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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 Christ_empowered on April 20, 2014, at 19:43:23
I'm either schizoaffective, manic type, or Bipolar I w/ heavy psychosis...or somewhere in between, if there is a gray area.
Now, I'm on Trileptal 1200 and Abillify 30 and Neurontin when and if I need it, max 300mgs in 3 doses daily.
I just don't know...I get what I guess is psychotic depression, but ADs can make you apathetic. And fat(ter). And there's TD to contend with, since I'm on Abilify forever and I'm concerned that adding in an AD might up the risk. Am I right or wrong?
I was on Tofranil. Ugh. Worked, I guess, but..now I see why they made newer drugs.
I'm torn. Sometimes, I want no ADs, ever. Then I think: Effexor or Cymbalta plus Remeron, NOW! I just don't know :-(
Anyone have insight?>
Posted by Phillipa on April 20, 2014, at 22:17:47
In reply to ADs for schizo-whatever...worth it?, posted by Christ_empowered on April 20, 2014, at 19:43:23
CE what does you gut tell you? Seriously? Phillipa
Posted by Christ_empowered on April 21, 2014, at 9:12:56
In reply to Re: ADs for schizo-whatever...worth it? » Christ_empowered, posted by Phillipa on April 20, 2014, at 22:17:47
My gut now says treat this depression and worry about long term AD use later. My tendency towards psychotic depression means I may one of the relatively few for whom older ADs work very well and for whom long term, maybe indefinite treatment, outweighs risks.
Posted by phidippus on April 21, 2014, at 12:27:52
In reply to ADs for schizo-whatever...worth it?, posted by Christ_empowered on April 20, 2014, at 19:43:23
Well, how are you feeling now? Are you taking antidepressants as prophylaxis for when you might become psychotic and depressed?
Eric
Posted by Christ_empowered on April 21, 2014, at 15:19:48
In reply to Re: ADs for schizo-whatever...worth it? » Christ_empowered, posted by phidippus on April 21, 2014, at 12:27:52
Ugh. I just re-started Tofranil. 200mgs/day for 3 days, then 150. I based this on some stuff from the 70s..loading dose ADs for the sad amongst us :-(
There's a feeling, before I get psychotic depression...a sense of descent into darkness, complete with low-grade paranoia and tension. I'm getting that now, so...probably should do *something*. I tried no AD and chasing the agitation+paranois w/ low dose PRN Risperdal and some Neurontin. Kinda helped, but killed my energy and motivation and lowered my mood a bit.
We'll see. Thanks for your response.
Posted by linkadge on April 21, 2014, at 19:44:44
In reply to Re: ADs for schizo-whatever...worth it?, posted by Christ_empowered on April 21, 2014, at 15:19:48
Question - have you ever tried fluvoxamine?
Posted by Phillipa on April 21, 2014, at 20:11:55
In reply to Re: ADs for schizo-whatever...worth it?, posted by linkadge on April 21, 2014, at 19:44:44
Link why luvox?
Posted by Christ_empowered on April 21, 2014, at 20:13:39
In reply to Re: ADs for schizo-whatever...worth it? » linkadge, posted by Phillipa on April 21, 2014, at 20:11:55
I did, briefly...made me feel strange. Then again, I was at an anti-AD phase.
Is luvox good for my form of sadness?
Posted by Louisiana Sportsman on April 21, 2014, at 22:31:25
In reply to ADs for schizo-whatever...worth it?, posted by Christ_empowered on April 20, 2014, at 19:43:23
Hey! I feel like I can relate to what you're going through with the medicine wagon along with some of your symptoms. I always try to give you the best advice, but sometimes it is wild and theoretical. Here's an analysis of this situation. Very interesting, btw, I enjoy this kind of thing. Keep posting.
>
> Now, I'm on Trileptal 1200 and Abillify 30 and Neurontin when and if I need it, max 300mgs in 3 doses daily.
>This is a good maintenance: oxcarbamazepine and aripiprazle with PRN gabapentin. You could stay on this "forever". If you feel depression sneaking up, I feel like you need to utilize what's on board already: gabapentin.
Instead of adding an AD, consider raising your low dosage of gabapentin or switch to pregablin. How about 800mg. x 3 (I know it's a big 2.6X dosage increase).
Lyrica 100mg. X 4 is a fantastic option! These higher dosages are the way to cure depression. Have you tried higher dosages of gabapentin while depressed?
> I just don't know...I get what I guess is psychotic depression, but ADs can make you apathetic. And fat(ter). And there's TD to contend with, since I'm on Abilify forever and I'm concerned that adding in an AD might up the risk. Am I right or wrong?
>I notice you're on Abilify. Latuda is very similar to Abilify, but it's way healthier. It also has similar mechanism of action.
I believe Latuda is superior than Abilify and should be approved an a supplement to antidepressant drugs for patients with MDD, just like Abilify.
In terms of serotonin receptor affinity shared, <8.7nM, significant activity, anything else that Abilify has that Latuda has is negligible in terms of action-- essentially, the only notable serotonin activity Latuda lacks that Abilify has is at the 5-HT2B receptor (Ki = 0.36 nM) This is actually a cardiotoxic, antitargetic, and not advisable to touch.
Abilify has antagonism at the 5-HT2A receptor (Ki = 8.7 nM), and partial agonism at the 5-HT1A receptor (Ki= 5.6 nM), 5-HT7 receptor (Ki = 10 nM), 5-HT2C receptor (Ki = 22.4 nM)
Antagonism at the 5-HT2A receptor (Ki = 2.0 nM), 5-HT7 receptor (Ki = 0.5 nM), 5-HT2C receptor (Ki = 415 nM) and partial agonism at the 5-HT1A receptor (Ki = 6.8 nM).
Latuda has the most relevant 5-HT7 activity of any atypical; this means that it might be cognitive enhancing and aid with learning and memory. It helps also cognitively since it lacks any anticholinergic effects
They both share similar serotoninergic backgrounds, which my hypothesis is: this explains why they're approved for similar purposes, Abilify is approved MDD AD augmentation and Latuda is approved for BP depression while other atypicals are not approved for purposes like this.
Abilify has more H1, relatively weak, but relevant action at H1 (Ki = 27.9 nM) while Latuda lacks affinity, which means is less sedating and that's a positive for me and a lot of patients.
Abilify is unique in the fact that it is a partial agonist at the D2, D3 and D4 (negligible effect) dopamine receptors. This accounts for a lot of its positive factors and why it might benefit a lot of patients such as yourself. This is a fact that Latuda lacks.
Besides partial dopamine agonism, they are very similar in terms of mechanism, but Latuda is much healthier, look at this study that also gives efficiency rates at different dosages. You'll see little difference in the low and high doses, besides side effects like akathisia.
*least QT interval prolongation, no warning about it required
*little weight gain, some studies showed weight loss compared to placebo
*less metabolic risk than Abilify: better with cholesterol, hdl, ldl, triglycerides, prolactin and glucose, some studies showed loss in all categories compared to placebo
*little sedation, some studies showed less sedationTherefore, have you considered Latuda for long-term AP maintenance?
> I was on Tofranil. Ugh. Worked, I guess, but..now I see why they made newer drugs.
>
> I'm torn. Sometimes, I want no ADs, ever. Then I think: Effexor or Cymbalta plus Remeron, NOW! I just don't know :-(
>
> Anyone have insight?>In terms of antidepressant: if you had Trileptal, Latuda, high dose Lyrica on board, you would likely not need an AD.
Have you considered levomilnacipran [(Fetzima) (Forest Laboratories)]?
Posted by phidippus on April 23, 2014, at 14:19:36
In reply to Re: ADs for schizo-whatever...worth it?, posted by Christ_empowered on April 21, 2014, at 20:13:39
Luvox is not FDA approved to treat depression, however it has been used in Europe as monotherapy for treating psychotic depression.
Eric
Posted by ed_uk2010 on April 23, 2014, at 14:54:39
In reply to Re: ADs for schizo-whatever...worth it? » Christ_empowered, posted by phidippus on April 23, 2014, at 14:19:36
> Luvox is not FDA approved to treat depression, however it has been used in Europe as monotherapy for treating psychotic depression.
>
> EricFluvoxamine is approved in Europe for depression (like all SSRIs), not specifically psychotic depression.
Posted by rockerchick46 on April 29, 2014, at 7:33:42
In reply to ADs for schizo-whatever...worth it?, posted by Christ_empowered on April 20, 2014, at 19:43:23
Hi I have schizoaffective disorder and Navane has been very effective for me in combination with Saphris and several other meds. The Navane and the Saphris get rid of the paranoid and other delusions.
Navane is a old school antipsychotic and Sapris is a relatively new drug you take sublingually.
Good Luck
Tammy
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