions of trazadone:
5-HT1A antagonism -- Latuda does that
5-HT1D antagonsim -- Brintellix has that covered
5-HT2A antagonism -- Latuda again
5-HT2B antagonism -- Brintellix does thatThere is mention about 5-HT2C antagonism but I see the binding affinity at 223.9? So... I guess it's got that going for it if it's really significant. I guess a little is going on at my 300mg. dose. The a1 adrenergic effect it has is mimicked by Latuda as well.
So, it mainly has 5HT-2a going for it where lurasidone antagonism is higher.
I can't find anything unique about trazadone except H1 antagonism, seriously. Maybe I should have been taking an antihistamine before bed all this time? I guess I miss out on negligible 5-HT2C antagonism, that's it.
I will be discontinuing Oleptro ER and breaking the 300mg. bisectable tablets in half and having a really, really quality sleep aid.
I've never thought about it, but generic modafinil and gabapentin should be pretty cheap right. I can pay for it without insurance. I will likely get that next time. Generic lamotrigine, not XL, would be cheap without insurance too, but I'm not complaining about getting off of it.
Posted by phidippus on May 2, 2014, at 13:30:51
In reply to Re: Reducing meds. PDOC advise trial of any AAP Ideas? » phidippus, posted by Louisiana Sportsman on May 1, 2014, at 15:05:46
>I've wanted to try it; well, I want to try them all.
Invega has a very soothing quality to it and can really help with anxiety.
I have tried them all :) Geodon and Zyprexa are my favorites.
>I wouldn't want to be on clozapine long-term, but it'd be interesting to evaluate.
It really is the a-bomb of atypicals. I took it to end a severe depression with psychotic features and Cotard Syndrome (I thought I was dead).
>I just want to see what's so great about Zyprexa
Zyprexa will fix just about anything, haha.
Eric
Posted by ed_uk2010 on May 2, 2014, at 15:01:25
In reply to Abilify Maintena, posted by Louisiana Sportsman on May 1, 2014, at 3:35:16
>Are there any benefits to an injection over an oral pill? (RE Abilify)...
Only in terms of compliance, mainly in schizophrenia.
Posted by klein on May 4, 2014, at 11:22:21
In reply to Cool post!, posted by Louisiana Sportsman on May 1, 2014, at 14:17:40
Posted by klein on May 4, 2014, at 14:24:43
In reply to Re: Reducing meds. PDOC advise trial of any AAP Ideas?, posted by LouisianaSportsman on May 1, 2014, at 19:40:04
> Hey, Klein! You're now on SLS (been inactive lately) and Eric status to me. Sorry if I was rude to you on that SSRI empathy thread.
>
> Well, I've admitted this deep in this forum before, but I guess I'll admit it again-- I just really enjoy changing up, reading up and trying different medications as my hobby.
>
> I can say that I do not know much about depot injections. I thought that it might have offered metabolic benefits even, but I was kinda skeptical about that. I figured it was just exclusively for non-compliant patients or people who didn't seem so eager to be taking their medication.
>
> I was on Abilify at 5mg. to augment sertraline (Zoloft) at the time and noticed that it was a sugar pill so I raised the dosage to 10mg. which was something my old PDOC seemed very reluctant to do. (Thank God I have my current PDOC) I noticed about three days later that I had a definitive positive effects from Abilify that were not placebo at 10mg. and I stuck with it. It made me gain weight so bad. I was on Abilify when I switched to my new, awesome PDOC and she switched me to Latuda per my request (very tough choice to switch since I thought Abilify did work) and added Topamax for weight and mood.
>
> Very much so want to try Saphris! I might trial it for a month and see what happens. It might be better than Latuda! If I do good at Abilify 10mg./ Latuda 40/60mg.-- what dosage of Saphris should I try? I'm pretty for real about switching. I'm pretty for real about Invega too. :/ But Saphris just looks more appealing. It's my third favorite AAP.
>
> Olanzapine looks like a nice, safer sequel to clozapine if I was going to try that right route, and I've always wanted to see what the hype is about. The Zydis form seems to cause less weight gain.
>
> I'm going to basically ask my PDOC, who I know who is a fan of Saphris, Invega, and Zyprexa what she thinks would be best to try out for a month. I'm pretty positive she'd be down to let me try something different, and if I like it better-- I'll stick with it.
>
> The insurance letter said to cut back down on the medications used for stimulation, CNS depressants, and concomitant usages. I'm not sure why they sent that-- they're still continuing to pay. I believe the Gralise, Xanax XR and the Desoxyn raised a red flag in someone's department. The letter did state that narcolepsy was no associated with the Nuvigil script and it exceeded the quantity dispensed limit of #30 (I was getting #60 for 500mg. armodafinil ~600mg. modafinil). The letter stated that shingles was not associated with the Gralise. The Lamictal XR was singled out due to the fact that I am already on an extended-release anticonvulsant. The Desoxyn was mentioned as being for narcolepsy and while approved for ADHD, anyone prescriber who prescribes Desoxyn is under a monthly review process.
>
> Basically, in the future, I guess we're going to have to stay on-label. I think we could still get away with some stuff however as it was just was just an "Advisement" and not a warning or anything, but my PDOC still took it seriously.
>
> I tried the Oleptro ER 300mg. last night and didn't experience much next-day sedation or even nightly sedation with my clonazepam, but I do miss the armodafinil a lot. That's why I'm thinking may be desipramine for energy. I'm also thinking about mirtazapine at night, but I'm scared of weight now that I no longer have the Nuvigil on board. I'm not sure what to think about the Oleptro just yet.
>
> I go back in two weeks, I have in mind: desipramine, mirtazapine, and what else?Hey Louisiana,
Sorry for not answering your posts sooner.I took no offense whatsoever re: your comments on the apathy thread because:
Everybody has an opinion. Some are more adamant than others, probably due to their own personal experience. Everybody has a bad day, I know I've lost my cool posting on opther boards several times. Also, lest we forget, this is after all a mental health forum (I certainly don't mean that in a bad way ;) a lot of people here are quirky and eccentric, lol). I might sound chummy cos I've lurked a lot so I'm familiar with a few posters. And, I'm constantly working on my self-esteem issues, I've learned to NOT take things so personally all the time :) Thanks for your apology though, I appreciate it.
I'm flattered by your comparison, Eric and SLS are much more seasoned than me. I'm just an amateur nerd, lol, I took a few biochemistry classes and that's about it.
Enough about me. What did you decide to take?
A few thoughts:
- Mirtazapine is an amazing AD (by far the best one I've tried) but not usually "weight friendly". A good way to counteract weight gain and sedation is to take it the European way, start right off at 60mg.
- Asenapine is like a stripped down Remeron. It has the tetracyclic's AD power, with a different side effect profile (little, if any weight gain, heavy sedation tat wears off quickly due to it's short half life and a few others). Apparently it's not as good an AAP as others for positive symptoms, but it works very well on negative symptoms.
- Ziprasidone is very similar to asenapine. It's activating at low doses, and sedating at higher doses.
- Zyprexa at 5mg-20mg did nothing for me except drain my pocket. Thankfully the sedation I got was minimal, no weight gain, nothing. Maybe I was a bit zombified. Keep in mind that I'm unipolar, I was only put on AAPs to control the racing thoughts I started getting whilst doing psychoanalytic therapy (my doc put me on Risperdal, then we switched to Zyprexa etc).
- I have no experience with Invega, Latuda and a few others you mentioned. I avoid Invega like the plague because I had a paradoxical reaction when I took Risperdal.
- I managed to get my hands on brand name Desyrel, PI and all (very hard to find where I live). According to the manufacturer, it should only take 2 weeks to *ss*s if trazodone is working or not. I don't know if this is accurate. I imagine the same holds true for Oleptro.
- I really got no additional benefit from dissolving wafers ie: Zyprexa Zydis and Remeron Soltab. These two are the most weight-unfriendly meds out there, so I suspect the labs were trying to find an alternate form of delivery to avoid weight gain - if so, fail!
- To me, Abilify is a pain, the long half life and constant dosage tweaking is not worth the effort. Taking 2mg for a few days once in a while will give me a boost though.
Okay.. once again, please bear in mind that my dx is unipolar MDD with melancholic and schizoid features, and GAD. Not a trace of bipolar. Recovered alkie too which might be relevant. At the moment I'm smoking heavily, which I know affects several medication's metabolism (ie Zyprexa).Okay, hth. Warm regards =)
Posted by spemat on May 17, 2014, at 19:02:23
In reply to Reducing meds. PDOC advise trial of any AAP Ideas?, posted by LouisianaSportsman on May 1, 2014, at 2:13:32
I used to be on Clozaril but it was because although Lamictal itself with a 6 week on 6 week off cycle of Klonopin has been the one that made it through the long haul. I have tried them all, the older ones and I was on depakote ER 1,500 mg, xanax 2 mg 3x/day, ativan 2-4 mg bed, lamictal 200mg bed, adderall xr 30 mg 2 in am, 2 at noon, seroquel (300 mg pm), risperdal consta (37.5) and dexedrine for boosters (10-20 mg 4 times a day) together at one point. I can relate to this. Clozaril only lasted 3 weeks before risperdal consta.
Risperdal, Xanax and Seroquel were misery to stop taking and took a long time. Ativan was weak to me, useless. Depakote wasn't needed at all... I have mania with psychotic features and hyperactive ADHD which can escalate and set off mania.
I use Haldol and Ativan in extreme rare cases, 0.5 mg haldol and 2 mg ativan... I also take 60 mg of dexedrine in the winter and 90-120 in the summer because my mania started at age 5 and it was seasonal and lasted months. Lamictal and Dexedrine are both meds that I took for years and had good results and Klonopin was easy because after 5-6 weeks on 1 mg in am and at bed, it felt like bricks were in my feet. Geodon wasn't hard to stop for me but Invega is a risperdal related med, correct? I'd just ask... antidepressants induced mania after 3 days as did Strattera in my case but I am subdued and calm on dexedrine. I tried all the ADHD meds and they all were either weaker or the side effects were hell. I wasn't too hot on Desoxyn either, it is different but given what it is, I was shocked it made me want to sleep at 60 mg per day.
Dexedrine tablets were stronger and I was in disbelief given what Desoxyn is. I took Abilify and Zyprexa only once and both made me sleep for days so I was all set. I cannot take antidepressants at all. When I was 9 I thought I had bugs under my arms and trying to cut them out led to costly tattoos to conceal them. The "cutter" or BPD assumptions were aggravating because I am hyper and get manic like I always did. Do you have ADHD?? hyper or inattentive? or is it a depression add on?? I wound up not needing daily long term AP treatment by working my way to this. In regards to the ADHD question, the Desoxyn dose I was on was twice the dose that you were on and my psych nurse practitioner had to write it during the shortage and I recorded my counts daily on my iphone cam and sent them all to her but nobody bothered her because I was flagged a few times since I was young due to the monster doses and my bipolar and hyperactive ADHD is a hybrid disorder. Everyone is different and I have been severely psychotic and manic but rarely take an AP unless I hear the voices (often neighbors make noise but if it is non stop and like a manic person, I know it isn't them because I will obsess over it until it becomes someone out to get me)... I was desperate though because the depakote was poor.
This is the end of the thread.
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