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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by linkadge on April 16, 2021, at 18:56:52
My mother is in BAD shape. She is currently on brexiprazole and valproate for bipolar and doing terrible. We are considering ECT and/or more hospitalization.
Her current symptoms are low appetite, anhedonia, headaches, GI symptoms, stomach pain, etc. To ANYBODY who can compare brexiprazole vs. seroquel.....
If you had hardcore melancholic symptoms (anxiety / insomnia, GI problems, anhedonia) would you chose brexiprazole or seroquel?
Nothing is lifting this bitch out of her funk. I want her off depakote but the doctor keeps doing one f*ck*ng thing at a time (see you in 2 weeks??) my dad hasn't slept more than 3 hours in 2 months. Everybody is completely at their wits end.
Linkadge
Posted by Christ_empowered on April 16, 2021, at 19:11:53
In reply to HELP - Seroquel or Brexiprazole, posted by linkadge on April 16, 2021, at 18:56:52
id personally nix seroquel.
Posted by linkadge on April 16, 2021, at 19:52:39
In reply to Re: HELP - Seroquel or Brexiprazole, posted by Christ_empowered on April 16, 2021, at 19:11:53
Hmm. She's currently not taking seroquel (switched to brexiprazole). I have taken seroquel but not brexiprazole, so I have no 'feel' for brexiprazole.
Do you think increasing the brexiprazole from 1 to 2mg would be worth it?
Linkadge
Posted by Christ_empowered on April 16, 2021, at 20:08:27
In reply to Re: HELP - Seroquel or Brexiprazole, posted by linkadge on April 16, 2021, at 19:52:39
my personal rules for managing crazy...
no depakote; no seroquel or 1st generation tranquilizers; D2 partial agonist (currently on Abilify, may see about Rexulti...); and...
-1-neuroleptic. not even as needed additional neuroleptic. tried that (risperidone prn to top off the anti-madness cocktail), not worth it, also risky.
even my community mental health psych person (read: social control with a very -thin- medical facade) openly talked about trileptal and depakote causing depression. true story.
and...i vaguely recall some drug-drug interaction in which depakote with seroquel=lower blood levels of seroquel, maybe (?).
is there any way to get a different doctor? i can't either, so I get it, just...wow. I can sense your frustration, that's why I'm asking.
Posted by rjlockhart37 on April 16, 2021, at 21:09:53
In reply to HELP - Seroquel or Brexiprazole, posted by linkadge on April 16, 2021, at 18:56:52
they advertise seroquel for depression in bipolar treatment, but personally i hated seroquel. It just, some people it effects them diffrently but did not like seroquel. ECT would be a hard option to do for your mom, i think should be off depakote but....antimania medications maybe she could switch to tegretol
Posted by undopaminergic on April 17, 2021, at 3:24:39
In reply to HELP - Seroquel or Brexiprazole, posted by linkadge on April 16, 2021, at 18:56:52
> My mother is in BAD shape. She is currently on brexiprazole and valproate for bipolar and doing terrible. We are considering ECT and/or more hospitalization.
>
> Her current symptoms are low appetite, anhedonia, headaches, GI symptoms, stomach pain, etc. To ANYBODY who can compare brexiprazole vs. seroquel.....
>
> If you had hardcore melancholic symptoms (anxiety / insomnia, GI problems, anhedonia) would you chose brexiprazole or seroquel?
>I don't know anything about brexpiprazole (Rexulti) except that it is similar to aripiprazole (Abilify) and cariprazine (Reagila). However, given that it is not working, given that more is not merrier with these drugs, and given that she has low appetite, I would try quetiapine (Seroquel) of the two, but why not lurasidone (Latuda)?
-undopaminergic
Posted by linkadge on April 17, 2021, at 7:20:31
In reply to Re: HELP - Seroquel or Brexiprazole, posted by Christ_empowered on April 16, 2021, at 20:08:27
The problem is that the healthcare system here in Canada is so strained with COVID. She went to the hopspital, but they kicked her out before she was really better.
She's having this severe stomach pain all the time. The doctors have looked for physical causes...I wonder if they checked for pancreatitis.
I would like to see her on less depakote.
Linkadge
Posted by Polarbear206 on April 17, 2021, at 10:18:37
In reply to Re: HELP - Seroquel or Brexiprazole, posted by linkadge on April 17, 2021, at 7:20:31
Hi. I havent posted in 10 years or more. Not sure if you remember me or not? Im very sorry your mom is having a severe exacerbation. This time of year with the season change doesnt help and can compounds things. I dont know her history , but I will add my input anyway. Her psychiatrist should take into consideration that not only your mother is severely suffering , but the whole family unit is. Considering the magnitude, ECT should be on the front burner.
Posted by jay2112 on April 19, 2021, at 0:41:27
In reply to HELP - Seroquel or Brexiprazole, posted by linkadge on April 16, 2021, at 18:56:52
> My mother is in BAD shape. She is currently on brexiprazole and valproate for bipolar and doing terrible. We are considering ECT and/or more hospitalization.
>
> Her current symptoms are low appetite, anhedonia, headaches, GI symptoms, stomach pain, etc. To ANYBODY who can compare brexiprazole vs. seroquel.....
>
> If you had hardcore melancholic symptoms (anxiety / insomnia, GI problems, anhedonia) would you chose brexiprazole or seroquel?
>
> Nothing is lifting this bitch out of her funk. I want her off depakote but the doctor keeps doing one f*ck*ng thing at a time (see you in 2 weeks??) my dad hasn't slept more than 3 hours in 2 months. Everybody is completely at their wits end.
>
> Linkadge
>
>
>
>Seroquel,
a small antidepressant dose (because you said you didn't think she had bipolar). Excellent combo....good for sleep.Jay
Posted by linkadge on April 19, 2021, at 8:42:54
In reply to Re: HELP - Seroquel or Brexiprazole » linkadge, posted by jay2112 on April 19, 2021, at 0:41:27
They don't really know what she has. She has really bad depressive episodes every 10 years or so. In between, there can be periods of irritability and some (possible) increase in goal directed behavior. She's possibly BPII, but always treated with heavy mood stabilizers.
Linkadge
Posted by linkadge on April 19, 2021, at 15:54:28
In reply to Re: HELP - Seroquel or Brexiprazole, posted by linkadge on April 19, 2021, at 8:42:54
Has anyone experienced an increase in depression on brexiprazole?
(I have never taken this med, so I have no feel for it).
Linkadge
Posted by Christ_empowered on April 19, 2021, at 20:16:49
In reply to Anyone experience increase in depression on brex?, posted by linkadge on April 19, 2021, at 15:54:28
hate to be the bearer of bad news, but...it can happen. i think the d2 partial agonists are supposed to be less likely to cause dysphoria and drug induced depression, but...
aripprazole is apparently a less toxic maintenance option for Schizophrenia...can effectively suppress mania in Bipolar I...but can also cause and/or exacerbate depression. problem there is..
so can seroquel. its...pretty much the nature of the beast, when dealing with the neuroleptics.
how is her overall physical health? here in the US, Symbyax--the zyprexa and prozac combo pill-- is available in generic, and they have one or two combos that are standard Prozac, lower on zyprexa, for treatment resistant depression. maybe since there's data on the exact combination, her treating physician might be willing to try that?
obviously...weight gain, diabetes, plus all the usual from any neuroleptic, ever. ugh.
id -seriously- steer clear of shock. just...my opinion.
Posted by undopaminergic on April 20, 2021, at 3:12:56
In reply to Re: Anyone experience increase in depression on brex?, posted by Christ_empowered on April 19, 2021, at 20:16:49
>
> obviously...weight gain, diabetes, plus all the usual from any neuroleptic, ever. ugh.
>Not all neuroleptics cause weight gain or diabetes. Histamine H1-antagonism is the problem.
-undopaminergic
Posted by linkadge on April 23, 2021, at 18:39:41
In reply to Re: Anyone experience increase in depression on brex?, posted by Christ_empowered on April 19, 2021, at 20:16:49
My concern with brexiprazole was the potent 5-ht1a autoreceptor agonism. Activating the 5-ht autoreceptors suppresses firing of serotonin. I had a bad experience with buspirone (possibly for this reason). I just felt really empty and sad. I can't say for sure. I almost want to consume some of it just to see what 'feel' it gives. I have a sense of how many of her meds feel, but not this one.
Linkadge
Posted by linkadge on April 23, 2021, at 18:40:47
In reply to Re: Anyone experience increase in depression on brex?, posted by undopaminergic on April 20, 2021, at 3:12:56
>Histamine H1-antagonism is the problem.
AND 5-ht2c receptor antagonism. Drugs like belviq do the opposite (activate 5-ht2c receptors) to suppress appetite.
Linkadge
Posted by Christ_empowered on April 23, 2021, at 19:03:01
In reply to Re: Anyone experience increase in depression on brex? » undopaminergic, posted by linkadge on April 23, 2021, at 18:40:47
ok. wow. -not- any sort of expert, just...wow. my rudimentary understanding was that brex is sort of like aripiprazole, just...maybe (?) better for some forms of depression and long term treatment of those with Schizophrenia who lean towards the (notoriously severe) depressive states found in Schizophrenia, Schizoaffective.
sorry. really. my take on "the miracle meds" has always been based more on a drug-centered approach to reading about "mental illnesses" and also the drugs to treat them, because...
I don't understand neurotransmitters, etc. but I do rather enjoy Dr.Joanna Moncrief's work.
different approach, I guess? at any rate, if your mother does not have a major problem with mania and/or psychotic, agitated states...
what's with the full dose depakote and neuroleptic combinations? anger? agitation? just...the standard mix from the local clinic (not trying to be snarky, I see that all the time, when I go in for 'treatment...' -shudder-)
i hope you and your family find some viable solutions for your mother. :-)
Posted by undopaminergic on April 24, 2021, at 0:24:07
In reply to Re: Anyone experience increase in depression on brex? » undopaminergic, posted by linkadge on April 23, 2021, at 18:40:47
> >Histamine H1-antagonism is the problem.
>
> AND 5-ht2c receptor antagonism. Drugs like belviq do the opposite (activate 5-ht2c receptors) to suppress appetite.
>Well, not in my experience. I've intentionally tried to find, and try, serotonin 5-HT2C receptor agonists, because they enhance dopamine release, and they had zero effect on appetite. On the other hand, they also had no effect that felt like a dopamine increase, so maybe it's just my experience.
-undopaminergic
Posted by undopaminergic on April 24, 2021, at 0:25:35
In reply to Re: Anyone experience increase in depression on brex?, posted by undopaminergic on April 24, 2021, at 0:24:07
I wrote:
>
> Well, not in my experience. I've intentionally tried to find, and try, serotonin 5-HT2C receptor agonists, ...
>I meant *ant*agonists.
-undopaminergic
This is the end of the thread.
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