Posted by ihatedrugs1 on October 28, 2015, at 15:39:19
In reply to Re: so, I've been depressed for a while... » ihatedrugs1, posted by SLS on October 27, 2015, at 16:09:19
> > > 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.
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> > > http://bipolarnews.org/?tag=cariprazine
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> > >
> > > - Scott
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> > >
> > 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.
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> Do you find that the akathisia produced by Abilify gets worse at higher dosages?Yes
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> 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?No bipolarity to speak of. Abilify pulled me from a severe episode but never enough to get close to remission. (I've taken up to 5mg).
> 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. brexpiprazole
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> It 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.I can't handle Akathisia, it is as bad as depression itself for me.
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> 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.I've tried Saphris and Latuda and neither one did anything. Only Abilify works on my depression along with an AD.
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> Maybe you don't need an antipsychotic.Before Abilify, I never used APs and was able to achieve some relief.
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> 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.Tried it already. It did nothing.
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> 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.Have tried Wellbutrin but never with Pristiq. Perhaps a thought! I really don't want anything that causes any more weight gain (nortriptyline). I called the doctor today and she said to give Pristiq 100mg one more week. I may call her and see if I should add wellbutrin.
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> 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.I have been on Ensam and it didn't work (up to 12 mg) but haven't taken any other MAOIs. At this point, I would have to go through a wash out period and I don't think I can go without some of the meds at this low point (the only things keeping going are either Nuvigil, Adderall or Vyvanse). I prefer Nuvigil because I don't go through a crash out hell as with the others. I have some anxiety but it is largely due to med side effects and not knowing what else to do.
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> So...
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> What should you try first?
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> 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.
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> 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.So do you think that brexpiprazole may not necessarily be any better than Abilify. As I said before, Saphris was ineffective. So Pristiq and Wellbutrin; I've taken Lamictal before and cannot even tell if it did anything. As for other meds, I think I've tried most SSRIs, SNRIs, Remeron (40lb weight gain) but for MAOI (did try Emsam) TCAs and AP (though had a small stint with Seroquel and hated it). I also did a full six weeks of Rtms and nothing but a $12,000 bill.
Thank you so much for your thoughtful answer. I hope you are doing more than well.
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> I hate drugs 2.
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>
> - Scott
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>
poster:ihatedrugs1
thread:1083714
URL: http://www.dr-bob.org/babble/20150929/msgs/1083740.html