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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by sharkie on October 23, 2005, at 13:51:12
Hello everyone,
I've been suffering from schizoaffective disorder for about 8 years. After first hospitalization I was on Serdolect for about 2 years. Then my pdoc stopped the treatment. After 5 months my problems came back. After that I was on Risperdal and came into terrible apathy. My pdoc changed a medication to Seroquel. I lost my apathy the first day and felt as in heaven ! Unfortunately, after 4 great years on Seroquel I had a relapse. Seroquel was too weak for my positive symptoms like dellusions and disorganized thinking. After hospitalization I took an experimental medication ORG5222 by Organon and suffered from a terrible akathisia and insomnia. Then I was on Zyprexa having somnolence, gaining weight. Now I am taking Abilify 15mg daily (for about 6 months) and Trittico (trazodon) at night (to beat insomnia and potential depression). Beeing under treatment of all three neuroleptics I still suffer from apathy, lost motivation, lost ability to learn, reduced memory abilities, etc. I would like to combine Abilify and Seroquel. I found on http://www.dr-bob.org/babble/20040308/msgs/322801.html
that it is possible and may be helpful. Can anybody help me how to persuade my pdoc
to prescribe me both neuroleptics ? He claims that it only multiplies side effects of meds,
brings problems with dosages, etc. After hospitalization, I took Seropram (citalopram) due to postpsychotic depression. I had similar feelings as with Seroquel 4 years before. Pdoc
said it was a serotonin effect. Was it the same in both situations ? Does anybody have
links to reliable medical studies about combination of neuroleptics ?Thanks,
Roman
Posted by xjs7 on October 23, 2005, at 20:13:45
In reply to Can Seroquel produce a serotonin effect ?, posted by sharkie on October 23, 2005, at 13:51:12
I am not a fan of combining antipsychotics, and I tend to agree with the general consensus that it basically causes more side effects for little extra gain. Currently what I am trying is a very high dose of one antipsychotic. This is working pretty well. You say you are taking 15 mg of Abilify. Maybe you could try 30 mg or 45 mg. Your apathy could be a symptom of your disease rather than a side effect. It is a common symptom.
Sometimes you can use AP side effects to your advantage, such as using Seroquel for sleep. But my doctor at the hospital doesn't think that doing so will enhance the antipsychotic effect. I don't think this sort of thing is well-studied. What psychiatrists have mostly done in the history of antipsychotics is go up really high on one. I think this is a proven method of reducing symptoms.
Posted by sharkie on October 24, 2005, at 6:25:03
In reply to Re: Can Seroquel produce a serotonin effect ?, posted by xjs7 on October 23, 2005, at 20:13:45
> I am not a fan of combining antipsychotics, and I tend to agree with the general consensus that it basically causes more side effects for little extra gain.
Every doctor I contacted has a similar opinion. I increased my dosage to 22,5mg. Anyway, the maximum of Abilify is 30mg.
My idea to combine Abilify and Seroquel comes from the fact that Abilify will cover positive symptoms, but Seroquel will cause a remission of some negative symptoms which still persist (apathy, cognitive problems, insomnia); and I have an experience that Seroquel can do that.
Posted by Bill LL on October 24, 2005, at 11:34:37
In reply to Re: Can Seroquel produce a serotonin effect ?, posted by sharkie on October 24, 2005, at 6:25:03
My understanding is that when one starts taking Seroquel, it works fast. If that is true, I guess you could start on it and just see if it helps or not. I guess the potential danger might be if it sends one into a psychotic episode before the person discontinues it.
I'm wondering if you went back on just seroquel, but at a higher dose than before, if that would help.
> > I am not a fan of combining antipsychotics, and I tend to agree with the general consensus that it basically causes more side effects for little extra gain.
>
> Every doctor I contacted has a similar opinion. I increased my dosage to 22,5mg. Anyway, the maximum of Abilify is 30mg.
> My idea to combine Abilify and Seroquel comes from the fact that Abilify will cover positive symptoms, but Seroquel will cause a remission of some negative symptoms which still persist (apathy, cognitive problems, insomnia); and I have an experience that Seroquel can do that.
>
Posted by ed_uk on October 24, 2005, at 14:10:41
In reply to Re: Can Seroquel produce a serotonin effect ?, posted by xjs7 on October 23, 2005, at 20:13:45
Hi XJ,
Which AP are you taking? At what dose?
~ed
Posted by sharkie on October 25, 2005, at 2:39:52
In reply to Re: Can Seroquel produce a serotonin effect ?, posted by Bill LL on October 24, 2005, at 11:34:37
> I'm wondering if you went back on just seroquel, but at a higher dose than before, if that would help.
I was on Seroquel on 600mg about 18 month ago and still had attacks of disorganized thinking. I would have to go on 1000mg or 1200mg to bring it into remission, but even on 600mg Seroquel is very sedating. I work mentally and can't afford this.
Posted by SLS on October 25, 2005, at 7:22:00
In reply to Re: Can Seroquel produce a serotonin effect ?, posted by sharkie on October 25, 2005, at 2:39:52
> I was on Seroquel on 600mg about 18 month ago and still had attacks of disorganized thinking. I would have to go on 1000mg or 1200mg to bring it into remission, but even on 600mg Seroquel is very sedating. I work mentally and can't afford this.
I've seen some work done with dosages of Seroquel as high as 1200mg, but I don't know if an increase in sedation would be expected. I guess if I were in your position, I would consider first adding another AP. Once you find one that shows a trend in improving your thinking, you can then wean off the Seroquel. I know someone who was simultaneously taking three APs. Risperdal was very effective at 3.0mg, but it affected adversely her menstrual cycle. When Seroquel was added, it became obvious that she was going to benefit from it. She was able to improve steadily as the Risperdal was decreased and the Seroquel was increased. She remained on Abilify to help with depression, although I doubt she needs it now. Wellbutrin has been quite adequate in treating it.
Which APs would you exclude from consideration and why?
- Scott
Posted by sharkie on October 25, 2005, at 7:59:45
In reply to Re: Can Seroquel produce a serotonin effect ? » sharkie, posted by SLS on October 25, 2005, at 7:22:00
> I guess if I were in your position, I would consider first adding another AP.
> Which APs would you exclude from consideration and why?I tried several APs and only Seroquel effectively fought with my apathy on a low dosage. I exclude Risperdal as useless and intolerable (even I didn't try to go up to 3mg). Serdolect is currently prohibitted due to changes in QT interval. Abilify has no side effects but being on 15mg I still feel apathy.
AFAIK Wellbutrin is antidepressant but my apathy has a schizoid origin, I guess.
Does anybody know how Abilify's partial agonism appears ? How to identify or feel it ?
Posted by xjs7 on October 25, 2005, at 14:44:49
In reply to Re: Can Seroquel produce a serotonin effect ? » xjs7, posted by ed_uk on October 24, 2005, at 14:10:41
Hi Ed,
I am taking Geodon at 240 mg. I got a robust response at 20 mg but the higher dose is so I don't have as many relapses. To tell the truth I don't notice any real difference between 120 mg and 240 mg but my doctor thought it would help so I take the higher dose. I don't really get any side effects from it. At first when I took it, even at the lower doses, I got EPS, but that went away after a few months (I used Cogentin for the stiffness).
Geodon is not a great med, but it doesn't cause any weight gain so I am happy with it. If for whatever reason I need to change meds I would go straight to Abilify. I started taking Geodon in 2001, and Abilify wasn't out then.
I have also tried Stelazine and Seroquel (for insomnia). After reading so many bad things about Stelazine and the older APs I was expecting to hate it but it really didn't bother me at all. It was gentler than Geodon in some ways.
XJS7
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