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Re: Depression sucks.

Posted by SLS on July 23, 2017, at 7:06:40

In reply to Re: Depression sucks., posted by LouisianaSportsman on July 22, 2017, at 18:26:14

> > > I'm doing well on:
> > >
> > > Zoloft 200mg
> > > Forfivo 450mg bupropion
> > > Rexulti 2mg
> > > Buspar 15mg TID
> > > Remeron 30mg QHS

> > That's great news. Your treatment shows logic and enlightenment. I really like it. What role does Buspar play?
> >
> > > Have you tried Rexulti? It works better than aripiprazole 10mg for me.
> >
> > I did try switching from Abilify to Rexulti. Rexulti was neutral. It did not help me as much as Abilify does. After restarting Abilify, I tried pushing the dosage higher than the 10 mg/day I had been taking. I went to 20 mg/day, but found that in impaired my cognitive and memory funtions. It also caused some dysphoria. I have settled on 15 m/day, and I feel better.
> >
> > I also tried Vraylar (cariprazine), another D2/3 partial agonist, in place of Abilify. It immediately made me feel horrendous. The increase in the severity of my depression was terrifying. I aborted the trial as soon as possible. I didn't want to get stuck fighting for my survival for the months it would take Vraylar to leave my system. The half-life of Vraylar and its active metabolite can be as long as 2 weeks.
> >
> > Overall, I'm feeling moderately improved, and remain encouraged by the trajectory of my antidepressant response. I am currently trying to remove prazosin from the mix. It totally wipes-out my sex drive. It might also be making me feel lazy. I find that I must taper prazosin in order to retain a treatment effect and prevent rebound nightmares.

> Very interesting. D3 receptor partial agonism gave you a dysphoric response. I could see it doing that.

Why would D3 receptors do that?

> I bet compulsive behaviors could occur on Vraylar compared to other atypicals.

That's an interesting idea. Sort of like pramapexole (Mirapex)?

> It's unfortunate that your response to brexpiprazole was inadequate. Apparently, it has more antagonistic activity vs aripiprazole?

The Ki ratio of D3/D2 binding is higher with aripiprazole than with brexpiprazole.

> I too have been on seriously every dose of Abilify. I found 10 worked the best. Dosage changes like you reported did temporarily improve symptoms. 2mg thinking it would act as an agonist with 71% stratial D2 binding was worthless in my case. 10mg was more and beyond that point, diminishing returns for me.
> My PDOC and I figured a little 5ht1a hit from buspirone would augment nicely with mirtazapine and my SSRI.

I hope that produces a robust improvement for you. Doesn't brexpiprazole partially agonize 5-HT1a receptors?

> I never trialed it at a higher dose. My PDOC put me on 15mg three times daily from the jump. I will report when it reaches therapeutic levels. I'm tolerating it well. Concomitantly dosing hs with mirtazapine has lead to "cool" dreams.

I haven't given buspirone a trial. I'll talk to my doctor about it should I get stuck.

> It also makes me feel more clearheaded, but I'm attributing that to the Rexulti swap from Abilify.

That's very possible.

> Have you thought about increasing the nortriptyline to 150mg? What if you just took say 5-10mg of the prazosin at night? Are you dosing it during the day?

I get significant brain-fog and diminishing returns when I increase the dosage of nortriptyline from 100 mg/day to 150 mg/day.

How would you characterize D2 and D3 receptors in striatum versus nucleus accumbens?


- Scott

Some see things as they are and ask why.
I dream of things that never were and ask why not.

- George Bernard Shaw




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