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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 Christ_empowered on June 1, 2011, at 9:11:58
So, I stopped taking the Celexa and the Abilify for about a week. I'm not going to restart the Celexa (I'm DONE with SSRIs!), but I decided I should probably re-start the Abilify at a lower dose.
I was at 30mgs/day. I read online that 7.5mgs is about equal to 100mgs Thorazine or 2mgs Haldol, both of which are apparently small but sometimes effective maintenance doses. Since I'm working with 30mgs tablets, its alot easier to get it into roughly 1/4 chunks than it would be to try to get 10mgs chunks (10mgs/Abilify is apparently just as effective as higher doses...).
So, I cut my pills into 1/4 chunks yesterday, and so far I'm feeling good. No voices, no significant agitation, no real mood problems of any sort, I'm just relatively normal, but feeling decidedly less tranquilized.
Posted by Phillipa on June 1, 2011, at 11:06:27
In reply to New low-dose of Abilify..feeling good, posted by Christ_empowered on June 1, 2011, at 9:11:58
Isn't a dose of l00mg of thorazine a lot? Med I don't want to see you get psychotic again. Maybe you should stick at the dose that was working so well? Remember you were going to work at stabilization? Just cold turkeyed celexa? Phillipa
Posted by Christ_empowered on June 1, 2011, at 12:46:36
In reply to Re: New low-dose of Abilify..feeling good » Christ_empowered, posted by Phillipa on June 1, 2011, at 11:06:27
100mgs/Thorazine=2mgs/Haldol. Back in the day, Thorazine was given in excessively high (up to 1200mgs, routinely) doses. These days, 100-400mgs/Thorazine or its equivalent seems more common.
I don't want to get psychotic again, either, but 30mgs/abilify is a bit much when I'm not experiencing significant agitation, mania, or florid psychosis. Plus, the available data I've read indicates that 15 works as well as 10 and that 15mgs=30mgs in terms of effectiveness. I think the higher doses sedate people more and result in more of a tranquilzing/neuroleptic effect.
Posted by sleepygirl2 on June 1, 2011, at 16:19:27
In reply to Re: New low-dose of Abilify..feeling good, posted by Christ_empowered on June 1, 2011, at 12:46:36
You're working with Pdoc right?
Sorry for meddlesome question
Posted by Christ_empowered on June 1, 2011, at 16:46:09
In reply to Re: New low-dose of Abilify..feeling good » Christ_empowered, posted by sleepygirl2 on June 1, 2011, at 16:19:27
your question isn't meddlesome, but no, this is something I've started doing on my own.
Posted by sleepygirl2 on June 1, 2011, at 19:21:06
In reply to Re: New low-dose of Abilify..feeling good, posted by Christ_empowered on June 1, 2011, at 16:46:09
Ok, take good care of yourself then and call Pdoc if you need to. Yes, I have turned into one of "those people"...the ones who don't want others not to take their meds. Sorry
I really do hope it goes well!! Good luck.
Posted by Christ_empowered on June 2, 2011, at 1:07:33
In reply to Re: New low-dose of Abilify..feeling good » Christ_empowered, posted by sleepygirl2 on June 1, 2011, at 19:21:06
yeah, if it starts going terribly wrong I'll go back up to 30mgs and talk to the pdoc. My problem is that, great as my doc is, he's a "true believer" in Abilify, probably because he's been doing this for decades and he spent a long time dealing with some of the older, nastier drugs. I guess from his perspective the question is "how much can you tolerate?" not "what's the smallest effective dose?"
Thanks for your concern.
Posted by SLS on June 2, 2011, at 6:07:19
In reply to New low-dose of Abilify..feeling good, posted by Christ_empowered on June 1, 2011, at 9:11:58
> So, I stopped taking the Celexa and the Abilify for about a week. I'm not going to restart the Celexa (I'm DONE with SSRIs!), but I decided I should probably re-start the Abilify at a lower dose.
>
> I was at 30mgs/day. I read online that 7.5mgs is about equal to 100mgs Thorazine or 2mgs Haldol, both of which are apparently small but sometimes effective maintenance doses. Since I'm working with 30mgs tablets, its alot easier to get it into roughly 1/4 chunks than it would be to try to get 10mgs chunks (10mgs/Abilify is apparently just as effective as higher doses...).
>
> So, I cut my pills into 1/4 chunks yesterday, and so far I'm feeling good. No voices, no significant agitation, no real mood problems of any sort, I'm just relatively normal, but feeling decidedly less tranquilizedAlthough you might remain stable at 7.5 mg, you may want to consider using at least 10mg should you lose the therapeutic effect. The "normal" that you feel might be a passing state. If you begin showing symptoms again, I would move to 10 mg, and on to 15-20 mg should you not be able to recapture the therapeutic effect at 10 mg. I do not believe that Abilify has a therapeutic window. It is more likely that it works at some minimum effective dosage, beyond which the "tranquilization" effect emerges. Don't be afraid to find the minimum effective dosage by titrating again.
- Scott
Posted by Christ_empowered on June 2, 2011, at 9:01:26
In reply to Re: New low-dose of Abilify..feeling good » Christ_empowered, posted by SLS on June 2, 2011, at 6:07:19
Thanks, that's really sound advice. I'm all for keeping my dose at a minimum, but you're right--getting the needed control of my psychosis is what really matter. I just kind of feel like 30mgs is/was overkill in that regard.
Since I have roughly 7.5mgs chunks, I figured I'd just take 1 daily and then if I start freaking out take an additional 1-3 and reassess.
Posted by SLS on June 2, 2011, at 9:28:37
In reply to Re: New low-dose of Abilify..feeling good, posted by Christ_empowered on June 2, 2011, at 9:01:26
> Thanks, that's really sound advice. I'm all for keeping my dose at a minimum, but you're right--getting the needed control of my psychosis is what really matter. I just kind of feel like 30mgs is/was overkill in that regard.
>
> Since I have roughly 7.5mgs chunks, I figured I'd just take 1 daily and then if I start freaking out take an additional 1-3 and reassess.I was taking 20 mg of Abilify for quite awhile. I was somewhat blunted or "tranquilized" at that dosage for at least a year. When I dropped the dosage back to 10 mg, I retained a therapeutic antidepressant effect, but was no longer tranquilized. There is a huge difference between 30 mg and 10 mg. Your dosage range should be higher than mine as you are treating schizoid symptoms.
Good luck!
- Scott
Posted by Christ_empowered on June 2, 2011, at 13:26:59
In reply to Re: New low-dose of Abilify..feeling good » Christ_empowered, posted by SLS on June 2, 2011, at 9:28:37
hey. You're quite knowledgeable, so I thought I'd ask you a question...
1) How can I overcome the tranquilized feeling I get from Abilify? Don't get me wrong--its better than being psychotic, and I imagine Abilify is less blunting than, say, zyprexa or a moderate dose of Haldol. Still, is there anything I can do (that won't mess with Abilify blood levels) to kind of feel less drugged and hazy? Wellbutrin has been suggested, but I don't know...
I checked online and it would probably be cheaper for me to take reboxetine than it would to take wellbutrin. Of course, my shrink isn't going to go for mail-ordering a non-FDA approved pill, no matter how boring it is, so I'd have to do this little experiment on my own. Would that maybe undo some of the tranquilization? Are there supplements that might help re-balance my brain somehow?
Posted by SLS on June 2, 2011, at 16:48:24
In reply to Question for SLS, posted by Christ_empowered on June 2, 2011, at 13:26:59
> hey. You're quite knowledgeable, so I thought I'd ask you a question...
>
> 1) How can I overcome the tranquilized feeling I get from Abilify?Using 10-20 mg/day might work. You could also consider replacing it with Geodon or Latuda. These two related drugs can be stimulating and are weight-neutral.
Other considerations.
1. Lithium (300-600 mg) + fish oil + phosphatidylserine: Enhance neuroplasticity (neuroprotection and neurotrophism).
2. N-acetylcysteine (NAC) + Alpha Lipoic Acid + Co-Q10: Arrest and reverse neuronal mitochondrial damage.
- Scott
Posted by SLS on June 2, 2011, at 20:28:01
In reply to Re: Question for SLS » Christ_empowered, posted by SLS on June 2, 2011, at 16:48:24
Int J Dev Neurosci. 2011 May;29(3):311-24. Epub 2010 Sep 15.
Mitochondrial dysfunction and pathology in bipolar disorder and schizophrenia.
Clay HB, Sillivan S, Konradi C.
SourceNeuroscience Graduate Program, Vanderbilt University, Nashville, TN 37232, USA.
AbstractBipolar disorder (BPD) and schizophrenia (SZ) are severe psychiatric illnesses with a combined prevalence of 4%. A disturbance of energy metabolism is frequently observed in these disorders. Several pieces of evidence point to an underlying dysfunction of mitochondria: (i) decreased mitochondrial respiration; (ii) changes in mitochondrial morphology; (iii) increases in mitochondrial DNA (mtDNA) polymorphisms and in levels of mtDNA mutations; (iv) downregulation of nuclear mRNA molecules and proteins involved in mitochondrial respiration; (v) decreased high-energy phosphates and decreased pH in the brain; and (vi) psychotic and affective symptoms, and cognitive decline in mitochondrial disorders. Furthermore, transgenic mice with mutated mitochondrial DNA polymerase show mood disorder-like phenotypes. In this review, we will discuss the genetic and physiological components of mitochondria and the evidence for mitochondrial abnormalities in BPD and SZ. We will furthermore describe the role of mitochondria during brain development and the effect of current drugs for mental illness on mitochondrial function. Understanding the role of mitochondria, both developmentally as well as in the ailing brain, is of critical importance to elucidate pathophysiological mechanisms in psychiatric disorders.
Posted by Christ_empowered on June 3, 2011, at 9:31:27
In reply to Re: Question for SLS, posted by SLS on June 2, 2011, at 20:28:01
OK. So antioxidants=good for madness. I take a hefty dose (1200 IU) of natural vitamin E, plus 300micrograms selenium, plus 3 grams niacinamide, plus 2 b-100 caps, plus a good bit (3grams) of green tea extract (500mgs caps, standardized to 98% polyphenols+50% EGCG) per day, plus 6 grams taurine and 30mgs optizinc and whatever comes in my wal-mart generic multivitamin.
Do you think I need to add more?
And...do the atypicals (abilify in particular) cause oxidative stress in the brain, or is that more of a moderate-to-high dose conventional neuroleptics thing?
Posted by larryhoover on June 3, 2011, at 10:04:42
In reply to awesome, thanks...and more Qs, posted by Christ_empowered on June 3, 2011, at 9:31:27
> OK. So antioxidants=good for madness. I take a hefty dose (1200 IU) of natural vitamin E, plus 300micrograms selenium, plus 3 grams niacinamide, plus 2 b-100 caps, plus a good bit (3grams) of green tea extract (500mgs caps, standardized to 98% polyphenols+50% EGCG) per day, plus 6 grams taurine and 30mgs optizinc and whatever comes in my wal-mart generic multivitamin.
>
> Do you think I need to add more?You're in the high end of those supplement doses. I know you know that, but those are not maintenance doses.
I see no mention of vitamin C. Or CoQ10 (ubiquinone). Ubiquinol(reduced ubiquinone) is probably preferred to ubiquinone itself, as I hear it's better absorbed. I don't know why you're taking that much taurine, but N-acetyl-cysteine would be a good addition to balance out your anti-oxidant pack.
Lar
Posted by larryhoover on June 3, 2011, at 10:46:17
In reply to Re: awesome, thanks...and more Qs » Christ_empowered, posted by larryhoover on June 3, 2011, at 10:04:42
N-acetyl cysteine (NAC) has demonstrated efficacy in reducing some of the symptoms of schizophrenia, and bipolar depression, without increasing adverse effects, when compared to untreated individuals. There are many theories as to why that may be the case, but the simplest may be all there is to it. NAC is a direct precursor for glutathione, which is a core antioxidant in the brain. Mitochondrial dysfunction is associated with mental illness, and low glutathione levels are associated with mitochondrial dysfunction (probably mediated through point mutations in mtDNA).
It can take many weeks to notice any effect, though, again lending support to the mitochondrial link. NAC is cheap. It's safe. And it's good for your liver, too.
Lar
Posted by Christ_empowered on June 3, 2011, at 10:55:03
In reply to Re: awesome, thanks...and more Qs, P.S., posted by larryhoover on June 3, 2011, at 10:46:17
thanks. I was taking NAC (2.4 grams/day) but I kinda slacked off. I take so much stuff! I still have the bottle, though, so I'll get back on it ASAP.
Posted by Phillipa on June 3, 2011, at 21:15:34
In reply to Re: awesome, thanks...and more Qs, P.S., posted by Christ_empowered on June 3, 2011, at 10:55:03
CE listen to Lar he is the expert on supplements. For real. Phillipa
Posted by floatingbridge on June 7, 2011, at 1:29:19
In reply to New low-dose of Abilify..feeling good, posted by Christ_empowered on June 1, 2011, at 9:11:58
Good luck CE!
Posted by floatingbridge on June 7, 2011, at 1:34:10
In reply to Re: awesome, thanks...and more Qs » Christ_empowered, posted by larryhoover on June 3, 2011, at 10:04:42
Lar,
Any dosage guidance you care to offer regarding nac and coQ10?
And curious. Why nac and not straight to glutathione?
Thanks,
fb
Posted by larryhoover on June 14, 2011, at 17:23:24
In reply to Re: awesome, thanks...and more Qs » larryhoover, posted by floatingbridge on June 7, 2011, at 1:34:10
> Lar,
>
> Any dosage guidance you care to offer regarding nac and coQ10?A good maintenance dose of NAC would lie between 500 and 1000 mg/day. I've seen others talking about higher therapeutic intake levels, but I haven't really looked into those.
CoQ10 is rather expensive, it would seem, so that limits my intake. I try to get 50 mg/day, but I'd take more if it cost less. CoQ10 and vitamin C are really good for the health of your gums.
> And curious. Why nac and not straight to glutathione?
Glutathione is a tripeptide (three amino acids joined together), and other than cysteine, the other two are abundant in our diet. Moreover, oral supplementation of glutathione has not been found to increase blood concentrations of glutathione, whereas oral NAC has.
> Thanks,
>
> fbWelcome,
Lar
This is the end of the thread.
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