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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 10 to 34 of 46. Go back in thread:
Posted by Lamdage22 on April 14, 2016, at 10:37:46
In reply to Re: medication: high cholesterol and triglycerides?, posted by Lamdage22 on April 14, 2016, at 10:37:28
and i try to eat better now.
Posted by linkadge on April 14, 2016, at 19:36:58
In reply to Re: medication: high cholesterol and triglycerides? » Lamdage22, posted by B2chica on April 12, 2016, at 23:38:34
I hear ya, but oftentimes I see some members clinging to long lists of medications when they don't seem able to explain exactly why they are taking them.
Taking more meds isn't the answer. Taking the right meds (or right treatments) at the right doses, for the right period of time, is.
Antipsychotics have the clear potential to make people worse if they don't need them. Many people are drawn to the sedative / tranquilizing qualities without recognizing the way the meds can hinder recovery. I try not to follow Breggin too much, but high dose antipsychotics really can be disabling - especially when the metabolic and cognitive complications start to set in.
Some recent studies in people with full schizophrenia have shown that patients often fare much better (in the long term) with lower doses, for shorter treatment periods. The drug companies (and perhaps psychiatrists) don't want you to know that.
Linkadge
Posted by linkadge on April 14, 2016, at 20:02:36
In reply to Re: medication: high cholesterol and triglycerides?, posted by Lamdage22 on April 13, 2016, at 3:40:13
OK, but people currently suffering frank psychosis, typically can't use the internet and have an intelligible conversation with other people. If you lower your Seroquel to say 300 mg, what happens? Have you ever tried testing lower doses, or do you take your meds exactly as prescribed? Why the use of 2 antipsychotics? Were you still suffering significant psychotic symptoms on just one, or were you not tolerating the side effects of other one?
Pardon my memory, but was it you who suffered a psychotic reaction to an MAOI? The reason I ask, is because I suffered a "frank psychotic" reaction to the MAOI parnate, which landed me in the hospital for a few weeks. They put me on Seroquel, but honestly, after the MAOI washed out, I came off the Seroquel with no problem. 2 psychiatrists at the time said this was a reaction to Parnate and that long term use of an antipsychotic *was not warranted*
The database of evidence based research includes combinations of 2 meds, but has virtually nothing to say about the use of 3 or more medications psych conditions. Some docs will just keep layering on the meds, willy nilly - even if you are not improving, or even getting worse.
MAOI's (like amphetamines) are notorious for causing psychotic reactions. I never (before or since parnate) had any similar reactions. If the only psychotic episode you've had was under the influence of an MAOI, you should NOT be on that high dose of antipsychotics - plain and simple. Get a second opinion!!
It appears your are being treated for schizophrenia, bipolar and major depressive disorder, all at once.
If your condition, for instance, is bipolar, then once you're on a mood stabilizer, this should greatly reduce (or eliminate) your need for antipsychotics.
Linakdge
Posted by linkadge on April 14, 2016, at 20:33:10
In reply to Re: medication: high cholesterol and triglycerides?, posted by linkadge on April 14, 2016, at 20:02:36
Lamdage,
I'm not telling you to come off the antipsychotics if you need them.
I am saying that you want to be 100% sure that this is the right diagnosis.
Some people on this board clearly come across as somebody needing 12.5mg of zyprexa and 600mg of Seroquel. You do not. But again, I know very little.
If you have schizoaffective, then Effexor isn't the best antidepressant to take.
Some antidepressants are known to worsen psychotic symptoms, others are known to be neutral or even improve psychotic symptoms. See the list I made below (from the reading I do).
More Likely to Worsen (or induce) Psychotic Symptoms (top)
More likely to improve psychotic symptoms (bottom)Parnate
Nardil
Marplan
Selegiline
Desipramine
Imipramine
Wellbutrin
Effexor
Nortriptyline
Amitriptyline
Paxil
Prozac
Zoloft
Trazodone / Nefazadone
Remeron
Trimipramine
Ascenapine
Celexa / Lexapro
FluvoxamineFor instance, for schizoaffective, I would probably try Lexapro (or fluvoxamine) over Effexor.
Also, something like ascenapine (a TCA antidepressant with antipsychotic effects) would probably leave your mood better and not have the same degree of metabolic side effects.
I just would avoid the double whammy of two atypical antipsychotics (esp. Zyprexa is notorious for screwing with metabolic profiles) if at all possible.
Linkadge
Posted by Christ_empowered on April 15, 2016, at 0:51:43
In reply to Re: medication: high cholesterol and triglycerides?, posted by linkadge on April 14, 2016, at 20:33:10
Ever tried Abilify? Abilify is sometimes used as an add-on medication, and it does help with some things (weight gain, metabolic stuff, prolactin), although apparently the results are mixed for the psychiatric symptoms (the study I read was w/ hardcore, treatment-resistant people on clozapine and still having probs...not your situation...).Speaking as someone who takes Abilify...if you need a tranquilizer, think about it. Its not perfect, but its probably about as tolerable as any neuroleptic out there, except maybe round 2 of the partial dopamine agonists, but there's not much data for those.
Amoxapine...I think linkadge mentioned it...a former pdoc recommended it, but I was scared of it. Should have said yes...partly metabolizes into loxapine, and the other part is an effective AD. The combination has been used in some small studies as an alternative to higher priced atypicals. The abstract I read used it in comparison to risperdal (back when risperidone was pricey) in Mexico or some other less developed, less affluent nation. The results were good, EPS was about the same as Risperdal. I think mood issues were better w/ amoxapine, which would make sense...
Anticonvulsants? I was once, long ago, diagnosed as having Bipolar I w/ mild schizophrenia...at the same time. I don't know how that works, or what "mild schizophrenia" is, but..yeah. Anyway, I'm saying I don't think our symptoms are all that different, and I think my 2 anticonvulsants (1200 Trileptal+100 lamictal) have made a significant, positive change in my life. Also...because of the 2 anticonvulsants, I can keep on Abilify at 30, and only rarely need that extra 2mgs risperidone and/or 100-200+ mgs neurontin.
I really think you should talk to your doc about some alternatives to what you're taking now. Even w/ the AAP drugs, there's a risk of drug induced depression. If you're on 2 of them at full doses, I would think the risk would be more significant.
Hope you can work something out.
Posted by Lamdage22 on April 15, 2016, at 3:39:25
In reply to Re: medication: high cholesterol and triglycerides?, posted by Christ_empowered on April 15, 2016, at 0:51:43
Abilify gives me akathisia.
I appreciate the concerns, guys, but if i reduce the APs too quickly, i end up taking more than before.
I am already reducing them every couple months.
Relax
Posted by Lamdage22 on April 15, 2016, at 4:43:32
In reply to Re: medication: high cholesterol and triglycerides?, posted by Lamdage22 on April 15, 2016, at 3:39:25
Believe me, i take as little as possible. Right now thats 600mgs of Seroquel and 12.5 mg of Zyprexa. In about 6 weeks, it will be 2.5 less Zyprexa or 100 less Seroquel.
I was forced on a shitload of APs in the clinic. Much more than i am on now. They are criminals.
Posted by J Kelly on April 15, 2016, at 12:18:26
In reply to Re: medication: high cholesterol and triglycerides?, posted by linkadge on April 14, 2016, at 20:02:36
> OK, but people currently suffering frank psychosis, typically can't use the internet and have an intelligible conversation with other people.
I was in a complete psychotic break for nine months. I thought people were living in my attic. I was not only able to have "normal" conversations with people but I fooled psych docs and nurses in two psych hospitals as well. I was a very clever psychotic.
>
> Pardon my memory, but was it you who suffered a psychotic reaction to an MAOI? The reason I ask, is because I suffered a "frank psychotic" reaction to the MAOI parnate, which landed me in the hospital for a few weeks. They put me on Seroquel, but honestly, after the MAOI washed out, I came off the Seroquel with no problem. 2 psychiatrists at the time said this was a reaction to Parnate and that long term use of an antipsychotic *was not warranted*Same here except it was Geodon. I'll never forget the severe anxiety I felt (either from the parnate w/d or the Geodon, not sure).
>
> MAOI's (like amphetamines) are notorious for causing psychotic reactions. I never (before or since parnate) had any similar reactions.Same. Although I've taken high doses of Ritalin and never came close to being psychotic (that I know of).
Out of desperation, I'm currently trialing Nardil. I'm on 5mg Zyprexa and hoping that will cover me. Fingers crossed.
Jade
Posted by linkadge on April 15, 2016, at 17:33:17
In reply to Re: medication: high cholesterol and triglycerides?, posted by Lamdage22 on April 15, 2016, at 4:43:32
So, if you don't mind me asking, specifically what happens if you reduce the Seroquel?
Is it anxiety, insomnia, agitation, auditory hallucinations, distorted thinking?
Do you experienced the same symptoms you had before you started it, or different ones?
You're right in that you have to reduce very slowly. There are some supplements (i.e. vitamin C) that may help reduce dopamine super-sensitivity rebound. Niacin is also worth trying.
I don't know if you can get the 25mg versions of Seroquel.
Linkadge
Posted by Phillipa on April 15, 2016, at 17:55:55
In reply to Re: medication: high cholesterol and triglycerides?, posted by linkadge on April 14, 2016, at 20:33:10
So lexapro & fluvoximine improve psychosis? Phillipa
Posted by linkadge on April 15, 2016, at 18:07:58
In reply to Re: medication: high cholesterol and triglycerides? » linkadge, posted by J Kelly on April 15, 2016, at 12:18:26
>I was in a complete psychotic break for nine >months. I thought people were living in my >attic. I was not only able to have "normal" >conversations with people but I fooled psych >docs and nurses in two psych hospitals as well. >I was a very clever psychotic.
So, your psychotic break was from parnate? From my experiences, med induced psychotic breaks can be much different from actual schizophrenia. Parante seriously messes with sleep cycles and can virtually completely supress rem sleep. Lack of rem sleep can cause psychotic type thinking in healthy individuals in only a few nights.
I should clarify that paranoid type psychosis(which tends to respond better to antipsychotics) often retains better cognitive function than those with disorganized type schizophrenia. However, paranoid type psychosis is more commonly associated with stimulants (and in this case MAOIs).
However, most people suffering natural course, schizophrenia, in a frankly psychotic state, will have difficulty hiding this. They may be able to hide certain delusions (which they feel they may be ridiculed for) but there are usually other indicators in their speech / thought process (or behavior).
For instance, spending time in the hospital with individuals who were hospitalized with schizophrenia, it is usually pretty obvious.
>Same here except it was Geodon. I'll never >forget the severe anxiety I felt (either from >the parnate w/d or the Geodon, not sure).
Geodon has some monoamine reuptake inhibiting capabilities. It is not the best antipsychotic to take during MAOI withdrawl (possible serotonin syndrome).
>Same. Although I've taken high doses of Ritalin >and never came close to being psychotic (that I >know of).
I take Ritalin too (low doses) and like you have never had a psychotic break. Ritalin doesn't supress REM sleep to the same extent as an MAOI.
>Out of desperation, I'm currently trialing >Nardil. I'm on 5mg Zyprexa and hoping that will >cover me. Fingers crossed.
Good luck. You've got a good doc that would let you try an MAOI again! Nardil may be a bit milder in that sense. It has a GABAergic metabolite (but then again it also metabolizes to PEA - the brains own version of amphetamine). You might want to try lower doses, and possibly skip doses if you feel strange thinking returning. The Zyprexa should help.
Linkadge
Posted by Phillipa on April 15, 2016, at 18:46:38
In reply to Re: medication: high cholesterol and triglycerides?, posted by linkadge on April 15, 2016, at 18:07:58
New study on my RN newsletter haven't read yet about adhd meds and depression. If pertenant will copy and paste
Posted by linkadge on April 15, 2016, at 20:47:48
In reply to Re: medication: high cholesterol and triglycerides? » linkadge, posted by Phillipa on April 15, 2016, at 17:55:55
Antidepressants are not exactly antipsychotics, however some are known to improve (and others worsen) some psychotic symptoms.
For some individuals with milder psychotic disorders (or prodromal issues) monotherapy with certain antidepressants can sometimes be all that is required.
There were a few studies on citalopram showing that it could alleviate psychotic and mood symtpoms in certain individuals.
SSRIs can lower dopamine which is the net effect of antipsychotics.
Linkadge
Posted by Phillipa on April 15, 2016, at 22:45:29
In reply to Re: medication: high cholesterol and triglycerides?, posted by linkadge on April 15, 2016, at 20:47:48
Link I didn't know this thank you. Phillipa
Posted by Lamdage22 on April 16, 2016, at 5:35:07
In reply to Re: medication: high cholesterol and triglycerides? » Lamdage22, posted by linkadge on April 15, 2016, at 17:33:17
> So, if you don't mind me asking, specifically what happens if you reduce the Seroquel?
Easily Paranoia. Actually it even happens now that i have not reduced it yet.
> Is it anxiety, insomnia, agitation, auditory hallucinations, distorted thinking?
Anxiety and Paranoia.
> Do you experienced the same symptoms you had before you started it, or different ones?
Hard to say. Why?
> You're right in that you have to reduce very slowly. There are some supplements (i.e. vitamin C) that may help reduce dopamine super-sensitivity rebound. Niacin is also worth trying.
I will look into it.
> I don't know if you can get the 25mg versions of Seroquel.
>
Sure can but its not necessary yet.
>
> Linkadge
>
>
Posted by SLS on April 16, 2016, at 6:57:35
In reply to Re: medication: high cholesterol and triglycerides?, posted by linkadge on April 14, 2016, at 20:33:10
This is a brilliant list.
- Scott
> Some antidepressants are known to worsen psychotic symptoms, others are known to be neutral or even improve psychotic symptoms. See the list I made below (from the reading I do).
>
>
> More Likely to Worsen (or induce) Psychotic Symptoms (top)
> More likely to improve psychotic symptoms (bottom)
>
> Parnate
> Nardil
> Marplan
> Selegiline
> Desipramine
> Imipramine
> Wellbutrin
> Effexor
> Nortriptyline
> Amitriptyline
> Paxil
> Prozac
> Zoloft
> Trazodone / Nefazadone
> Remeron
> Trimipramine
> Ascenapine
> Celexa / Lexapro
> Fluvoxamine
>
> For instance, for schizoaffective, I would probably try Lexapro (or fluvoxamine) over Effexor.
>
> Also, something like ascenapine (a TCA antidepressant with antipsychotic effects) would probably leave your mood better and not have the same degree of metabolic side effects.
>
> I just would avoid the double whammy of two atypical antipsychotics (esp. Zyprexa is notorious for screwing with metabolic profiles) if at all possible.
>
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> Linkadge
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Posted by Lamdage22 on April 16, 2016, at 7:07:05
In reply to Re: medication: high cholesterol and triglycerides?, posted by SLS on April 16, 2016, at 6:57:35
> This is a brilliant list.
> - ScottDo you feel it is accurate? My Dr asked me to try Wellbutrin.
> > Some antidepressants are known to worsen psychotic symptoms, others are known to be neutral or even improve psychotic symptoms. See the list I made below (from the reading I do).
> >
> >
> > More Likely to Worsen (or induce) Psychotic Symptoms (top)
> > More likely to improve psychotic symptoms (bottom)
> >
> > Parnate
> > Nardil
> > Marplan
> > Selegiline
> > Desipramine
> > Imipramine
> > Wellbutrin
> > Effexor
> > Nortriptyline
> > Amitriptyline
> > Paxil
> > Prozac
> > Zoloft
> > Trazodone / Nefazadone
> > Remeron
> > Trimipramine
> > Ascenapine
> > Celexa / Lexapro
> > Fluvoxamine
> >
> > For instance, for schizoaffective, I would probably try Lexapro (or fluvoxamine) over Effexor.
> >
> > Also, something like ascenapine (a TCA antidepressant with antipsychotic effects) would probably leave your mood better and not have the same degree of metabolic side effects.
> >
> > I just would avoid the double whammy of two atypical antipsychotics (esp. Zyprexa is notorious for screwing with metabolic profiles) if at all possible.
> >
> >
> > Linkadge
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Posted by Lamdage22 on April 16, 2016, at 7:10:30
In reply to Re: medication: high cholesterol and triglycerides?, posted by Lamdage22 on April 16, 2016, at 7:07:05
I may be able to give Trazodone a shot.
Also, i could try Rexulti and/or Viibryd.
Can trazodone be combined with SSRI/SNRI?
Posted by SLS on April 16, 2016, at 7:11:21
In reply to Re: medication: high cholesterol and triglycerides?, posted by linkadge on April 14, 2016, at 20:02:36
> It appears your are being treated for schizophrenia, bipolar and major depressive disorder, all at once.
This is very much how schizoaffective disorder, bipolar type is conceptualized. It was my observation with an old friend of mine (who has disappeared somewhere) that if you could prevent the mania, you thereby prevent the psychosis. Her illness followed a very predictable sequence of phases, although an unpredictable timing.
normal -> mania -> psychosis -> depression -> normal
> If your condition, for instance, is bipolar, then once you're on a mood stabilizer, this should greatly reduce (or eliminate) your need for antipsychotics.Exactly.
- Scott
Posted by Lamdage22 on April 16, 2016, at 7:16:24
In reply to Re: medication: high cholesterol and triglycerides?, posted by SLS on April 16, 2016, at 7:11:21
There is debate as to wether i am bipolar or not. Currently i am considered "type depressive".
There is no mania i go straight to extreme Paranoia. (And back to normal the next day).
Posted by SLS on April 16, 2016, at 7:29:04
In reply to Re: medication: high cholesterol and triglycerides?, posted by Lamdage22 on April 16, 2016, at 7:07:05
I would change a few things in the order of the list, but it is a nice way to configure a chart.
Wellbutrin is one drug that deserves to be further down the list in my opinion. Almost any antidepressant has the potential to trigger mania in a susceptible individual. However, Wellbutrin may be one of the least likely to do this. That has been the traditional position taken by doctors.
Funny - when Wellbutrin was first being studied, a few clinical investigators thought that it might actually act as a mood stabilizer.
By the way, a close friend of mine has schizoaffective disorder. Her schizoid symptoms include paranoia. She always thought that there was an intruder in the house. She was tried on Abilify and Seroquel to no avail. (I think the Abilify interfered with the Seroquel, but that's another story). Her doctor in the hospital made a brilliant move and placed her on Navane (thiothixene). It abolished the psychosis, but left her moderately depressed. Adding Saphris (asenapine) changed her life. She is now going to nursing school to become a RN and is working a job at the same time. Of course, I would love to see what would happen if the Navane were discontinued, but I wouldn't want her to change a thing if it is working so completely. Saphris cleared up her thinking, speeded up her sluggish thoughts, gave her more energy to accomplish things, and rid her of depression.
- Scott
Posted by SLS on April 16, 2016, at 7:34:23
In reply to Re: medication: high cholesterol and triglycerides?, posted by Lamdage22 on April 16, 2016, at 7:16:24
> There is debate as to wether i am bipolar or not. Currently i am considered "type depressive".
>
> There is no mania i go straight to extreme Paranoia. (And back to normal the next day).Wow. That sucks.
I wonder if chronotherapy would help - melatonin at night and light therapy in the morning. Just a thought. At the very least, you should be keeping a regular sleep-wake cycle.
- Scott
Posted by linkadge on April 16, 2016, at 7:36:31
In reply to Re: medication: high cholesterol and triglycerides?, posted by Lamdage22 on April 16, 2016, at 7:10:30
Trazadone is often combined with SSRIs or SNRIs (often to offset insomnia). Trazodone tends to be a bit weaker as an antidepressant (in lower doses) but can be good for insomnia / anxiety. There are studies with trazodone / antipsychotic combinations showing improvement in core symptoms with the addition of trazodone.
The list I made is by no means 100% definitive. It is possible that you respond very well to Wellbutrin. However, it acts predominantly on norepinephrine and dopamine. It has a different side effect profile than SSRIs. Chemically, it is related to amphetamine. It tends to be more activating / stimulating. It can supress appetite, occasionally cause seizures, and is associated with more psychotic side effects than say fluvoxamine.
You can get a good indication simply by googling "Wellbutrin + psychosis". Do the same for "fluvoxamine + psychosis".
For fluvoxamine, most articles are related to improving psychosis. For Wellbutrin most articles are related worsening psychosis.
Linkadge
Posted by Lamdage22 on April 16, 2016, at 7:41:20
In reply to Re: medication: high cholesterol and triglycerides?, posted by linkadge on April 16, 2016, at 7:36:31
I cant afford to worsen psychosis.
Posted by Lamdage22 on April 16, 2016, at 7:43:14
In reply to Re: medication: high cholesterol and triglycerides?, posted by Lamdage22 on April 16, 2016, at 7:41:20
Where would Viibryd be on that list? I could try this in the near future.
Over or under Effexor????
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