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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Christ_empowered on December 23, 2013, at 12:01:55
I was on 30/day. That's the FDA approved max. I also take 1200/trileptal and 20/Prozac and up to 300/Neurontin.
I decided to keep taking everything else and just stop the Abilify. I was *so* tired, in this tranquilized sort of way. Its only been a few days, but I already feel better. More energetic. More clarity of thought. Etc. etc. etc.
How low can I go with Abilify, you think? My shrink, she's good and all, but she's Public Health. I swear to you, high dose tranquilizers is the name of the game at Public Health. They just don't play.
Considering that my diagnosis is somewhere between a bipolar version of Schizoaffective and straight up Bipolar I, mostly psychotic depression and considering how much progress I've made, how low do you think a maintenance dose of Abilify can go? I also do Orthomolecular which, if nothing else, reduces agitation and seem to keep EPS at bay.
Thanks!
Posted by Phillipa on December 23, 2013, at 12:04:01
In reply to Abilify...how low can you go?, posted by Christ_empowered on December 23, 2013, at 12:01:55
CE the first day one usually feels better then it hits same with ad's for me. Start you med again. Phillipa
Posted by Tomatheus on December 23, 2013, at 14:42:14
In reply to Abilify...how low can you go?, posted by Christ_empowered on December 23, 2013, at 12:01:55
Christ_empowered,
I take 5 mg of Abilify daily, but I don't think that such a dose is likely to be sufficient for many other with psychotic disorders. My psychosis involves mainly ideas of reference, what I like to call "pseudohallucinations" (which may actually be "racing thoughts," even though I don't think that that term accurately describes my symptom), auditory sound hallucinations, and these mild visual dysperceptions. Unlike many others who experience psychosis, I don't experience what are usually called "fully-formed" voice hallucinations. The dose that I take keeps my symptoms mostly in check, but for many patients with psychotic disorders (or even mood disorders with psychotic features), a dose of 5 mg daily may be insufficient.
I think I recall you writing that you took 15 mg of Abilify daily in one of your past posts. Was that dose too low? Or do you think that you could have gone even lower? Taking 10 mg of Abilify daily might be an option to consider if you feel like maybe you were a bit over medicated at 15 mg and the medication was keeping your symptoms in check at that dose.
Of course, trying lower doses that what you're accustomed to involves some risk, but then again, I think that trying to find what the "lowest effective dose" for you is could be worthwhile, as well. As always, I would advise seeking the opinion of a medical professional when making a dose adjustment, and I wish you luck at seeing if maybe a lower Abilify dose might be best for you.
Tomatheus (who also hates his Abilify)
Posted by Tomatheus on December 23, 2013, at 15:09:04
In reply to Re: Abilify...how low can you go?, posted by Tomatheus on December 23, 2013, at 14:42:14
> I think I recall you writing that you took 15 mg of Abilify daily in one of your past posts.
Or maybe it was 20 mg that I recall you saying that you were taking. But I do think that I recall you saying that you were on a dose lower than 30 mg at one point.
Tomatheus
Posted by Brot on December 23, 2013, at 15:49:48
In reply to Abilify...how low can you go?, posted by Christ_empowered on December 23, 2013, at 12:01:55
so its time again..... i can recall approximately 10 posts from you where you state you quit abilify and you already feel better, sharper, clearer, lucid, ... whatever
but it seems you always relapse and get worse. i dont think you should quit your abilify....
if you really want to reduce your abilify and want to find out the lowest effective dosage you have to go SLOW.
if you are now on 30mg, then go to 25mg for about a month and see what happens. if you still feel dosage is too high, got to 20mg for another month .... and so on and on ....best wishes
Posted by Christ_empowered on December 23, 2013, at 17:08:10
In reply to Re: Abilify...how low can you go? » Christ_empowered, posted by Brot on December 23, 2013, at 15:49:48
yeah, I should have been a little more clear in my initial post. I'm not quitting the Abilify. I just want it wash out a little bit and re-start it and see if I'm less (over)tranquilized. Not actually quitting it...the risk of relapse and craziness is too high.I may just be blaming the Abilify for...life. I do that sometimes, because I was over-exposed to antipsychiatry literature (I'd like to thank Peter Breggin for making me paranoid about meds).
I may just go w/ 30 until I see my doc (or a pdoc, if I can get into a private practice shrink) who might be able to skillfully lower it a bit. I don't think its wise to jump down from 30 to 20 like I did before (to be fair, those are the available pill sizes).
Ugh. Meds. Craziness.
Thanks for the input.
Posted by Brot on December 24, 2013, at 9:28:59
In reply to Re: Abilify...how low can you go?, posted by Christ_empowered on December 23, 2013, at 17:08:10
I know what you mean. I am also shizoaffective but mainly depressive typus. i also often "played" with my neuroleptic dosage beacuse i felt uncomfortable with it. but in the end i could slowly decrease it while the years have passed. it often takes a lot of time to get well...
good luck to you
Posted by Christ_empowered on December 24, 2013, at 16:28:08
In reply to Re: Abilify...how low can you go? » Christ_empowered, posted by Brot on December 24, 2013, at 9:28:59
cool. I keep getting diagnosed with Bipolar w/ psychotic features, but I'm pretty sure its schizoaffective. I don't know if its depressive or manic subtype. I've had one severe manic-ish episode, complete with lots of psychosis and some moments of straight up euphoria.Anyway, thanks for your input. One reason I keep doing Orthomolecular is because I'm hoping to be able to lower the neuroleptic dose at some point, eventually. Sometimes I wish I'd gone for Seroquel over Abilify, since its easier to adjust Seroquel doses. Oh well :-(
What do you take?
Posted by ed_uk2010 on December 29, 2013, at 10:51:26
In reply to Abilify...how low can you go?, posted by Christ_empowered on December 23, 2013, at 12:01:55
>I was on 30/day. That's the FDA approved max. I also take 1200/trileptal and 20/Prozac and up to 300/Neurontin.
Hi,
If you stop Abilify completely, I think you will relapse pretty soon. Based on your previous response to Abilify, and the fact that you take fluoxetine (which interacts), I do not think you should go below 15mg of Abilify.
Posted by SLS on December 29, 2013, at 13:40:24
In reply to Re: Abilify...how low can you go? » Christ_empowered, posted by ed_uk2010 on December 29, 2013, at 10:51:26
> >I was on 30/day. That's the FDA approved max. I also take 1200/trileptal and 20/Prozac and up to 300/Neurontin.
>
> Hi,
>
> If you stop Abilify completely, I think you will relapse pretty soon. Based on your previous response to Abilify, and the fact that you take fluoxetine (which interacts), I do not think you should go below 15mg of Abilify.C_E, I tend to agree with Ed. If you don't like how Abilify affects you cognitively, you might consider a trial of Saphris. Because of the catastrophic nature of your illness, I think that you would be better off bringing Saphris on board before attempting to discontinue the Abilify.
A friend of mine had been on Navane and Seroquel before starting Saphris. Up until this time, she was sedated, cognitively slowed, and suffering from brain-fog and residual depression. Immediately upon starting Saphris, her energy and mental acuity improved along with her mood. Unfortunately, she remained hypersomniac and sedated. I suggested that she ask her doctor about reducing or eliminating the Seroquel. She is now taking half of her original dosage of Seroquel with the intent to discontinue it entirely. The taper process will take several months in order to avoid triggering a rebound relapse and withdrawal insomnia. She feels dramatically better.
As an antipsychotic, Saphris tends to be alerting and can act as an antidepressant. If Saphris monotherapy is insufficient to treat your psychotic symptoms, you might consider a first generation antipsychotic. I like what I see in Navane (thiothixene). Ed_uk would be better than me at characterizing the various typical neuroleptics.
For now, my friend, who suffers from schizoaffective disorder, is in remission. She also takes Wellbutrin and Neurontin. At some point, she might opt to discontinue the Neurontin. One would think that the Neurontin serves no purpose, but you never know. There might be a need for an anticonvulsant mood-stabilizer in her treatment regime that Neurontin fills.
C_E, I would not discontinue Abilify until you have first added another antipsychotic and titrated it to a therapeutic dosage. For now, you might as well stay at a therapeutic dosage of Abilify. I get the impression that the minimum effective dosage for you is no lower than 20 mg/day. Ed_uk might have better insight into your illness so as to recommend 15 mg/day. However, the consequences of your becoming psychotic are substantial.
- Scott
Posted by SLS on December 29, 2013, at 13:41:59
In reply to Re: Abilify...how low can you go? » ed_uk2010, posted by SLS on December 29, 2013, at 13:40:24
Posted by ed_uk2010 on December 30, 2013, at 13:28:37
In reply to Re: Abilify...how low can you go? » ed_uk2010, posted by SLS on December 29, 2013, at 13:40:24
Hi Scott,
>Ed_uk might have better insight into your illness so as to recommend 15 mg/day.
I don't have any special insight, I just suggested 15mg as a possible minimum because potent CYP2D6 inhibitors appear to approximately double aripiprazole levels. I believe C_E was on fluoxetine 40mg, but now fluoxetine 20mg? So perhaps 20mg of Abilify would indeed be more suitable.
>However, the consequences of your becoming psychotic are substantial.
That's exactly my concern. All adjustments to Abilify certainly require a lot of care.
Ed
Posted by phidippus on December 30, 2013, at 15:20:04
In reply to Abilify...how low can you go?, posted by Christ_empowered on December 23, 2013, at 12:01:55
2.5 mg
eric
Posted by SLS on December 30, 2013, at 17:02:55
In reply to Re: Abilify...how low can you go? » SLS, posted by ed_uk2010 on December 30, 2013, at 13:28:37
> Hi Scott,
>
> >Ed_uk might have better insight into your illness so as to recommend 15 mg/day.
>
> I don't have any special insight, I just suggested 15mg as a possible minimum because potent CYP2D6 inhibitors appear to approximately double aripiprazole levels.I see. Thanks, Ed. I did not know that. 2x is a huge difference.
- Scott
Posted by SLS on December 30, 2013, at 17:07:26
In reply to Re: Abilify...how low can you go? » Christ_empowered, posted by phidippus on December 30, 2013, at 15:20:04
Psychosis is the main concern, I believe.
I wouldn't think that Abilify 2.5 mg/day would help very much. For me, 10 mg/day is the minimum (and optimal) dosage of Abilify that acts as an antidepressant in the treatment of my bipolar depression. Hopefully, it will also act as a prophylactic against drug-induced mania. So far, so good.
- Scott
Posted by Christ_empowered on December 30, 2013, at 17:20:55
In reply to Re: Abilify...how low can you go?, posted by SLS on December 30, 2013, at 17:07:26
back on 30 :-(
Here's the thing: once you've been on a higher dose, its hard to go lower. sedatives can help ease the transition, sometimes.
I was thinking...OK, a few days wash out, start cutting those babies in 1/2, see how that goes. Got agitated! Ugh...
I declined to refill the 'zac. Yes, it was helpful, but I really just needed a Band-Aid, not a long term solution, you know?
I think I may see about adding in Lamictal. Or maybe a switch to Seroquel xr? The old school Seroquel was terrible for me back in the day, but then again...I was 19, loaded up on other drugs, etc. etc.
I need a long-term solution for depressive states that isn't an AD. SRI drugs are, at best, temporary fixes for me.
Is Seroquel better with depression than Abilify? What about some of the new round of neuroleptics? My subjective feeling is that the high dose Abilify doesn't make things worse, but it doesn't do a whole lot to help things, either. Kinda unfortunate state of affair, really.
Thanks for all the helpful info...STAY ON YOUR MEDS! (that's really for me, excuse the screaming caps....)
Posted by herpills on January 3, 2014, at 15:32:33
In reply to Re: Abilify...how low can you go?, posted by Christ_empowered on December 30, 2013, at 17:20:55
CE haven't you been on Lamictal before? Did it help?
This is the end of the thread.
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