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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by Christ_empowered on September 22, 2011, at 1:59:39
I'm feeling *so* much better on 200 lamictal and 15 abilify. Its only been a little while on 15 abilify, but I already feel more clear-headed and happy.
Now, here's the thing: my main problem is psychotic depression. Recurrent, severe psychotic depression with everything that goes along with it (anxiety, paranoia, blah blah blah). I've had a few episodes that could qualify as mixed, and one long, drawn out psychotic episode that got me diagnosed Bipolar I w/ Psychotic Features. I also have dissociative episodes when I hit the higher points (or mixed areas) on the mood chart.
Abilify has been great to me, really it has, but I'm wondering if maybe its time to go another route. I don't want TD and I don't want to be tranquilized forever.
Do you think a LOW dose of Lithium+Lamictal would help the psychotic depression? I could still have the Abilify on hand for any mixed/manic episodes. I have to say, though, that my "crack up" (mixed/manic/psychotic episode) followed a long period of psychotic depression; I almost feel as if a switch was made inevitable by having such a low mood for so long. Does that make any sense at all? I feel that with proper management of the psychotic depression and control over psychosocial problems, I might be able to avoid a future psychotic break.
What do you guys think? Of course, the absolute easiest thing to do would be to try lamictal monotherapy, but I don't know if my doc is up for that; she already said 400 was too high a dose, so it looks like I'm probably going to need at least 1 additional medication to make it through OK.
Thanks in advance.
Posted by SLS on September 22, 2011, at 7:40:03
In reply to maybe low-dose lithium?, posted by Christ_empowered on September 22, 2011, at 1:59:39
What criteria do you use to differentiate psychotic depression from schizoaffective disorder or mixed-state bipolar I?
What do you need lithium for?
What is absent from your current response that you would like to remedy? Would the passage of time allow for a more robust improvement on your current treatment regime?
At low dosages (300-600mg), it is unlikely to do any harm. However, I doubt that it would serve as an acute or prophylactic agent against mania.
- Scott> I'm feeling *so* much better on 200 lamictal and 15 abilify. Its only been a little while on 15 abilify, but I already feel more clear-headed and happy.
>
> Now, here's the thing: my main problem is psychotic depression. Recurrent, severe psychotic depression with everything that goes along with it (anxiety, paranoia, blah blah blah). I've had a few episodes that could qualify as mixed, and one long, drawn out psychotic episode that got me diagnosed Bipolar I w/ Psychotic Features. I also have dissociative episodes when I hit the higher points (or mixed areas) on the mood chart.
>
> Abilify has been great to me, really it has, but I'm wondering if maybe its time to go another route. I don't want TD and I don't want to be tranquilized forever.
>
> Do you think a LOW dose of Lithium+Lamictal would help the psychotic depression? I could still have the Abilify on hand for any mixed/manic episodes. I have to say, though, that my "crack up" (mixed/manic/psychotic episode) followed a long period of psychotic depression; I almost feel as if a switch was made inevitable by having such a low mood for so long. Does that make any sense at all? I feel that with proper management of the psychotic depression and control over psychosocial problems, I might be able to avoid a future psychotic break.
>
> What do you guys think? Of course, the absolute easiest thing to do would be to try lamictal monotherapy, but I don't know if my doc is up for that; she already said 400 was too high a dose, so it looks like I'm probably going to need at least 1 additional medication to make it through OK.
>
> Thanks in advance.
>
Posted by Phillipa on September 22, 2011, at 10:37:41
In reply to maybe low-dose lithium?, posted by Christ_empowered on September 22, 2011, at 1:59:39
Hi CE I know you are an adult but have you discussed this with your parents? I only ask because it seems that your Dad is pretty good at assessing your condition. Also I find personally that what is going on in my life acutely effects how I feel. What's you doc think other than that dose of lamictal is too high? I say keep some abilify as you recovered on it? Phillipa
Posted by floatingbridge on September 22, 2011, at 14:06:18
In reply to Re: maybe low-dose lithium? » Christ_empowered, posted by SLS on September 22, 2011, at 7:40:03
CE, you want to dump the 15mg of abilify?
I can't answer at all. Is there something intolerable (besides the idea) about the 15mg dose?
What does your pdoc think? I would think that prophylactic lithium would need to be higher, but that's not something I can say with any authority or certainty.
You sound fab. And without celexa or Prozac?
I'm very pleased for you.
Posted by SLS on September 22, 2011, at 14:20:02
In reply to maybe low-dose lithium?, posted by Christ_empowered on September 22, 2011, at 1:59:39
I have a mood chart that I think is useful. The file is in PDF format.
http://www.slschofield.com/medicine/mood_chart_beam.pdf
You can save it using the browser or by right-clicking the above link and choosing to save the file.
The chart was meant to be used in bipolar disorder. For unipolar depression, one can modify it by extending the scale or use it as is. I extend the scale by making the top of the chart represent euthymia / remission.
- Scott
Posted by Christ_empowered on September 22, 2011, at 15:19:14
In reply to Re: maybe low-dose lithium? - Mood Chart » Christ_empowered, posted by SLS on September 22, 2011, at 14:20:02
Maybe I'll just stick with the Abilify. How low can you go for taking the edge of psychotic mood disorders? Like I said, my manic episode(s) had a lot of psychosocial stressors involved, so I don't know that it'd be necessary to take a full anti-manic dose. I read somewhere that 7.5mgs Abilify can do the trick, but I haven't seen that number anywhere else.
I am feeling better, though, so maybe I'll just stick with what works.
Posted by SLS on September 22, 2011, at 15:29:41
In reply to Re: maybe low-dose lithium? - Mood Chart, posted by Christ_empowered on September 22, 2011, at 15:19:14
> Maybe I'll just stick with the Abilify. How low can you go for taking the edge of psychotic mood disorders? Like I said, my manic episode(s) had a lot of psychosocial stressors involved, so I don't know that it'd be necessary to take a full anti-manic dose. I read somewhere that 7.5mgs Abilify can do the trick, but I haven't seen that number anywhere else.
>
> I am feeling better, though, so maybe I'll just stick with what works.For me, 10mg is the sweet spot for Abilify. However, in my case, Abilify is being used as an augmenter to antidepressants to treat bipolar depression.
What would your ideal treatment regime look like?
Which drugs would you include? Which drugs would you exclude? Why?
I hope you can find a treatment that works well while sparing you from side effects. I guess that's what we are all looking for - next to spontaneous remission, of course.
- Scott
Posted by zonked on September 22, 2011, at 20:36:27
In reply to maybe low-dose lithium?, posted by Christ_empowered on September 22, 2011, at 1:59:39
> I'm feeling *so* much better on 200 lamictal and 15 abilify. Its only been a little while on 15 abilify, but I already feel more clear-headed and happy.
>
> Now, here's the thing: my main problem is psychotic depression. Recurrent, severe psychotic depression with everything that goes along with it (anxiety, paranoia, blah blah blah). I've had a few episodes that could qualify as mixed, and one long, drawn out psychotic episode that got me diagnosed Bipolar I w/ Psychotic Features. I also have dissociative episodes when I hit the higher points (or mixed areas) on the mood chart.
>
> Abilify has been great to me, really it has, but I'm wondering if maybe its time to go another route. I don't want TD and I don't want to be tranquilized forever.
>
> Do you think a LOW dose of Lithium+Lamictal would help the psychotic depression? I could still have the Abilify on hand for any mixed/manic episodes. I have to say, though, that my "crack up" (mixed/manic/psychotic episode) followed a long period of psychotic depression; I almost feel as if a switch was made inevitable by having such a low mood for so long. Does that make any sense at all? I feel that with proper management of the psychotic depression and control over psychosocial problems, I might be able to avoid a future psychotic break.
>
> What do you guys think? Of course, the absolute easiest thing to do would be to try lamictal monotherapy, but I don't know if my doc is up for that; she already said 400 was too high a dose, so it looks like I'm probably going to need at least 1 additional medication to make it through OK.
>
> Thanks in advance.
>CE: I empathize with you. Your posts show intelligence, insight, clarity of mind and thought... If I had psychotic features, or a psychotic disorder I would probably fight with myself every day because I think those drugs are nasty. But it is, perhaps, something you must do until better treatments are available.
How consistent has your psychosis been, how did it evolve? If it's consistent, you may be stuck with the Abilify until drugs to treat psychosis with more novel mechanisms make it through trials.
I believe there is a specifier in DSM-IV-TR for "occasional" psychotic features. Like brief reactive psychosis... but, if off APs, you are psychotic much of the time I would not dump or taper the Abilify if I were you.
And if I were in your shoes with your diagnosis, Abilify (or perhaps Latuda) would be the only drugs in that class I'd be willing to put in my body.
You know yourself - given your history, how quickly might psychosis emerge in the absence of APs? What damage might it do? Is it infrequent/occasional or pretty dominant?
I've done enough reading on the topic (yes, mental health issues I don't have interest me too) to know there's nothing out there that can prevent psychosis except APs, mostly because I (quietly) felt so sorry for a brilliant friend I have in Real Life who has BP1 with psychotic features, and I thought "she's killing her brain with Seroquel. There MUST be something else."
I'm afraid there might not be.
Be careful, and good luck. Ask your closest friends what they think.
-z
Posted by Christ_empowered on September 22, 2011, at 21:06:49
In reply to Re: maybe low-dose lithium? » Christ_empowered, posted by zonked on September 22, 2011, at 20:36:27
Maybe I should just stick with the Abilify. I'm apparently already brain damaged, thanks to heavy meds (uppers and downers, anyone? The combo apparently never really went out of style...) and a blow to the head during a botched mugging. My shrink at the mental hospital called it "transcendent intelligence." I suppose as long as I can avoid massive doses of Haldol, I'm pretty much good to go-for whatever reason, I'm able to take a lickin' and keep on tickin'.
TD is more what I'm scared of. I already have social anxiety issues; can you imagine how much exponentially worse they would become if I had disfiguring, "Yes, I take hardcore psych drugs"-type movements? Ugh.
I will say that I seem to be one of those people who gets clarity of thought from appropriately dosed neuroleptics. After my last dissociative/psychotic episode, I could barely form complete sentences. At one point, all I could do was repeat what other people were saying. The Abilify helped tremendously, although it took a good bit of time for everything to come back together for me.
I must admit, I have a simple, possibly even elegant, med combo here. A bipolar-friendly mood elevator and (I suppose) regulator, and a reasonably tolerable tranquilizer. Lots of people are stuck on far more meds and get fewer results with a lot more side-effects, so I should probably just pray that I can make it through treatment without becoming the Village Idiot (again) and give thanks that I'm not on a massive dose of Thorazine or something.
Thanks again for the posts.
Posted by zonked on September 22, 2011, at 21:35:52
In reply to thanks, zonked, fb, sls, others, posted by Christ_empowered on September 22, 2011, at 21:06:49
I would be just as scared as you were I in your position about the long term side effects of AAPs. I already sort of am about benzos, but I'm casting that aside for now.
If you're feeling good, stay with what ya got before making any changes.
What does Abilify (other than abating psychosis) "feel" like? Some people find it activating - you find it tranquilizing? The only comparison I can make is the one time Seroquel entered my body - I felt like I had downed a box of Benadryl for two days. Totally out of it.
Weird, because people say it's "activating."
Curious...
-z
Posted by Christ_empowered on September 22, 2011, at 21:47:21
In reply to Re: thanks, zonked, fb, sls, others » Christ_empowered, posted by zonked on September 22, 2011, at 21:35:52
I find Abilify to simply be a tolerable tranquilizer--nothing more, nothing less. At 30, I felt dulled out, but it wasn't sedating. Now at 15, so far I feel less tranquilized but I'm maintaining the benefits you associate with properly dosed neuroleptics in psychotic disorders (clarity of though, reduced anxiety and agitation, less paranoia, fewer mood swings).
Even when I first started, at 7.5mgs/day, I didn't find it activating. Maybe smaller doses would be different? I dunno.
I definitely think its an effective anti-psychotic and anti-manic; I'm not so sure that its antidepressant activity is all that pronounced, although again, that could just be b/c of the dosages I've taken.
Posted by Phillipa on September 22, 2011, at 21:48:30
In reply to thanks, zonked, fb, sls, others, posted by Christ_empowered on September 22, 2011, at 21:06:49
CE somehow I don't recall you speaking of a mugging. Are you speaking of illicit drugs? Or just a lot of meds? So sorry. Phillipa
Posted by floatingbridge on September 22, 2011, at 21:53:22
In reply to thanks, zonked, fb, sls, others, posted by Christ_empowered on September 22, 2011, at 21:06:49
CE, do you think you are more brain damaged than the average person on or off meds? If you are, which I have no way of knowing because to me your posts do not show it. You seem more than smart enough to me.
I can think of one other topic as almost as terrifying and compelling as brain damage from meds, injuries, screen-time, heavy metal toxicity, deprivation of oxygen, etc. What to eat, do, and think while pregnant.
Sometimes, I don't know, I get very scared, and perhaps rightfully so, about meds. Then I weigh that with what my hardcore cbt, ivy league, übermensch doctor told me which was to get on drugs because what my brain was doing all on
it's own was known to cause brain damage and even more
precisely an idea of the types of damage being done, whereas med damage evidence was more inconclusive.I know our challenges in life differ. I am not saying taking an
AAP is a happy thing. Yes, I felt relived when my pdoc said my tiny bit of risperidone might be discontinued in a few months. I certainly hope you do not develop TD and do not dismiss your anxiety or thoughts regarding the possible risks. They are important factors to weigh in treatment considerations. I wish I could help diminish them, though, so it weighed on you less.
Posted by floatingbridge on September 22, 2011, at 22:06:56
In reply to the 'feel' of Abilify, posted by Christ_empowered on September 22, 2011, at 21:47:21
I think the smaller doses are more 'activating'.
I found 10mg was sedating. But I did not feel tranquilized. I felt agitated and sedated.
So I am guessing it is doing something for you. And you tolerate it well.
Posted by Christ_empowered on September 22, 2011, at 22:25:56
In reply to Re: the 'feel' of Abilify » Christ_empowered, posted by floatingbridge on September 22, 2011, at 22:06:56
hello again. The people at the hospital never explained what kind of brain damage I had. I was mugged and hit on the head with a pipe (who the hell carries a pipe around with them, anwyay?) and then ended up in the mental hospital about 24 hours later. They did a brain scan while I was sedated (I kinda sorta almost woke up for part of it).
I woke up in a cold room with white walls, with some angry nurse looking at me. She told me I was "supposed to be a vegetable" and that I "probably had an IQ of 75." I didn't know what to say or do, I just started screaming and grunting. So bizarre.
Anyway, back to the present. The Abilify works for me the way any good antipsychotic/neuroleptic/major tranquilizer should: I calm the hell down and I can think straight. 30mgs was way too much, but this 15 business is feeling about right.
I take antioxidants in the hopes that they will prevent TD. Lots of taurine, vitamin E, so on and so forth. There's really not a whole lot else I can do.
Back to the brain damage. It strange, when I think about; its almost like the brain damage used to affect me, but now, with some meds on board, I'm OK. Maybe that's the idea behind "transcendent intelligence," I don't know. My therapist a couple years ago wrote in his notes about how I was "wide-eyed" and all but called me stupid in session a couple times. My last therapist, who is better educated and religious, told me I definitely "wasn't average" when it came to intelligence and that I should get an intellectually stimulating job. My, my, how times change.
Posted by SLS on September 22, 2011, at 22:40:14
In reply to Re: the 'feel' of Abilify, posted by Christ_empowered on September 22, 2011, at 22:25:56
Among the AAPs, Abilify might carry the lowest risk of producing TD and the highest risk of producing akathisia. This relates to the locales in the brain where these drugs accumulate and bind to receptors.
Abilify accumulates in limbic structures. Other AAPs tend to act in the striatum. It is in the striatum where movement EPS originates.
You may have less to worry about than you think.
- Scott
Posted by zonked on September 22, 2011, at 22:46:43
In reply to Re: the 'feel' of Abilify, posted by Christ_empowered on September 22, 2011, at 22:25:56
WTF? Unless you're sitting in a chair reading "My Pet Goat" drooling and someone else is writing your posts... stupid?
And even if she thought you were stupid she TOLD you that? Good you've moved on, but I'd report that to the licensing board if a therapist ever called me stupid, or anything similar.
My Mom reported her therapist to that board (the California Board of Behavioral Sciences, there should be something similar in your state) when she discovered her insurance was being billed for sessions that never happened. Repeatedly. And informed the insurance company. We'll never know, but she is no longer practicing. Go, Mom.
-z
Posted by floatingbridge on September 22, 2011, at 23:53:40
In reply to Re: the 'feel' of Abilify » Christ_empowered, posted by SLS on September 22, 2011, at 22:40:14
> Among the AAPs, Abilify might carry the lowest risk of producing TD and the highest risk of producing akathisia. This relates to the locales in the brain where these drugs accumulate and bind to receptors.
>
> Abilify accumulates in limbic structures. Other AAPs tend to act in the striatum. It is in the striatum where movement EPS originates.
>
> You may have less to worry about than you think.This is great info, Scott.
>
>
> - Scott
Posted by floatingbridge on September 23, 2011, at 0:29:08
In reply to Re: the 'feel' of Abilify, posted by Christ_empowered on September 22, 2011, at 22:25:56
> hello again. The people at the hospital never explained what kind of brain damage I had. I was mugged and hit on the head with a pipe (who the hell carries a pipe around with them, anwyay?) and then ended up in the mental hospital about 24 hours later. They did a brain scan while I was sedated (I kinda sorta almost woke up for part of it).
>I am sorry CE. What an awful event.
> I woke up in a cold room with white walls, with some angry nurse looking at me. She told me I was "supposed to be a
vegetable" and that I "probably had an IQ of 75." I didn't
know what to say or do, I just started screaming and grunting. So bizarre.What a harmful jerk she acted like. She or no one else
understands how traumatic brain injuries can manifest. She sounds like she had her basic knowledge and that maybe you waking up inconvenienced her, like she was just planning on taking a cigarette break. Perhaps, l having been made vulnerable by the assault and injury, her words struck you more deeply than her ten cent opinion merited. Please try and toss her out of your head. She just had no idea what she was talking about.A doc did something similar. My husband broke his neck body surfing. At the hospital, he was very scared, his head braced against movement, and he was losing feelingnin his left hand and arm. The great and powerful Oz/doctor walks in and when my husband asks this doctor about what's
happening, the doctor says, 'oh, we're just waiting to see what else goes.'. Like loss of function. Yeah, my husband started going into shock. Fortunately, a nurse was there and
stroked his arm, told him he was going into shock, and told him he was goingnto be alright.And he was. Completely. He regained all feeling. Stupid,
harmful doctor!>
> Anyway, back to the present. The Abilify works for me the way any good antipsychotic/neuroleptic/major tranquilizer
should: I calm the hell down and I can think straight. 30mgs was way too much, but this 15 business is feeling about right.
>Yay!
> I take antioxidants in the hopes that they will prevent TD. Lots of taurine, vitamin E, so on and so forth. There's really
not a whole lot else I can do.Well, I'm gonna go with Scott's post here.
>
> Back to the brain damage. It strange, when I think about;
its almost like the brain damage used to affect me, but now,
with some meds on board, I'm OK. Maybe that's the idea behind "transcendent intelligence," I don't know. My therapist a couple years ago wrote in his notes about how I was "wide-eyed" and all but called me stupid in session a couple times.Well, pooh to him. Besides, you must have been very young.
I looked up transcendental intelligence and could find very, very little of anything meaningful. Does it mean? I have an idea that it means, maybe, a wisdom or co-wisdom it was termed of a religious source. I think it points to your (well what I see as) your philosophical abilities.
> My last therapist, who is better educated and religious, told me I definitely "wasn't average" when it came to intelligence and that I should get an intellectually stimulating job. My, my, how times change.
>
>
Yes, and you have wanted that yourself as well. I recall
when there was pressure on you not to consider nursing as a career because you'd be wasting your intelligence (not my opinion, nursing seems to be great work), but maybe you could use that pressure, wrong-headed as it might be about
nursing, as more evidence of your intelligence and help you give that therapist and that nurse the boot. I would consider them just flat out wrong. That's my take on it. You're getting your game back.
Posted by Zyprexa on September 23, 2011, at 1:18:33
In reply to Re: the 'feel' of Abilify, posted by Christ_empowered on September 22, 2011, at 22:25:56
I think you should give your current combo with 15mg abiilify a while longer. You have not been on it that long and probably have not stabilized on it yet. That could take a month or so. Remember the half life of abilify is 3 days.
Posted by Christ_empowered on September 23, 2011, at 1:22:15
In reply to Re: the 'feel' of Abilify » Christ_empowered, posted by floatingbridge on September 23, 2011, at 0:29:08
Thanks, fb and others. I really appreciate all the insightful and supportive input I've received.
And, fb...about transcendent intelligence...
I have *no* idea what it is, either. When the doc said it, I assumed it just meant that I was smarter than the brain scan(s) would have led experts to believe, so my intelligence transcended the brain matter. It wasn't until much later that I looked it up and found that there's a concept dating back to ancient times of certain "souls" having their own "transcendent intelligences" which makes them closer to the divine or something. I don't believe that, but it is interesting to read about.
Thanks again.
Posted by emmanuel98 on September 23, 2011, at 18:17:33
In reply to the 'feel' of Abilify, posted by Christ_empowered on September 22, 2011, at 21:47:21
This really falls into the category of "everyone is different." I took abilify for major depression and it pulled me out almost immediately. I never felt sedated. I had no side effects at all except weight gain (which is why I stopped it). I was completely unaware of having it in my system when I took it. Risperdal and zyprexa had pretty much the same effect on me -- after a couple of days of feeling sedated, I felt fine. Seroquel sedated me and didn't help my depression. Geodon did nothing, but didn't make me gain massive amounts of weight.
Posted by Phillipa on September 23, 2011, at 19:57:49
In reply to :-), posted by Christ_empowered on September 23, 2011, at 1:22:15
CE how old were you when hit on head? If caused brain damage how could you get a mental diagnosis? Were you fine til the mugging? And you are extremly intelligent!!!! Known you a long time and know this to be true. Phillipa
This is the end of the thread.
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