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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by sheilac on April 21, 2011, at 16:22:25
I can get by on low doses of meds (slow metabolizer or fast metabolizer, I don't know).
Anyway, I have tried several antipsychotics as my mood stabilizers and have a few questions.
I love Seroquel because it knocks me out and I get great sleep. I usually take 1mg of Klonopin and 25mg of Seroquel at night. If I try to take 50mg of Seroquel I am mean and irritable the next day. This seems weird to me since it is suppose to treat those issues NOT cause them.
When I tried Geodon, I did pretty good for awhile, but it made me feel hypomanic (as did Abilify). So, I don't understand again, why a drug used to treat this condition would CAUSE this condition.
I guess I am able to keep my BPII in check with low dose Prozac, 1 - 2 mg of Klonopin, Nuvigil for ADD and energy, and 25mg of Seroquel for sleep.
When I try to take "theraputic" levels of meds they just don't work.
Am I just a super light weight?
Posted by Christ_empowered on April 21, 2011, at 16:38:25
In reply to Antipsychotic side effects?, posted by sheilac on April 21, 2011, at 16:22:25
BP II often doesn't require an antipsychotic, anyway. BP I sometimes does; schizophrenia+schizoaffective disorder usually do. To me, as someone who has to take Abilify for his issues, you're better off w/o an antipsychotic if you can manage; fewer risks that way.
Sometimes antipsychotics can cause agitation/hypomania (I've read case reports of full-blown mania). A lot of the atypicals have antidepressant properties (I wish I could explain how, but...I can't), so if you're low dosing it anyway (less anti-manic action), and you're taking an antidepressant and a stimulant, you might be setting up a stimulating, rather than traquilizing, mix.
Its also important--and I have to keep reminding myself of this--that diagnoses are really just educated guesses, and they're the best docs can do. Experts don't really understand what's going on with mental illness; the research is focused on suppressing certain symptoms with meds. So, if your symptoms are under control, you have a good quality of life, and you don't have any serious side effects, I'd say just forget about your official diagnosis and enjoy your stability.
Posted by bleauberry on April 21, 2011, at 17:18:30
In reply to Antipsychotic side effects?, posted by sheilac on April 21, 2011, at 16:22:25
My opinion is that normal dosing instructions are only a rough guideline and that the actual dose needs to be tailored to the individual, as judged by the individual's reaction to different doses. The body talks, we just have to listen to what it is saying. In your case it is saying going to 50mg from 25mg is bad. But...it could be down the road maybe 50mg is great....but probably won't go that way with one huge jump of 100% increase from the previous dose. For some of us the body takes longer to adjust, or reacts violently to being tweeked too much too fast, so we have to tone it down by attempting dose increases in smaller steps. 25mg to 30mg for example, accomplished by various methods of making custom sized doses out of the capsules or tablets.
Just a gut hunch, but of all your meds to increase I would probably have my eye on prozac more than seroquel. For bipolar? Yeah. I know that bucks the conventional census. Most clinicians would say an ssri increase would destabilize a bipolar patient. But I've seen them work good when the conventional census meds didn't. Everything in psychiatry is general consensus, opinion, and all of it unproven theory, so each patient, each med, and each dose change is an experiment with an unpredictable outcome. Trial and error is the only way to discover the proper road to be on. Having failures or duds along that journey have to be expected. Sometimes, as in my case, a lot of them.
In any case, I'm all in support of what you are doing I just think that whatever you do needs to be done in much smaller steps. Which means making your own custom sized doses.
Posted by huxley on April 21, 2011, at 18:54:46
In reply to Antipsychotic side effects?, posted by sheilac on April 21, 2011, at 16:22:25
Sheilac,
Read my post above to see what side effects I am getting from Zyprexa, an AP.
Some people will tell you that there is no such thing and that they are good for you.
You can make up your own mind.
Posted by mellow on April 21, 2011, at 20:09:11
In reply to Antipsychotic side effects?, posted by sheilac on April 21, 2011, at 16:22:25
It seems like taking a stimulant and antipsychotic would be counterproductive. It would be easy to diagnose me as ADD when I am hypomanic but when controlled with a mood stabilizer and an atypical (rispersal) for anti manic purposes I regain focus and proper attention span.
You could be a rapid cycler in that you have some good days and some really crummy days but nothing really meets the 4 day thresholds for hypomanic episodes. In that case it would be totally normal for bipolar type illness to mimic attention deficit, irritability and sleeplessness.
I know if you put me on Prozac and Nuvigil id be through the roof with energy. Which isn't always the best thing if I'm cycling. If you continue you to struggle you might ask about lithium, valporate, or lamictal and eliminate some of the other stuff.
And if seroquel is working by all means go with it! Best of luck.
mellow
Posted by sheilac on April 22, 2011, at 7:52:54
In reply to Re: Antipsychotic side effects?, posted by bleauberry on April 21, 2011, at 17:18:30
I was afraid to try prozac for the very reason that it would cause mania, but I have noticed the exact opposite reaction. I take prozac in the afternoon and it actually calms me down and helps my sleep - as well as slight depression and irritability. Must be the serotonin effect I need. At my next doc visit I will be going up a little on the prozac.
I take a small dose of nuvigil in the morning to help with energy and focus. I tend to have low energy and I think that causes some irritability too. I have tried Adderall but even in low doses it causes me to go manic.
I also think that maybe I am a rapid cycler and the Adderall just made that worse.
> My opinion is that normal dosing instructions are only a rough guideline and that the actual dose needs to be tailored to the individual, as judged by the individual's reaction to different doses. The body talks, we just have to listen to what it is saying. In your case it is saying going to 50mg from 25mg is bad. But...it could be down the road maybe 50mg is great....but probably won't go that way with one huge jump of 100% increase from the previous dose. For some of us the body takes longer to adjust, or reacts violently to being tweeked too much too fast, so we have to tone it down by attempting dose increases in smaller steps. 25mg to 30mg for example, accomplished by various methods of making custom sized doses out of the capsules or tablets.
>
> Just a gut hunch, but of all your meds to increase I would probably have my eye on prozac more than seroquel. For bipolar? Yeah. I know that bucks the conventional census. Most clinicians would say an ssri increase would destabilize a bipolar patient. But I've seen them work good when the conventional census meds didn't. Everything in psychiatry is general consensus, opinion, and all of it unproven theory, so each patient, each med, and each dose change is an experiment with an unpredictable outcome. Trial and error is the only way to discover the proper road to be on. Having failures or duds along that journey have to be expected. Sometimes, as in my case, a lot of them.
>
> In any case, I'm all in support of what you are doing I just think that whatever you do needs to be done in much smaller steps. Which means making your own custom sized doses.
Posted by sk85 on April 22, 2011, at 13:06:46
In reply to Antipsychotic side effects?, posted by sheilac on April 21, 2011, at 16:22:25
> I can get by on low doses of meds (slow metabolizer or fast metabolizer, I don't know).
>
> Anyway, I have tried several antipsychotics as my mood stabilizers and have a few questions.
>
> I love Seroquel because it knocks me out and I get great sleep. I usually take 1mg of Klonopin and 25mg of Seroquel at night. If I try to take 50mg of Seroquel I am mean and irritable the next day. This seems weird to me since it is suppose to treat those issues NOT cause them.
>
> When I tried Geodon, I did pretty good for awhile, but it made me feel hypomanic (as did Abilify). So, I don't understand again, why a drug used to treat this condition would CAUSE this condition.
>
> I guess I am able to keep my BPII in check with low dose Prozac, 1 - 2 mg of Klonopin, Nuvigil for ADD and energy, and 25mg of Seroquel for sleep.
>
> When I try to take "theraputic" levels of meds they just don't work.
>
> Am I just a super light weight?The irritability subsides after awhile on the higher dose.
Posted by B2chica on April 25, 2011, at 14:27:20
In reply to Antipsychotic side effects?, posted by sheilac on April 21, 2011, at 16:22:25
who cares if your a light-weight or not. that would be good right? dont need as much med to help you.
as for the irritability id first try to stop the klonopin and try something else...for me and several others now that i;ve talked to klonopin actually causes severe agitation and aggravation. i especially felt it next morning, i took 2mg at bed. its not that common but might give that a try. check with doc if you can replace klonopin with something else.
and geodon at normal doses did nothing for me once it was upped i became psychotic. So we never know how each person may react to meds.
you maybe have reacted similarly mine just presented differently.
i had same issue with abilify as well. (i had the severe anger with klonopin and abilify not sure which was worse or if the two were working together to make things worse but...zyprexa has always worked well for me. but normally i need to go to 10mg and thats when i gain weight. if i could stay at 5 i never gain weight and even can loose some if want.
and fyi i am now on a very very low dose of perphenazine. and working great good anxiety. i like being a light-weight there. the higher the dose the more chance of side-effects.
Best Wishes!
B2c.
Posted by B2chica on April 25, 2011, at 14:28:42
In reply to Re: Antipsychotic side effects?, posted by mellow on April 21, 2011, at 20:09:11
to Mellow.
the two do work on different receptors...
i actually take an antipsychotic and a stimulant and have for years.
it seems that the stimulant catches what the AP doesn't catch.
i get severe anxiety (or sometype of mania in my head)and it gets really bad. and actually taking a bit more stimulant slows those thoughts or at least reorganizes them so i'm not so quickly scattered and feel like my brain is a hotbed.most stimulants also seem to have a bit of antidepressant quality to them as well.
Posted by Zyprexa on April 26, 2011, at 4:00:15
In reply to Re: Antipsychotic side effects?, posted by B2chica on April 25, 2011, at 14:27:20
Do you still take the zyprexa? What dose? I find there are some things that perphenazine can't quite do. I take both. Find that if I go to the gym once a week and watch what I eat, I've actualy been losing weight. I take 15mg zyprexa and 3x 12mg perphenazine. What are you taking now? And is it enough?
Posted by B2Chica on April 26, 2011, at 10:32:11
In reply to Re: Antipsychotic side effects? » B2chica, posted by Zyprexa on April 26, 2011, at 4:00:15
no. its not enough. my low is not only sticking around...its getting gradually worse.
i'm not good today...or yesterday. or feel like i ever will be.
zyprexa i'm so tired of messing with meds. before i was always willing to try something new, to change dose...now. i'm just tired.i'm still on only 2mg perphenazine
20mg adderall
50mg pristiq
i take 1mg xanax at night to sleep
and during the day for anxiety i take anywhere between 600mg and 1500mg gabapentin...i have a feeling today is going to be a 1500mg day.im guessing i'll need to go back on zyprexa, but if i can only stay at 5mg then i wont gain the weight. i've finally took off all i gained from that med.
problem now is my anxiety is still high. i texted pdoc this morning but havent heard back.
and my low is low.im starting to have some obsessive thinking. bad thing is i keep thinking of someone that i know of that committed suicide and the way she did it. i cant get it out of my mind...not a good thing at all.
i just want to curl up in bed and stare at the wall.
good thing i have very simple analysis to run today at work.b2c. :(
Posted by B2Chica on April 26, 2011, at 10:34:59
In reply to Re: Antipsychotic side effects? » Zyprexa, posted by B2Chica on April 26, 2011, at 10:32:11
the 2mg perphenazine is BID
Posted by Zyprexa on April 27, 2011, at 9:44:37
In reply to Re: Antipsychotic side effects? » B2Chica, posted by B2Chica on April 26, 2011, at 10:34:59
I think what you should try to do is go on 5mg zyprexa and continue some perphenazine and see if that keeps you from needing more zyprexa.
Posted by B2chica on April 27, 2011, at 10:14:17
In reply to Re: Antipsychotic side effects? » B2Chica, posted by Zyprexa on April 27, 2011, at 9:44:37
i see pdoc in two weeks. ill suggest that then.
the only good thing right now is that between the depression and anxiety i'm still losing weight. i'm not a small thing so i can afford the LB's.
i guess thats one up side.i am feeling better than yesterday. though i had a bit of a breakdown yesterday. had to leave work, went to a friends house and just chilled and cried a bit. last night had a big...big glass of red wine. and this morning things seem better.
so we'll see how things go.
thanks so much.
i know in my heart of hearts zyprexa is what my body needs. it just always fixes me.
i wish it didnt have that weight gain issue.
if they could find a way to get rid of that side effect i think it would be the best selling med in the US!b2c.
Posted by Zyprexa on April 28, 2011, at 3:40:34
In reply to Re: Antipsychotic side effects? » Zyprexa, posted by B2chica on April 27, 2011, at 10:14:17
You could always try the whole pill, take 4mg perphenazine? Might be worth a shot before seeing your pdoc in two weeks.
Posted by B2chica on April 28, 2011, at 8:08:20
In reply to Re: Antipsychotic side effects? » B2chica, posted by Zyprexa on April 28, 2011, at 3:40:34
i have been SO tempted to try that...i honestly dont know why i haven't.
maybe partly afraid of any side effects, but also because i really trust my pdoc. and feel almost like id betray him or some crap like that.
but you know, since its a while before i see him....maybe tonight i'll give it a try...thanks Z!
b2c.
Posted by Zyprexa on April 30, 2011, at 2:46:33
In reply to Re: Antipsychotic side effects? » Zyprexa, posted by B2chica on April 28, 2011, at 8:08:20
I thought pdoc had prescribed 4mg??
Posted by desolationrower on April 30, 2011, at 4:05:32
In reply to Re: Antipsychotic side effects?, posted by B2chica on April 25, 2011, at 14:27:20
Hm, i would not try another antispychotic, or prozac - the drugs you have gotten worse on all are 5ht2 antagonists (and given prozacs long half life its hard to tell quickly how it will work). A anticonvulsant 'mood stabilizer' should be tried i think.
Also, i wonder if the irritability and the 'hypomania' are more an ADD problem than a BP problem. antipsychotics work by reducing dopamine function, and that might worsen ADD (the neurons here work sort of backwards..) Guanfacine might help with those, or you could have clonidine would would be useful for sleep as well
-d/r
Posted by B2Chica on May 2, 2011, at 12:11:29
In reply to Re: Antipsychotic side effects?, posted by desolationrower on April 30, 2011, at 4:05:32
thanks d/r.
the only antipsychotic that has worked wonderful in the past is zyprexa. but i usually have to go to 10 to stabalize and then i gain weight.
**as a note i've been on prozac...you are SOOOO right.
that landed me my very first hospital visit for depression (severe SI and constant crying)...AND my first (and only) true manic episode.i dont think ive even really had hypomania before...its all been dysphoric all aggitated/mixed whatever they are calling it these days. so with that do you think that the aggression or aggitation would still be more of an ADD thing?
though sometimes i notice when my anxiety gets pretty bad in my head my adderall helps...
and i haven't heard of guanfacine or clonidine? i'll check em out.
i had real sleep troubles this weekend.
had bad nightmares, multiple weird dreams and bad hypnogogic episodes where i totally believed i was having seizures...
Posted by B2Chica on May 2, 2011, at 12:12:49
In reply to Re: Antipsychotic side effects? » B2chica, posted by Zyprexa on April 30, 2011, at 2:46:33
pdoc rx'd 4mg tablets but i have to split them and take half in morning and half at night...
only thing i notice is bit less anxiety, but to be honest i think that just got better on its own? not conviced it was med with that low dose.
but who knows.thanks
b2c.
Posted by desolationrower on May 2, 2011, at 17:58:03
In reply to Re: Antipsychotic side effects? » desolationrower, posted by B2Chica on May 2, 2011, at 12:11:29
> thanks d/r.
> the only antipsychotic that has worked wonderful in the past is zyprexa. but i usually have to go to 10 to stabalize and then i gain weight.
> **as a note i've been on prozac...you are SOOOO right.
> that landed me my very first hospital visit for depression (severe SI and constant crying)...AND my first (and only) true manic episode.
>
> i dont think ive even really had hypomania before...its all been dysphoric all aggitated/mixed whatever they are calling it these days. so with that do you think that the aggression or aggitation would still be more of an ADD thing?
>
> though sometimes i notice when my anxiety gets pretty bad in my head my adderall helps...
>
> and i haven't heard of guanfacine or clonidine? i'll check em out.
>
> i had real sleep troubles this weekend.
> had bad nightmares, multiple weird dreams and bad hypnogogic episodes where i totally believed i was having seizures...
>
>oh sorry, i was mostly addressing sheilac's post. not that you can't use information you find useful!
-d/r
Posted by B2chica on May 3, 2011, at 10:39:39
In reply to Re: Antipsychotic side effects?, posted by desolationrower on May 2, 2011, at 17:58:03
This is the end of the thread.
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