Posted by SLS on October 27, 2015, at 16:09:19
In reply to Re: so, I've been depressed for a while... » SLS, posted by ihatedrugs1 on October 27, 2015, at 14:31:35
> > If you are still struggling by this winter, Vraylar (cariprazine) should become available. It is an Abilify-like drug that is stronger on dopamine D3 receptors than is Abilify. I am guessing that it will help more than Abilify for depression and the negative symptoms of schizoid disorders.
> >
> > http://bipolarnews.org/?tag=cariprazine
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> >
> > - Scott
> >
> >
> Hi Scott, I have been taking Abilify for a few years along with other antidepressants which have been switched around from one kind to another. I've been on Effexor 300 and Abilify at 2mg (higher dose gives me akathisia) and Nuvigil 250 (and other stimulants if needed) for a little over 7 months. I still feel depressed but about 5 weeks ago I began feeling better, enough to work in my yard and even go to some events. I figured it was that Effexor finally reached a therapeutic level and that perhaps I didn't need Abilify after all. So I stopped Abilify for around 10 days. I did really well for a week and then "bam" I went down the black hole again. I went back on Abilify again but this time it didn't work as fast as before and I'm still having a rough for the last three weeks. My dr. switched me to Pristiq 100mg and I still feel not well. I went off the Abilify because since I began using it I haven't been able to sit and watch a movie or go to a restaurant without feeling restless. Do you think this new medication Vraylar is a good idea for unipolar treatment resistant depression as an adjunct to Pristiq?. How about brexpiprazole, what do you think of it?
> I've been going through a very rough time the last three years and especially this year. I am at my wits end with this illness.Do you find that the akathisia produced by Abilify gets worse at higher dosages?
Is there any bipolarity involved with you or your first degree relatives? Do you feel it makes sense to pursue antipsychotics with antidepressant properties, or move directly to other antidepressants?
I didn't realize you were so severely affected. I'm sorry. Have you ever tried Lamictal and Wellbutrin together in combination with Abilify? As far as Abilify is concerned, you probably need a higher dosage to get the antidepressant effect from it that it is otherwise capable of providing you with (10 mg/day). Unfortunately, you experience some akathisia with it. These drugs differ in their ratios of dopamine D3/D2 binding. The order from highest to lowest is:
1. cariprazine
2. aripiprazole
3. brexpiprazoleIt might be that cariprazine is the more effective for treating depression, but also the most liable to produce akathisia. Of course, my guesses could be very wrong. Only time will tell. Unfortunately, akathisia has already been observed with cariprazine during clinical trials.
You really should consider trying Saphris (asenapine) as a replacement for Abilify. Akathisia isn't much of a problem with this antipsychotic, and it can produce robust antidepressant effects. There's Latuda, a antipsychotic that some doctors like for depression. It does not produce weight gain. However, if dopamine receptor partial agonism it most important for why your respond to Abilify, these other drugs may not work. That being said, I have seen Saphris produce complete remission for someone who suffered from schizoaffective disorder, predominated by depression. I tried Saphris. It had an amazing antidepressant effect for me that lasted only a week before turning foul on me. I am sure this drug will work well for a subset of people. The thing about Saphris is that you will know rather quickly whether it will be helpful to you. If it doesn't help by day 14, it probably won't. It might help within a few days.
Maybe you don't need an antipsychotic.
Have you discussed Brintellix (vortioxetine) with your doctor? It is an antidepressant. Brintellix is a combination serotonin reuptake inhibitor and receptor modulator. You would want to try this in place of a SSRI or SNRI rather than using it in combination with one. It can clear up thoughts (cognition), and has a lower liability to produce sexual side effects compared to SSRIs.
You might also try adding nortriptyline, desipramine, or Wellbutrin to your SNRI. For me, nortriptyline 75 mg/day made Effexor 300 mg/day work better (just not good enough). Nortriptyline can cause weight gain. A good friend of mine has found remission with a combination of Pristiq 100mg/day and Wellbutrin 300 mg/day.
If you do decide to try a MAOI, I think Parnate makes more sense than Nardil if anergia predominates and there is little or no anxiety.
So...
What should you try first?
I would add the Saphris first without discontinuing the Abilify. If you feel significantly better, you can then try jettisoning the Abilify. If that doesn't help, I would then add Wellbutrin to the Pristiq. I would then add Lamictal if necessary.
Perhaps Vraylar would help more than Abilify. However, you might want to wait for guinea pigs like me to try it first so that you can better assess how appropriate it is for you.
I hate drugs 2.
:-)
- Scott
Some see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1083714
URL: http://www.dr-bob.org/babble/20150929/msgs/1083721.html