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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 55. This is the beginning of the thread.
Posted by LlurpsieNoodle on July 28, 2007, at 15:07:04
So, last night was pretty wicked.
the worst insomnia I've had in months, despite taking 2 sonata and also my regular dose of klonopin.
I'm tapering off of geodon.
took 240 for a week, then 180 for a day, now 120 for the next week then 60 for a week then nil. (reasons- it puts me in medicated stupor which I will do just about anything to escape)
Meanwhile
Started Abilify yesterday. bedtime dose of 5mg
Started Zoloft yesterday. bedtime dose of 25mg (will eventually go up to 50mg)Any thoughts on whether the following symptoms are more characteristic of withdrawal or start-up?
insomnia
brain zaps & tinglies
nausea
headache
vertigo & dizziness
extreme fatigue (daytime, of course!)Well, not that it matters, I'm just curious. I'm going to stay on this cocktail and reevaluate after 2 weeks. kind of a dramatic shift, huh?
I'm gonna take my vitamins today...
-Ll
Posted by linkadge on July 28, 2007, at 15:41:00
In reply to startup of abilify + zoloft OR geodon withdrawal, posted by LlurpsieNoodle on July 28, 2007, at 15:07:04
Yeah, you may want to take zoloft in the morning.
I am not sure about the abilify. Some say it is activating. Not sure what time of day people take it.
Linkadge
Posted by Phillipa on July 28, 2007, at 16:03:13
In reply to Re: startup of abilify + zoloft OR geodon withdrawal, posted by linkadge on July 28, 2007, at 15:41:00
I think most take the abilify in the am as it's activating and some say zoloft is too. Good luck Lurpsie. Love Phillipa
Posted by med_empowered on July 28, 2007, at 18:46:52
In reply to Re: startup of abilify + zoloft OR geodon withdrawal » linkadge, posted by Phillipa on July 28, 2007, at 16:03:13
id do abilify AM. Abilify can cause pretty intense akathisia...so can ssris. Withdrawal from sedating antipsychotics can cause a similar set of symptoms; I think its not an either/or situation so much as an overlap of unfortunate events in your brain. Can you up the Klonopin, or take some propranolol? Also..Abilify is intensely high potency. Even at 10-15mgs, over 80% D2 occupancy is going on. I imagine at 5mgs its still intense, especially since some of your other meds may be slowing the clearance of aripiprazole (SRIs tend to). So...you may be having problems b/c of increased neuroleptic load, too.
Good luck.
Posted by LlurpsieNoodle on July 28, 2007, at 19:01:48
In reply to Re: startup of abilify + zoloft OR geodon withdrawal, posted by med_empowered on July 28, 2007, at 18:46:52
> id do abilify AM. Abilify can cause pretty intense akathisia...so can ssris.
I've never taken an ssri before, but when I took cymbalta I got some akasthesia from time to time. I'd be dancing at the bus stop and tapping toes like crazy under my desk. I'm going to continue taking it per Dr.'s orders for another 2-3 days, and if things don't get better, I'll give him a call about switching to am dose. Maybe he's like my old pdoc and Rx's drugs at night to minimize side effects? Well, I still had to get up in the middle of the night to drink some soymilk, the acid nausea was so bad. I am also hoarse after trying to take a nap and have had wicked hiccups all day long. makes my H laugh at me :)
>Withdrawal from sedating antipsychotics can cause a similar set of symptoms; I think its not an either/or situation so much as an overlap of unfortunate events in your brain. Can you up the Klonopin, or take some propranolol?
Well, I *COULD* do this, but pdoc wouldn't know. my propanolol is bootleg from 3rd world pharmacy I went to on vacation. I probably have about 3 10mg tablets left. klonopin I can increase maybe take an extra .5mg at night to help me sleep some more. I think that would be pdoc-sanctioned.
>Also..Abilify is intensely high potency. Even at 10-15mgs, over 80% D2 occupancy is going on. I imagine at 5mgs its still intense, especially since some of your other meds may be slowing the clearance of aripiprazole (SRIs tend to). So...you may be having problems b/c of increased neuroleptic load, too.
>
> Good luck.Thanks for your kind suggestions. You know lots, and I really appreciate your advice. I envision "neuroleptic load" as me being a camel and carrying around a bundle of hay.
I *do* feel much better today. Was contemplating applying for prestigious dream job without intense anxiety/helplessness, so that's a big positive. Also visited healthclub to enquire after membership. That might be good to get my apathetic *ss out of the house. If I'm a brave Llurpsie I can even ride my bike there.
Take care med-empathetic
-Ll
Posted by Phillipa on July 28, 2007, at 20:34:36
In reply to Re: startup of abilify + zoloft OR geodon withdraw » med_empowered, posted by LlurpsieNoodle on July 28, 2007, at 19:01:48
Lurpsie med_empowered knows a lot I mean a lot about meds. Love Phillipa
Posted by linkadge on July 28, 2007, at 21:10:45
In reply to Re: startup of abilify + zoloft OR geodon withdraw » med_empowered, posted by LlurpsieNoodle on July 28, 2007, at 19:01:48
Zoloft was much better for akathesia for me. I had much less akathesia than say paxil or prozac.
Zoloft can be slightly more activating which is why I would try taking it in the AM.
PM dosing of zoloft could cause insomnia.
You may want to start abilify on as low a dose as possable.
Linkadge
Posted by Phillipa on July 28, 2007, at 21:46:11
In reply to Re: startup of abilify + zoloft OR geodon withdraw » LlurpsieNoodle, posted by Phillipa on July 28, 2007, at 20:34:36
And so does Link you are lucky they are making the suggestions to you. Link is right too on starting on a low dose of abilify. Love Phillipa
Posted by Keith Talent on July 29, 2007, at 3:28:32
In reply to Re: startup of abilify + zoloft OR geodon withdraw » Phillipa, posted by Phillipa on July 28, 2007, at 21:46:11
Don't know your diagnos(i/e)s but I would gradually stop all except the Abilify. Take just 2.5 mg in the morning for 8 weeks, then evaluate. If it provided no benefit, stop it; if some benefit, add an antidepressant or lamotrigine. If you go the Zoloft route, it might be best to take it twice daily, as the short half-life can result in withdrawal side effects. Also Zoloft needs to be taken at 100-200 mg/day by most patients (although you might be lucky enough that 50 mg/day does the trick). Again, take it for a full 8 weeks once you've reached a dose that your psychiatrist believes will be effective. Making only one medication change at a time can be SO important.
Posted by LlurpsieNoodle on July 29, 2007, at 7:16:30
In reply to Re: startup of abilify + zoloft OR geodon withdraw, posted by Keith Talent on July 29, 2007, at 3:28:32
> Don't know your diagnos(i/e)s
Being treated for bipolar symptoms (mood swings like CRAZY) and also psychotic perceptual and memory disturbances related to the trauma part of PTSD. Also meet Dx criteria for major depression at the moment, probably since April
>but I would gradually stop all except the Abilify. Take just 2.5 mg in the morning for 8 weeks, then evaluate. If it provided no benefit, stop it; if some benefit, add an antidepressant or lamotrigine. If you go the Zoloft route, it might be best to take it twice daily, as the short half-life can result in withdrawal side effects.
Since I was in suicidal crisis last week, I think pdoc (T agrees) wants to treat me with some new meds to try to get me out of the suicidal depression. It's a dangerous illness :( Also, since I was on SUCH a high dose of Geodon for the last 4 months, I'm not sure that I would respond too well to a small dose of abilify. pdoc told me that 5 mg is a fairly small dose. I'm going to need some neuroleptics to control the psychotic stuff :( I accept that. begrudgingly.
Also, I don't really feel that I have the luxury of trying an extended trial of one drug. This is the long-term goal, of course, to get me off of all meds, but not really the time or the place. Given that I was recommended by T and pdoc to go to hospital last week but decided to stick it out and wait until my next office visits.
>Also Zoloft needs to be taken at 100-200 mg/day by most patients (although you might be lucky enough that 50 mg/day does the trick). Again, take it for a full 8 weeks once you've reached a dose that your psychiatrist believes will be effective. Making only one medication change at a time can be SO important.
I think the idea is to work with a really small dose of Zoloft, maximum 50mg. Something gentle to my system, since so many things are changing all at once. I totally agree with you. I *wish* I were in the situation to make only one change at a time.
I believe that there is empirical evidence (at least my old pdoc told me) that as far as neuroleptics are concerned, it's best to keep neuroleptic 1 at the the therapeutic dose while tapering up to neuroleptic 2, and then gradually decrease neuroleptic 1. The idea is to get the patient (me) stabilized and prevent some kind of psychosis. This approach worked really well when I switched from seroquel to geodon.
Sorry that I seem to disagree with your suggestions. In a perfect world, I totally agree with you. Very sensible, but this is kind of a touch-and-go thing.So far though, I feel okay. I even got 8 hours of sleep last night with no toss and turn. ((((sleep))))
best to you K.T.
-Ll
Posted by linkadge on July 29, 2007, at 10:18:38
In reply to Re: startup of abilify + zoloft OR geodon withdraw, posted by Keith Talent on July 29, 2007, at 3:28:32
I don't know about the statment that most people need 200mg of zoloft is true for everbody.
I think that many people do well on 50mg.
Linkadge
Posted by Keith Talent on July 29, 2007, at 14:12:06
In reply to Re: startup of abilify + zoloft OR geodon withdraw » Keith Talent, posted by LlurpsieNoodle on July 29, 2007, at 7:16:30
> Being treated for bipolar symptoms (mood swings like CRAZY) and also psychotic perceptual and memory disturbances related to the trauma part of PTSD. Also meet Dx criteria for major depression at the moment, probably since April
>
> Since I was in suicidal crisis last week, I think pdoc (T agrees) wants to treat me with some new meds to try to get me out of the suicidal depression. It's a dangerous illness :( Also, since I was on SUCH a high dose of Geodon for the last 4 months, I'm not sure that I would respond too well to a small dose of abilify. pdoc told me that 5 mg is a fairly small dose. I'm going to need some neuroleptics to control the psychotic stuff :( I accept that. begrudgingly.
>
> Also, I don't really feel that I have the luxury of trying an extended trial of one drug. This is the long-term goal, of course, to get me off of all meds, but not really the time or the place. Given that I was recommended by T and pdoc to go to hospital last week but decided to stick it out and wait until my next office visits.
>
> I think the idea is to work with a really small dose of Zoloft, maximum 50mg. Something gentle to my system, since so many things are changing all at once. I totally agree with you. I *wish* I were in the situation to make only one change at a time.
>
> I believe that there is empirical evidence (at least my old pdoc told me) that as far as neuroleptics are concerned, it's best to keep neuroleptic 1 at the the therapeutic dose while tapering up to neuroleptic 2, and then gradually decrease neuroleptic 1. The idea is to get the patient (me) stabilized and prevent some kind of psychosis. This approach worked really well when I switched from seroquel to geodon.
>
> Sorry that I seem to disagree with your suggestions. In a perfect world, I totally agree with you. Very sensible, but this is kind of a touch-and-go thing.
>
> So far though, I feel okay. I even got 8 hours of sleep last night with no toss and turn. ((((sleep))))
>
> best to you K.T.
> -LlLlurpsie, I wasn't aware of your context. Sounds like you need 10 mg or more of Abilify + mood stabilizer(s). Your psychiatrist would be careful with the Zoloft, I'm sure, given your bipolar status. Perhaps a short hospital stay for evaluation and dose titration would be worthwhile (though no-one goes to hospital if they can avoid it!). Hope you get better soon, KT.
Posted by LlurpsieNoodle on July 29, 2007, at 15:03:29
In reply to Re: startup of abilify + zoloft OR geodon withdraw, posted by Keith Talent on July 29, 2007, at 14:12:06
Hi Keith,
Thanks for writing back-> Llurpsie, I wasn't aware of your context. Sounds like you need 10 mg or more of Abilify + mood stabilizer(s). Your psychiatrist would be careful with the Zoloft, I'm sure, given your bipolar status. Perhaps a short hospital stay for evaluation and dose titration would be worthwhile (though no-one goes to hospital if they can avoid it!). Hope you get better soon, KT.
>
>
It's okay not to be aware of my context. often I'm not aware either ;) I'm doing okay today. I went to the home despot and sanded/refinished part of my 4posterbed and put furniture polish and buffed the rest. I tried to nap after that, but I couldn't. Husband is all eager to put it together. I am completely sapped of all energy.hospital seems unlikely place to spend the night. I hope the same remains true of tomorrow and the day after that. I guess by the third or fourth day of this withdrawal/titration I'll know how badly it's going to kick my asterisk. XXXXX that's 10 crossed fingers.
Thats the context for today. I know that most posts on this meds board aren't chatty, but I am, and I can't help it.
happy sunday,
-Ll
Posted by LlurpsieNoodle on July 29, 2007, at 15:07:46
In reply to Re: startup of abilify + zoloft OR geodon withdraw, posted by linkadge on July 29, 2007, at 10:18:38
> I don't know about the statment that most people need 200mg of zoloft is true for everbody.
>
> I think that many people do well on 50mg.
>
> LinkadgeThat's reassuring. Usually I'm feeling all giddy to look up the monograph and chemical structure of my latest Rx. This time though I'm just so apathetic. Pills to take? okay.
I had my pdoc type out the instructions. how many days on this. how many days on that. what days to split pills what days to throw away my geodon. He was a sweetie and typed it and printed it in about 20pt font. Times New Roman, of course. I have it taped to my bathroom window.
I'm glad to know that I've got a chance to feel better on small dose of zoloft. I feel better already, but that might be because of the lack of geodon sedation (have cut my dose in half in 48 hours. yippee.
adios link
-Ll
Posted by linkadge on July 29, 2007, at 15:25:53
In reply to Re: startup of abilify + zoloft OR geodon withdraw » linkadge, posted by LlurpsieNoodle on July 29, 2007, at 15:07:46
Effective drug dose levels are highly individual. I was under the impression that 50mg was kind of a standard dose for depression anyway.
My mother knew a woman who took 50mg to start (she was bipolar) but had to back off to 25mg as it was too much!
Higher dose ranges are used often for OCD, and TRD.
Linkadge
Posted by cactus on July 30, 2007, at 0:14:22
In reply to Re: startup of abilify + zoloft OR geodon withdraw » linkadge, posted by LlurpsieNoodle on July 29, 2007, at 15:07:46
I just went up to 100mg of zoloft and I agree with everyone else, take it in the morning it's quite activating and it has been by far, the best ssri I have ever taken. I took one dose of 20mg of geodon with zoloft and slept for 14 hours, so I threw the geodon away, I don't like zombie meds and I'm starting to feel really good again. Good luck and don't be scared to use your klonopin at higher doses when you need to. I know a lot of people are scared of benzos but they have been wonder drugs to me and have saved my *ss on numerous occasions. Good Luck Lurpsie, oh and I think that the brain zaps are from the geodon withdrawal
Posted by linkadge on July 30, 2007, at 8:22:34
In reply to Re: startup of abilify + zoloft OR geodon withdraw » LlurpsieNoodle, posted by cactus on July 30, 2007, at 0:14:22
Yeah, I found the combination of just zoloft and klonazepam good.
Linkadge
Posted by LlurpsieNoodle on July 30, 2007, at 9:15:49
In reply to Re: startup of abilify + zoloft OR geodon withdraw, posted by linkadge on July 30, 2007, at 8:22:34
Sometimes I'm intimidated by the diversity of suggestions that I get from psychobabble, but from what I'm hearing from linkadge and cactus and others, the addition of zoloft to my combo will likely do me good. hopefully the klonopin and lamictal will help ease the mood swings that have been plaguing me much.
Another night of restless sleep. I give one more day and then contact pdoc about dose timing.
Thank you for your inspiration. I feel hopeful again.
-Ll
Posted by linkadge on July 30, 2007, at 16:35:43
In reply to Re: startup of abilify + zoloft OR geodon withdraw » linkadge, posted by LlurpsieNoodle on July 30, 2007, at 9:15:49
I agree. You can get a lot of different opinions on babble.
Nobody here knows for sure what will help you, we can only make suggestions.
Listening to what your own brain is telling you about certain meds may be your best asset.
Linkadge
Posted by cactus on July 31, 2007, at 23:42:58
In reply to Re: startup of abilify + zoloft OR geodon withdraw » linkadge, posted by LlurpsieNoodle on July 30, 2007, at 9:15:49
be sure and let us know how it goes!!!!!!!
Posted by LlurpsieNoodle on August 1, 2007, at 11:00:51
In reply to Re: startup of abilify + zoloft OR geodon withdraw » LlurpsieNoodle, posted by cactus on July 31, 2007, at 23:42:58
> be sure and let us know how it goes!!!!!!!
Okay, some bad insomnia and a lot of kicking and tossing and turning all night long.
daytime- MUCH better mood, don't worry not hypomanic !!
I have a lot more energy and have been applying for pt time work. Even shopping for new car, which is exhausting. APR. and I paid bills. ((((paying bills)))
Those are the behavioral/mood effects
side effects, (besides insomnia)
GI stuff. you know the drill
got a migraine
some tremors
clumsiness and dizziness
reduced suicidal and self-injury ideation. (what a relief. this was VERY bad last week)-Ll
Posted by LlurpsieNoodle on August 1, 2007, at 13:41:35
In reply to how it goes » cactus, posted by LlurpsieNoodle on August 1, 2007, at 11:00:51
> I have a lot more energy and have been applying for pt time work. Even shopping for new car, which is exhausting. APR. and I paid bills. ((((paying bills)))
>
> Those are the behavioral/mood effects
>
> side effects, (besides insomnia)
> GI stuff. you know the drill
> got a migraine
> some tremors
> clumsiness and dizziness
> reduced suicidal and self-injury ideation. (what a relief. this was VERY bad last week)
>
you know what?
I take that back. I'm not feeling well at all. still having bad mood swings. thinking about diagnosing myself with agitated depression and asking my pdoc for more klonopin. I'm bored, restless, can't seem to find satisfaction in doing any activities, can't concentrate and am very anxious about? what?This is awful. and the dark thoughts return. that feeling of dread. I don't know whether I should talk to pdoc again or what. I see him in about 10 days. I have 2 t appts too. I know I can do this. but still. so hard :(
Posted by KayeBaby on August 1, 2007, at 14:16:45
In reply to AgiTaTeD DepreSsiOn, posted by LlurpsieNoodle on August 1, 2007, at 13:41:35
Hang in there.
Sounds like your mood is sputtering. Hopefully it will start to sputter in a good direction very soon.Peace,
Kaye
Posted by Phillipa on August 1, 2007, at 19:40:32
In reply to Re: AgiTaTeD DepreSsiOn » LlurpsieNoodle, posted by KayeBaby on August 1, 2007, at 14:16:45
Lurpsie sounds like you do better when busy as you've been for quite a while. And then you try and relax and can't? Is this kind of how it is? Love Phillipa
Posted by cactus on August 1, 2007, at 22:57:37
In reply to AgiTaTeD DepreSsiOn, posted by LlurpsieNoodle on August 1, 2007, at 13:41:35
hey lurpsie I know you've had mega med changes but why not try valium instead of klonopin, it's not depressing at all. Good luck and hang in there, I'm living with my sister and she is in crisis mode at the moment, she has got really bad cutting urges back and has finally agreed to see a pdoc tomorrow, I'm very happy about that, it's that darn family curse I tells ya. I have had bouts of agitated depression and psychotic depression but for now it's just anxiety depression. Bloody genetics, blah, my rant for the day. The zoloft is good and getting me stablised for now, no ssri has ever done that to me before and I only have lexapro to try.
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