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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Alexei on May 9, 2012, at 7:54:11
Hello, my pdoc has placed me on abilify 2.5mg to augment effexor ... which alone is not helping enough.
Instead, abilify seems to be making me more depressed and sad, and canceling out my vyvanse! It feels like it flattens and blunts my emotions and I do not perceive things as clearly as before. It puts my mind into a haze.
I feel a lift in mood sometimes, but it comes and goes. Has anyone had this happen? Any thoughts & suggestions would be great. Is it actually helping anyone?
I thought this med was supposed to kill depression in its tracks.
Alexei
Posted by Christ_empowered on May 9, 2012, at 15:07:00
In reply to Abilify making my depression worse! .. for real??, posted by Alexei on May 9, 2012, at 7:54:11
Antipsycohtics can cause or worsen depression. There's also "neuroleptic induced dysphoria," which includes emotional blunting. This is supposed to be less of a problem with lower doses and newer drugs, but it still happens.
If you're on a stimulant for your depression, I'm kind of surprised that your doc would think a neuroleptic at any dose would be appropriate. Then again, I'm not a doctor.
Posted by Alexei on May 9, 2012, at 16:33:58
In reply to Re: Abilify making my depression worse! .. for real??, posted by Christ_empowered on May 9, 2012, at 15:07:00
Thank you C_e ... That helps me make some sense of this. I felt this emotional blunting from day one. The only way I can describe it ... I feel like I've been thrown into a parallel universe, wondering who the heck I am .. very disturbing.
I will be d/c'ng it tomorrow. We are going to try to augment with nortriptyline and forget the AAP's. Although, moderate dose seroquel actually helps me. (sleep, anxiety, depression) 200mg or so. IIRC, Quel doesn't antagonize Dopa until 300mg+ , correct?
Christ, you have any experience with AAP's?
Alexei
> Antipsycohtics can cause or worsen depression. There's also "neuroleptic induced dysphoria," which includes emotional blunting. This is supposed to be less of a problem with lower doses and newer drugs, but it still happens.
>
> If you're on a stimulant for your depression, I'm kind of surprised that your doc would think a neuroleptic at any dose would be appropriate. Then again, I'm not a doctor.
Posted by Christ_empowered on May 9, 2012, at 18:10:52
In reply to Re: Abilify making my depression worse! .. for real?? » Christ_empowered, posted by Alexei on May 9, 2012, at 16:33:58
I think you do have to hit 300+ for neuroleptic effects with seroquel. Then again...I'm not entirely sure. I think The Last Psychiatrist has a number of seroquel-related posts you might want to check out.
My experience with AAPs is actually minimal. When I finally realized that I needed a neuroleptic, I also found that I couldn't tolerate most on the market. Zyprexa=akathisia. Seroquel=rage and dysphoria. Risperdal=EPS, cognitive dulling. Abilify=best of the bunch.
I will say that I've found that the Orthomolecular approach helps me tolerate Abilify better. Even at 15, I'd get mildly stiff gait and a bit of dulling. Now, I need 30 to stop agitation, but with all the vitamins and botanicals on board, I benefit without any noticeable side effects.
Anyway, I just thought I'd throw that out there for you, because the Orthomolecular approach has also been used to prevent TD, which is *always* an issue when using a neuroleptic, no matter what any "expert" says.
I can't think of a good atypical for you. I *hated* Risperdal and its kind of a fattening medication, but very low doses can act against agitation, anxiety, and some forms of depression. Risperdal made me dysphoric, but then again...most AAPs do. Its generic now, so if you cap the dose at, I dunno, 1-2mgs/day, probably in divided doses, at least at first, that might work. Its not terribly sedating and it does help "take the edge off" things for a lot of people.
Zyprexa...is tricky. I'm glad it gave me akathisia at a low dose, because that stuff kills people. Then again, I've heard some people use it strictly PRN for freak outs, when they need a break. Its sedating and helps depression for some people. I think its kind of overrated, but then again...it gave me akathisia, lol.
There are a bunch of new AAP drugs on the market that I know nothing about. I don't think any of them are approved, at any dose, for unipolar depression or even the depressed phase of Bipolar I. I think right now, its all schizo-whatever and Bipolar I mania.
Have you tried Lamictal? Low-dose lithium? Maybe...BuSpar, probably at the higher end of the dosage spectrum? Just some thoughts.
Posted by phidippus on May 9, 2012, at 22:23:39
In reply to Abilify making my depression worse! .. for real??, posted by Alexei on May 9, 2012, at 7:54:11
Its even mentioned as a possible side effect on television commercials...
WHo told you it would kill depression?
Eric
Posted by bleauberry on May 10, 2012, at 5:20:08
In reply to Abilify making my depression worse! .. for real??, posted by Alexei on May 9, 2012, at 7:54:11
Any psych med can make depression worse. It happened with every med in every clinical trial, and it happens with every med on the real streets.
Experiencing a bit of emotional numbness from an antipsychotic is pretty much expected as common most of the time. That's what they are supposed to do.
As an antidepressant, abilify is primarily viewed that way when added to a ssri antidepressant. And yes it probably would cancel out a lot of what vynase does.
Posted by Alexei on May 10, 2012, at 9:09:57
In reply to Re: Abilify making my depression worse! .. for real??, posted by bleauberry on May 10, 2012, at 5:20:08
@Phidippus ... Who told me? Quite a few mental health providers ... pdocs, MD's, Rn's, APRN's ... plus ive been studying up on it. It's specifically indicated for augmenting AD's.
@Bleauberry ... Have you had any good experience with abilify AFA depression augmentation? I am using it with an snri... effexor. I know u love amisulpride, but that is not available in the USA.
So if I want my vyvanse to work the way I need it to, AAPs are off the table? By what mechanism does abilify help depression? How would antagonizing dopa be of any value? abilify 5mg is enough to screw vyvanse up?
Sorry for all the questions ...
Thanks,
Alexei
> Any psych med can make depression worse. It happened with every med in every clinical trial, and it happens with every med on the real streets.
>
> Experiencing a bit of emotional numbness from an antipsychotic is pretty much expected as common most of the time. That's what they are supposed to do.
>
> As an antidepressant, abilify is primarily viewed that way when added to a ssri antidepressant. And yes it probably would cancel out a lot of what vynase does.
Posted by phidippus on May 10, 2012, at 19:37:55
In reply to Re: Abilify making my depression worse! .. for real?? » bleauberry, posted by Alexei on May 10, 2012, at 9:09:57
Abilify helps with depression by antagonizing 5ht1a receptors. Unfortunately it has the possible side effecct of worsening depression.
You can continue to take Vyvanse while you are on Abilify. Neither medication contraindicates the other.
Antagonizing dopa may not have any value for you.
Eric
Posted by phidippus on May 10, 2012, at 19:42:56
In reply to Re: Abilify making my depression worse! .. for real??, posted by bleauberry on May 10, 2012, at 5:20:08
Abilify iss not going to cancel out Vyvanse. The meds are working on different Dopamine receptor sites.
Eric
Posted by Raisinb on May 10, 2012, at 21:38:52
In reply to Abilify making my depression worse! .. for real??, posted by Alexei on May 9, 2012, at 7:54:11
IS it causing you insomnia or interrupted sleep? If so, that could be the problem. If not, maybe it just isn't the drug for you. I was on it recently and the doc said that when it worked it was usually "scary effective" in the first few days, so I should think doing a couple weeks' trial is mo than adequate. As always, consult the doctor.
Posted by Alexei on May 11, 2012, at 8:00:50
In reply to Re: Abilify making my depression worse! .. for real?? » Alexei, posted by phidippus on May 10, 2012, at 19:37:55
Thank you both. Vyvanse would be considered a full dopamine agonist, correct? At which dopamine receptors? And abilify would antagonize different dopa receptors? There is no overlap?
Maybe the fact that abilify is throttling my thinking is why the vyvanse seems less effective.
Which other meds are 5ht1a antagonists? May I ask by what mechanism can abilify worsen depression? Dopamine antagonism?
Thank you,
Alexei> Abilify helps with depression by antagonizing 5ht1a receptors. Unfortunately it has the possible side effecct of worsening depression.
>
> You can continue to take Vyvanse while you are on Abilify. Neither medication contraindicates the other.
>
> Antagonizing dopa may not have any value for you.
>
> Eric
Posted by Alexei on May 11, 2012, at 8:47:20
In reply to Re: Abilify making my depression worse! .. for real??, posted by Raisinb on May 10, 2012, at 21:38:52
@raisinb ... "Scary effective"? Wow, ive heard people say similar things.
My sleep is pretty jagged, but it has been that way since before abilify. Did you do well on abilify? Are you still on it?
I need an alternate to seroquel for sleep if I stay on abilify. Not sure being on both is a good idea, even tho Quel dose is low.
Alexei
> IS it causing you insomnia or interrupted sleep? If so, that could be the problem. If not, maybe it just isn't the drug for you. I was on it recently and the doc said that when it worked it was usually "scary effective" in the first few days, so I should think doing a couple weeks' trial is mo than adequate. As always, consult the doctor.
Posted by phidippus on May 14, 2012, at 16:27:12
In reply to Thank you phidippus and raisinb ... » phidippus, posted by Alexei on May 11, 2012, at 8:00:50
What's funny is you can induce depression by lowering any of the major naurotransmitters. Neurepenephrine,Seretonin, GABA, Etc.
Vyvanse is a full dopamine agonist, mostly on D1 receptors. There is probabaly some overlap between abilify and Vyvanse but not enough to cause problems.
Abilify is a 5ht1a partial agonist. Other drugs that do this are Buspar, Latuda and Pindolol.
Eric
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