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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 burial on July 13, 2014, at 12:24:02
The thing is, i'm not satisfied with my current med regimen. These are:
600mg amisulpride
20mg escitalopram
30mg mirtazapine
2mg clonazepamI have schizoaffective disorder depressive type and i want to mix things up because life is colourless right now. Have in mind, that some types of medications are compensated for me so i have very few choices as to what i can use. What i was thinking was:
20mg zyprexa - was modest at 10mg, but great at 20mg. Was thinking Abilify, but my insurance won't cover it and it's expensive as hell.
30mg mirtazapine - i think it's ok.
4mg clonazepam, i still have anxiety, so i will increase the dosage. Don't talk me out of this, because i won't change my mind.
The most confusing is my last option. I can choose either paroxetine or fluoxetine. I know fluoxetine is more energizing and it has some synergy with olanzapine being Symbiax and all, but i already have enough 5ht 2c antagonism from olanzapine and mirtazapine. Paroxetine however is quite potent at norepinephrine transporter and once i did very good on it. Maybe i have some ADHD too but stimulants are out of question because of lack of money.
My main symptoms are lack of energy, anhedonia, anxiety and attention problems. I'm leaning more on the paroxetine side because according to some stuff i read it causes less manic switches than other SSRI's, i just don't want to be sedated to the point where i can barely get out of bed. Any input is welcomed.
Posted by phidippus on July 13, 2014, at 17:04:24
In reply to Meds change, support needed, posted by burial on July 13, 2014, at 12:24:02
Are you aware that Clonazepam blocks serotonin and can cause depression? Maybe if you switch to another benzo you'll experience less depressio
>energy...attention problems
Ritalin or dextramphetamine are your best bets, but since you don't want them, perhaps strattera will help.
I'm also thinking an antipsychotic with 5ht1a agonism might benefit your mood and anxiety. Latuda, Geodon and Abilify.
Eric
Posted by burial on July 14, 2014, at 3:51:27
In reply to Re: Meds change, support needed » burial, posted by phidippus on July 13, 2014, at 17:04:24
I'll try to save up some money for methylphenidate and test myself. Is it okay taking it being on two antidepressants?
And it does seem that clonazepam even speeds up the reuptake of serotonin so it indeed may have depression-like symptoms. Is lorazepam any better in this situation?
And i can't take Abilify, although it was my choice of antipsychotic. The insurance only covers it for schizophrenia but not schizoaffective disorder :(
Posted by Christ_empowered on July 14, 2014, at 8:11:47
In reply to Re: Meds change, support needed, posted by burial on July 14, 2014, at 3:51:27
Hey. I have a similar diagnosis. I take Abilify 30 Lamictal 100 Trileptal 1200.Have you considered switching the clonazepam to Xanax xr, Ativan, maybe good ole valium? The only problem with valium is that a lot of docs under dose it, so you get messed up when they essentially cut your dose by under dosing the new benzo. Lame.
Have you ever tried an anticonvulsant? For me, anticonvulsants help calm me down and keep mood issues from getting out of hand. I don't care for antidepressants.
Geodon? Maybe Symbyax, instead of separate AD and zyprexa Rx? Prozac and Remeron have been studied together and it seems promising. I have no idea what adding an atypical would do to that mix, although it seems that the mix would be sedating and weight gain would be an issue.
Ummm....maybe...amoxapine? TCA, partly breaks down into loxapine, supposed to help with intractable depression. You'd have to be careful what else you took with it, though.
Posted by phidippus on July 14, 2014, at 9:34:02
In reply to Re: Meds change, support needed, posted by burial on July 14, 2014, at 3:51:27
>Is it okay taking it being on two antidepressants?
I took Ritalin while on prozac and mirtazapine and it was safe.
>Is lorazepam any better in this situation?
Lorazepam does not affect serotonin like clonazepam.
> And i can't take AbilifyTry Latuda or Geodon.
Eric
Posted by burial on July 14, 2014, at 11:06:14
In reply to Re: Meds change, support needed » burial, posted by phidippus on July 14, 2014, at 9:34:02
Thank you for your replies, i will try Geodon and see how it goes
Posted by burial on July 14, 2014, at 11:17:05
In reply to Re: Meds change, support needed, posted by burial on July 14, 2014, at 11:06:14
30mg paroxetine
30mg mirtazapine
5mg lorazepam split in two doses
200mg lamotrigine
60 or 120mg of Geodon.How's that for a regimen? Is it sensible?
Posted by Christ_empowered on July 14, 2014, at 11:22:44
In reply to Re: Meds change, support needed, posted by burial on July 14, 2014, at 11:17:05
I'm not sure, but the paxil might not be necessary. If I recall (and I could be wrong), Geodon does some reuptake inhibition stuff.
Posted by burial on July 14, 2014, at 11:48:45
In reply to Re: Meds change, support needed, posted by Christ_empowered on July 14, 2014, at 11:22:44
you're not wrong, Geodon does inhibit both reuptakes, but the effects are quite weak. Anyways, i will try the Geodon, if that does not work i still always have my good old zyprexa
Posted by phidippus on July 14, 2014, at 12:02:58
In reply to Re: Meds change, support needed, posted by burial on July 14, 2014, at 11:17:05
You'll get the most out of Geodon at 160 mg.
What's the lamotrogine for?
Eric
Posted by burial on July 14, 2014, at 13:24:38
In reply to Re: Meds change, support needed » burial, posted by phidippus on July 14, 2014, at 12:02:58
i'm also ultradian cyclying bipolar with mostly depression features. I figured i need a stabilizer, but carbamazepine and valproic acid did nothing for me so i thought lamotrigine may be a choice as i did very well with it before
Posted by Christ_empowered on July 14, 2014, at 15:21:16
In reply to Re: Meds change, support needed, posted by burial on July 14, 2014, at 13:24:38
high(ish) dose trileptal? doesn't do as many drug-drug things as tegretol...
This is the end of the thread.
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