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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by pseudoname on October 2, 2006, at 15:47:42
I have a med that works on 90% of my worst depression (buprenorphine). But it doesn't help with listlessness, anhedonia, “ambition”, or my bizarre fears. So my sweet pdoc added the antipsychotic Abilify (aripiprazole).
BAD PART: After a couple weeks when the drowsy-making wore off, it started to freak me out. I got seized with worries and anxieties, and long-dormant panic attacks started returning. This was at 5 mg/day, then even at 2.5 mg/day.
GOOD PART: It seemed to clear my head & improve concentration a little, but in retrospect I didn't read any more or better than before. I also didn't get any more done of avoided chores. But it did totally put a stop to my fears of going outside and "being seen": walking anywhere, any time was no problem. Also, I stopped obsessing so much about What Other People Think About Me.
The good part was very much like what the good effect of CAFFEINE feels like.
Due to the freak-out part, I'm off it now. But I still don't mind as much going outside nor do I obsess as much WOPTAM. If I ever try Paxil for my other fears, I may try Abilify again. (Anybody know if that would be safe? buprenorphine + Paxil + Abilify?)
Posted by ed_uk on October 3, 2006, at 15:57:26
In reply to my Abilify® experience, posted by pseudoname on October 2, 2006, at 15:47:42
Hi PN
How do you react to other antipsychotics?
Ed
Posted by pseudoname on October 3, 2006, at 16:14:51
In reply to Re: my Abilify® experience » pseudoname, posted by ed_uk on October 3, 2006, at 15:57:26
Hiya, Ed! My gorsh, it seems like forever since I've talked to you.
> How do you react to other antipsychotics?
I tolerated 50mg Mellaril/thioridazine okay. On my third day with Haldol/haloperidol (dunno what dose), I got confused and smashed my head through a wall. Not a good reaction.
Posted by ed_uk on October 3, 2006, at 16:20:43
In reply to Re: my antipsychotics » ed_uk, posted by pseudoname on October 3, 2006, at 16:14:51
Hi PN!
Abilify comes in 2mg tablets now, perhaps you could try 1mg/day?
Ed x
Posted by pseudoname on October 3, 2006, at 16:35:42
In reply to Re: my antipsychotics » pseudoname, posted by ed_uk on October 3, 2006, at 16:20:43
> perhaps you could try 1mg/day?
I was hoping to take a higher dose to get more of the good effect while doing something to control the increased bad effect. Even at 2.5 mg every other day, the crazy panicky responses were not good.
> Abilify comes in 2mg tablets now
Chuckle. Actually, I bought the 20-mg tablets and got good at splitting them into 8 pieces (2.5 mg), to save about $260 a month. I can take that every other day for about 1.25 mg/day.
But there's no known reason NOT to combine Paxil + Abilify + bupe, right? (I don't want to end up like Anna Nicole Smith's kid…)
Posted by ed_uk on October 4, 2006, at 11:27:43
In reply to Abilifization » ed_uk, posted by pseudoname on October 3, 2006, at 16:35:42
Hi PN
>I can take that every other day for about 1.25 mg/day.
Good idea, Abilify has a very long half life so taking it on alternate days might work well.
>Chuckle. Actually, I bought the 20-mg tablets and got good at splitting them into 8 pieces (2.5 mg), to save about $260 a month.
The 'flat pricing' of Abilify is crazy!
>But there's no known reason NOT to combine Paxil + Abilify + bupe, right?
AFAIK, Paxil inhibits the metabolism of Abilify. You might be better off trying citalopram, which has very few drug interactions.
Ed
Posted by ed_uk on October 4, 2006, at 11:36:01
In reply to Abilifization » ed_uk, posted by pseudoname on October 3, 2006, at 16:35:42
Hi PN,
I think Scott gave some good advice below, when he suggested than an SSRI might not be the right treatment for your anxiety.
Ed x
Posted by pseudoname on October 4, 2006, at 12:07:17
In reply to Re: Abilifization » pseudoname, posted by ed_uk on October 4, 2006, at 11:36:01
Thanks, Ed. I appreciate the info very much.
Perhaps I will go off the buprenorphine again to try to reduce anxiety reactions. Just a hunch.
I could then try the Abilify again, perhaps with intermittent benzos, and tough it out a while to see if the freak-outs eventually go away. On the other hand, that idea fills me with dread because the freak-outs were so horrible. Neither Ativan/lorazepam nor alcohol helped with those freak-outs (but perhaps I didn't take enough, 0.25-0.5 mg). I think nothing is worse than panic.
Maybe I should just go for bilateral ECT, like blueberry……
Thanks for your thoughts.
Posted by psychobot5000 on October 4, 2006, at 14:10:33
In reply to Thanks » ed_uk, posted by pseudoname on October 4, 2006, at 12:07:17
You could try Tianeptine with Abilify--it's an antidepressant with a more consistent anxiolytic effect than SSRIs. And it's not metabolised by the cytochrome p450 system, so like Celexa (also seems like a good idea), it wouldn't interact with the metabolism of Abilify.
Posted by pseudoname on October 4, 2006, at 18:43:00
In reply to Re: Thanks, posted by psychobot5000 on October 4, 2006, at 14:10:33
> You could try Tianeptine with Abilify
Thanks, p-bot. Many things about Stablon®/tianeptine sound good, but is there any legal way I could get it to try? I live in the U.S.
Posted by psychobot5000 on October 5, 2006, at 8:31:35
In reply to Stablon / tianeptine » psychobot5000, posted by pseudoname on October 4, 2006, at 18:43:00
Legality is a good question.
Short answer, no. The full answer is more complicated. First off, I should mention that Tianeptine is supposedly in development (phase 1?) in the US for treating irritable-bowel-syndrome, so it's -possible- that in a year or two or three, it will be available in the normal manner.
As for today's legality, the answer is...sort of. It is not approved in the US, but when terminal AIDS patients needed the newest drugs, about ten years ago, the FDA loosened up their restrictions on foreign drugs, for those in extreme need--deliberately creating a legal grey area, for those in need. If your depression is resistant enough, you might be able to convince a psychiatrist to write you for it, so that you could import the stuff. It then becomes the decision of the individual customs inspector, whether or not the stuff is okay (should it actually get inspected, which is unlikely).
The difficulty would be in convincing a doctor, since it's not well known in the US, and is unnaproved as of now. Also, I'm sure no insurance would pay for it. You'd have to do it on your own, I imagine (120$/month).
The advantage of this medication is a novel mechanism of action, decent antidepressant effect, few drug interactions, mild anxiolytic action, and very few side-effects. If you think that sounds worth it, than you could at least try to get a psychiatrist on your side. It'd be a strange experience, I'd imagine, but at least actually ordering the stuff is easy.
Posted by SLS on October 5, 2006, at 9:03:42
In reply to Re: Stablon / tianeptine legality--grey area, posted by psychobot5000 on October 5, 2006, at 8:31:35
> The advantage of this medication is a novel mechanism of action, decent antidepressant effect,
By "decent", do you think it is appropriate for a severe angergic bipolar depression?
- Scott
Posted by Declan on October 5, 2006, at 10:09:25
In reply to Re: Stablon / tianeptine legality--grey area » psychobot5000, posted by SLS on October 5, 2006, at 9:03:42
Tianeptine doesn't give you heaps of energy. Heaps of energy would likely turn nasty with me anyway. So I'd wondered about its use for severe anergic depression. Seems to be mildly prosocial.
Posted by Declan on October 5, 2006, at 10:13:45
In reply to Stablon / tianeptine » psychobot5000, posted by pseudoname on October 4, 2006, at 18:43:00
My doctors are fine with it, but they are unusual doctors. One is the nutritional bloke and he kind of avoids drugs if possible. My GP has cross cultural and countercultural tendancies. I told them I was on it and importing it, they were interested, and that was it. It was OK with customs. I guess that means I had a prescription; I could certainly get one.
Posted by ed_uk on October 5, 2006, at 16:59:04
In reply to Abilifization » ed_uk, posted by pseudoname on October 3, 2006, at 16:35:42
Hi PN
Perhaps it would be best to stay on bupe, give up on Abilify, and try something else instead?
Ed
Posted by pseudoname on October 5, 2006, at 17:14:43
In reply to Re: Abilifization » pseudoname, posted by ed_uk on October 5, 2006, at 16:59:04
> Perhaps it would be best to stay on bupe, give up on Abilify, and try something else instead?
Hi, Eddy. I'm going off the buprenorphine for a while. I like to do that periodically anyway just to assure myself I'm not too physically dependent. There seems to be very little if any tolerance for me with bupe, but a break does seem to increase sensitivity somewhat. Also, I *do* suspect that for whatever reason the bupe mildly increases certain categories of anxiety for me.
I have a month of Abilify left at low doses, and I am curious about its effects if I stick it out longer. Scott suggests the freak-outs may go away; we'll see. Oddly, I spent SEVEN HOURS this morning completely depression-free for the first time in years, for unknown reasons. (The 2 g of EPA I started taking 10 days ago?? I'm clueless.)
But you say
> try something else instead?
What did you have in mind?
Posted by psychobot5000 on October 5, 2006, at 22:51:01
In reply to Re: Stablon / tianeptine legality--grey area » psychobot5000, posted by SLS on October 5, 2006, at 9:03:42
> By "decent", do you think it is appropriate for a severe angergic bipolar depression?
I think Declan's response is a good one.(Tianeptine doesn't give you heaps of energy. Heaps of energy would likely turn nasty with me anyway. So I'd wondered about its use for severe anergic depression. Seems to be mildly prosocial.)
...I take it for severe treatment-resisitant, anergic, atypical depression, and it does pretty well for that, except for not helping with drive and energy. But at least it isn't sedating, either. I'd say that, for mood-elevation, it's about as powerful as an SSRI, WITHOUT the nausea, insomnia, anxiety, and diverse other unpleasant accompanying factors.
Many researchers suggest it has mood-stabilizing properties, and I've read reports of that on this forum. My moods are more even when taking it, though I imagine it's less powerful than lithium, or whatever, in that respect. Still, definitely seems as though it'd be useful to BP patients.
I don't know what's contraindicated in BP patients, but something like low dose reboxetine, desipramine, or a psychostimulant might help with the anergia. The mechanisms-of-action in the various drugs suggest they can be combined with each other, but I suppose in treating bipolar disorder, one must be careful.
Hope that's useful to you--stablon is the best medication I've found for myself. It seems to be very safe.
P-bot
Posted by SLS on October 6, 2006, at 4:39:23
In reply to Re: Tianeptine for anergic bipolars » SLS, posted by psychobot5000 on October 5, 2006, at 22:51:01
Thanks!
That was very helpful.
I am disappointed that it doesn't help so much with drive or energy. Perhaps combining it with nortriptyline would help.
> WITHOUT the nausea, insomnia, anxiety, and diverse other unpleasant accompanying factors.
That makes total sense. You don't get all that nasty mass over-stimulation of receptors. What an elegant way to reset the system.
- Scott
Posted by psychobot5000 on October 6, 2006, at 9:15:27
In reply to Re: Tianeptine for anergic bipolars » psychobot5000, posted by SLS on October 6, 2006, at 4:39:23
Nortript seems like an interesting one to combine it with--since it does have some significant serotonin reuptake inhibition, though, it would be interesting to see how the two interact--if they augment each other....well then that's very interesting.
I intend to be adding low doses of doxepin, for sleep.
Posted by Declan on October 6, 2006, at 16:25:37
In reply to Re: Tianeptine/Nortriptyline, posted by psychobot5000 on October 6, 2006, at 9:15:27
I dunno if this is relevant but in the evenings I take a combo of (among other things!) inositol hexaniacinate, 5 hydroxytryptophan, and pyridoxal 5 phosphate.
There seems to be no adverse result and sleep is better, for whatever reason.
Posted by pseudoname on October 8, 2006, at 15:05:11
In reply to my Abilify® experience, posted by pseudoname on October 2, 2006, at 15:47:42
Since I've already bought it, I'm taking it 2.5 mg every other day. If it goes okay for a while (without freakish anxieties), I may increase that slightly. No sedation this time around, but it's only been 10 days or so since I dropped it, so I guess I'm still used to it.
I went off my buprenorphine for 5 days because, I now realize, it seemed to be pooping out. Horrors! But this afternoon I took a fragment and about an hour later started to feel much less depressed but still anhedonic and feckless.
Really, folks, I don't know what else to try. I may follow blueberry into bilateral ECT. And then try to get into the DBS study.
This is the end of the thread.
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