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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Justherself54 on March 1, 2010, at 23:05:45
I'm currently not on an AD but decided to try a small dose of abilify. I took half of a 5 mg tablet and had a most horrible day. I was awash with sadness and spent the day on the couch in a strange anxiety ridden stupor. I'm actually having trouble finding the right words to describe it.
Has anyone experienced this? I usually like to give meds a decent trial. I was actually expecting some restlessness. This didn't happen. I'm scared to take any more. Akkkk.
Posted by Phillipa on March 2, 2010, at 0:00:35
In reply to Abilify, posted by Justherself54 on March 1, 2010, at 23:05:45
I'm sorry. I've heard different experiences here with abilify. How come you are trying it? Love Phillipa
Posted by jedi on March 2, 2010, at 0:54:28
In reply to Abilify, posted by Justherself54 on March 1, 2010, at 23:05:45
Hi, The word is akathisia. Abilify is the only medication that has ever caused this side effect in me. It is a very uncomfortable feeling.
From Wikipedia: Akathisia is a syndrome characterized by unpleasant sensations of "inner" restlessness that manifests itself with an inability to sit still or remain motionless. Its most common cause is as a side effect of medications, mainly neuroleptic antipsychotics. Akathisia may range in intensity from a mild sense of disquiet or anxiety (which may be easily overlooked) to a total inability to sit still, accompanied by overwhelming anxiety, malaise, and severe dysphoria (manifesting as an almost indescribable sense of terror and doom). The condition is difficult for the patient to describe and is often misdiagnosed. When misdiagnosis occurs in antipsychotic neuroleptic-induced akathisia, more antipsychotic neuroleptics may be prescribed, potentially worsening the symptoms. High-functioning patients have described the feeling as a sense of inner tension and torment or chemical torture.
Two recent studies put the percentage of the akathisia side effect at 25% with Abilify.
Jedi
> I'm currently not on an AD but decided to try a small dose of abilify. I took half of a 5 mg tablet and had a most horrible day. I was awash with sadness and spent the day on the couch in a strange anxiety ridden stupor. I'm actually having trouble finding the right words to describe it.
>
> Has anyone experienced this? I usually like to give meds a decent trial. I was actually expecting some restlessness. This didn't happen. I'm scared to take any more. Akkkk.
Posted by Justherself54 on March 2, 2010, at 1:10:09
In reply to Re: Abilify » Justherself54, posted by jedi on March 2, 2010, at 0:54:28
Yeah..that pretty much describes it, except I didn't have the need to move. I had the same thing with Risperdal..the chemical torture pretty much sums it up. Oh well, scratch that one off the list..actually I don't have a list anymore..unless my pdoc can pull a rabbit out of his hat.
Posted by desolationrower on March 2, 2010, at 1:20:06
In reply to Re: Abilify, posted by Justherself54 on March 2, 2010, at 1:10:09
I don't think i had 'akathisia' but i experienced something similar on 5mg+ of aripiprazole. I lost any remaining motivation, and would just lie on the floor of my apartment. like ssri apathy, but with less contentment or life.
-d/r
Posted by Verloren on March 2, 2010, at 13:18:28
In reply to Abilify, posted by Justherself54 on March 1, 2010, at 23:05:45
Hi Justherself
My 2 cents:
I was on 5mg of Abilify for almost a week and it was horrible for me too. I had no will or energy to do anything. It would take great strength just to get myself into the car to go somewhere but the I couldn't even put the key in the ignition to start it. I would just sit there staring out the windshield.
Abilify should be called Disabilify.
-V
Posted by bleauberry on March 2, 2010, at 16:22:03
In reply to Abilify, posted by Justherself54 on March 1, 2010, at 23:05:45
> I'm currently not on an AD but decided to try a small dose of abilify. I took half of a 5 mg tablet and had a most horrible day. I was awash with sadness and spent the day on the couch in a strange anxiety ridden stupor. I'm actually having trouble finding the right words to describe it.
>
> Has anyone experienced this? I usually like to give meds a decent trial. I was actually expecting some restlessness. This didn't happen. I'm scared to take any more. Akkkk.Yes, I have definitely experienced this. Not on abilify in particular, but quite a few other common meds. Truly horrible. The good thing is, it is temporary. Abilify has a long halflife, about a week, but you should start bouncing back to where you were pre-abilify in a day or two.
The last time I tried abilify I only did 1mg, and it was without any other meds. I think abilify needs a ssri or snri companion. I don't recall anyone or any studies using it as monotherapy for depression.
Sorry for the experience! You'll be fine.
Posted by Elimino Pete on March 4, 2010, at 1:10:48
In reply to Re: Abilify » Justherself54, posted by jedi on March 2, 2010, at 0:54:28
Hello,
I had some communication with you about a year ago regarding our medication history (MAOIs mostly) and comorbidities. I have been off this forum for about a year. I have social phobia, GAD, atypical depression and ADD. My daily medications are currently a bit in flux but are as follows:
Klonapin 1.0 mg
Adderall 30 mg
Inderal 100 mg
Abilify (just dropped from 5 to 2.5 mgContrary to the report in this thread, my pdoc said there is growing evidence that Abilify could benefit my symptom mix without concurrent use of an antidepressant.
My experiences with Abilfy are odd. After about 2 weeks on 2 mg, I thought I'd found a part of the ever elusive answer. I was feeling stable, activated, more focused and less socially anxious. The only notable side effect was some tolerable insomnia and irritability.
Over the next two weeks, all the positive effects diminished. I've since became what somebody here described -- just hanging around in my apartment with no drive or energy to do anything at all. It's still like that. I am on a furlough and sleep many more hours than I am awake. I thought perhaps Abilify had just petered out, so the doc increased the dose to 5 mg. After about another two weeks at the higher dose, the positive effects never returned and the negative ones only increased. A theory I had was Abilify was at least partially blocking the dopamine agonist effect of Adderall. Pdoc didn't elaborate, but may have agreed, as he switched Abilify to bedtime at 1/2 the former dose, furthest away from my Adderall doses. He also increased the Adderall to twice the former dose. It has been about a week since those changes. So far, I'm still the same zombie and I can't believe I'm even able to write this post.
I don't know if what I'm experiencing is related to akathisia, but maybe. Anhedonia seems to describe how I'm feeling, but there may also be an element of inner angst (while I'm sitting around having great difficulty motivating to keep up even with routine household chores).
My instincts tell me not to give up on Abilify just yet. Something tells me it holds promise (after years of trying 'this and that' with less than good results with anything other than Nardil) either with or without an antidepressant. Other than Nardil (assuming it is contraindicated with Abilify?), Wellbutrin worked better and had fewer side effects than the others. It might therefore be the one to throw in the mix. I just don't want to spend too much time in this state of nothingness I'm feeling right now. I want to believe I'm more than that.
Your thoughts, as well as those of others, would be greatly appreciated.
Posted by jedi on March 4, 2010, at 3:06:56
In reply to Re: Abilify » jedi, posted by Elimino Pete on March 4, 2010, at 1:10:48
Hi Pete, Everybody is different when it comes to medications. Your symptoms do not sound like akathisia to me. Sometimes it takes a while to get used to the medications and there are other medications, like the beta blocker proprananol, to counteract the akathisia if that is the problem. Looking again, you are taking proprananol (Inderal) which probably helps with Abilify. I do not see an antidepressant in your current cocktail. With the atypical depression, I would think you need to add something. Of course, my choice is Nardil, but with the ADD and the need for stimulants, you need a very experienced PDOC to guide you through that combination. I have not seen any studies of Abilify as a stand alone antidepressant. It has been approved for augmentation. But maybe your PDOC knows some things that aren't published. The oversleeping is definitely a symptom of atypical depression. If the other symptoms are there, the social phobia goes hand in hand with rejection senitivity, you probably need to add something else for the atypical depression.
I have taken Wellbutrin in the past. I have even augmented Nardil with it even though they are contraindicated. One thing about me and Wellbutrin is it tends to make me somewhat aggressive. I even had an experience of road rage on it, which is completely unlike me. These three guys pulled off the side of the road in front of me. I swerved hard to miss them, stopped, looked back and all three were flipping me off. I got out of my truck and knocked the sh*t out of all three. Again, never before, never again, so I blamed it on the Wellbutrin. I am not a kid, I'm 52 years old.
I'm currently adding 2mg of clonazepam to 60mg of Nardil. I'm trying to get to the lowest dosage that will keep me out of major depression. 60mg with the clonazepam is right on the edge. The side effects are so much better at 60 than at 90 or 105. I went down to 1mg of clonazepam for a while. It was no problem reducing the dosage, but after a while it became a choice of increasing the Nardil or raising the clonazepam up to 2mg, to keep the atypical depression at a respectable distance. The clonazepam does give me some brain fog. But most people I know have a level of CRS(Can't remember S**t) anyway.
Good luck and be well,
Jedi
> Hello,
>
> I had some communication with you about a year ago regarding our medication history (MAOIs mostly) and comorbidities. I have been off this forum for about a year. I have social phobia, GAD, atypical depression and ADD. My daily medications are currently a bit in flux but are as follows:
>
> Klonapin 1.0 mg
> Adderall 30 mg
> Inderal 100 mg
> Abilify (just dropped from 5 to 2.5 mg
>
> Contrary to the report in this thread, my pdoc said there is growing evidence that Abilify could benefit my symptom mix without concurrent use of an antidepressant.
>
> My experiences with Abilfy are odd. After about 2 weeks on 2 mg, I thought I'd found a part of the ever elusive answer. I was feeling stable, activated, more focused and less socially anxious. The only notable side effect was some tolerable insomnia and irritability.
>
> Over the next two weeks, all the positive effects diminished. I've since became what somebody here described -- just hanging around in my apartment with no drive or energy to do anything at all. It's still like that. I am on a furlough and sleep many more hours than I am awake. I thought perhaps Abilify had just petered out, so the doc increased the dose to 5 mg. After about another two weeks at the higher dose, the positive effects never returned and the negative ones only increased. A theory I had was Abilify was at least partially blocking the dopamine agonist effect of Adderall. Pdoc didn't elaborate, but may have agreed, as he switched Abilify to bedtime at 1/2 the former dose, furthest away from my Adderall doses. He also increased the Adderall to twice the former dose. It has been about a week since those changes. So far, I'm still the same zombie and I can't believe I'm even able to write this post.
>
> I don't know if what I'm experiencing is related to akathisia, but maybe. Anhedonia seems to describe how I'm feeling, but there may also be an element of inner angst (while I'm sitting around having great difficulty motivating to keep up even with routine household chores).
>
> My instincts tell me not to give up on Abilify just yet. Something tells me it holds promise (after years of trying 'this and that' with less than good results with anything other than Nardil) either with or without an antidepressant. Other than Nardil (assuming it is contraindicated with Abilify?), Wellbutrin worked better and had fewer side effects than the others. It might therefore be the one to throw in the mix. I just don't want to spend too much time in this state of nothingness I'm feeling right now. I want to believe I'm more than that.
>
> Your thoughts, as well as those of others, would be greatly appreciated.
Posted by Elimino Pete on March 4, 2010, at 20:44:52
In reply to Re: Abilify » Elimino Pete, posted by jedi on March 4, 2010, at 3:06:56
Hello Jedi,
Will definitely question the pdoc about the Abilify used without an antidepressant (that ought to piss him off). When it was working, it really seemed to work on the ADD too. Wellbutrin may be the one to request as it is the one that did not give me that lousy awful side effect of anorgasmia. It helped some with depression, but it was subtle. Maybe with Abilify augmenting it...?
I'll watch out for that aggression symptom if I do try Wellbutrin next. I do tend to be a bit volatile, especially under stress. I don't often think in terms of meds being part of it, though clearly they may be. If it was a sure bet, I might get a good amount of bupropion in my veins and go out to take care of a couple of trouble makers that need to be cut down a notch or two now (just kidding- sort of). Wellbutrin or no Wellbutrin, you must be no small guy to be able to beat the s**t out of three troublemakers on the road! We're almost the same age and I don't even want to know how many pounds of muscle I've lost since in my prime.
I don't really know what keeps me from going back to Nardil. It is partly that the stimulants do help me, but I took a small dose of Adderall with Emsam without issue. Emsam did not help me much at the lowest dose and I figured I'd go back to Nardil before upping Emsam and having to deal with the dietary restrictions anyway. I stopped short of doing just that. Maybe it is the dietary part, but I did handle that okay before. Probably it is the sexual side effects. I had to keep my Nardil dose quite low to be able to even tolerate them. Call me crazy (in a way that minimizes my extreme rejection sensitivity!), but I'd rather be depressed as to have major sexual dysfunction. Do you battle that too? How do you do with diet and contraindicated OTC and other drugs? I took the liberal road with it myself, but I was younger (am I obsessed with that?). I even drank without problems (did stay away from red wine which wasn't hard for me). I don't drink any more.
If this Abilify 'tangent' doesn't come through and my pdoc doesn't know any other tricks we've not tried (too many to count), I may just go back to Nardil. My life has been so contained, more due to the social anxiety than anything else. I get used to it and even try to make friends with it, but its not truly any happy thing, as you must well know. Sometimes I think it is because I gave up alcohol, but most of the time, the smarter part of me realizes Alcohol was no true answer. It sure does treat social phobia effectively, but the side and after effects...oh God! Does your gut tell you I should go back to Nardil? I won't hold you responsible for anything so 'speak' freely please.
I've got the CRS syndrome too and I'm sure there are multiple causes, including the many bad habits I supported in my youth (yes I guess I am traumatized by mid-life).
Wish you well,
Pete
Posted by jedi on March 5, 2010, at 8:54:08
In reply to Re: Abilify » jedi, posted by Elimino Pete on March 4, 2010, at 20:44:52
Hi Pete,
As I remember, the bupropion did help with the delayed orgasm of Nardil. Of course they are contraindicated but I had no problem with high doses of both medications. My side effects from Nardil are really mild if I can keep the dosage down around 60mg. I have to add the 2mg of clonazepam in order to keep my social anxiety under control. Many people say that clonazepam worsens their depression, but I have not noticed that. It has a nice long half life so you don't get the ups and down of some of the shorter acting benzos.I think medications, especially stimulants and others that affect dopamine can make a person abnormally aggressive. If you have ever had to deal with someone tweaking on methamphetamine, you will know what I mean.
I think most people can combine a low dose stimulant with Nardil under the right supervision. My MD is afraid to do it but he is not an expert on MAOIs. I think I have taught him most of what he knows about MAOIs. I am always sending him studies that I have read on them. I believe, if you are taking an MAOI like Nardil or Parnate, you really have to take your education and responsibility to the next level. There are so many doctors, pharmacists, and other health professionals with no knowledge of these medications.
I live in a small town in central Washington State. I don't think there are more than a couple of PDOCs in the whole town. And you have to be on Medicaid or welfare to even see them. Psychiatrists tend to congregate together in the large cities where there are more patients and more colleagues. This town is the medical center for all of Central Washington State. I just looked in the yellow pages. There are 223 MDs listed for the area. There is one psychiatrist listed.
Yes Nardil is one of the worse at causing delayed ejaculation. At the lower doses I am fine, at the upper doses, forget about orgasm. It does not seem to affect my libido, but I do use a compounded testosterone gel. Just getting old I guess.
The diet is no problem for me. The one thing I miss is the aged cheeses, but I can live with that. I don't eat anything that I don't know the ingredients, but the conservative MAOI diet is way overblown. I have never had trouble with any kind of alcohol, though I avoid tap bear just because you don't know how long since they cleaned the taps. Here is the diet I go by. This was written by a long term poster to this site, Elizabeth. This lady was a wealth of knowledge about treatment resistant depression. http://www.dr-bob.org/babble/20010814/msgs/75408.html Read some of her old posts on MAOIs and opioids if you get a chance; very interesting. I swear she had a photographic memory! Does anybody out there know what Elizabeth is doing now?
OTC medications are not a problem for me. I rarely get a cold anymore, and that stuff doesn't really help anyway. I do take diphenhydramine hydrochloride(Benadryl) for sleep. I also sometimes take a micro dose of Seroquel(12.5 mg) if the insomnia is bad. Again, do your own research on this. I was in British Columbia, Canada years ago; where they sell codeine over the counter. Codeine is fine, but they had mixed some pseudoephedrine or dextromethorfan in with the Codeine. The pharmacist swore it was fine with Nardil. I did not have my reading glasses and could not read the fine print on the bottle. Later, when I read it there was no MAOI warning at all. I guess the Canadians were used to seeing Moclobemide, the placebo of MAOIs. This mistake by the pharmacist cost me a trip to the ER with a BP that would not even register on my own cuff and a splitting headache. I trust no one but myself with Nardil interactions anymore.
That brings up another side effect for me. My presbyopia is worse on Nardil. I need reading glasses to read the paper. When not on Nardil I can read it just fine. Again, not a big deal; compared to major depression.
I have been on 45+ different combinations of antidepressants and augmenters. That is a lot of pain considering most of them were given at least four weeks before stopping each trial. Nardil with clonazepam has been the only thing that has worked for me. I am still looking for an augmenter to help with my residual dysthymia. A low dose stimulant would probably help, but I would have to go to Seattle and do a lot of research to find a PDOC who would prescribe it.
In my humble opinion, I believe that Nardil augmented with clonazepam is still the gold standard for atypical depression with social anxiety disorder. This combination can work when countless others have not. You do fight some side effects. For me the biggest battle is the carbohydrate cravings and associated weight gain. I keep this under control with intense exercise. But all of the side effects put together don't come close to serious major depression; where you are on the floor in a fetal position in such psychic torture you wonder how survival is possible.
Good Luck and Be Well,
Jedi> Hello Jedi,
>
> Will definitely question the pdoc about the Abilify used without an antidepressant (that ought to piss him off). When it was working, it really seemed to work on the ADD too. Wellbutrin may be the one to request as it is the one that did not give me that lousy awful side effect of anorgasmia. It helped some with depression, but it was subtle. Maybe with Abilify augmenting it...?
>
> I'll watch out for that aggression symptom if I do try Wellbutrin next. I do tend to be a bit volatile, especially under stress. I don't often think in terms of meds being part of it, though clearly they may be. If it was a sure bet, I might get a good amount of bupropion in my veins and go out to take care of a couple of trouble makers that need to be cut down a notch or two now (just kidding- sort of). Wellbutrin or no Wellbutrin, you must be no small guy to be able to beat the s**t out of three troublemakers on the road! We're almost the same age and I don't even want to know how many pounds of muscle I've lost since in my prime.
>
> I don't really know what keeps me from going back to Nardil. It is partly that the stimulants do help me, but I took a small dose of Adderall with Emsam without issue. Emsam did not help me much at the lowest dose and I figured I'd go back to Nardil before upping Emsam and having to deal with the dietary restrictions anyway. I stopped short of doing just that. Maybe it is the dietary part, but I did handle that okay before. Probably it is the sexual side effects. I had to keep my Nardil dose quite low to be able to even tolerate them. Call me crazy (in a way that minimizes my extreme rejection sensitivity!), but I'd rather be depressed as to have major sexual dysfunction. Do you battle that too? How do you do with diet and contraindicated OTC and other drugs? I took the liberal road with it myself, but I was younger (am I obsessed with that?). I even drank without problems (did stay away from red wine which wasn't hard for me). I don't drink any more.
>
> If this Abilify 'tangent' doesn't come through and my pdoc doesn't know any other tricks we've not tried (too many to count), I may just go back to Nardil. My life has been so contained, more due to the social anxiety than anything else. I get used to it and even try to make friends with it, but its not truly any happy thing, as you must well know. Sometimes I think it is because I gave up alcohol, but most of the time, the smarter part of me realizes Alcohol was no true answer. It sure does treat social phobia effectively, but the side and after effects...oh God! Does your gut tell you I should go back to Nardil? I won't hold you responsible for anything so 'speak' freely please.
>
> I've got the CRS syndrome too and I'm sure there are multiple causes, including the many bad habits I supported in my youth (yes I guess I am traumatized by mid-life).
>
> Wish you well,
> Pete
>
>
Posted by Elimino Pete on March 6, 2010, at 9:50:22
In reply to Re: Abilify + Other Meds » Elimino Pete, posted by jedi on March 5, 2010, at 8:54:08
Hi Jedi,
Interesting about the Klonapin. I have been on it for 10+ years, but my experience has been more benefit from the Ativan days. I like the idea of the long half-life so that it works more in the background. Since in theory it should be better for me, I am still with Klonapin. I am not sure if my reasoning there is sound, but my pdoc concurs. Annoying sedation is probably a bigger problem for me with the benzos than memory issues, but as stated, I too have the memory problems. It's hard for me to know the causes when there are so many meds in the mix and even those that are ever in flux. Besides, I think there is a baseline memory problem in my case, as much as I may wish to deny it. The brain fog of ADD is another layer to that.
To echo your predicament, my pdoc is not even up on MAOI drugs, so I do know what you mean about having to be proactive with your health care. I try to do that, but you are clearly much more researched than I. Given the area of rather isolated geography in which I live, the pdoc is decent over all, but is way more new school.
You are to be congratulated for what you have done. It sounds like you are living testament to the fact that people with mental health problems can and do get better. You've even done it without a lot of direct assistance from the medical community. From what you've revealed, I admire you for what you've been able to accomplish, in spite of the apparent profound challenges. Though I too have come a long way (at least I think so most days), you give me hope that there is more.
If I do go back onto Nardil (and I think I may), I may look into the testosterone gel treatment you mentioned. I sometimes test borderline low testosterone and my pc doc has mentioned the gel if the tests become consistent. Did you try any of the standard ED treatments and did they help with the Nardil side effects? I've used them but not while on any drugs that caused me ejaculatory problems(Selegeline 6 mg did not). Sounds like you may be able to readily settle for sex without orgasm, at least sometimes. I wish I was more like that. For me, it often becomes an exercise in frustration.
You mentioned codeine. I actually used to use it to self-medicate and found it to have robust anti-anxiety and anti-depressive effects. Too bad it isn't something one can typically use long-term or I might just push a doc for a script (fat chance I'm sure). Im glad you were able to get beyond your frightening episode with the combo confusion. I used to carry some drug (I'm sure you know of it) that was designed to counteract a hypertensive crisis, but I was naive to the threats of hypotensive emergencies with an MAOI(still am to a great extent actually). Thanks for the account as it will generate some research on my part.
I like Elizabeth's MAOI diet list, particularly in light of the fact that you have field tested it and it works well for you. I will certainly refer to it again, esp. if and when I go back to Nardil. It's good to know that the MAOI dietary restrictions have been relaxed in the years since I had to deal with that.
I have to admit that the weight gain is also a huge factor in my hesitancy to go back on Nardil. It in fact may be the biggest one. When I more recently tried 6 mg Emsam, I experienced a spike in weight, but got no real therapeutic benefit. That too has me gun shy to going back on Nardil. At the end of Nardil treatment, I was down to only 30 mg Nardil and actually did receive benefit, but who knows about now until I try. If I could contain sexual and weight side effects and go higher more easily, I'd be back on Nardil in a heartbeat. I guess I'm not quite ready to give up on other drug and drug combo possibilities just yet, but after over a decade of a lot of disappointment, I wonder in the long run if I'd had been better off to just stick with the tried and true. Then again, I'd never had known, had I not tried.
Incidentally, in spite of the literature that says it is the treatment of choice for social phobia, CBT was not my answer. My case is substantial, however.
Thanks again for all your input, Jedi. You have no idea how much you help me and I will always be grateful.
Regards,
Pete
This is the end of the thread.
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