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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Little Bird KK on August 26, 2008, at 0:45:15
Hi,
Im new to this site but I heard I can get support and experience advice on medications and for mental health problems.
My concern is for my boyfriend. He is 35 and he has Bipolar mixed schizophrenia. Hes been on meds for about 15 years. That I don't care about, because I don't judge my man for that...he's a sweetheart. In the last 2 years hes been on a nightly dose of Seroquel 100mg, Abilify 30mg and Citalopram 20mg. He just started the Citalopram in March because he was complaining of depression and negative thoughts. Well, it just doesn't seem like the meds he's on are working. On a almost daily basis he is in bed all day and complains constantly of having no energy or desire for any goals or for fun!!! I do have to say that last summer he had a psychotic break and was in the hospital for about 3 weeks, however since then he has been a zombie!!! His sex drive is normal, but he has no energy for anything else. Hes only out of bed for a couple of hours and when he is, hes usually just sitting down. Not to mention our conversations are pretty void. He tells me its not me, so I know for sure its not because of our relationship. I try to get him to do things with me, nicely, without being a nagging B****. Can anyone tell me if he is on the wrong kind of meds and or if he is on a toxic level? Does anyone have a suggestion of meds? Thanks
Posted by SLS on August 26, 2008, at 5:34:04
In reply to Concern about boyfriends med mix, posted by Little Bird KK on August 26, 2008, at 0:45:15
Hi.
The Seroquel might be the culprit. At dosages above 100mg, it has the effect of an antpsychotic. At lower dosages, it can be soporific (excessive sleep producing) and make one lethargic and flat. The Abilify is ok, but I question whether it is necessary. You might as well leave it, though, as it can produce a mild to moderate increase energy and motivation. I think things would be better if the Seroquel were brought up to 200mg or higher. Many people need 800mg to treat schizophrenia or schizoaffective disorder.
- Scott
Posted by Phillipa on August 26, 2008, at 10:41:15
In reply to Concern about boyfriends med mix, posted by Little Bird KK on August 26, 2008, at 0:45:15
Just wanted to welcome you to babble and your question was answered by a great expert. Good luck to your boyfriend and you . Phillipa
Posted by desolationrower on August 26, 2008, at 11:42:29
In reply to Concern about boyfriends med mix, posted by Little Bird KK on August 26, 2008, at 0:45:15
God, who would feel like doing anything on that much antipsychotics? That is giving me negative thoughts just thinking about it. The easiest thing would be reducing the dosages. How did he get on that much anyway? If he does need a sleep aid, one with antidepressant properties like mirtazapine would be preferable. Lithium would be the other thing i'd ask his doctor about.
Posted by med_empowered on August 26, 2008, at 11:51:29
In reply to Re: Concern about boyfriends med mix, posted by desolationrower on August 26, 2008, at 11:42:29
100mgs of Seroquel is probably sedating him. 30mgs of Abilify is actually the *maximum* dosage; you can use as little as 10mgs/day for schizophrenia/schizoaffective/bipolar/whatever.
SSRI antidepressants can make people flatten out, so it probably doesn't help that he's on the citalopram.
If were you, I'd recommend: 1) cutting the seroquel; 2) reducing the abilify--although 10mgs is the usual minimum for mental illness, some people actually respond to less than that. 30mgs is overkill. 3) See if he can do without the antidepressant at some point, b/c it sounds like his "depression" is actually some sort of drug-induced problem....maybe "neuroleptic-induced dysphoria," or perhaps the "neuroleptic-induced deficit syndrome."
Basically, the antispychotics are f*cking him up and flattening him out; at the very least, you should try to get him on the *minimum effective dose* of only *1* antipsychotic. An even better option would be to find a doc who will taper the antipsychotics and find some other way (lithium, depakote, trilpetal, benzos) to stabilize his moods.
Posted by SLS on August 26, 2008, at 12:08:27
In reply to Re: Concern about boyfriends med mix, posted by desolationrower on August 26, 2008, at 11:42:29
> God, who would feel like doing anything on that much antipsychotics? That is giving me negative thoughts just thinking about it. The easiest thing would be reducing the dosages. How did he get on that much anyway? If he does need a sleep aid, one with antidepressant properties like mirtazapine would be preferable. Lithium would be the other thing i'd ask his doctor about.
I disagree.For a schizophreniform illness, hubby is probably not taking enough antipsychotic, unless the goal of taking Seroquel is to remedy insomnia caused by Abilify. 30mg of Abilify is said to be the maximum for this drug, but that does not mean that it is doing the job. I guess we should ask for what reason the Seroquel was prescribed. 100mg is generally too low to be used as a treatment for bipolar disorder or for schizoaffective disorder.
Also, I think lithium is the wrong drug to start with where a mood stabilizer is called for. Unless we are looking at a classic bipolar I disorder, lithium would probably do little to prevent mania. On the other hand, Abilify might. There are just too many side effects and potential toxicity associated with lithium to try it first.
It might be the main concern of Little Bird KK that taking two antipsychotics is dangerous. It is not.
*****************************************Little Bird KK:
What is your main concern?
Is the illness being treated called schizoaffective disorder?
What is the role that Seroquel plays? Has it been prescribed for sleep only?
- Scott
Posted by desolationrower on August 26, 2008, at 12:44:55
In reply to Concern about boyfriends med mix » Little Bird KK » desolationrower, posted by SLS on August 26, 2008, at 12:08:27
No, two antipsychotics is not going to be more dangerous. It isn't going to be helpful, either, since you already have most of the relevant receptors occupied. Adding another molecule isn't going to make that more effective.
I agree we need to know more about what bf's history has been & how and why he got on the medications he is on. But, given a current bipolar depression, treating the depression with a moodstabilizer is the next step after considering titration of the antipsychotic.
Posted by SLS on August 26, 2008, at 13:00:00
In reply to Re: Concern about boyfriends med mix » SLS, posted by desolationrower on August 26, 2008, at 12:44:55
> No, two antipsychotics is not going to be more dangerous. It isn't going to be helpful, either, since you already have most of the relevant receptors occupied. Adding another molecule isn't going to make that more effective.
Not to be a pain in the butt, but it is not always a successful venture to invest so heavily in theories and hypotheses when the only way to be sure of things is simply to observe clinical outcomes. Some people don't respond to Abilify whom do respond to Seroquel. It is still confounding to our best scientists why someone would respond to one drug and not another. I am not suggesting to disregard entirely the raw data that comes from the study of neurobiology. It sometimes yields clues to what is really a clinical art.
I am glad that my doctors and I did not exclude from consideration drugs that now occupy important roles in my treatment regime simply because they did not seem to make sense based on the unlikely circumstance that anyone knows enough to do such a thing.
Understanding often comes after observing a clinical fact, and not before.
- Scott
Posted by desolationrower on August 26, 2008, at 13:18:01
In reply to Re: Concern about boyfriends med mix » desolationrower, posted by SLS on August 26, 2008, at 13:00:00
Yes this is going off topic and i apologize, but while I agree with that, I think that when picking from the range of medicines, one should prefer options that have some evidence. What is the justification for mixing antispychotics, especially broad-spectrum ones at high doses?
Posted by SLS on August 26, 2008, at 14:14:04
In reply to Re: Concern about boyfriends med mix » SLS, posted by desolationrower on August 26, 2008, at 13:18:01
> Yes this is going off topic and i apologize, but while I agree with that, I think that when picking from the range of medicines, one should prefer options that have some evidence. What is the justification for mixing antispychotics, especially broad-spectrum ones at high doses?
Are you looking for double-blind placebo controlled studies?
- Scott
Posted by bleauberry on August 26, 2008, at 17:27:17
In reply to Concern about boyfriends med mix, posted by Little Bird KK on August 26, 2008, at 0:45:15
Pure opinion here, but some commments to ponder.
I tend to agree with SLS, but might take it a little more into detail and add something else.
Seroquel...up it to the 300mg-400mg range.
Abilify...reduce it to 10mg-15mg range.
Celexa...ditch it, replace with Prozac.The antipsychotics by themselves are going to make anyone a zombie. Those things could knock out a horse. I was on a low dose of one for years and fully respect their potency. Seroquel is strange in that it is more sedating at lower doses than higher doses. Higher doses are more effective at depression and schiz. So even though it seems like overkill already, it actually makes sense to increase the seroquel. It will lose some of the zombieness at higher doses. Abilify is usually more activating with more antidepressant power at lower doses, so it makes sense to go lower on that one. A primary complaint of most people on celexa is tiredness and lethargy. Replace it with one a little more activating, such as prozac first choice, zoloft second choice, lexapro third choice.
And I have to extend to you my gratitude and respect for being such an understanding lover to your partner through all this. You are gem.
Posted by Jay_Bravest_Face on August 26, 2008, at 21:04:41
In reply to Re: Concern about boyfriends med mix » desolationrower, posted by SLS on August 26, 2008, at 13:00:00
Yes, I have to agree with you Scott, I've been on some pretty diverse mixes of meds, and my current cocktail also includes two atypical antipsychotics. (At low doses tailored for me...basically by just adjusting the dose up or back down until I hit what felt right.) Some meds have very unique qualities, even if just subtle, that especially in combinations, just somehow work *best* for some people.
Take care...
Jay
Posted by Zyprexa on September 3, 2008, at 1:37:14
In reply to Concern about boyfriends med mix, posted by Little Bird KK on August 26, 2008, at 0:45:15
I think its the Abilify. Also the high dose. When I was on Abilify it made me nervous, anxious, tired low energy, unable to sleep. Its a very high dose, I only made it up to 15mg, and that was where I felt the worse. I can't even imagine 30mg, although my doc was mentioning it, I refused. When I was on abilify, I felt psychotic and was very psychotic. I could not function at work and lost my job.
So, I think you should try losing the abilify. The longer you take it the longer it takes to recuperate. You don't feel beter at first and some times worse after you quit.
Maybe try the seroquel. I take zyprexa and perphenazine. I took abilify for 6 months at the longest trial. When I took it for a 2 week trial it took 6 weeks before I was feeling normal again.
I not saying what happened to me will or is happening to your boyfreind. But thats my experience. Some people say it works for them!
This is the end of the thread.
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