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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by tensor on April 4, 2010, at 13:04:58
I have always been afraid of antipsychotics, but I think I have come to a point where I no longer have the luxury to avoid them.
I currently take:
Remeron 30mg
Effexor 300mg
modafinil 200mg
clonazepam 2mgFor depression, panic, anxiety and SP. The symptoms I'm trying to control now is depression, predominantly fatigue/apathy and loss of interest/drive. I have tried most of the available ADs and many combinations of them, except MAOIs because they are simply not used here. There is a RIMA, moclobemide, but you don't come across too many people who are happy with it.
I know many on this board are taking or have taken APs, many because you simply have no choice due to your illnesses (psychosis etc.), but also people who take them for anxiety and depression. Of course if depression or anxiety gets severe enough you have no choice either.
But for people like me who have a choice, i.e., my depression is not a direct threat to my life. But I'm really not feeling like I'm living now either. Can the use of APs be justified? Can benefits outweigh risks?
Reading the arcives, tardive dyskinesia is mentioned now and then, but is there anyone here that has TD? I have been thinking of a low dose Abilify. So basically, is it worth it?Thank you,
Mattias
Posted by Willful on April 4, 2010, at 13:32:01
In reply to Need encouragement, posted by tensor on April 4, 2010, at 13:04:58
What dose were you thinking of?
If you don't feel that you're living, that (to me) would be a justification for low-dose atypical aps. Risk/benefit analysis is different for everyone, but having a certain quality of life is important. I wouldn't go above a certain level, and would certainly see my pdoc regularly or be aware if I felt any sort of unusual pressure or movement.
I haven't checked on the safety profiles of abilify lately, but I take a small dose and have found it very helpful.
Willful
Posted by tensor on April 4, 2010, at 13:41:17
In reply to Re: Need encouragement, posted by Willful on April 4, 2010, at 13:32:01
Hi,
probably 2.5mg every or every other day and to up 5mg if needed. Yes, it's the fact that my life is all about getting through the day in the sofa that have changed my perspective on the APs and the risks associated with them.
What dosage would you not go above? Are you taking it to augment antidepressants?Thanks,
Mattias> What dose were you thinking of?
>
> If you don't feel that you're living, that (to me) would be a justification for low-dose atypical aps. Risk/benefit analysis is different for everyone, but having a certain quality of life is important. I wouldn't go above a certain level, and would certainly see my pdoc regularly or be aware if I felt any sort of unusual pressure or movement.
>
> I haven't checked on the safety profiles of abilify lately, but I take a small dose and have found it very helpful.
>
> Willful
>
Posted by alchemy on April 4, 2010, at 14:18:53
In reply to Need encouragement, posted by tensor on April 4, 2010, at 13:04:58
The new thing of course is the addition of abilify. It would probably be a good idea to try it, starting at a small dose.
Posted by ed_uk2010 on April 4, 2010, at 17:39:25
In reply to Re: Need encouragement » Willful, posted by tensor on April 4, 2010, at 13:41:17
Mattias,
I don't think you would need to go above 10mg of Abilify per day.
Posted by bleauberry on April 4, 2010, at 18:09:56
In reply to Need encouragement, posted by tensor on April 4, 2010, at 13:04:58
Abilify or Zyprexa both have good potential to help your symptom cluster.
I may differ from most, but my opinion is it would not be wise to add another medication to your existing cocktail. If the current stuff is already falling short, the addition of something else is not going to magically all of a sudden make them all work like miracle.
Gotta get rid of the duds, weed them out. Make room for other possible winners. Don't want your possible winners to be drowned out or watered down by dud losers. A drug that is not working right now can certainly stop an otherwise good med from working. Looking at your meds, I would say either modafinil or remeron have to go bye bye. You need to decide which one is doing the least good. Clonaz is probably not doing you many favors either except maybe somewhat in the SP department.
Judging from your symptoms despite all those meds, it makes no sense in my mind to add yet another med to an already underperforming mix. For all you know, it could be one of those meds, like remeron for example, or clonaz, making the symptoms worse than they would otherwise be without those meds. High dose effexor itself can create the very symptoms you are complaining of.
Someone has 5 meds. They say they are depressed, not alive, anxiety, yuck. So why do they keep taking those same meds? I don't get that backward logic.
Though I have done it myself. I'm guilty of that painful mistake.
We get caught in a trap and don't see what we are doing. Next thing you know, the person is on 7 or 8 meds, still in bad shape, and now they are real deep water. Dependent on all these drugs that aren't improving their lifestyle. I hate to see people go down that road. It's easy to get there, and so hard to get out. So I say, drop one of the meds if you want to add something else. At this point in the game, it has to be a one-for-one swap.
If zyprexa is the choice, 2.5mg to 5mg is a good starting point, and probably the final point as well, while 10mg would be an upper ceiling.
If abilify, others here already said it well I think. Low dose.
As for the longterm side effects, well, I was on zyprexa for about 8 years and escaped fine. It was a big help for a long time.
Posted by tensor on April 5, 2010, at 4:40:55
In reply to Re: Need encouragement, posted by bleauberry on April 4, 2010, at 18:09:56
Thanks for your reply bleauberry.
I understand what your are saying and I have been swapping a lot of meds lately. I was off Remeron a couple of months and things didn't improve depression-wise, I added it again though, for its ability to mitigate SSRI/SNRI induced s/e such as nausea, sexual problems and in this case also sweating. Plus I sleep well on it, no need for zopiclone.
So I want to keep Remeron, and modafinil is not really taken on regular basis, I have taken it mon-fri and can be stopped without tapering. So modafinil is already out. Clonazepam is for SP and is doing wonders. I'm not sure about Effexor, all I know is that an SSRI/SNRI makes me a nicer person, not so irritable and grumpy which is easy to become when running low on energy.
I'm reducing the Effexor dosage to 150mg in case, as you said, it makes me tired, no point in taking 300mg now.Kind regards,
Mattias
Posted by Zyprexa on April 5, 2010, at 5:59:07
In reply to Re: Need encouragement » bleauberry, posted by tensor on April 5, 2010, at 4:40:55
My experience with abilify was if it didn't work in the begining it will only get worse. I would probably give it 2 weeks. It can build up a lot in system if you take it every day. So I would start at a low dose like you were thinking 2.5-5. Like blueberry said I would try zyprexa if the abilify does not work. I've taken zyprexa about 12 years now and all good, for anxiety, which was worsened in the abilify. For you though its probably better to try the abilify first.
Posted by tensor on April 5, 2010, at 7:45:54
In reply to Re: Need encouragement, posted by Zyprexa on April 5, 2010, at 5:59:07
Posted by ed_uk2010 on April 5, 2010, at 8:55:17
In reply to Re: Need encouragement » bleauberry, posted by tensor on April 5, 2010, at 4:40:55
> I'm reducing the Effexor dosage to 150mg in case, as you said, it makes me tired, no point in taking 300mg now.
That makes sense, if the higher dose wasn't giving any extra benefit. Do you see your doctor soon Mattias?
Posted by tensor on April 5, 2010, at 9:15:45
In reply to Re: Need encouragement, posted by ed_uk2010 on April 5, 2010, at 8:55:17
I met my pdoc last Wednesday, so next appointment is four weeks away. But, I will give hime a call this week and tell him I'm done with modafinil, and how to proceed. Will probably up the Remeron dosage and add something instead of modafinil, if I can't come up with something else, Abilify.
/Mattias
> That makes sense, if the higher dose wasn't giving any extra benefit. Do you see your doctor soon Mattias?
Posted by ed_uk2010 on April 5, 2010, at 9:49:23
In reply to Re: Need encouragement » ed_uk2010, posted by tensor on April 5, 2010, at 9:15:45
> I met my pdoc last Wednesday, so next appointment is four weeks away. But, I will give hime a call this week and tell him I'm done with modafinil, and how to proceed. Will probably up the Remeron dosage and add something instead of modafinil, if I can't come up with something else, Abilify.
>
> /Mattias
>
> > That makes sense, if the higher dose wasn't giving any extra benefit. Do you see your doctor soon Mattias?
>
>Hi Mattias,
Did you once try a high dose of mirtazapine before and it made you feel restless? Perhaps I imagined that.
Posted by tensor on April 5, 2010, at 11:49:06
In reply to Re: Need encouragement, posted by ed_uk2010 on April 5, 2010, at 9:49:23
Yes Ed, you're right, impressive :-)
And you are now thinking that raising the Remeron dosage is not a good idea since Abilify can cause restlessness, correct? Perhaps best to stay at 30mg, need to hear what my pdoc says too. You mentioned an aCh antagonist for akathisia, is there one that is preferred over the others?
/Mattias
> Hi Mattias,
>
> Did you once try a high dose of mirtazapine before and it made you feel restless? Perhaps I imagined that.
Posted by Phillipa on April 5, 2010, at 12:29:55
In reply to Re: Need encouragement » ed_uk2010, posted by tensor on April 5, 2010, at 11:49:06
Mattias, isn't it nice to have Ed back I so have missed his non technical but informative posts and his answers on meds that seem to be right on spot for so many babblers. Ed so nice to see you back. Love PJxx
Posted by tensor on April 5, 2010, at 12:34:49
In reply to Re: Need encouragement, posted by Phillipa on April 5, 2010, at 12:29:55
Yes, he's great :-) I have really missed him.
> Mattias, isn't it nice to have Ed back I so have missed his non technical but informative posts and his answers on meds that seem to be right on spot for so many babblers. Ed so nice to see you back. Love PJxx
Posted by ed_uk2010 on April 5, 2010, at 14:42:21
In reply to Re: Need encouragement » ed_uk2010, posted by tensor on April 5, 2010, at 11:49:06
> And you are now thinking that raising the Remeron dosage is not a good idea since Abilify can cause restlessness, correct? Perhaps best to stay at 30mg, need to hear what my pdoc says too. You mentioned an aCh antagonist for akathisia, is there one that is preferred over the others?
I thought I remembered you saying that!
Abilify can cause akathisia but it can also cause a type of agitation which is not akathisia. True akathisia with intense physical restlessness generally requires a dosage reduction. Anticholinergics such as procyclidine and trihexyphenidyl (benzhexol) sometimes relieve the symptoms. These particular anticholinergics are non-sedating. Procyclidine is used at a variety of doses. 5mg twice a day is common.
Posted by ed_uk2010 on April 5, 2010, at 14:46:04
In reply to Re: Need encouragement, posted by Phillipa on April 5, 2010, at 12:29:55
>non technical posts
I don't like too much neuro-babble :)
I think it's important to accept that even the best scientists do not understand how the brain works. There are hundreds of neurotransmitters, neuromodulators and hundreds of different types of enzymes and receptors. We can't reduce the brain down to a model based on levels of serotonin, NE and dopamine. That just isn't sensible.
Posted by Phillipa on April 5, 2010, at 21:13:07
In reply to Re: Need encouragement » Phillipa, posted by ed_uk2010 on April 5, 2010, at 14:46:04
Ed so many are glad your're back and you just proved it with that statement. Some get lost with neuro talk. I for one. Plus confused. Love PJxxxx
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