Psycho-Babble Medication Thread 836355

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Re: Abilify dosage - too low? SLS

Posted by Bob on June 25, 2008, at 16:48:23

In reply to Re: Abilify dosage - too low? mav27, posted by SLS on June 25, 2008, at 13:11:16


>
> If you don't mind...
>
> What are you taking Abilify for, and is it helping?
>
> Thanks.
>
>
> - Scott


Scott:

That's actually what I wanted to ask you.

Bob

 

Re: Abilify dosage - too low? Bob

Posted by SLS on June 25, 2008, at 16:58:57

In reply to Re: Abilify dosage - too low? SLS, posted by Bob on June 25, 2008, at 16:48:23

>
> >
> > If you don't mind...
> >
> > What are you taking Abilify for, and is it helping?
> >
> > Thanks.
> >
> >
> > - Scott
>
>
> Scott:
>
> That's actually what I wanted to ask you.
>
> Bob

I have an unusual case of bipolar disorder that produces mania only as a reaction to antidepressant medications. These manic reactions have been few. My main problem has been one of severe anergic depression with cognitive impairments.

I found that Abilify helped restore some energy and motivation, but that it does so more robustly when it is added to the rest of the drugs I am taking.

Currently:

Nardil 90mg
nortriptyline 150mg
Lamictal 200mg
Abilify 20mg
Deplin 7.50mg


I am responding to this treatment quite well. I am experiencing a stable improvement of depression that is still growing in robustness.

I look forward to hearing good things from you.

Be Well.


- Scott

 

Re: Abilify dosage - too low? SLS

Posted by Bob on June 25, 2008, at 23:54:36

In reply to Re: Abilify dosage - too low? Bob, posted by SLS on June 25, 2008, at 16:58:57

> >
> > >
> > > If you don't mind...
> > >
> > > What are you taking Abilify for, and is it helping?
> > >
> > > Thanks.
> > >
> > >
> > > - Scott
> >
> >
> > Scott:
> >
> > That's actually what I wanted to ask you.
> >
> > Bob
>
> I have an unusual case of bipolar disorder that produces mania only as a reaction to antidepressant medications. These manic reactions have been few. My main problem has been one of severe anergic depression with cognitive impairments.
>
> I found that Abilify helped restore some energy and motivation, but that it does so more robustly when it is added to the rest of the drugs I am taking.
>
> Currently:
>
> Nardil 90mg
> nortriptyline 150mg
> Lamictal 200mg
> Abilify 20mg
> Deplin 7.50mg
>
>
> I am responding to this treatment quite well. I am experiencing a stable improvement of depression that is still growing in robustness.
>
> I look forward to hearing good things from you.
>
> Be Well.
>
>
> - Scott


Talk about unusual cases of bipolar/depression! I spend almost all my time in a nasty unipolar depression with ruminations and obsessions, but when I take AD's it often results in agitation, anger, mixed states, or and anxious hypomania.
But that's only if the AD actually gives me any sort of energy. Mostly I get severely fatigued, drowsy, weak, tired and anhedonic on psych drugs.

I can't really win it seems. If I treat my anxiety, anger, and obsessions, I become flat and fatigued and drowsy. If I treat the lack of energy and depression, I get the anxiety anger and agitation.

On another note, I marvel at those who can tolerate the multi-drug cocktails such as yours. I'm so outrageously sensitive to meds that my doc recently stated that we can't really know if I'd respond to most of the meds because I can't get on appreciable doses any longer. In any case, it's good to hear that you are responding well to your mixture.

Bob

 

Re: Abilify dosage - too low? SLS

Posted by Bob on June 25, 2008, at 23:58:12

In reply to Re: Abilify dosage - too low? Bob, posted by SLS on June 25, 2008, at 16:58:57

Scott -

What was your reasoning behind the Nortriptyline, as opposed to something like Remeron or Welbutrin?

What is the rationale for the Lamictal?

- Bob

 

Re: Abilify dosage - too low?

Posted by Tomatheus on June 26, 2008, at 0:35:22

In reply to Abilify dosage - too low?, posted by SLS on June 25, 2008, at 8:08:08

Scott,

I actually noticed a worsening of depressive symptoms at doses of 7 and (especially) 10 mg/day. I imagine that higher doses would probably exacerbate the depressive symptoms further in my case. I'm currently taking 5 mg of the medication daily.

Tomatheus

 

Re: Abilify dosage - too low? Tomatheus

Posted by Bob on June 26, 2008, at 0:53:14

In reply to Re: Abilify dosage - too low?, posted by Tomatheus on June 26, 2008, at 0:35:22

> Scott,
>
> I actually noticed a worsening of depressive symptoms at doses of 7 and (especially) 10 mg/day. I imagine that higher doses would probably exacerbate the depressive symptoms further in my case. I'm currently taking 5 mg of the medication daily.
>
> Tomatheus

Was your worsening characterized by an increase in anger?

 

Re: Abilify dosage - too low? Bob

Posted by Tomatheus on June 26, 2008, at 1:12:07

In reply to Re: Abilify dosage - too low? Tomatheus, posted by Bob on June 26, 2008, at 0:53:14

> Was your worsening characterized by an increase in anger?

No, mostly reduced energy.

Tomatheus

 

Re: Abilify dosage - too low? SLS

Posted by michael on June 26, 2008, at 3:29:31

In reply to Abilify dosage - too low?, posted by SLS on June 25, 2008, at 8:08:08

> I see so many people describe their experience with Abilify as one of side effects at dosages of less than 5mg. I am wondering if things wouldn't be better if one were to initiate treatment at 10mg. I started at 20mg. I experienced some inner restlessness, but this passed within a week. I am responding better to Abilify at 20mg than I did at 10mg. Many people tolerate 30mg just fine.
>
> Any thoughts?
>
>
> - Scott

Isn't it often similar with remeron...? The low doses are so sedating. Starting at a higher dose (don't remember the numbers just now) helped to eliminate some of the heavy sleepiness. If I recall correctly?

Michael

 

Re: Abilify dosage - too low? Bob

Posted by SLS on June 26, 2008, at 5:32:57

In reply to Re: Abilify dosage - too low? SLS, posted by Bob on June 25, 2008, at 23:58:12

> Scott -
>
> What was your reasoning behind the Nortriptyline, as opposed to something like Remeron or Welbutrin?
>
> What is the rationale for the Lamictal?
>
> - Bob

It works. :-)

The beauty and abomination of clinical psychiatry is that there is often no rationale, only trial-and-error experience. I first tried Lamictal as monotherapy in 1993. I experienced what many others do with this drug. I felt improved during week 2 for a few days, and then upon dosage increases. I have developed a "feel" for drugs and how they affect me. I chose 4 of the 5 drugs I currently take, even though I had pry Nardil + nortriptyline out of my doctor.

Yes, one can make educated guesses based upon experience, and even choose drugs based upon mechanisms of action. An educated guess - that's all. I think we are evolving here at Psycho-Babble, such that our educated guesses are becoming relevant.

I had two reasons to choose Lamictal. I received partial relief from it. Secondly, that I guessed so early that it had secondary pro-dopaminergic effects supported my continued use of it. But clinical outcome was, of course, more important.

My first success with treatment came in 1987. I responded well to Parnate + desipramine. Unfortunately, it lasted only 6 months. However, the MAOI + TCA combination remained partially effective before other doctors got a hold of me. I won't cover that lengthy story here, but suffice it to say that their inappropriate use of antidepressants and neuroleptics produced even greater treatment resistance than I had had previously.

I find each of nortriptyline and Nardil to be more anti-anhedonic than desipramine or Parnate.

Both Wellbutrin and Remeron make me very much more depressed. I verified this through trying both drugs several times.


To make a long story short, I have tried to offer here the clinical experiences that I and the many doctors I have seen over the years. I believe that they are more relevant than PB theories.

Q: What drugs helped you, regardless of the length of the time spent improved or the magnitude of the response?

Theory?

Ok.

Low-dose Abilify acts to block presynaptic receptors and does not affect postsynaptic receptors to the same degree. In fact, if synaptic levels of dopamine are low, the postsynaptic receptors are actually stimulated by the drug. It is a question of ratios between pre- versus post-synaptic tone. It might make sense to avoid the pro-dopaminergic side effects (nausea, etc.) by starting at a higher dosage to begin with.

Just a layman's educated guess...


- Scott

 

Re: Abilify dosage - too low?

Posted by SLS on June 26, 2008, at 5:35:34

In reply to Re: Abilify dosage - too low? SLS, posted by michael on June 26, 2008, at 3:29:31

So far, it seems that people are having trouble with dosages of 5mg and higher.

So much for my theory...

>:-(

Damned mental illness!


- Scott

 

Re: Abilify dosage - too low? SLS

Posted by mav27 on June 26, 2008, at 11:57:56

In reply to Re: Abilify dosage - too low? mav27, posted by SLS on June 25, 2008, at 13:11:16


>
> If you don't mind...
>
> What are you taking Abilify for, and is it helping?
>
> Thanks.
>
> - Scott

Im not really using it for its main purpose... there's a couple reasons i've tried it.. 1. to see it it would help augment an anti-depressent, but mostly to see if it would help give me a sort of energy boost.. well more like a 'mental motivation' boost i think would be a better way to describe it... i can barely make myself get out of bed ect(AD's havnt helped except for nardil and parnate)... and it has actually been working, and i'm not currently on any AD's.

 

i take abilify 7.5 mg a half of 15 mg

Posted by Jeroen on June 26, 2008, at 12:20:08

In reply to Abilify dosage - too low?, posted by SLS on June 25, 2008, at 8:08:08

i take abilify 7.5 mg a half of 15 mg for psychosis induced by lamictal

also clozapine

 

Re: Abilify dosage - too low? mav27

Posted by Bob on June 26, 2008, at 12:29:49

In reply to Re: Abilify dosage - too low? SLS, posted by mav27 on June 26, 2008, at 11:57:56

>
> >
> > If you don't mind...
> >
> > What are you taking Abilify for, and is it helping?
> >
> > Thanks.
> >
> > - Scott
>
> Im not really using it for its main purpose... there's a couple reasons i've tried it.. 1. to see it it would help augment an anti-depressent, but mostly to see if it would help give me a sort of energy boost.. well more like a 'mental motivation' boost i think would be a better way to describe it... i can barely make myself get out of bed ect(AD's havnt helped except for nardil and parnate)... and it has actually been working, and i'm not currently on any AD's.

I have always had this problem too, where I can't get out of bed, even with AD's. It's almost comical that they're called antidepressants and yet many of them slow me down to the point where I can't function.

 

Re: Abilify dosage - too low? SLS

Posted by llurpsienoodle on June 26, 2008, at 12:42:43

In reply to Abilify dosage - too low?, posted by SLS on June 25, 2008, at 8:08:08

Hi Scott,
I started at 5mg of abilify, and took this (along with 300mg of lamictal and 50mg of zoloft for about 6 months. I wasn't hopelessly depressed, but I was incredibly agitated (had to take klonopin everyday) and had a lot of suicidal ideation. I increased the dose to 10mg and felt calmer almost by the next day. It really helped a lot with intrusive thoughts that I get from traumatic past. Then I increased zoloft to 100mg, which helped with depressive symptoms, but I was still agitated and anxious.

It wasn't until I added 150mg of wellbutrin that my apathy and agitation went away. A nice 4 weeks of hypomania helped me transition to being a nice normal productive member of society.

I wish that I had started Abilify at 10mg, as maybe my agitation could have been managed without so much klonopin, (.5-1mg day). I believe that the klonopin contributed to my depressive symptoms.

-Ll

 

Re: i take abilify 7.5 mg a half of 15 mg Jeroen

Posted by Zyprexa on June 26, 2008, at 14:24:37

In reply to i take abilify 7.5 mg a half of 15 mg, posted by Jeroen on June 26, 2008, at 12:20:08

Jeroen,

The abilify could be why the clozapine is not working.

When I took abilify with the zyprexa, the zyprexa did not work. Even for time after stoping abilify, it takes a long time before zyprexa works compleatly again.

Abilify messed me up.

 

Re: i take abilify 7.5 mg a half of 15 mg

Posted by Jeroen on June 26, 2008, at 14:51:07

In reply to Re: i take abilify 7.5 mg a half of 15 mg Jeroen, posted by Zyprexa on June 26, 2008, at 14:24:37

im stuck Zyprexa, maybe i should try Seroquel XR

 

Re: Abilify dosage - too low?

Posted by SLS on June 26, 2008, at 15:52:50

In reply to Re: Abilify dosage - too low? SLS, posted by llurpsienoodle on June 26, 2008, at 12:42:43

Hi llurpsienoodle.

> I started at 5mg of abilify, and took this (along with 300mg of lamictal and 50mg of zoloft for about 6 months. I wasn't hopelessly depressed, but I was incredibly agitated (had to take klonopin everyday) and had a lot of suicidal ideation. I increased the dose to 10mg and felt calmer almost by the next day.

This is what I would have predicted. However, since I never started Abilify at a dosage lower than 10mg, I can't provide personal experience of a biphasic response pattern to Abilify.

Thanks for your reply.

Stay well.


- Scott


 

Re: Abilify dosage - too low?

Posted by bleauberry on June 26, 2008, at 16:30:29

In reply to Abilify dosage - too low?, posted by SLS on June 25, 2008, at 8:08:08

My GP recently was just not enthused with me trying any more ADs. But he is keen on the APs, so he prescribed me abilify 10mg. When I reminded him how sensitive I am he agreed to start it at 2mg. In the conversation though he said he just started another patient at 30mg right from the get go and he does that frequently. Wow.

 

Re: Abilify dosage - too low? bleauberry

Posted by Bob on June 26, 2008, at 22:43:14

In reply to Re: Abilify dosage - too low?, posted by bleauberry on June 26, 2008, at 16:30:29

> My GP recently was just not enthused with me trying any more ADs. But he is keen on the APs, so he prescribed me abilify 10mg. When I reminded him how sensitive I am he agreed to start it at 2mg. In the conversation though he said he just started another patient at 30mg right from the get go and he does that frequently. Wow.


Indeed, "wow" is right! I'd be afraid of exploding with a starting dose like that, but if a "biphasic" is actually how Abilify behaves then maybe it's not so bad. My doctor didn't seem to think there was much data to support such a phenomenon however.

 

Re: i take abilify 7.5 mg a half of 15 mg Zyprexa

Posted by Bob on June 27, 2008, at 12:18:19

In reply to Re: i take abilify 7.5 mg a half of 15 mg Jeroen, posted by Zyprexa on June 26, 2008, at 14:24:37

> Jeroen,
>
> The abilify could be why the clozapine is not working.
>
> When I took abilify with the zyprexa, the zyprexa did not work. Even for time after stoping abilify, it takes a long time before zyprexa works compleatly again.
>
> Abilify messed me up.


How high a dose of Abilify did you manage to get up to and for how long before you had to stop?

 

Re: i take abilify 7.5 mg a half of 15 mg Jeroen

Posted by Zyprexa on June 27, 2008, at 12:42:27

In reply to Re: i take abilify 7.5 mg a half of 15 mg, posted by Jeroen on June 26, 2008, at 14:51:07

What do you mean you are stuck? Do you have no choise in taking abilify, as you are in hospital?

 

Re: i take abilify 7.5 mg a half of 15 mg Bob

Posted by Zyprexa on June 27, 2008, at 12:53:14

In reply to Re: i take abilify 7.5 mg a half of 15 mg Zyprexa, posted by Bob on June 27, 2008, at 12:18:19

My highest dose was 15mg. I also took a lot of lower doses. The lower doses were much easyer to tolerate. The first time I took 15mg for 2 weeks and stoped because of anxiety and masive panic attacks. IE it didn't replace the zyprexa. The last time I took abilify for about 6 months at doses between 2mg and 15mg. 3 months in I decided it was not working, my doc decided it was because I was not taking enough, he said try 30mg. I was in disbelive, and said no! So I took 15 for anouther 3 months and went psychotic. Its taken me a long time to recover from it, more than a year now. This time I'm trying perphenazine, with much beter results. Still need the zyprexa. So its looking like its going to be a mix of the the two. The interesting thing I notice when I quit abilify is that it takes 3 times the time I was on abilify, for the zyprexa to start working again.

 

Re: i take abilify 7.5 mg a half of 15 mg Zyprexa

Posted by Bob on June 27, 2008, at 14:54:50

In reply to Re: i take abilify 7.5 mg a half of 15 mg Bob, posted by Zyprexa on June 27, 2008, at 12:53:14

> My highest dose was 15mg. I also took a lot of lower doses. The lower doses were much easyer to tolerate. The first time I took 15mg for 2 weeks and stoped because of anxiety and masive panic attacks. IE it didn't replace the zyprexa. The last time I took abilify for about 6 months at doses between 2mg and 15mg. 3 months in I decided it was not working, my doc decided it was because I was not taking enough, he said try 30mg. I was in disbelive, and said no! So I took 15 for anouther 3 months and went psychotic. Its taken me a long time to recover from it, more than a year now. This time I'm trying perphenazine, with much beter results. Still need the zyprexa. So its looking like its going to be a mix of the the two. The interesting thing I notice when I quit abilify is that it takes 3 times the time I was on abilify, for the zyprexa to start working again.


I'm just taking little chunks right now. I'm gathering that for you, there was no threshold where the drug flipped over into a calming and sedative effect? Sounds like the higher the dose, the more over stimulated you got.

What an f'ed up conundrum... Abilify actually caused psychosis for you and it's an antipsychotic! That is harsh.

I would take Zyprexa, but I'm very afraid of getting trapped on a med that causes me massive weight gain and intractable sedation, to the point where I can no longer stay awake and move around much.

What is perphenazine? Is it related to Zyprexa?

 

Abilify and causing psychosis, my doc said that

Posted by Jeroen on June 27, 2008, at 15:24:19

In reply to Re: i take abilify 7.5 mg a half of 15 mg Zyprexa, posted by Bob on June 27, 2008, at 14:54:50

Abilify and causing psychosis, my doc said that
or it might just cure you.

 

Re: i take abilify 7.5 mg a half of 15 mg Bob

Posted by Zyprexa on June 27, 2008, at 15:44:32

In reply to Re: i take abilify 7.5 mg a half of 15 mg Zyprexa, posted by Bob on June 27, 2008, at 14:54:50

I actualy do better with the sedation AP's, the hunger keeps me eating. As I was losing weight and not eating befor the zyprexa. I also couldn't eat.

Perphenazine is a typical AP. Causes somnolince, but not hunger. In fact it seems to help me lose weight. It also seem to give me a little energy. Working realy well with the zyprexa.

The only way abilify made me tired was the lack of sleep while on it, made me tired during the day. I tried all the doses, 1-15mg.


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