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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by Christ_empowered on October 31, 2011, at 20:26:28
I haven't taken any Abilify today, but I'm considering it. I think the problems are that a) I was on an excessively high dose for too long, which made me dislike Abilify (which is the only AAP I can tolerate) and b) short-term, Abilify isn't that bad, especially at 15 (I have lots of 30 tabs, so I just take 1/2). However, over time, I start to feel kind of dull, apathetic, lethargic...tranquilized, basically. I'm also prone to depression anyway, and long term I don't think full-dose Abilify really helps in that department, and I suspect it may actually make the situation worse.
So, I don't really know what to do. My parents get generic Abilify from India (God bless the internet), so it wouldn't be too hard to order a stash of a lower dose. I'd need my doctor's approval though. They just ordered more 30 tabs, so I should probably work with those first. I was thinking about taking a 1/4 tab daily (roughly 7.5mgs) to see if that would be better than 15. I did read somewhere, in an article or something from the early-to-mid 200s, that 7.5mgs Abilify was roughly equivalent to 100ms Thorazine, which is apparently a good, small maintenance dose for those with psychotic "issues."
I don't think I need clozapine. I mean, I'm glad they're still using it, since it seems to help people who aren't adequately helped by other available options, but man--that is some rough stuff. Even if you ignore the potentially fatal side effects and hassle of doing blood work, you still have to admit that something that densely sedating (some people have a tendency to drool on it) probably isn't ideal, especially considering that I've become accustomed to Abilify.
As much as I hate reuptake inhibitors ("antidepressants"), I kind of think that a low dose of something relatively tolerable--celexa, for instance--might help with my problems. This time around, if I could get on an antidepressant, I'd probably also try to haggle with my doc to get a lower Abilify dose approved. Unfortunately for me, my doctor is convinced that an antidepressant would make things worse. She has a point--even people without a history of psychosis or mania can have problems with the reuptake inhibitors--but I think there's a lot of variability in response to these drugs, and in my own experience I sometimes benefit from them.
As for diagnosis...I have no idea. Auditory hallucinations that become more pronounced with very low or very high mood. No current sleep problems, except for a screwed up sleep schedule because of my bout with the flu. Anxiety and agitation have been minimized by the Lamictal 200, which to me would mean that the mood-elevating properties plus the anticonvulsant action (they have a "taming effect," at least on animals) really does the trick for me. I get agitated, psychotic depression (or whatever you call it) and my last "manic episode" lasted 5 months and involved paranoia, religious delusions, periods of euphoria, periods of dysphoria, lack of concentration, hyperkinesis, high blood pressure, a half-*ss*d suicide attempt, hostility, weight loss, high blood pressure, and dissociation.
I'd love to say "hey, its Bipolar with Psychotic Features," but I think maybe I'm one of those people who doesn't really fit into the DSM. Then again, I think shrinks have a tendency to *make* people fit into the DSM by emphasizing some problems and minimizing (or ignoring) others. My "manic episode" left me feeling as if my whole personality was disintegrating. I don't think that's terribly common in classic Bipolar I, but I don't know.
There have always been strong psychosocial and environmental factors in my "illness," most of which have now been minimized or rectified, which may explain why I'm able to do more with less medication. Or I could have outgrown an immature, self-absorbed personality.
What's strange is that, looking back, I feel as if my psychosocial and personality issues masked an underlying problem. On paper, it looks like I've gone from neurotic and disordered to straight up crazy as hell. The psychiatric symptoms are now more distinct and more easily treated. I kind of feel as if some of my so-called "defense mechanisms helped "hold back" severe psychotic issues. Now that those defense mechanisms have been destroyed, I'm left with more maturity, more insight, a better ability to engage in life and function, but I also have to contend with more severe mood and psychosis problems. Such is the price of progress, I suppose.
Sorry this was so long and rambling. Its just that I think my madness, and most people's madness, is so much more nuanced and complicated than just a "broken brain" that results in aberrant (or at least undesirable) behavior. Factor in the hot mess that is modern day psychiatry, and you have a recipe for Trouble (note the capital T).
Thanks, everyone, for taking an interest in my well-being. I can assure all of you that I'm not in denial or looking to land in a mental hospital; I'm just trying to figure out how to function without turning into a tranquilized zombie.
I think I'll go ahead and take some Abilify now. I have a fear of ending up in a mental hospital. Not only do those places suck for everybody, I seem to earn the contempt of the physicians and other staff of the hospitals I've been in. I think I'm a little too "spunky" for my own good, at least when it comes to inpatient "treatment." So, its probably wise to take 7.5-15 Abilify and keep myself out of psychiatry's more oppressive forms of "treatment."
Posted by Phillipa on October 31, 2011, at 23:26:16
In reply to More on Abilify...(long, sorry), posted by Christ_empowered on October 31, 2011, at 20:26:28
CE seriously I feel this is a very wise move for you. Sorry about the flu. I feel pretty strongly that you do need the abilify from knowing you this long. And lamictal can act as an antidepressant also. So technically you have both. Phillipa
Posted by SLS on October 31, 2011, at 23:34:27
In reply to More on Abilify...(long, sorry), posted by Christ_empowered on October 31, 2011, at 20:26:28
> Thanks, everyone, for taking an interest in my well-being. I can assure all of you that I'm not in denial or looking to land in a mental hospital; I'm just trying to figure out how to function without turning into a tranquilized zombie.
That is perfectly understandable. I can commiserate. I, too, would want to discontinue Abilify were I able to. I would consider taking 20 mg as your first loading dose, and 10 mg thereafter. I hope your experience is similar to mine. 20 mg caused me to become somewhat zombified (nice nomenclature we devise here). At 10 mg, I retain the antidepressant benefit, but without cognitive blunting. Let's hope that, for you, this is true of the AP effects as well.
- Scott
Posted by sigismund on November 1, 2011, at 1:33:13
In reply to More on Abilify...(long, sorry), posted by Christ_empowered on October 31, 2011, at 20:26:28
Could 7.5mg Abilify have something of an AD effect?
Posted by jono_in_adelaide on November 1, 2011, at 5:44:26
In reply to Re: More on Abilify...(long, sorry), posted by sigismund on November 1, 2011, at 1:33:13
Just a thought, but if you dont want a reuptake inhibitor, could you consider trimipramine - it excerts its antidepressant effect through blocking the 5HT2 receptors..... not sure, but this might also mean its less likely to send you into mania?
Posted by SLS on November 1, 2011, at 6:01:47
In reply to Re: More on Abilify...(long, sorry), posted by jono_in_adelaide on November 1, 2011, at 5:44:26
> Just a thought, but if you dont want a reuptake inhibitor, could you consider trimipramine - it excerts its antidepressant effect through blocking the 5HT2 receptors..... not sure, but this might also mean its less likely to send you into mania?
That's a great thought worthy of further research. I wouldn't hold your breath, though.
- Scott
Posted by SLS on November 1, 2011, at 6:06:35
In reply to Re: More on Abilify...(long, sorry), posted by jono_in_adelaide on November 1, 2011, at 5:44:26
> > Just a thought, but if you dont want a reuptake inhibitor, could you consider trimipramine - it excerts its antidepressant effect through blocking the 5HT2 receptors..... not sure, but this might also mean its less likely to send you into mania?
> That's a great thought worthy of further research. I wouldn't hold your breath, though.I forgot to mention that I tried trimipramine (Surmontil), but failed to respond to it. It didn't even give me my usual 3-day improvement like many of the other TCAs do.
Q: Do you feel strongly that 5-HT2 receptor blockade is solely responsible for the therapeutic effects of trimipramine?
- Scott
Posted by Christ_empowered on November 1, 2011, at 6:25:00
In reply to Re: More on Abilify...(long, sorry) » jono_in_adelaide, posted by SLS on November 1, 2011, at 6:06:35
I actually thought about Surmontil. Probably won't happen. My shrink is Public Health. I don't think they prescribe TCA drugs because of the OD risk. They also are prohibited from prescribing any controlled substances.
Apparently, Surmontil is similar in some respects to clozapine, which might explain why it calms people down. Google turned up a few studies on Surmontil at high doses in Schizophrenia. Apparently, at high doses there can be some EPS and its not as effective as normal doses of phenothiazines (I couldn't find any studies comparing it to the newer neuroleptics).
Luckily for me, the Lamictal @ 200 seems to improve my mood and somehow keep the agitation under control. Lamictal also seems to help a bit with the anxiety, although I do still find myself blushing for no reason or getting nervous in public.
I was kind of hoping for Prozac, honestly. Never tried it before, but because of the drug-drug interaction with Abilify, I could lower the Abilify to 1/4 of a 30 tab, which would cut drug acquisition costs for me, since the Prozac is now a $4 generic. Also, its apparently stimulating, which I'd appreciate; however, I think my doctor is of the opinion that stimulation is the absolute last thing I need.
Anyway, with the TCAs probably not an option ever and the newer reuptake inhibitors not an option for right now, I think the best approach might be to just go back on the Abilify at 15 (even in the absence of hallucinations I find that it helps me calm down and focus on things, which is always a good thing), stay there for a while, and then see about maybe reducing to 10 to maybe reduce the tranquilized feeling and/or get a little bit of stimulation.
My dream would be to say good bye to the neuroleptics forever, except maybe a couple weeks of treatment here and there for acute episodes of crazy, but I think maybe I should face up to the fact that I'm going to be on neuroleptics for a long time.
I'm trying to make my body better able to handle the neuroleptics by loading up on antioxidants orthomolecular medicine style. I know, its not exactly orthodox and some of their practitioners seem to make wild claims, but so far the vitamins have really improved the tolerability and effectiveness of my medications. No EPS, no akathisia, and as much as I complain about the "tranquilizer psychosis," in my more objective moments, I realize that I'm not as dulled out as I often think I am. Or maybe I've just convinced myself to accept the chemical straitjacket. Who knows, right?
Posted by Phillipa on November 1, 2011, at 18:32:58
In reply to Re: More on Abilify...(long, sorry), posted by Christ_empowered on November 1, 2011, at 6:25:00
CE what supplements have you found to help? Glad you are staying on the abilify. Phillipa
Posted by Solstice on November 1, 2011, at 21:14:02
In reply to More on Abilify...(long, sorry), posted by Christ_empowered on October 31, 2011, at 20:26:28
> So, I don't really know what to do. My parents get generic Abilify from India (God bless the internet)I don't know much about the manufacturing of medications, but how does one assure themselves of the accurate production of, and safety of, medications that come from a country that has until recently been considered third-world, and at best is probably currently considered a developing country?
Solstice
Posted by g_g_g_unit on November 2, 2011, at 3:36:39
In reply to Re: More on Abilify...(long, sorry), posted by Christ_empowered on November 1, 2011, at 6:25:00
Y'know, for someone who's "straight up crazy," you write with remarkable clarity and thoughtfulness. Sorry, I don't have anything constructive to add to your dilemma, but just felt the need to point that out.
Actually, have you (or your psychiatrist) considered Provigil? I was under the impression it was one of the 'safer' stimulants with respect to (controlled) psychosis.
Posted by jono_in_adelaide on November 2, 2011, at 4:05:45
In reply to Re: More on Abilify...(long, sorry) » jono_in_adelaide, posted by SLS on November 1, 2011, at 6:06:35
Hey scott, I realy dont know - its just what i have read........ I thought after i wrote it that Abifily is also a 5HT2 blocker, so trimipramine probably wouldnt have much to add to it except sedation.
i have never tried it, the only tricyclic i have ever tried is dotheipin (Prothiaden), in the days before the SSRI's and Effexor took hold it was the #1 antidepressant in the UK, Australia, NZ etc, and nortriptyline, which i found easier to tolorate
Posted by Solstice on November 2, 2011, at 19:36:39
In reply to More on Abilify...(long, sorry), posted by Christ_empowered on October 31, 2011, at 20:26:28
Here's a New York Times Article from 2008 regarding safety problems with medications from India
http://latimesblogs.latimes.com/booster_shots/2008/09/fda-issues-warn.html
Posted by jono_in_adelaide on November 3, 2011, at 1:24:04
In reply to More on Abilify...(long, sorry), posted by Christ_empowered on October 31, 2011, at 20:26:28
Can I ask why?
To me, along with chlorpromazine, the reuptake inhibitor antidepressants (starting with imipramine) were the bigest advance ever in psychiatry.
Posted by SLS on November 3, 2011, at 5:37:29
In reply to More on Abilify...(long, sorry), posted by Christ_empowered on October 31, 2011, at 20:26:28
> I haven't taken any Abilify today, but I'm considering it. I think the problems are that a) I was on an excessively high dose for too long, which made me dislike Abilify (which is the only AAP I can tolerate) and b) short-term, Abilify isn't that bad, especially at 15 (I have lots of 30 tabs, so I just take 1/2).
HOMEOSTASIS!
Try 10 mg/day of Abilify before you try pulsing it.You could even alternate between 10 mg and 15 mg every other day. The long half-life of Abilify allows for this without actually pulsing the drug.
You seem to be compulsive or impulsive in your constantly changing your treatment. I am concerned that you are getting stuck in a behavioral loop such that you will never allow any one regime time enough to establish itself.
As always, Best Wishes.
- Scott
Posted by Christ_empowered on November 3, 2011, at 7:32:05
In reply to Re: More on Abilify...(long, sorry) » Christ_empowered, posted by SLS on November 3, 2011, at 5:37:29
Hey. To Jono--the reuptake inhibitors *do* seem to help with acute psychotic depression (or whatever you call what I experience periodically), but unless the depression is deep and dark, its really not worth it. With milder depressions (and I get voices with milder depressions, its weird), the side effects (emotional blunting, mild mood instability, etc.) really don't justify the almost non-existent benefits.
SLS--I think you might be on to something. I alternate between "psychiatry is helpful" and "psychiatry is oppressive, pseudo-scientific BS," largely because of my experiences as a mental patient. I've experienced both warm and helpful doctors (outpatient) and cruel and unhelpful doctors (inpatient), and some outpatient doctors who were in between those extremes. I also used to be a big Dr.Thomas Szasz fan, and even though I disagree with his premise that mental illness is a "myth," many of his other criticisms of psychiatry and psychology are spot on, so its hard to just go with what the experts tell me to do. Also, in my experience, shrinks diagnose me differently based on their own issues (age, gender, how long they've been practicing, etc.), so its hard to accept any diagnosis as entirely valid.
Still, you do what works, right? I've been taking 15 (I have a stockpile of 30 tabs. They're scored, so I just break it and take 1/2 daily), and I feel pretty good. Minimal paranoia, minimal auditory hallucinations, no major anxiety or agitation, no "fuzzy" concentration, so on and so forth. I've even fixed my screwed up sleep schedule (for now, at least...), so I'm definitely making progress towards being a stable, sane human being, which is a good thing.
I think while the voices were more intense and my mood was lower, I thought if I could elevate my mood, the voices might go away or become less intense and bothersome. As it turns out, my mood has gotten better from non-medical "treatment" (social interaction and taking some initiative in my life), and the voices have gotten more tolerable. Some days I don't even hear voices, which is nice.
Thanks, as always, for your insight and concern. Once I run out of 30 tabs, I think I'll order (or get an Rx, if I get Medicaid+disability) for 20 tabs and take 1/2 and then pop a whole one if I'm feeling agitated.
Posted by morgan miller on November 3, 2011, at 18:28:29
In reply to More on Abilify...(long, sorry), posted by Christ_empowered on October 31, 2011, at 20:26:28
CE, I thought you didn't mind Celexa much. The only thing you said you didn't like about it was feeling a bit too numb. Why not consider ordering a low dose of generic Lexapro online? You may do much better on it.
Why would your doc think an SSRI like Celexa is bad for you when you experienced quite a bit of success with it?
So I guess you don't like the idea of taking depakote or lithium. Maybe I missed something here.
Morgan.
Posted by Christ_empowered on November 3, 2011, at 21:57:16
In reply to Re: More on Abilify...(long, sorry), posted by morgan miller on November 3, 2011, at 18:28:29
Hey Morgan.
I don't know why my shrink is against any antidepressant. Honestly, I don't even know if she actually heard what I said about the Celexa helping, or if she somehow heard what fit into her own thoughts on the subject (that antidepressants make voices worse). I told her "I got depressed on 30, started hearing voices, went on low-dose Celexa, and I got better. Then I dropped the Celexa after a few months," to which she responded "ahh yes, Lexapro can make voices and agitation worse. There's this other medication, called Clozaril..."
All too often, I've found that shrinks come to the table with their own ideas, both about your condition in general and your situation in particular, and then everything you say is made to fit their preconceived notions about your problem(s). That said, this is a pretty good doctor; she's been doing this for 30+ years, she doesn't try to high-dose my antipsychotic (even when I'm hearing voices), and she was open to me doing therapy to deal with the residual hallucinations. All in all, I'm pleased.
Depakote is my Kryptonite, especially combined with Abilify. When I take it alone, I throw up. With Risperdal, it set off mad anxiety and tremors. With Abilify, I had nausea early on (Abilify apparently lacks any anti-emetic action) and it "potentiated" the Abilify in such a way that I looked, sounded, and acted like some Thorazine-d 1950s State Mental Hospital patient. Dropping the Depakote made the Abilify a lot easier to tolerate, and reduced my anxiety levels.
Lithium scares me. I know, I know--small doses. The thing is, lithium is even worse for triggering EPS in combo with neuroleptics than Depakote is, so that's perfectly terrifying. Also, right now I'm doing all this w/o insurance, so although Lithium would be cheap up front, the added expense of labs and (most likely) additional shrink appointments to get the dose adjusted would really start to add up.
I guess I could order some sort of antidepressant online. I'd feel like I was misleading my shrink. Also, my mood seems to have improved a good bit since I hit 200 on the Lamictal. The problem is that the Abilify at 15 is definitely *NOT* an antidepressant at all--in fact, I suspect that despite its reputation as "clean" and "activating," standard-to-high Abilify doses may actually push my mood a bit lower over the long haul. I guess then the question would be: what neuroleptic out there do you try that won't do this? To which I would have to respond..no clue. Zyprexa caused akathisia at 2.5mgs; Seroquel made me angry and oversedated; Risperdal caused EPS and dysphoria. Geodon, honestly, kind of scares me a little bit, although many people do benefit from it. The newest neuroleptics don't interest me. The problem isn't that I'm "treatment resistant," the problem is that even today's neuroleptics seem to have a built-in anti-happiness feature that depresses the hell out of me, especially with long-term, full dose use.
OK, sorry this was so long. I appreciate your concern, I really do. I'll think about getting on magic pharma or something and ordering an AD if things get considerably worse.
Thanks again.
Posted by Phillipa on November 3, 2011, at 23:42:08
In reply to Re: More on Abilify...(long, sorry), posted by Christ_empowered on November 3, 2011, at 21:57:16
CE this does make a lot of sense to me. Someone wrote that the luvox I take could be for psychotic depression maybe look into that. If it's voices. From the patients I took care of that had auditory hallucinations they just wanted them gone. I wathched clozaril do this but they slept all the time at least when in the hospital. What a tough call this is for you. Love Phillipa
Posted by morgan miller on November 4, 2011, at 11:41:30
In reply to Re: More on Abilify...(long, sorry), posted by Christ_empowered on November 3, 2011, at 21:57:16
CE, I do think a low dose of lithium may be worth a shot.
I think I understand your pdoc's concerns over using Lexapro, but I think that at a low dose, say 2.5 to 5 mg, it could be better in several ways than Celexa.
Posted by Phillipa on November 4, 2011, at 21:30:12
In reply to Re: More on Abilify...(long, sorry), posted by morgan miller on November 4, 2011, at 11:41:30
Morgan do you feel celexa is more sedating than lexapro? Phillipa
Posted by jono_in_adelaide on November 5, 2011, at 3:48:02
In reply to As much as I hate reuptake inhibitors (antidepress, posted by jono_in_adelaide on November 3, 2011, at 1:24:04
I hear you re those side effects, but arnt they usualy with the SSRI's - somthing like Welbutrin shouldnt give you emotional blusting and flattening of mood should it?
Posted by Christ_empowered on November 5, 2011, at 4:55:04
In reply to Re: As much as I hate reuptake inhibitors (antidepress, posted by jono_in_adelaide on November 5, 2011, at 3:48:02
hey Jono,
Yeah, I've heard that Wellbutrin doesn't cause the same level of flattening. There are still a couple of problems though. 1) Wellbutrin is activating, so my shrink probably won't OK it for a while because of the residual hallucinations (although honestly,I think it would help); 2) I don't have any sort of insurance right now, so I'd have to pay out-of-pocket; and 3) Wellbutrin doesn't like its been very well studied in psychotic depression, although it is used in schizoaffective disorder when the hallucinations are well-controlled with a neuroleptic.
In an ideal world, by now I'd either have Medicaid from disability (I'm probably going to appeal my denial--in the US, getting disability can take a while) or I'd be able to get an Rx for an older stimulating drug, like Pamelor or something.
Thanks for your post.
Posted by Phillipa on November 5, 2011, at 19:01:22
In reply to Re: As much as I hate reuptake inhibitors (antidepress, posted by Christ_empowered on November 5, 2011, at 4:55:04
CE I took pamelor low dose and it knocked me out slept half the next day? Is it higher doses that are stimulating? Phillipa
This is the end of the thread.
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