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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 12 to 36 of 36. Go back in thread:
Posted by creepy on March 30, 2012, at 10:20:28
In reply to Abilify + TCA?, posted by tensor on March 24, 2012, at 14:33:49
Could make it worse. abilify has a reputation for causing akathisia in some folks. It can help with depression if you respond to serotonin receptor antagonism versus reuptake inhibition. Two different mechanisms there. It could cause cognitive issues on its own with the dopamine antagonism.
Irritability can mean youre a little mixed on that TCA. You might be able to work around it with a different dose or add on a small amount of a mood stabilizer. Might have to switch to something else.
cognitive impairment can be depression too. Some meds can cover up the depression like a 'psychic painkiller' and the symptoms persist in the background. cognitive decline might be one of those.
If the medication is the cause and it persists after a few weeks it might stick around till you switch to something else.
Posted by banga000 on March 31, 2012, at 7:43:18
In reply to Re: Abilify + TCA?, posted by creepy on March 30, 2012, at 10:20:28
Hi,
I used to post here long ago. With help from others, I landed on this combination:desipramine 100 mg (TCA which acts more on norepinephrine than serotonin)
lamictal 200 mg
Abilify 5 mg
zoloft 50 mg
adderall 30 mgI must be completely deplete of dopamine and need a lot of stimulating meds. I found the Ability stimulating and the first days it increased anxiety...but then it actually *helped* immensely with anxiety. Abilify is a complex drug, it can alter its effect at different dosages. Right now I'm extremely anxious, but realized I have taken too much Abilify lately (10 mg)and maybe that's too much. It caused slight akasthisia the first years, but it calmed down.
Banga
Posted by phidippus on April 3, 2012, at 19:02:59
In reply to Abilify + TCA?, posted by tensor on March 24, 2012, at 14:33:49
I had a lot of luck with clomipramine and abilify, where as Abilify in other settings wa unbearable.
Eric
Posted by SLS on April 3, 2012, at 20:43:46
In reply to Re: Abilify + TCA? » tensor, posted by phidippus on April 3, 2012, at 19:02:59
> I had a lot of luck with clomipramine and abilify, where as Abilify in other settings wa unbearable.
>That must have been very frustrating. Do you have any ideas as to why this happened?
- Scott
Posted by phidippus on April 5, 2012, at 16:13:14
In reply to Re: Abilify + TCA? » phidippus, posted by SLS on April 3, 2012, at 20:43:46
The D2 partial agonism always threw me for a loop. Also, it tended to disturb my mood, rather than help attenuate it.
Eric
Posted by tensor on April 9, 2012, at 13:35:28
In reply to Re: Abilify + TCA? » tensor, posted by phidippus on April 3, 2012, at 19:02:59
> I had a lot of luck with clomipramine and abilify, where as Abilify in other settings wa unbearable.
>
> EricDid you take it for MDD? What doses were you on? Are you still taking it? I take nortrip + Remeron right now with no success yet, I'm still not sure what to do next, maybe add Abilify. I'm interested in the Lamictal/Abilify combo.
/t
Posted by phidippus on April 9, 2012, at 15:47:45
In reply to Re: Abilify + TCA? » phidippus, posted by tensor on April 9, 2012, at 13:35:28
I was using both to treat OCD and depression. I am bipolar.
Rather than addd to nor and remeron, maybe you should look at replacing one with another AD. Abilify isn't going to magically make the two work for you.
Eric
Posted by tensor on April 9, 2012, at 21:52:03
In reply to Re: Abilify + TCA? » tensor, posted by phidippus on April 9, 2012, at 15:47:45
> I was using both to treat OCD and depression. I am bipolar.
>
> Rather than addd to nor and remeron, maybe you should look at replacing one with another AD. Abilify isn't going to magically make the two work for you.
>
> EricYou're right. I'm thinking of adding Lamictal and keep nortrip a few weeks and see if it starts working. If nortrip does not work by then, I could replace it with Abilify and perhaps quit Remeron too.
/t
Posted by SLS on April 10, 2012, at 6:17:56
In reply to Re: Abilify + TCA? » phidippus, posted by tensor on April 9, 2012, at 21:52:03
> > I was using both to treat OCD and depression. I am bipolar.
> >
> > Rather than addd to nor and remeron, maybe you should look at replacing one with another AD. Abilify isn't going to magically make the two work for you.
> >
> > Eric
>
> You're right. I'm thinking of adding Lamictal and keep nortrip a few weeks and see if it starts working. If nortrip does not work by then, I could replace it with Abilify and perhaps quit Remeron too.Abilify + Lamictal is particularly effective in BD according to some recent studies performed by the NIH. It works well to prevent future episodes. I have seen it work to treat ongoing depression as well. It might be worth a shot.
What has been your experience with Wellbutrin? Anything positive at all?
- Scott
Posted by tensor on April 10, 2012, at 6:31:09
In reply to Re: Abilify + TCA? » tensor, posted by SLS on April 10, 2012, at 6:17:56
> Abilify + Lamictal is particularly effective in BD according to some recent studies performed by the NIH. It works well to prevent future episodes. I have seen it work to treat ongoing depression as well. It might be worth a shot.
>
> What has been your experience with Wellbutrin? Anything positive at all?
>
>
> - ScottDo you have any links?
When I tried Wellbutrin a few years ago it worked very well for about six weeks then it made me tired. When I tried it recently it had no antidepressant effect, made me more anxious and a little tired.
When I tried Lamictal a few years back 200mg was the target dose and we stopped there because of lack of efficacy. It made me a little tired and some headache. I talked to a person who did not respond to 200mg but had a good response at 300mg. Maybe all I needed was higher dose? Only one way to find out, I guess./t
Posted by SLS on April 10, 2012, at 7:08:24
In reply to Re: Abilify + TCA? » SLS, posted by tensor on April 10, 2012, at 6:31:09
> > Abilify + Lamictal is particularly effective in BD according to some recent studies performed by the NIH. It works well to prevent future episodes. I have seen it work to treat ongoing depression as well. It might be worth a shot.
> >
> > What has been your experience with Wellbutrin? Anything positive at all?
> >
> >
> > - Scott
> Do you have any links?
I read it in a NIH bulletin that is not yet available online.Terrence Ketter performed a similar study but reported no significant clinical effect. Sometimes it is difficult to decide whose study is worth basing decisions upon. Remember, though, that this was a study of prophylaxis against mania in bipolar I disorder, and not for the acute treatment of ongoing depression.
http://www.ncbi.nlm.nih.gov/pubmed/22329471
> When I tried Wellbutrin a few years ago it worked very well for about six weeks then it made me tired.
That's what I was hoping to hear, although I would have hoped that you would get more than six weeks out of it. In any even, your reaction to Wellbutrin might be a prognosticator of response to the combination of Lamictal and Abilify. I have seen this occur.
> When I tried Lamictal a few years back 200mg was the target dose and we stopped there because of lack of efficacy.
I have never seen Lamictal work as monotherapy for depression, despite early blip improvements occurring during titration.
> It made me a little tired and some headache. I talked to a person who did not respond to 200mg but had a good response at 300mg.
It happens. If you don't experience significant cognitive impairments at higher dosages, it might be worth pursuing.
> Maybe all I needed was higher dose? Only one way to find out, I guess.
Things happen between Lamictal and Abilify that are synergistic and may involve the potentiation of dopamine activity. My doctor has had success combining Lamictal with Wellbutrin. It sounds as if you have not exhausted your options. This is a good thing.
To what extent is mania a component of your disorder?
You'll get there. It might involve a little bit of luck to come upon the right treatment sooner rather than later, but you will find it. A partial or brief success is not a failure to respond. It is a reasonable strategy to identify such treatments and combine them, especially if the agents have different mechanisms of action. That is how I chose the drugs to remain on as I experimented with the addition of new. Combining Lamictal + nortriptyline was the first base treatment I used to maintain an improvement, albeit a very small one. It was enought to allow me to live independently and discourage me from entertaining thoughts of suicide.
Currently:
Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg
prazosin 6 mgGood luck.
- Scott
Posted by tensor on April 10, 2012, at 7:46:14
In reply to Re: Abilify + TCA? » tensor, posted by SLS on April 10, 2012, at 7:08:24
> > It made me a little tired and some headache. I talked to a person who did not respond to 200mg but had a good response at 300mg.
>
> It happens. If you don't experience significant cognitive impairments at higher dosages, it might be worth pursuing.
>
> > Maybe all I needed was higher dose? Only one way to find out, I guess.
>
> Things happen between Lamictal and Abilify that are synergistic and may involve the potentiation of dopamine activity. My doctor has had success combining Lamictal with Wellbutrin. It sounds as if you have not exhausted your options. This is a good thing.What is the mechanism behind that, do you know?
> To what extent is mania a component of your disorder?
No mania, ever.
> You'll get there. It might involve a little bit of luck to come upon the right treatment sooner rather than later, but you will find it. A partial or brief success is not a failure to respond. It is a reasonable strategy to identify such treatments and combine them, especially if the agents have different mechanisms of action. That is how I chose the drugs to remain on as I experimented with the addition of new. Combining Lamictal + nortriptyline was the first base treatment I used to maintain an improvement, albeit a very small one. It was enought to allow me to live independently and discourage me from entertaining thoughts of suicide.
I'm taking 45mg of Remeron and 150mg of nortrip now. I was thinking that replacing Remeron with Lamictal would be a good move. Then I can give nortrip a little more time to prove itself since the slow titration of Lamictal.
I'm not sure when or how to introduce Abilify to my regime, I know my pdoc is not keen on starting two meds at the same time. I will see him in two days.> Good luck.
>
>
> - Scott
>Thanks, Scott!
Posted by SLS on April 10, 2012, at 8:29:15
In reply to Re: Abilify + TCA? » SLS, posted by tensor on April 10, 2012, at 7:46:14
> > > It made me a little tired and some headache. I talked to a person who did not respond to 200mg but had a good response at 300mg.
> >
> > It happens. If you don't experience significant cognitive impairments at higher dosages, it might be worth pursuing.
> >
> > > Maybe all I needed was higher dose? Only one way to find out, I guess.
> >
> > Things happen between Lamictal and Abilify that are synergistic and may involve the potentiation of dopamine activity. My doctor has had success combining Lamictal with Wellbutrin. It sounds as if you have not exhausted your options. This is a good thing.
>
> What is the mechanism behind that, do you know?
Lamictal: My guess after researching the matter is that Lamictal increases DA in the nucleus accumbens via disinhibition as glutamate release is inhibited in the thalamus.Abilify: Limbic DA activation via D2/D3 receptor partial agonism and 5-HT1a receptor partial agonism.
> I'm taking 45mg of Remeron and 150mg of nortrip now. I was thinking that replacing Remeron with Lamictal would be a good move. Then I can give nortrip a little more time to prove itself since the slow titration of Lamictal.That's a great move in my opinion.
> I'm not sure when or how to introduce Abilify to my regime, I know my pdoc is not keen on starting two meds at the same time. I will see him in two days.
If you are unipolar, starting Abilify at a very low dosage probably makes the most sense. You can start at 1.25 - 2.5 mg and work up to 5 mg if needed. If you are bipolar, you might need to go up to 10 mg.
- Scott
Posted by phidippus on April 10, 2012, at 16:08:46
In reply to Re: Abilify + TCA? » tensor, posted by SLS on April 10, 2012, at 8:29:15
Don't start more than two meds at a time. Remeron is probably more therapeutic than Nortryptaline. I would lower o up on the Lamictal.the N and g
Eric
Posted by phidippus on April 10, 2012, at 16:18:01
In reply to Re: Abilify + TCA? » phidippus, posted by tensor on April 9, 2012, at 21:52:03
What's your current regimine?
Eric
Posted by tensor on April 11, 2012, at 3:39:29
In reply to Re: Abilify + TCA? » tensor, posted by phidippus on April 10, 2012, at 16:18:01
> What's your current regimine?
>
> EricRemeron 45mg, nortrip 150mg, clonazepam 2mg.
/t
Posted by SLS on April 11, 2012, at 6:21:01
In reply to Re: Abilify + TCA? » SLS, posted by phidippus on April 10, 2012, at 16:08:46
> Remeron is probably more therapeutic than Nortryptaline.
I don't know how you came to this conclusion, but I don't think Remeron is generally as effective as nortriptyline. I am basing this on observation and not statistics.
I know that it was initially thought that mianserin was more effective than imipramine, but I think that idea has not been verified in many years of clinical usage. I think the same has been observed with Remeron.
http://ajp.psychiatryonline.org/article.aspx?Volume=163&page=1161&journalID=13
"Results: For mirtazapine, remission rates were 12.3% and 8.0% per the Hamilton and QIDS-SR16 scores, respectively. For nortriptyline, remission rates were 19.8% and 12.4%, respectively."
- Scott
Posted by phidippus on April 11, 2012, at 20:00:38
In reply to Re: Abilify + TCA? » phidippus, posted by SLS on April 11, 2012, at 6:21:01
Its all in the mechanism of action. Mirtazapine does a lot more work than nortryptaline.
Eric
Posted by phidippus on April 11, 2012, at 20:05:49
In reply to Re: Abilify + TCA? » phidippus, posted by tensor on April 11, 2012, at 3:39:29
Add Lamictal or Lithium!
Eric
Posted by tensor on April 12, 2012, at 9:14:20
In reply to Re: Abilify + TCA? » tensor, posted by phidippus on April 11, 2012, at 20:05:49
> Add Lamictal or Lithium!
>
> EricYeah, we added Lamictal. If it works well, no rash or anything, we will decide after month to replace either Remeron or nortrip with Abilify.
/t
Posted by phidippus on April 13, 2012, at 12:46:37
In reply to Re: Abilify + TCA? » phidippus, posted by tensor on April 12, 2012, at 9:14:20
Good! I would recommend Abilify plus Remeron in the future (however, you may not need to if the Lamictal works well)-that's a combo I was on before and it was very ggood.
Eric
Posted by Alexei on April 21, 2012, at 15:36:33
In reply to Re: Abilify + TCA? » tensor, posted by phidippus on April 13, 2012, at 12:46:37
> Good! I would recommend Abilify plus Remeron in the future (however, you may not need to if the Lamictal works well)-that's a combo I was on before and it was very ggood.
>
> EricSo, is it a generally better choice to add lamictal before adding abilify? What is the criteria to determine this?
I ask because I already take seroquel xr, and do quite well with it... Covers many of my symptoms.
I do not think that it is good plan to have two AAP's in my regime. Any thoughts on this?
Thank you ...
Posted by papillon2 on April 21, 2012, at 15:52:15
In reply to Re: Abilify + TCA? » phidippus, posted by Alexei on April 21, 2012, at 15:36:33
> So, is it a generally better choice to add lamictal before adding abilify? What is the criteria to determine this?
>
> I ask because I already take seroquel xr, and do quite well with it... Covers many of my symptoms.
>
> I do not think that it is good plan to have two AAP's in my regime. Any thoughts on this?
>
> Thank you ...What illness(es) are you treating? What are the residual symptoms you are hoping to treat with Lamictal or Abilify? Does your illness have psychotic features? Are you on any meds other than Seroquel XR?
Posted by phidippus on April 21, 2012, at 19:51:02
In reply to Re: Abilify + TCA? » phidippus, posted by Alexei on April 21, 2012, at 15:36:33
It is always recommended you addd a mood stabilizer before you add an antipsychotic. The mood stabilizer may just treat all the symptoms you are having. Add abilify if you have lingering depression.
Its not a big deal to being treated with two AAPs. This may happen if you have manic symptoms that just won't be treated by the Lamictal and a single AP.
Eric
Posted by Alexei on April 22, 2012, at 9:53:14
In reply to Re: Abilify + TCA?, posted by papillon2 on April 21, 2012, at 15:52:15
> What illness(es) are you treating? What are the residual symptoms you are hoping to treat with Lamictal or Abilify? Does your illness have psychotic features? Are you on any meds other than Seroquel XR?
Thank you papillon and phiddipus.
I'm working to resolve MDD, OCD with major anxiety & some racing thoughts. There is no psychosis, and the purpose of lamictal and/or abilify is to augment venlafaxine for depression, as well as lessen my agitation & racing thoughts.
Here is my regime...
Effexor 225mg
Lamictal 100mg
Vyvanse 70mg
Klonopin 0.5 x2
Seroquel xr 50mgAs alternative to adding abilify, My thoughts are to possibly increase seroquel to 150-200mg ... to increase its AD and calming effects... and it is still well below any dopamine antagonism or AAP behavior at that dose,
I do not find it sedating any more.
Thank you for your thoughts...
This is the end of the thread.
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