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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 33. This is the beginning of the thread.
Posted by CareBear04 on October 27, 2005, at 10:19:18
I've been on Abilify for months, first starting at 10mg, then progressing up to now 30mg. I'm not schizophrenic or anything, so this seems like an awfully high dose to me. What are other people's doses of Abilify?
...It's a really expensive drug, and the problem is that I can't tell whether or not it's working. I'm not experiencing side effects, but I also can't tell the difference between 10mg and 30mg. I still occasionally have hallucinations... shouldn't they be controlled by the Abilify? I'm getting frustrated with this drug, but I don't know that I have other options. The only one of the atypical antipsychotics I haven't been on is Geodon. As for the older APs, I've been on Haldol and Trilafon. The one that works best for me is Haldol, but I don't think it's as safe to use for long periods at relatively high doses.
Anyway, any thoughts or advice? Thanks!
Posted by Phillipa on October 27, 2005, at 20:55:40
In reply to Abilify-- does it work, and how much is too much?, posted by CareBear04 on October 27, 2005, at 10:19:18
What is your dx? And yes it sounds like a high dose. I've seem on the board doses from 5mg to l5mg. Fondly, Phillipa
Posted by theo on October 27, 2005, at 23:05:24
In reply to Abilify-- does it work, and how much is too much?, posted by CareBear04 on October 27, 2005, at 10:19:18
I'm getting ready to try Abilify. Do you take it morning or evening. What are you taking it for?
Posted by Ilene on October 27, 2005, at 23:50:45
In reply to Abilify-- does it work, and how much is too much?, posted by CareBear04 on October 27, 2005, at 10:19:18
I used to take 40 mg. It didn't do anything for me, but it had no side effects even at that dose.
I.
Posted by xbunny on October 28, 2005, at 5:10:01
In reply to Abilify-- does it work, and how much is too much?, posted by CareBear04 on October 27, 2005, at 10:19:18
> I still occasionally have hallucinations... shouldn't they be controlled by the Abilify?
I take a moderate dose of two antipsychotics and still experience hallucinations, for the me the mark of if an antipsychotic is working is if the hallucinations are manageable and not too intrusive. I have gone upto some quite high doses on some antipsychotics and still experienced hallucinations so for me I know to not to expect 100% releif.
> As for the older APs, I've been on Haldol and Trilafon. The one that works best for me is Haldol, but I don't think it's as safe to use for long periods at relatively high doses.
Maybe you could try a low dose of haldol and a low dose of abilify?
Do you get any other benefit from abilify such as improved or more stable mood?How did you find haldol? I have never taken it.
Buns
Posted by med_empowered on October 28, 2005, at 5:47:13
In reply to Re: Abilify-- does it work, and how much is too mu, posted by xbunny on October 28, 2005, at 5:10:01
30mgs is the max (according to the manufacturer; in the clinical setting, it seems some people do take more). I think the rules may be different for atypicals but with the old antipsychotics, the idea was that a neuroleptic had three points:
1) generalized sedation
2) "psychic" sedation (induces apathy, reduces emotional intensity)
and 3) "specific" antipsychotic effectThis 3-point system held true for low to medium-potency drugs; drugs like Haldol cover points 2 and 3, but don't do quite as much in the way of generalized sedation as, say, Thorazine or Trilafon. Anyway, the rule is that the top 2 should be apparent pretty quickly; antipsychotic effect may not be apparent for 6-8 weeks. Like buns said, sometimes the best bet is to opt for less medication with some mild hallucinations instead of over-medicating and eliminating the hallucinations (but also eliminating your quality of life). As for how much is too much...for me, anything above 10 was really too much. I can't really describe it..15 was great for psychotic depression, but it also had more side effects. When the dose jumped up to 30, it was waaaaay too much. You may want to ask your doc why you're being RX'd the max; it is the usual dose for managing **acute** mania, but that's about it. Good luck!
Posted by CareBear04 on October 28, 2005, at 13:04:19
In reply to Re: Abilify-- does it work, and how much is too much? » CareBear04, posted by Phillipa on October 27, 2005, at 20:55:40
hi phillipa-- my diagnosis is bipolar disorder. i see a psychopharmacologist who is supposed to be excellent-- he has a PhD in addition to his MD-- and his specialty is depression, though, not bipolar. he also spends the vast majority of his time doing research and not seeing clinical patients, so i'm not sure how much experience he has dosing abilify this high. 30mg does seem like a lot. thanks! cb
Posted by CareBear04 on October 28, 2005, at 13:05:27
In reply to Re: Abilify-- does it work, and how much is too much? » CareBear04, posted by theo on October 27, 2005, at 23:05:24
theo-- i take my 30mg of abilify in the morning. i haven't tried taking it at night, so i don't know whether it would keep me awake, but morning works well. i take it for bipolar disorder.
Posted by CareBear04 on October 28, 2005, at 13:09:47
In reply to Re: Abilify-- does it work, and how much is too much?, posted by Ilene on October 27, 2005, at 23:50:45
ilene-- do you mind if i ask what you were taking that much abilify for? and what kind of doctor prescribed that dose for you? (ie, a medication specialist, PCP, all-purpose psychiatrist, etc.) i'm glad you had no side effects, but don't the risks of antipsychotics increase along with the dose?
Posted by CareBear04 on October 28, 2005, at 13:15:42
In reply to Re: Abilify-- does it work, and how much is too mu, posted by xbunny on October 28, 2005, at 5:10:01
buns-- i've found that most pharmacies i've gone to carry haldol or will order it.
which two antipsychotics are you taking currently?
the problem with suggesting adding haldol and going down on my abilify dose is that i only see my doctor once a month, so when i do, there is so much else to talk about. also, he's fairly young and spends most of his time in research and not seeing clinical patients, so i think those types of doctors are more likely to mistrust haldol because of the bad side effects they've heard of anecdotally. most psychiatrists i know who see a lot of clinical patients and who might be of the older generation know that haldol, especially at low to moderate doses, can be helpful. i think the goal is to have me off neuroleptics altogether, not to increase the number from one to two, but i agree with your suggestion and would be open to trying it. i'm just on a whole pharmacy of meds already, so the drs are reluctant to add more meds. thanks for the suggestions. cb
Posted by CareBear04 on October 28, 2005, at 13:40:31
In reply to Re: Abilify-- does it work, and how much is too mu, posted by med_empowered on October 28, 2005, at 5:47:13
hey med_empowered--
i don't know why i'm being rx'd the max dose. this has never happened to me before; with antidepressants and antipsychotics, especially, i've always been on the very low end of the dosing spectrum. when i was on zyprexa, 2.5mg was too much, on risperdal, i took 0.5 to 1mg, and also low doses of seroquel and haldol and the others.
my dr. admitted that i don't have acute mania, so except for the fact that i'm still having some hallucinations, i don't know why i've been increased to the max.
besides 30mg of abilify, i'm also on a mood stabilizer. it used to be 300mg of topamax, and now, because i asked to switch back to lithium, which is my gold standard, i'm on 600mg of lithium. i don't know if that's a therapeutic dose or not. i used to take up to 1800mg, but i've also been very toxic a lot and once needed dialysis because i had a lithium level of 4.2+. i'm also on klonopin 2mg at night and 50-100mg of trazodone and 15mg twice a day of dexedrine. then, i'm on a bunch of meds for medical conditions. i'm not sure what the abilify does for me, if anything.
did abilify do anything for you?
thanks, cb
Posted by ed_uk on October 28, 2005, at 15:17:42
In reply to Re: Abilify-- does it work, and how much is too mu, posted by xbunny on October 28, 2005, at 5:10:01
Hi Buns!
Glad to hear you're still doing well :-)
What sort of hallucinations do you have? Voices?
~Ed
Posted by ed_uk on October 28, 2005, at 15:21:17
In reply to Re: Abilify-- does it work, and how much is too mu » med_empowered, posted by CareBear04 on October 28, 2005, at 13:40:31
Hi CB,
Out of all the antipsychotics you've tried, which was the most effective? Which had the least side effects? I remember you saying that you took 1mg/day Haldol.
~Ed
Posted by CareBear04 on October 28, 2005, at 15:27:10
In reply to Re: Abilify-- does it work, and how much is too mu » CareBear04, posted by ed_uk on October 28, 2005, at 15:21:17
hey ed,
you have a great memory-- i did take 1mg/day of haldol. and i think that of all the APs, haldol was the most effective for me. it slowed my thoughts down and took away anxiety without making me sleepy. with abilify, i haven't had any side effects, but i can't say for sure that it's doing anything good, either.
Posted by ed_uk on October 28, 2005, at 15:49:21
In reply to Re: Abilify-- does it work, and how much is too mu » ed_uk, posted by CareBear04 on October 28, 2005, at 15:27:10
Hi CB,
Have you tried 0.5mg haloperidol? It might work as well as 1mg.
~ed
Posted by Phillipa on October 28, 2005, at 17:46:10
In reply to Re: Abilify-- does it work, and how much is too mu » ed_uk, posted by CareBear04 on October 28, 2005, at 15:27:10
CareBear, What part of the counry do you live in? Just wondering because I have to change pdocs. And wondered if a University Doc was any better. Or one affiliated with a hospital. Any suggestions? Fondly, Phillipa
Posted by Lazarus on October 28, 2005, at 18:19:17
In reply to Abilify-- does it work, and how much is too much?, posted by CareBear04 on October 27, 2005, at 10:19:18
Don't give up on the Abilify. The risk of tardive dyskinsia is much lower than with the other newer APs (Zyprexa, Seroquel, Geodon, Risperdal) and the older APs (Haldol, Thorazine). Try taking the smallest dose of Abilify possible. I take 5 mg daily for bipolar disorder and it is an excellent medication.
Good-luck.
Lazarus
Posted by xbunny on October 28, 2005, at 19:06:51
In reply to Re: Abilify-- does it work, and how much is too mu » xbunny, posted by ed_uk on October 28, 2005, at 15:17:42
> Hi Buns!
>
> Glad to hear you're still doing well :-)
>
> What sort of hallucinations do you have? Voices?I get the whole range; voices, unidentified sounds, music, various auditory perceptual effects like echoes (especially hearing (literally) my own thoughts a few moments after thinking them, sometimes with external commentary), lights, patterns overlayed in my vision, things changing visually from one thing into another (it was a bag changing into a dog the other day - really took my breath away, hollywood couldnt have done it better), depth and visual perception distortions, messages from the TV and radio (more of a delusion I suppose), smell hallucinations like burning, chemical smell, rotting meat (never flowers or perfume typical). Most of the time now I am well these are probably correctly classed as illusions since I know they arent real however sometimes I still fall for them. The smell hallucinations are the worst, whether I beleive they are real or not they still make me paranoid and panic. I used to get alot of paranoid delusions of persecution, mind control, I was in the after life things like that, medication seems to have wiped these completely out thank god.
Buns
Posted by xbunny on October 28, 2005, at 19:16:45
In reply to Re: Abilify-- does it work, and how much is too mu » xbunny, posted by CareBear04 on October 28, 2005, at 13:15:42
> buns-- i've found that most pharmacies i've gone to carry haldol or will order it.
By how did you find haldol I meant what was your experience with it like? sorry I should have been more accurate.
Buns
Posted by ed_uk on October 28, 2005, at 19:26:53
In reply to Re: Abilify-- does it work, and how much is too mu » ed_uk, posted by xbunny on October 28, 2005, at 19:06:51
Hi Buns,
Flupenthixol must be working well because you clearly have a lot of insight into your illness. Are you still on 6mg?
~ed
Posted by xbunny on October 28, 2005, at 19:46:18
In reply to Re: Abilify-- does it work, and how much is too mu » xbunny, posted by ed_uk on October 28, 2005, at 19:26:53
Hi Ed,
>
> Flupenthixol must be working well because you clearly have a lot of insight into your illness. Are you still on 6mg?Yes 6mg of flupenthixol and 20mg of pericyazine. I really rate pericyazine now I have tolerated > 10mg it really chills me out, helps me focus and brings my anxiety down. I used to get this weird 'under attack' type feeling whenever I was out, I was always checking the rooftops for snipers and being really careful to look at people when they walked past to make sure they werent 'agents' or something. I dont do any of that now, I can happily spend an hour out of doors without feeling uncomfortable. If I could only get used to using public transport I would have almost all of my old life back, though I am planning (have been for months) to get a motorbike and get my mobility back that way. The psychiatric services have down graded me to a standard care plan a few weeks ago, though after reading my description of my symptoms I just made I am still kinda struck by the ticking timebomb suggestion my last CPN made lol.
Buns
Posted by CareBear04 on October 29, 2005, at 13:05:39
In reply to Re: Abilify-- does it work, and how much is too mu » CareBear04, posted by Phillipa on October 28, 2005, at 17:46:10
hi phillipa,
i live in the NE united states where there is a million of every type of pdoc. i've seen several in private practice, and right now, i'm seeing a psychopharmacologist who is on faculty at harvard. i don't think it matters so much what their affiliation, so long as the dr has an open mind and is willingn to try different interventions, even those that are thought to be controversial. it seems to me that once one dr starts a treatment, others are more likely to continue it, as long as you seem reasonably stable. that's probably why i've been on high-dose benzo treatment and stimulant treatment with so many drs, even though most wouldn't have started with that treatment. best of luck in finding a new pdoc and let me know if you have any more questions. cb
Posted by CareBear04 on October 29, 2005, at 13:12:47
In reply to Re: Abilify-- does it work, and how much is too mu, posted by xbunny on October 28, 2005, at 19:16:45
buns-- i found the haldol to be kind of soothing without knocking me out or making me feel drugged like other neuroleptics. it just calmed me down and slowed my too-fast thoughts and helped me focus on whwat i needed to do.
Posted by ed_uk on October 29, 2005, at 15:05:04
In reply to Re: Abilify-- does it work, and how much is too mu » ed_uk, posted by xbunny on October 28, 2005, at 19:46:18
Hi Buns,
You've made so much progress lately :-)
>If I could only get used to using public transport I would have almost all of my old life back.......
What do you fear? Perhaps a slightly higher dose of pericyazine would help. Have you tried 25mg?
Kind regards
Ed
Posted by xbunny on October 29, 2005, at 18:52:14
In reply to Re: Abilify-- does it work, and how much is too mu » xbunny, posted by ed_uk on October 29, 2005, at 15:05:04
Hi Ed,
>
> You've made so much progress lately :-)
>
> >If I could only get used to using public transport I would have almost all of my old life back.......
>
> What do you fear? Perhaps a slightly higher dose of pericyazine would help. Have you tried 25mg?I get really panicy and paranoid when Im on the bus or train. As soon as I get on I want to get off and once Im stuck on it I just start trying to suss out the other passengers and what their agenda regarding me might be. Even though I know in my head they dont care a thing about me, I still get more and more paranoid and panicy. The whole experience is just unbearable. I have taken my pericyazine dose upto 30mg before and not noticed much improvement but then again maybe I would need to sustain it for a while. The doctor has prescribed enough for me to go upto 30mg a day if I want.
Buns
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