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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 Laney on March 13, 2012, at 14:17:01
For unipolar depression or MDD? Not sure of my exact DX....
I've read up on it and it looks good at low doses. also in combination with Wellbutrin.
Nort. isn't doing much at 3 wks. in (worked fairly quickly last time)
Opinions/experiences??
Thanks!
Laney
Posted by kagome on March 13, 2012, at 14:45:27
In reply to What do you think of abilify at a low dose for Uni, posted by Laney on March 13, 2012, at 14:17:01
I'm not sure if it's the Abilify or if my Parnate *finally* kicked in (which I doubt, cause I've been titrating down to only 10mg a day) but I'm feeling so much better and if I had to guess I'd say the credit goes to Abilify. I'm pretty sure I'm unipolar (after yet another psych eval last week, my new doctor loves them) and yet it really seems to be lifting depression. I'm finally cracking jokes again! And I'm only on 2mg. I'm probably going to have to find another basic AD but even as an adjunct it seems to be doing all the work! Of course mileage varies, but I highly recommend it.
=kagone
Posted by SLS on March 13, 2012, at 14:58:01
In reply to Re: What do you think of abilify at a low dose for Uni, posted by kagome on March 13, 2012, at 14:45:27
> I'm not sure if it's the Abilify or if my Parnate *finally* kicked in (which I doubt, cause I've been titrating down to only 10mg a day) but I'm feeling so much better and if I had to guess I'd say the credit goes to Abilify. I'm pretty sure I'm unipolar (after yet another psych eval last week, my new doctor loves them) and yet it really seems to be lifting depression. I'm finally cracking jokes again! And I'm only on 2mg. I'm probably going to have to find another basic AD but even as an adjunct it seems to be doing all the work! Of course mileage varies, but I highly recommend it.
> =kagone
One possible drug to add to Abilify is Lamictal. I have seen this combination work in the absence of antidepressants. There might be a pro-dopaminergic thing going on between the two of them. If standard antidepressants don't help, you might consider Lamictal.I wish you the best of luck.
- Scott
Posted by Emily Elizabeth on March 13, 2012, at 15:44:54
In reply to What do you think of abilify at a low dose for Uni, posted by Laney on March 13, 2012, at 14:17:01
My thought: AMAZING! I went through so, so many drugs for my unipolar depression before I added abilify to the combo. It made a huge difference for me. I don't really think I had side effects either.
I was stable on it for a few years. I recently went off to start getting ready to try to get pregnant and the depression came back (so I definitely know it was working!) Luckily, I had the opportunity to TMS and it cleared up the depression that came back when I had to stop abilify. (my only problem now is anxiety!)
Best,
EE
Posted by Phillipa on March 13, 2012, at 15:50:25
In reply to Re: What do you think of abilify at a low dose for Uni, posted by Emily Elizabeth on March 13, 2012, at 15:44:54
What dose did you take forgot as you did so well? Phillipa
Posted by Emily Elizabeth on March 13, 2012, at 16:02:32
In reply to Re: What do you think of abilify at a low dose for Uni » Emily Elizabeth, posted by Phillipa on March 13, 2012, at 15:50:25
To get me out of my deepest depression my old pdoc had me on 30mg! That is very high for depression. ALthough I typically need a dose higher than most folks. More recently, I was maintained on 5mg.
Best,
EE
Posted by Phillipa on March 13, 2012, at 20:41:12
In reply to Re: What do you think of abilify at a low dose for Uni » Phillipa, posted by Emily Elizabeth on March 13, 2012, at 16:02:32
Assuming also that 5mg isn't a weight gainer? Yes 30mg is a hefty dose. So TMS does really work. Phillipa
Posted by kagome on March 14, 2012, at 0:31:04
In reply to Re: What do you think of abilify at a low dose for Uni » kagome, posted by SLS on March 13, 2012, at 14:58:01
I agree with Scott that Lamictal is a great add-on. Fantastic med, few side effects, just take supplements and avoid if you have any auto-immune issues (which is why I had to stop). But seriously for healthy people Lamictal works great, and I bet it would be a perfect combo with Abilify.
Posted by papillon2 on March 14, 2012, at 3:07:43
In reply to Re: What do you think of abilify at a low dose for Uni, posted by kagome on March 14, 2012, at 0:31:04
I'm mildly interested in Abilify, but I'm not sure I'm brave enough to try it. I have little tolerance for weight gain, it massively screws with my head.
Posted by SLS on March 14, 2012, at 5:02:21
In reply to Re: What do you think of abilify at a low dose for Uni, posted by papillon2 on March 14, 2012, at 3:07:43
> I'm mildly interested in Abilify, but I'm not sure I'm brave enough to try it. I have little tolerance for weight gain, it massively screws with my head.
What do you need a drug to do for you such that you are considering taking Abilify to do it?
- Scott
Posted by LostBoyinNCReturns on March 15, 2012, at 1:05:42
In reply to What do you think of abilify at a low dose for Uni, posted by Laney on March 13, 2012, at 14:17:01
> For unipolar depression or MDD? Not sure of my exact DX....
>
> I've read up on it and it looks good at low doses. also in combination with Wellbutrin.
>
> Nort. isn't doing much at 3 wks. in (worked fairly quickly last time)
>
> Opinions/experiences??
>
> Thanks!
>
> Laney
I would not do it, with the blood sugar risks. Abilify is an atypical AP as you already know. It is just not worth the risk. You could easily start out with one serious illness, Major depression. And end up a year or more later with two major illnesses. Major depression and type II diabetes.Diabetes in any form is difficult to treat, like depression. It is very very serious.
Eric
Posted by SLS on March 15, 2012, at 6:15:11
In reply to Re: What do you think of abilify at a low dose for Uni, posted by LostBoyinNCReturns on March 15, 2012, at 1:05:42
Hi Eric.
> I would not do it, with the blood sugar risks. Abilify is an atypical AP as you already know. It is just not worth the risk. You could easily start out with one serious illness, Major depression. And end up a year or more later with two major illnesses. Major depression and type II diabetes.
Are you saying that all atypical antipsychotics carry a risk of producing diabetes? If not, do you happen to know what the statistical rate of occurrence is for the various drugs? What about Abilify?For me, Abilify has not produced any untoward changes in my blood-sugar. I have been taking this drug at a dosage of 10 mg or more for a decade.
Thanks.
- Scott
Posted by LostBoyinNCReturns on March 15, 2012, at 10:28:35
In reply to Re: What do you think of abilify at a low dose for Uni » LostBoyinNCReturns, posted by SLS on March 15, 2012, at 6:15:11
> Hi Eric.
>
> > I would not do it, with the blood sugar risks. Abilify is an atypical AP as you already know. It is just not worth the risk. You could easily start out with one serious illness, Major depression. And end up a year or more later with two major illnesses. Major depression and type II diabetes.
>
>
> Are you saying that all atypical antipsychotics carry a risk of producing diabetes? If not, do you happen to know what the statistical rate of occurrence is for the various drugs? What about Abilify?
>
> For me, Abilify has not produced any untoward changes in my blood-sugar. I have been taking this drug at a dosage of 10 mg or more for a decade.
>
> Thanks.
>
>
> - Scott
>
I dont keep up with all these meds like I used to, but I do know there is an FDA black box warning on Abilify. For blood sugar elevations (diabetes). All atypical APs have that FDA black box warning on them now. I would not think they would carry that warning unless there was some foreseeable evidence that says atypical APs have a decent likelihood of raising blood sugar and inducing type II diabetes in a goodly percentage of folks.Not arguing, just sayin...
Prevention is the best cure, IMO.
Eric
Posted by papillon2 on March 15, 2012, at 22:09:24
In reply to Re: What do you think of abilify at a low dose for Uni » papillon2, posted by SLS on March 14, 2012, at 5:02:21
> What do you need a drug to do for you such that you are considering taking Abilify to do it?
>
> - ScottTo remove residual depression that seems stubborn as a mule. I'm a lot better than I was last year, when I spent 4 months in hospital, but I still have a ways to go.
- low motivation, lack of care about a lot of things
- some residual anhedonia, I have more mood reactivity these days and occasionally find myself enjoying something, which is nice!
- still unable to work
- still have days / moments where I feel depressed as hell and it's obvious to those around me (better at hiding it when I'm less depressed).
- still struggle majorly with diurnal mood variation, it's one of the major barriers to working
- cognitively better but still not all there
- still some psychomotor retardation / leaden paralysis but no where near the same extent (was in a freaking wheelchair and unable to talk)Currently:
Nortriptyline 100mg (blood level 0.5, I suspect any higher would just make me miserable from side effects)
Lamictal 200mg
Lithium 125mg (blood level 0.2, can't go higher as super sensitive)
And melatonin 3mgMy psychiatrist suggested Epilim (a valproate) but has forgotten that she took me off it as I was shaking all the time. Her colleague, who specializes in melancholic depression, has suggested Doxepin and/or a course of ultra brief right unilateral ECT. I have refused the latter at present.
Posted by SLS on March 16, 2012, at 5:51:07
In reply to Re: What do you think of abilify at a low dose for Uni, posted by papillon2 on March 15, 2012, at 22:09:24
> > What do you need a drug to do for you such that you are considering taking Abilify to do it?
> >
> > - Scott
> To remove residual depression that seems stubborn as a mule. I'm a lot better than I was last year, when I spent 4 months in hospital, but I still have a ways to go.I know the feeling. Despite feeling better, it is not enough for me to socialize effectively and return to work.
> - low motivation, lack of care about a lot of things
Abilify helped me with energy and motivation.
> - some residual anhedonia, I have more mood reactivity these days and occasionally find myself enjoying something, which is nice!
I will be very curious to see if Abilify helps with anhedonia.
> - still unable to work
Frustrating. Employment is my goal.
> - still have days / moments where I feel depressed as hell and it's obvious to those around me (better at hiding it when I'm less depressed).
I HATE that. Being quiet and having nothing to say along with having a depressed expression on my face leads some people to approach me and ask what's wrong. I feel that my depression is obvious to everyone, even when it's not. It is embarassing.
> - still struggle majorly with diurnal mood variation, it's one of the major barriers to working
What does your diurnal pattern look like? Do you feel worse in the mornings? If so, then you might have a classic endogenous melancholic depression. This would indicate that you are probably be more apt to respond to tricyclics.
> - cognitively better but still not all there
Me, too.
> - still some psychomotor retardation / leaden paralysis but no where near the same extent (was in a freaking wheelchair and unable to talk)
OMG. I am SO sorry. You were very sick. It angers me to hear this.
Psychomotor retardation would be sufficient to explain this, though. Classic leaden paralysis might not apply to you. If it does, then I would entertain the idea that there might be some bipolarity going on.
> Currently:
> Nortriptyline 100mg (blood level 0.5, I suspect any higher would just make me miserable from side effects)Give it a try anyway. You might be VERY surprised. I suspect that you are an extensive metabolizer and that you will need 150 mg/day to reach full remission. Get closer to 150 ng/ml than to 50 ng/ml. For me, side effects are no greater at 150 mg/day than at 75 mg/day. Side effects might get worse immediately upon a dosage increase, but they should decrease over time. After being on nortriptyline for an extended period of time (months), you might not even know that you are taking it. I hope this is the case for you. Even if side effects linger, they should be reduced. I am SURE you will find it to be a worthwhile trade-off if increasing the dosage works.
> Lamictal 200mg
> Lithium 125mg (blood level 0.2, can't go higher as super sensitive)
> And melatonin 3mgThat is a sufficient blood level of lithium for it to exert an antidepressant effect when used as an adjunct to antidepressants. It is far too low to address bipolar mania. For me, lithium at 300 mg/day results in the same blood level as yours. Going higher in dosage does not produce an increased therapeutic effect. It just brings on apathy and amotivation.
> My psychiatrist suggested Epilim (a valproate) but has forgotten that she took me off it as I was shaking all the time.
Combining lithium and valproate acts synergistically to produce shaking. Valproate by itself might not be so bad.
> Her colleague, who specializes in melancholic depression, has suggested Doxepin and/or a course of ultra brief right unilateral ECT. I have refused the latter at present.
Ah, so you are melancholic after all? That was an easy guess to make.
You might profit from adding a MAOI to bring you to full remission if your depression is a hybrid between melancholic and atypical. Actually, this is what bipolar depression looks like; with symptomology looking more atypical. How is you appetite / body weight? What time of day do you feel worst? Is it a regular cycle? My mood was actually worst at 2:00 PM. This is not terribly common.
My illness lies somewhere along the bipolar spectrum. This is what I am currently taking:
Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg
prazosin 6 mg
- Scott
Posted by phidippus on March 17, 2012, at 20:49:06
In reply to What do you think of abilify at a low dose for Uni, posted by Laney on March 13, 2012, at 14:17:01
Abilify works well when used as augmentation treatment as it does not have a robust anti-depressant profile.
If you want to try a medication with the same 5ht1a a partial agonist features Abilify has, I would recommend Viibryd, which can be a powerful SSRI.
Eric
Posted by LostBoyinNCReturns on March 18, 2012, at 13:37:14
In reply to Re: What do you think of abilify at a low dose for Uni, posted by papillon2 on March 15, 2012, at 22:09:24
The type II diabetes that the atypical APs can all cause can in itself cause severe, debilitating fatigue that could in itself, masquarade as major depression. Personally, I would not rely upon any psychiatrist to "catch it" if you are being treated on an outpatient basis.
I read it took the company that makes Abilify three attempts with the FDA to get it formally approved as an add on for unipolar major depression. I also read the black box warning was a major factor in why the FDA resisted an already established anti-psychotic for getting FDA approved for more things.
Why not just go have regular ECT, unilateral ECTs? It is probably much safer than taking atypical APs longterm, in all likelihood.
Also, CPAP moved me from the TRD category to the respond to antidepressants category.
I had to look outside psychiatry to get better. IMO, many others need to as well. The medication merry go round DOES NOT WORK.
Eric
Posted by papillon2 on March 19, 2012, at 21:50:26
In reply to Re: What do you think of abilify at a low dose for Uni » papillon2, posted by SLS on March 16, 2012, at 5:51:07
> What does your diurnal pattern look like? Do you feel worse in the mornings? If so, then you might have a classic endogenous melancholic depression. This would indicate that you are probably be more apt to respond to tricyclics.
Yes, as you guessed further down I have melancholic depression. I am worse in the mornings. I am responding to Nortriptyline.
> > - still some psychomotor retardation / leaden paralysis but no where near the same extent (was in a freaking wheelchair and unable to talk)
>
> OMG. I am SO sorry. You were very sick. It angers me to hear this.
>
> Psychomotor retardation would be sufficient to explain this, though. Classic leaden paralysis might not apply to you. If it does, then I would entertain the idea that there might be some bipolarity going on.Basically, when I am at my sickest I am unable to move as I have no energy and my limbs feel very heavy. It is more than just not having the motivation to move. I was told this was leaden paralysis.
I was screened more than once for bipolar, but I don't experience mania or hypomania.
> > Currently:
> > Nortriptyline 100mg (blood level 0.5, I suspect any higher would just make me miserable from side effects).> Give it a try anyway. You might be VERY surprised. I suspect that you are an extensive metabolizer and that you will need 150 mg/day to reach full remission. Get closer to 150 ng/ml than to 50 ng/ml. For me, side effects are no greater at 150 mg/day than at 75 mg/day. Side effects might get worse immediately upon a dosage increase, but they should decrease over time. After being on nortriptyline for an extended period of time (months), you might not even know that you are taking it. I hope this is the case for you. Even if side effects linger, they should be reduced. I am SURE you will find it to be a worthwhile trade-off if increasing the dosage works.
I might give it a try if other options seem worse. I have two concerns:
(1) I believe the palpitations and chest pain would resolve in about a month as they have on previous dose increases. However I think my resting heart rate would increase further (currently 25bpm above my usual rate due to Nortriptyline) and I think it contributes to my anxiety. It is not that I am anxious ABOUT it, it's just that it is a very much like anxiety. Not surprising given a racing heart rate is a symptom of anxiety. It is like having high adrenaline coursing constantly through me.
(2) My eyes which are dry from Nortriptyline are especially bad in the mornings and I think it contributes to my feeling bad in the morning and wanting, and going, back to bed. I know however that I need to be more diligent with using eyedrops for this purpose but motivation is an issue. Surprise!> > Lamictal 200mg
> > Lithium 125mg (blood level 0.2, can't go higher as super sensitive)
> > And melatonin 3mg
>
> That is a sufficient blood level of lithium for it to exert an antidepressant effect when used as an adjunct to antidepressants. It is far too low to address bipolar mania. For me, lithium at 300 mg/day results in the same blood level as yours. Going higher in dosage does not produce an increased therapeutic effect. It just brings on apathy and amotivation.This is really good to know. I don't have mania so controlling mania is not an issue. I think doctors assume my Lithium is too low to be helping but I think it does and I like it's beneficial effect on the brain.
> > My psychiatrist suggested Epilim (a valproate) but has forgotten that she took me off it as I was shaking all the time.
>
> Combining lithium and valproate acts synergistically to produce shaking. Valproate by itself might not be so bad.
>
> > Her colleague, who specializes in melancholic depression, has suggested Doxepin and/or a course of ultra brief right unilateral ECT. I have refused the latter at present.
>
> Ah, so you are melancholic after all? That was an easy guess to make.Yup.
> You might profit from adding a MAOI to bring you to full remission if your depression is a hybrid between melancholic and atypical. Actually, this is what bipolar depression looks like; with symptomology looking more atypical. How is you appetite / body weight? What time of day do you feel worst? Is it a regular cycle? My mood was actually worst at 2:00 PM. This is not terribly common.
My mood and energy are worse in the morning; this is a very regular cycle. My appetite and weight decrease with depression. I have to closely monitor both as I used to have anorexia nervosa and losing too much weight can trigger it.
I am told that for melancholic depression ECT > MAOI > TCA > TeCA > SNRI > SSRI, so I may have to try a MAOI eventually.
Posted by SLS on March 22, 2012, at 7:42:41
In reply to Re: What do you think of abilify at a low dose for Uni, posted by papillon2 on March 19, 2012, at 21:50:26
Hi.
Yes. What you describe is leaden paralysis. I believe that you also suffer psychomotor retardation simultaneously. That's a hell of a thing to have to experience.
> I am told that for melancholic depression ECT > MAOI > TCA > TeCA > SNRI > SSRI, so I may have to try a MAOI eventually.
I would reverse the order of the TCA and MAOI.
As I said before, perhaps your case comprises a hybrid of melancholic and atypical with greater emphasis on the melancholic. Perhaps combining TCA with MAOI along with lithium might work.
I bet your palpitations would disappear at higher dsoages of nortriptyline. Your heart rate will remain elevated, but you won't notice it. The heart actually works less hard per beat when peripheral NE alpha-1a receptors are blocked by a TCA. This is known as "afterload reduction". Without knowing anything more about your case and drug sensitivities, I would think that raising the dosage of nortriptyline now is most logical.
Good luck with whatever you decide.
- Scott
Posted by stewie on March 23, 2012, at 16:06:48
In reply to What do you think of abilify at a low dose for Uni, posted by Laney on March 13, 2012, at 14:17:01
A very small dose of Abilify has been very helpful for me. All that remains to be seen is if it lasts.
Best to you,
Stewie
Posted by SLS on March 24, 2012, at 7:10:39
In reply to Re: What do you think of abilify at a low dose for Uni, posted by stewie on March 23, 2012, at 16:06:48
> A very small dose of Abilify has been very helpful for me. All that remains to be seen is if it lasts.
It should.
This has been my observation of myself and others.
- Scott
Posted by Phillipa on March 24, 2012, at 20:04:18
In reply to Re: What do you think of abilify at a low dose for Uni » stewie, posted by SLS on March 24, 2012, at 7:10:39
Why does it seem like no poop out on ap's? Phillipa
This is the end of the thread.
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