![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Christ_empowered on January 24, 2014, at 10:49:08
I was on 1200/Trileptal, 30/Abilify, and up to 300/Neurontin. Briefly on 20/Prozac.
So, my doc Rx'd Tofranil-PM, 150mgs at night. Its a once-nightly Tofranil. I figured it'd be generic and cheap. Wrong! Old school Tofranil is quite cheap. This stuff is generic, but expen$ive. So, disability won't cover it w/o prior authorization. I called the clinic and suggested that maybe normal Tofranil would be better. Haven't heard from them or the pharmacy.
Anyway, I did a little online drugs interaction checker. No wonder I've been feeling agitated! Trileptal reduces Abilify blood levels. Abilify is the core of my anti-batsh!t cocktail. Trileptal is OK and all, but it kinda scares me (osteoporosis, anyone?), and its not the main medication. It would also reduce levels of Tofranil.
So,...then there were 2. Low-dose Neurontin and high dose Abilify. Today is day #1 of no mo' Trileptal. We'll see how it goes.
Posted by Phillipa on January 24, 2014, at 12:01:57
In reply to Dropping Trileptal, posted by Christ_empowered on January 24, 2014, at 10:49:08
No more trileptal? Didn't know it caused osteoporosis either? Seems most of the meds cause another problem sometimes worse than the first one. Phillipa
Posted by SLS on January 24, 2014, at 13:51:30
In reply to Dropping Trileptal, posted by Christ_empowered on January 24, 2014, at 10:49:08
> So,...then there were 2. Low-dose Neurontin and high dose Abilify. Today is day #1 of no mo' Trileptal. We'll see how it goes.
Are you at all concerned about seizures for discontinuing Trileptal abruptly?
What do you feel that Trileptal was doing for you? Would you want to replace it with another mood stabilizer?
Good luck. Navigating these changes in your treatment may not be straight-forward because you are changing more than one variable at the same time. That is not to say that you won't be able to do it, though.
Schizoaffective, bipolar type? Any paranoia?
Saphris might be a drug worth looking at with or without Abilify - and perhaps Wellbutrin if depression is a problem.
Have you ever tried Depakote?
So...
What will your treatment regime look like when you are done making adjustments?
- Scott
Posted by phidippus on January 24, 2014, at 16:39:48
In reply to Dropping Trileptal, posted by Christ_empowered on January 24, 2014, at 10:49:08
What's your diagnosis?
Eric
Posted by Christ_empowered on January 25, 2014, at 4:11:50
In reply to Re: Dropping Trileptal » Christ_empowered, posted by phidippus on January 24, 2014, at 16:39:48
Right now, the line up is simple: 30 Abilify in the morning, up to 300 Neurontin (max 3 doses of 100mgs/each), plus my Orthomolecular combo.
When and if the Tofranil-PM gets covered, I'll be taking Tofranil-PM at night (I was prescribed 150mgs, which is a lot for a starting dose, so we'll see...).
I don't care for Depakote. IR and ER caused stomach problems. XR was more tolerable, but still triggered EPS when combined with Abilify.
I don't know my diagnosis. It ranged from Schizophrenia when younger to Narcissism to psychotic depression to Schizoaffective of some persuasion to Bipolar I w/ Psychotic Features.
If I had to diagnose myself, I'd probably go for either fairly manageable Schizoaffective, manic type (1 severe manic episode, plus the fits of crazy and agitation) or a psychotic-depression heavy Bipolar I.
I dunno. My last shrink was from Europe. They apparently avoid diagnosing schizophrenia when there's prominent mood symptoms and lots of lucidity. My first shrink was southern and American. Paranoid schizophrenia---ignored the mood and anxiety/agitation.
My least favorite shrink called it severe narcissistic personality disorder and prescribed reuptake inhibitors. I was all of 20 years old and homosexual, so that diagnosis strikes as suspect.
My new shrink...time will tell...
...I suspect that I don't fit in the DSM because my personality is different from other peoples' in modern US society, so my problems manifest differently. Only child of white collar academicians, spent lots of time alone, natural born homosexual (a degree of androgyny to my personality), so...
...its hard to fit someone like me into a DSM that's based on observations of people with much different life experiences. Not that I'm "special" or whatever, just that I think all that time alone, reading and being crazy from a young age (like a little queer Sylvia Plath, lol) makes it hard to categorize with current diagnostic criteria.
I imagine that if they pulled out one of the older DSMs, they could figure something out.
Posted by phidippus on January 25, 2014, at 22:59:05
In reply to Re: Dropping Trileptal, posted by Christ_empowered on January 25, 2014, at 4:11:50
> Right now, the line up is simple: 30 Abilify in the morning, up to 300 Neurontin (max 3 doses of 100mgs/each), plus my Orthomolecular combo.
Crap. Where's your mood stabilizer? Please don't be one of those people that thinks their atypical is going to provide mood stability.
>I'll be taking Tofranil-PM at nightWhich may destabilize your mood. A mood stabilizer will prevent that.
> I don't care for Depakote.
Neither do I. I think anticonvulsants are problematic mood stabilizers. So many side effects. Nothing but Lithium for me.
> I don't know my diagnosis.
Bipolar I seems accurate.
> If I had to diagnose myself
Its more about which diagnosis you accept. You focus alot on your psychotic depressive symptoms, but you've experienced manic and mixed states which excludes you from a psychotic depressive diagnosis. If you were schizoaffective, you would have psychotic symptoms outside of mood episodes-is this the case?
> My least favorite shrink called it severe narcissistic personality disorder
WTF? I don't think Narcissistic Personality Disorder is in the DSM manual anymore.
> ...I suspect that I don't fit in the DSM because my personality is different from other peoples'
Personality is a separate issue from illness of neurochemical issue. When diagnosed, personality disorders are listed on Axis II concurrent to mood disorders and the like. SO, your personality issues really aren't considered to have an impact on say a diagnosis of Scchizophrenia. Your personality has no bearing on your Bipolar disorder.
>so my problems manifest differently.
Your personality traits manifest separately from your mood disorder.
>spent lots of time alone, natural born homosexual (a degree of androgyny to my personality), so...
So what?
> ...its hard to fit someone like me into a DSM that's based on observations of people with much different life experiences.Nah. Bipolar symptoms are the same across the board. Just like whooping cough is them same for anyone who gets it.
>(like a little queer Sylvia Plath, lol)
HA. Do you write?
Have you ever been on Lithium?
Eric
Posted by Christ_empowered on January 26, 2014, at 7:40:41
In reply to Re: Dropping Trileptal » Christ_empowered, posted by phidippus on January 25, 2014, at 22:59:05
hey! OK, I guess I see Bipolar as being accurate. The problem, then, is getting a new mood stabilizer on board, because the Trileptal was definitely reducing the anti-crazy power of the Abilify :-(Lamictal? Like, 200-400mgs/day? I can get a starter pack in a couple weeks. Thanks for all your help.
Posted by SLS on January 26, 2014, at 8:22:24
In reply to Re: Dropping Trileptal, posted by Christ_empowered on January 26, 2014, at 7:40:41
> hey! OK, I guess I see Bipolar as being accurate. The problem, then, is getting a new mood stabilizer on board, because the Trileptal was definitely reducing the anti-crazy power of the Abilify :-(
Why did you start Trileptal in the first place? What benefits did it provide you?
> Lamictal? Like, 200-400mgs/day? I can get a starter pack in a couple weeks. Thanks for all your help.
I question the bipolar diagnosis. I don't think you have provided enough information to rule-out schizoaffective disorder, bipolar type. During those periods of time when you discontinued Abilify, can you describe what you experienced? Any paranoia? Auditory hallucinations?
If you are schizoaffective, bipolar type, then that should reinforce the need for one or two antipsychotics. That you are bipolar type might call for a mood stabilizer, but an antipsychotic alone can provide anti-psychotic, anti-manic, and anti-depressant effects all at the same time. Can you provide a list of your symptoms that occur when you do not take any medication?
Lamictal is a poor antimanic and of questionably value as a true mood stabilizer, although it can provide relief from any bipolar depression that you might experience.
You might look at Saphris (asenapine) for schizoaffective disorder. I have seen it work wonders in combination with Navane (thiothixene) for schizoaffective disorder, bipolar type. It can provide antipsychotic (including paranoia) and antidepressant effects. It is often energizing. It can also clear up one's thoughts and reduce brain-fog. I don't think Saphris has been approved as an antimanic drug, but many antipsychotics effectively treat mania. If I were you, and Abilify monotherapy is insufficient to control your illness, I would consider adding a second complementary antipsychotic temporarily and then reduce the Abilify gradually to see if you still need it. It may be that Saphris monotherapy will still allow for mania, but Abilify would probably serve to control that. I would not overlook Latuda (lurasidone), but I have not had the opportunity to observe its use personally.
- Scott
Posted by phidippus on January 27, 2014, at 18:54:52
In reply to Re: Dropping Trileptal, posted by Christ_empowered on January 26, 2014, at 7:40:41
>the Trileptal was definitely reducing the anti-crazy power of the Abilify
How was it doing this?
>Lamictal?
Lamictal is a good choice and may help with your depressive symptoms. Its not the best anti-manic, but you take enough Abilify that this would be a non-issue.
Have you ever been on Lithium?
Eric
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.