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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Mogger on January 3, 2014, at 1:22:30
I am seeing my pdoc tomorrow and am unfortunately going to have to come off seroquel due to my restlessness and pounding heartbeat. I have lost weight on the med and don't sleep well however it does have powerful anti depressant properties more so than zyprexa that I used to take. Any ideas as my pdoc wants to keep me on an atypical for my OCD? My current meds are:
400 mg Lamictal (recently went up from 300mg and it has made a huge difference in mood).
150 mg zoloft (can't go any higher due to sweating with 18 grams of inositol)
300 mg seroquel (tried 150 but no change)
1mg klonopin (keeps the restlessness at bay)
45 mg remeron (think it might be magnifying the restlessness with seroquel)
5400 mg NACThanks for any feedback,
Joseph
Posted by Christ_empowered on January 3, 2014, at 18:33:13
In reply to Atypical that has equal AD effects to seroquel?, posted by Mogger on January 3, 2014, at 1:22:30
maybe Abilify w/ a temporary increase in Klonopin? Just a thought...
Posted by Tomatheus on January 3, 2014, at 18:59:23
In reply to Atypical that has equal AD effects to seroquel?, posted by Mogger on January 3, 2014, at 1:22:30
Aside from Abilify, which Christ_empowered mentioned and is indicated for the adjunctive treatment of depression, another antipsychotic that might have antidepressant properties is the new drug Latuda (luradisone). Like Abilify and Seroquel, it's a 5HT1A receptor partial agonist, which might conceivably contribute to the antidepressant actions of Abilify and Seroquel. One member here (Stargazer2) has also reported experiencing antidepressant benefits from taking Latuda with other medications. It would be hard to say for sure, though, whether or not Latuda or Abilify might have antidepressant benefits that are equal to those of Seroquel for you, even though Abilify seems to have a decent track record in the adjunctive treatment of depression.
Tomatheus
Posted by mogger on January 3, 2014, at 19:21:39
In reply to Re: Atypical that has equal AD effects to seroquel?, posted by Tomatheus on January 3, 2014, at 18:59:23
Thank you both for your thoughts I will mention these to him if our plan doesn't work out. He said the tachardia and restlessness should subside going from 300 which is where I am at now, to 150mgs. As I am taking it with other AD's he said I might still retain the AD benefits even at the lower dose as 300 mg is the dose for stand alone depression. Would you agree? Thanks again for replying,
Joseph
Posted by Tomatheus on January 3, 2014, at 20:05:14
In reply to Re: Atypical that has equal AD effects to seroquel?, posted by mogger on January 3, 2014, at 19:21:39
> Thank you both for your thoughts I will mention these to him if our plan doesn't work out. He said the tachardia and restlessness should subside going from 300 which is where I am at now, to 150mgs. As I am taking it with other AD's he said I might still retain the AD benefits even at the lower dose as 300 mg is the dose for stand alone depression. Would you agree? Thanks again for replying,
>
> JosephI think that what your doctor said makes sense. It's always difficult to predict with certainty what effect a medication adjustment might have, but as far as I can tell, I think that it would make sense that you'd retain at least some antidepressant benefits from Seroquel at 150 mg with your other antidepressants.
Good luck with the lower dose.
Tomatheus
Posted by SLS on January 3, 2014, at 20:21:32
In reply to Atypical that has equal AD effects to seroquel?, posted by Mogger on January 3, 2014, at 1:22:30
What about adding nortriptyline and discontinuing the Remeron?
The Seroquel metabolite (norquetiapine) might be trying to tell you something. You might profit from NE reuptake inhibition. Nortriptyline goes well with Abilify. If simply adding nortriptyline to Seroquel doesn't help, you might then try switching APs.
Have you tried Lamictal?
- Scott
Posted by SLS on January 3, 2014, at 20:25:25
In reply to Re: Atypical that has equal AD effects to seroquel?, posted by mogger on January 3, 2014, at 19:21:39
Oops.
Sorry Mogger. I forgot that you are already taking Lamictal.
Have you ever combined Lamictal with Abilify or Wellbutrin?
- Sorry
Posted by mogger on January 3, 2014, at 20:30:32
In reply to Re: Atypical that has equal AD effects to seroquel? » mogger, posted by Tomatheus on January 3, 2014, at 20:05:14
Thanks Tomatheus, Happy New Year to you.
Posted by mogger on January 3, 2014, at 20:36:14
In reply to Sorry... » mogger, posted by SLS on January 3, 2014, at 20:25:25
I never have Scott. I tried Wellbutrin about 15 years ago at University well before Lamictal but I remember getting anxiety from Wellbutrin. I wonder if Remeron (I recently went to 45mgs) has the same metabolite as Seroquel as I know they both have norepinephrine properties. I am loathe to try Abilify as I know from your experience you have had trouble with weight gain correct? I was on Zyprexa and only gained a few pounds. Seroquel has actually made me lose weight. But I shouldn't disregard something before I try it.
Posted by SLS on January 3, 2014, at 20:57:02
In reply to Re: Sorry... » SLS, posted by mogger on January 3, 2014, at 20:36:14
> I never have Scott. I tried Wellbutrin about 15 years ago at University well before Lamictal but I remember getting anxiety from Wellbutrin. I wonder if Remeron (I recently went to 45mgs) has the same metabolite as Seroquel as I know they both have norepinephrine properties. I am loathe to try Abilify as I know from your experience you have had trouble with weight gain correct? I was on Zyprexa and only gained a few pounds. Seroquel has actually made me lose weight. But I shouldn't disregard something before I try it.
Wellbutrin can exacerbate anxiety. I really wasn't thinking about your OCD. I imagine Wellbutrin can make it worse in some people. I was hoping to come up with a way to boost the clinical effect of Lamictal using a dopaminergic agent. Abilify does a nice job of stabilizing DA synaptic activity.
Perhaps the place to start is to try adding nortriptyline. It is primarily a norepinephrine reuptake inhibitor, as is the active metabolite of Seroquel. Nortriptyline might allow you to keep the dosage of Seroquel to 150 mg/day or perhaps even allow you to discontinue it entirely. Notriptyline goes well with just about anything, including MAOIs. Come to think of it, I don't think I ever saw nortriptyline added to Wellbutrin. I wouldn't think that it would be a high-percentage treatment. Seroquel acts more like nortriptyline than does Remeron. The mechanism by which Remeron increases synaptic NE concentrations is NE alpha-2 receptor blockade. If you bring in nortriptyline, you might be able to swap out the Seroquel for Latuda. You would lose nothing and gain 5-HT7 antagonism.
There is some evidence that adding Abilify to an SSRI can improve OCD.
- Scott
Posted by mogger on January 3, 2014, at 21:06:31
In reply to Re: Sorry... » mogger, posted by SLS on January 3, 2014, at 20:57:02
Very interesting thanks. I will give this decrease a shot and then go in with this info next time I see him if it doesn't work out. Funnily enough I tried nortriptyline also about 17 years ago but again long before all of this. Yes I see you take it with your parnate. I would have thought there would be some serotonin syndrome cause to worry but it is great there isn't.
Posted by Tomatheus on January 3, 2014, at 21:14:26
In reply to Re: Atypical that has equal AD effects to seroquel? » Tomatheus, posted by mogger on January 3, 2014, at 20:30:32
Mogger/Joseph,
Thank you for the new year's wishes. I hope that you too will have a good 2014.
Tomatheus
This is the end of the thread.
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