![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 6 to 30 of 30. Go back in thread:
Posted by seeking information on October 19, 2014, at 8:25:17
In reply to Restarted Abilify - Feeling better., posted by SLS on October 18, 2014, at 22:13:58
Hi Scott,
I am sorry that you have not felt well. It sounds as though you are getting back onto a treatment plan that will help you.
I noticed you mentioned N-acetylinecysteine. Do you know much about this supplement. I am taking it low dose (600 MGs) concurrently with Prozac, and am concerned that it will interfere with it as from what I understand, it has liver detoxing properties. I found a study where they indicated that apparantly, the mininum effective dose of prozac goes up if one takes NAC with it. It might be trivial have no meaningful impact on a human (they used rats) but I am curious as to whether or not you had ever heard anything about NAC interferring with SSRI use?
> I discontinued Abilify 6 months ago due my to concerns about increased body weight and high triglycerides. I managed to taper and discontinue the drug with minimal discomfort. My depression did not worsen immediately. My guess is that it took about 4 - 6 weeks for me to begin deteriorating. I did not restart Abilify at this time. My doctor and I had already begun to experiment with discontinuing nortriptyline and using desipramine as a substitute once I relapsed. I am back on my previous treatment regime and feeling better. I added back the Abilify a few days ago using a loading dose of 20 mg. I am now taking 10 mg/day.
>
> The whole summer was wasted. Things could be worse, though. At least I was able to recapture an improvement.
>
> I am looking closely at intranasal ketamine. If I manage to get my hands on it, it will take a bit of time to discover the optimal dosage and dosing frequency. If one takes too small a dosage, glutamate (GLU) release is unaffected and of no therapeutic value. The correct intermediate dosage increases GLU release and produces an antidepressant response. However, if one pushes the dosage of ketamine too high, there is a reversal of effect. GLU release is suppressed, and an antidepressant effect fails to emerge. Benzodiazapines can reduce the effectiveness of ketamine. On the other hand, N-acetylinecysteine (NAC) might increase its effectiveness. I would have to look into that more. NAC does modulate GLU function.
>
> After that, vortioxetine (Brintellix), deep rTMS, cariprazine, and even DBS are considerations.
>
>
> - Scott
Posted by Phillipa on October 19, 2014, at 9:52:30
In reply to Re: Restarted Abilify - Feeling better. » SLS, posted by seeking information on October 19, 2014, at 8:25:17
Scott glad you are feeling better. Phillipa
Posted by oceansun on October 19, 2014, at 10:17:00
In reply to Re: Restarted Abilify - Feeling better. » oceansun, posted by SLS on October 19, 2014, at 7:19:53
Metformin was no joy. Major GI effects, but maybe I'm just prone to them. No bathroom near my desk at work, so impractical for me :(.
Cariprazine sounds interesting. That's one of the drugs you're considering? How do you think D3 action would help you in particular? Hope it comes out soon then!
Lurasidone or Seroquel seem promising if I get too much anxiety. Do you know which one has less risk of EPS? I'm skittish about APs though now since the EPS, even though it's very mild. I like how lurasidone sounds, as it acts opposite to clonidine and clonidine made me almost instantly depressed. And I've always wanted to try Remeron, but the weight gain scared me away.
BTW, this is Anita from the olden days, in case you couldn't tell :). Thank you for the words of hope -- I wish the same for you.
> Hi, Oceansun!
>
> You might want to consider taking metformin to help prevent the emergence of diabetes due to ariprizole (Abilify) treatment.
>
> Also, a drug called cariprazine is nearing FDA approval. It is similar to aripiprazole in that it is a dopamine D2/D3 receptor partial agonist. However, cariprazine displays much greater potency for D3 relative to D2 than does ariprizole. The consequences of this difference in cariprazine mechanisms might include reduced movement EPS, reduced prolactin secretion, reduced weight gain, reduced risk of diabetes, and a more robust antidepressant response. Akathisia is still problematic, but it often occurs as a temporary startup side effect.
>
> Lurasidone (Latuda), another neuroleptic antipsychotic, is supposed to help with depression. However, I have yet to see someone declare it to be magical. It does not act as a DA partial agonist. However, it does act as a serotonin 5-HT7 receptor antagonist, something that it has in common with aripiprazole. You might want to leave aripiprazole in place while you introduce lurasidone. Once you establish a therapeutic dosage of lurasidone, you can then begin to taper the aripiprazole. If you begin to relapse, you can very quickly reinstate your therapeutic dosage of aripiprazole and discontinue the lurasidone. Please note that, unlike aripiprazole, lurasidone is a NE alpha-2 antagonist. It shares this property with mirtazapine (Remeron). Drugs that have this property have historically made me feel worse, and lurasidone was no exception. Of course, this is an atypical reaction. I imagine that more people will be helped than harmed by this pharmacological action.
>
> Keep working! I'm sure that you will be able to optimize your treatment.
>
>
> - Scott
Posted by SLS on October 19, 2014, at 11:36:59
In reply to Re: Restarted Abilify - Feeling better. » SLS, posted by seeking information on October 19, 2014, at 8:25:17
Hi Seeking.
> I noticed you mentioned N-acetylinecysteine. Do you know much about this supplement. I am taking it low dose (600 MGs) concurrently with Prozac, and am concerned that it will interfere with it
I saw your asking this question on another thread. The URL link you provided suggested that whereas the use of N-acetylinecysteine (NAC) requires higher dosages of Prozac, it allows for reduced dosages of the other SSRIs. However, I would not want to make major treatment decisions based upon this study. Afterall, there is quite a bit of interindividual variability in minimum effective dosages without adding NAC. You will just have to discover this minimum effective dosage through clinical titration.
I don't think that the effects of NAC on the liver are consequential on the metabolism of medication. I have not seen a list of cytochrome P450 enzymes that NAC might inhibit or induce. I would have to check on that, though. Actually, Ed_UK would be a better source of information on this. With acetaminophen (paracetamol) poisoning, NAC replenishes the supply of glutathione for detoxification.
I believe that the recommended dosage of NAC in the treatment of mood illness is 2000 mg/day.
NAC reduces extracellular levels of glutamate by inducing its uptake by glial cells (neuron helper cells). It would be my guess that NAC enhances the antidepressant response to lamotrigine (Lamictal). This would perhaps be facilitated by the ability of lamotrigine to reduce synaptic glutamate release.
- Scott
Posted by seeking information on October 19, 2014, at 11:52:50
In reply to Re: Restarted Abilify - Feeling better. » seeking information, posted by SLS on October 19, 2014, at 11:36:59
Thanks Scott, very interesting indeed.
EdUK, if you happen to see this, do you have any thoughts to share on this?
Thanks
Posted by Tomatheus on October 19, 2014, at 11:55:12
In reply to Re: Restarted Abilify - Feeling better. » Tomatheus, posted by SLS on October 19, 2014, at 6:36:21
> Tomatheus, you are exceptionally kind. I continue to profit from your unconditional support and intelligent clinical perspectives. I always feel better after reading your posts - not only those that are adressed to me, but also those that are addressed to others.
>
> Thank you!
>
>
> - ScottYou're welcome, Scott. Your response to what I wrote is much appreciated.
Tomatheus
Posted by SLS on October 19, 2014, at 11:58:40
In reply to Re: Restarted Abilify - Feeling better. » SLS, posted by oceansun on October 19, 2014, at 10:17:00
Hi Anita.
Yes, I knew who you were. I know that you have an affinity for the ocean. I was not going to use the name "Anita" unless that was to be okay with you.
Anyway...
> Metformin was no joy. Major GI effects, but maybe I'm just prone to them. No bathroom near my desk at work, so impractical for me :(.
That's too bad. You are not the only one who reacts to metformin that way. My mother has not had a hint of G.I. side effects with metformin.
> Cariprazine sounds interesting. That's one of the drugs you're considering? How do you think D3 action would help you in particular?D3 receptors are located in the limbic system with greater freqency than D2 receptors whereas D2 predominates in striatal structures. Partial agonism of D3 receptors might be contributory to the antidepressant properties of cariprazine. The reduced binding of D2 receptors by cariprazine should leave it less apt to produce movement and dystonic EPS.
D2 - striatal - movement
D3 - limbic - moodIt really is good to see you again. I never removed you from my contacts list. I'll write soon.
- Scott
Posted by oceansun on October 19, 2014, at 22:29:59
In reply to Re: Restarted Abilify - Feeling better. » oceansun, posted by SLS on October 19, 2014, at 11:58:40
Good to see you here again too :).
Posted by herpills on October 21, 2014, at 14:25:29
In reply to Re: Restarted Abilify - Feeling better. » SLS, posted by oceansun on October 19, 2014, at 10:17:00
>
> Lurasidone or Seroquel seem promising if I get too much anxiety. Do you know which one has less risk of EPS? I'm skittish about APs though now since the EPS, even though it's very mild. I like how lurasidone sounds, as it acts opposite to clonidine and clonidine made me almost instantly depressed. And I've always wanted to try Remeron, but the weight gain scared me away.
>
>You shouldn't be afraid to at least try Remeron. Not everyone gains weight. I've been on it for almost 9 months and no weight gain (except the weight I had lost due to depression/lack of appetite)
herpills
Posted by Christ_empowered on October 22, 2014, at 3:06:11
In reply to Re: Restarted Abilify - Feeling better. » SLS, posted by oceansun on October 19, 2014, at 10:17:00
Maybe you should try Remeron. Its been used in combination in some studies with various neuroleptics, old and new, with good results. Not only does the combination seem to help with positive and negative symptoms, the Remeron seems to help with some EPS and akathisia.
I read an abstract for a short, small study using Abilify with Remeron. As with much of the data in psychiatry, this little study was too small to "prove" anything, but it seems that the combo yields faster results than Remeron alone (it was for depression) and the 2 drugs somehow cancel out each other's side effects.
Good luck!
Posted by oceansun on October 22, 2014, at 23:52:48
In reply to for oceansun, posted by Christ_empowered on October 22, 2014, at 3:06:11
Thanks for writing me! If Remeron could help with the EPS, I would be eager to try it and be able to stay on Abilify. Just very hesitant about the probable weight gain - I gained 40 lb on Nardil and that was horrible. Does anyone _not_ gain weight on Remeron?
I wonder if Remeron works faster because it's really the AP working. (Always a pessimist ;).)
I'm down to 5 mg Abilify from 15 mg, and starting to feel a little hyper, which I expected. Now I await the anxiety and paranoia and depression. (Again, always a pessimist ;).)
Do you remember what dose of Abilify was used in the study?
> Maybe you should try Remeron. Its been used in combination in some studies with various neuroleptics, old and new, with good results. Not only does the combination seem to help with positive and negative symptoms, the Remeron seems to help with some EPS and akathisia.
>
> I read an abstract for a short, small study using Abilify with Remeron. As with much of the data in psychiatry, this little study was too small to "prove" anything, but it seems that the combo yields faster results than Remeron alone (it was for depression) and the 2 drugs somehow cancel out each other's side effects.
>
> Good luck!
Posted by phidippus on November 3, 2014, at 21:01:16
In reply to Restarted Abilify - Feeling better., posted by SLS on October 18, 2014, at 22:13:58
Which helped you more? The 5ht1a agonism or the dopamine partial agonism? Or did both help?
I think your running out of pill options, Scott. Maybe DBS is the way to go. Unless you're going to wait for all those fancy new NMDA antagonists. Why don't you do Ketamine infusions?
How have you held on so long?
Eric
ps. you have a tendency not to answer my replies to your posts. If you don't answer this I'll start being mean.
Posted by SLS on November 4, 2014, at 7:22:12
In reply to Re: Restarted Abilify - Feeling better. » SLS, posted by phidippus on November 3, 2014, at 21:01:16
> Which helped you more? The 5ht1a agonism or the dopamine partial agonism? Or did both help?
It may be that DA receptor partial agonism is essential. However, this does not indicate that 5-HT1a receptor partial agonism is unecessary for Abilify to produce an improvement in my depression, since Abilify is also a 5-HT1a partial agonist. At no time have I tried taking a 5-HT1a partial agonist in the absence of DA partial agonism, so I can't parse the importance of either mechanism.
> I think your running out of pill options, Scott.I have not tried Brintellix, nefazodone, or Luvox. However, at this juncture, I am not inclined to discontinue Parnate in order to try them. If I were to see Brintellix produce magic for people, I would consider it. So far, I haven't.
> Maybe DBS is the way to go.
My doctor will offer it as an alternative occasionally. I have been reluctant to go with DBS. What if they screw up? The idea is nice, but the reality is less than impressive for depression. The numbers aren't there, and they are not even sure what brain structure to target. There are too many variables with depression - more than with Parkinsons.
> Unless you're going to wait for all those fancy new NMDA antagonists. Why don't you do Ketamine infusions?
Good idea. Thanks. This is the direction I will probably head in next. I would first try intranasal ketamine. It is convenient, inexpensive, and effective. I have seen it work. Deep TMS is something that I would consider trying if ketamine fails.
> How have you held on so long?
Early on, I decided to live rather than die. The next decision was to choose to live with a positive attitude rather than a negative one in order to get the most out of life. I then chose to fight to be constructive in order to nurture this positivism rather than to passively allow my depression to create a mind infected with a malignant perpetual negativism. Optimism? I really can't account for it. Perhaps it is the inevitable result of the choices that I described above. Alternatively, it might be the result of some sort of genetic disposition that facilitates resilience. I am very grateful for this.
> ps. you have a tendency not to answer my replies to your posts.
Sorry. If this is true, I cannot account for it. It is not selective or purposeful. In general, I am less apt to post stuff lately. I don't fully understand why. Please don't take it personally.
> If you don't answer this I'll start being mean.
Uh oh. I definitely don't want that!
:-)
I always click on your posts, regardless of what thread you participate in. I am always grateful for the generous attention that you pay to me. I acknowledge the expertise with which you apply your efforts to help me get well.
- Scott
Posted by phidippus on November 4, 2014, at 13:56:09
In reply to Re: Restarted Abilify - Feeling better. » phidippus, posted by SLS on November 4, 2014, at 7:22:12
>At no time have I tried taking a 5-HT1a partial agonist in the absence of DA partial agonism, so I can't parse the importance of either mechanism.
Have you tried augmenting the 5ht1a agonism with another 5ht1a agonist? Pindolol? Buspar?
Are there any other agents that do DA partial agonism?
> I have not tried Brintellix
What was remarkable about Brintellix was that it started working fairly quickly, most predominately as an anxiolytic, then its antidepressant effects became apparent. I think this may be owed to its 5ht1a full agonism. Unfortunately, Brintellix caused me to cycle and I could not take it anymore.
>nefazodone
What an odd duck. Wouldn't you be worried about liver toxicity?
>Luvox
I can tell you it works wonders for OCD and its been studied in the treatment of psychotic depression (even as monotherapy). Its action on sigma receptors is novel but may owe to its efficacy as an anxiolytic and antidepressant.
>However, at this juncture, I am not inclined to discontinue Parnate in order to try them.
What are you running at? 60%? 40%? I would be very worried about Parnate's efficacy. Its supposed to be your main tool in treating your depression, but it doesn't seem to be all that effective if you're having to augment it with so many other drugs. Its like adding turbo to an engine with faulty fuel injectore in hopes it will help keep the car up to speed. I feel strongly you should be reconsidering the Parnate. Are you afraid switching it out will lead to crushing depression?
>What if they screw up?
What are you afraid will happen? Worsened depression?
>The idea is nice, but the reality is less than impressive for depression.
Don't they adjust the implant while you're awake so you'll know if its working before they close your skull?
>I would first try intranasal ketamine. It is convenient, inexpensive, and effective.
I have spoken with so many people who have tried intranasal ketamine to know its efficacy. It hasn't worked for any of them, so I can't recommend it. IV Ketamine seems to work very well, however. The data just isn't there for intranasal ketamine, where as certain clinics now offer Ketamine infusions and have data to back up its efficacy. For a list of those clinics, check this out: http://www.ketamineadvocacynetwork.org/46-2/ The only drawback is the cost-insurance usually doesn't cover it.
>Optimism?
On a scale of 1 to 10, how would you rate your depression, 1 being the most depressed and 10 being the least depressed?
>I really can't account for it.
I think you found some things to live for. I am also convinced you are not as depressed as you think you are.
What about this neuroscience stuff? You seem to have a knack for it. Why not make a living out of it?
That's what I'm doing ;)Eric
Posted by oceansun on November 4, 2014, at 23:03:23
In reply to Re: Restarted Abilify - Feeling better. » phidippus, posted by SLS on November 4, 2014, at 7:22:12
"I have not tried Brintellix, nefazodone, or Luvox. However, at this juncture, I am not inclined to discontinue Parnate in order to try them. If I were to see Brintellix produce magic for people, I would consider it. So far, I haven't."
I haven't seen much luck for Brintellix either. Or Viibryd for that matter. Quite the opposite -- nasty side effects with no efficacy. I'm thinking of nefazodone too. 5HT2A antagonism. Is the liver stuff preventing you from trying it?
"I would first try intranasal ketamine. It is convenient, inexpensive, and effective. I have seen it work."
Where would you get intranasal ketamine? How is it used?
"I then chose to fight to be constructive in order to nurture this positivism rather than to passively allow my depression to create a mind infected with a malignant perpetual negativism."
I strive for your actively positive thinking and am impressed by it. It shows tremendous strength. Your fight to be constructive has lent caring and intelligence to this board for many years, and I'm sure many are grateful for it, as am I.
Posted by SLS on November 4, 2014, at 23:36:47
In reply to Re: Restarted Abilify - Feeling better. » SLS, posted by phidippus on November 4, 2014, at 13:56:09
> >At no time have I tried taking a 5-HT1a partial agonist in the absence of DA partial agonism, so I can't parse the importance of either mechanism.
> Have you tried augmenting the 5ht1a agonism with another 5ht1a agonist? Pindolol? Buspar?
I haven't tried any of these. I did try Viibryd, though. Regarding Buspar, I am reluctant to try any drug that blocks NE alpha-2 receptors. My depression has been made significantly worse when trying such a drug (idazoxan, mirtazapine, lurazidone). Unfortunately, the metabolite of Buspar, 1-PP, does this. Perhaps 1-PP serves to promote antidepressant effects for most people.
> Are there any other agents that do DA partial agonism?
Cariprazine should be available soon. It is more potent at D3 receptors than is Abilify. It is also a 5-HT1a partial agonist. It also acts to reduce the activity of 5-HT2 receptors. I might try it if I don't continue to improve.
http://en.wikipedia.org/wiki/Cariprazine#Pharmacodynamics
> > I have not tried Brintellix
> What was remarkable about Brintellix was that it started working fairly quickly, most predominately as an anxiolytic, then its antidepressant effects became apparent. I think this may be owed to its 5ht1a full agonism. Unfortunately, Brintellix caused me to cycle and I could not take it anymore.
What was the nature of your cycle? Mania? OCD?
> > nefazodone
> What an odd duck.
I know.
> Wouldn't you be worried about liver toxicity?
Yes, but the incidence of fulminant liver failure is rather low. According to the black-box warning, the incidence of severe liver damage is approximately 1 in every 250,000 to 300,000 patient-years.
> >Luvox
> I can tell you it works wonders for OCD and its been studied in the treatment of psychotic depression (even as monotherapy). Its action on sigma receptors is novel but may owe to its efficacy as an anxiolytic and antidepressant.
I think you are right about this.
> > However, at this juncture, I am not inclined to discontinue Parnate in order to try them.
> What are you running at? 60%? 40%?
I have stabilized at about 40% relative to baseline. That is quite a bit. I am thinking of returning to work if I can maintain this improvement.
> I feel strongly you should be reconsidering the Parnate. Are you afraid switching it out will lead to crushing depression?
Yes. I am pretty sure I would lose most of my current improvement. I would probably be left at 15%. I can barely survive independently at that level.
> > What if they screw up?
> What are you afraid will happen?
Brain damage.
> > The idea is nice, but the reality is less than impressive for depression.
> Don't they adjust the implant while you're awake so you'll know if its working before they close your skull?
Yes, but by that point, the damage might already be done. Before undergoing DBS, I would want to see more established rates of efficacy. I would also want to see a consensus on what brain structures to target. Finally, I would want to see the establishment of case profiles that have the most and least rates of response.
> > I would first try intranasal ketamine. It is convenient, inexpensive, and effective.
> I have spoken with so many people who have tried intranasal ketamine to know its efficacy. It hasn't worked for any of them
That sucks.
> IV Ketamine seems to work very well, however.
Yes. They are able to adjust more precisely the amount of ketamine to administer. This is critical to produce an improvement in depression. There is a rather narrow dosage "sweet spot" or therapeutic window for ketamine treatment.
http://mediasite.video.ufl.edu/Mediasite/Play/4a46e8f9a6f84560aadacc408f77f6b51d
* See the end of the video for Q and A by John Krystal.
I am doubtful that this therapeutic window is taken into consideration with most people when they use intranasal delivery. Titration must be performed painstakingly to optimize a response (dosage x frequency).
> For a list of those clinics, check this out:
>
> http://www.ketamineadvocacynetwork.org/46-2/
>
> The only drawback is the cost-insurance usually doesn't cover it.That's quite a drawback.
> > Optimism?
>
> On a scale of 1 to 10, how would you rate your depression, 1 being the most depressed and 10 being the least depressed?4 (40%)
> > I really can't account for it.
> I think you found some things to live for.
One of the major motivators for me to remain alive is that I know what it is like to live without depression. I hold tightly my memories of remission.
> I am also convinced you are not as depressed as you think you are.
You might be right. However, I think that my illness must be judged as a function of my untreated baseline rather than during a temporary improvement. Professors at university programs and researchers at the NINH, NIH have called my condition "horrendous" and "very sick." My doctor at the NIH called my efforts at remaining alive as being "heroic". This has been vindicating. I am uncomfortable disclosing these things, but they do represent professional and objective impressions.
> What about this neuroscience stuff? You seem to have a knack for it. Why not make a living out of it?
I'd be happy just to be able to make a living selling cars.
> That's what I'm doing ;)
Do it! You've got the smarts for it. I look forward to watching you learn.
:-)
Thanks again.
- Scott
Posted by mogger on November 5, 2014, at 11:12:59
In reply to Restarted Abilify - Feeling better., posted by SLS on October 18, 2014, at 22:13:58
Good to hear you are feeling better Scott. Have you added metformin to help your Abilify weight gain? It has completely stopped my zyprexa weight gain. When do you think cariprazine will be released? Hope you continue to improve and it sounds like you will.
mogger
Posted by SLS on November 5, 2014, at 21:33:43
In reply to Re: Restarted Abilify - Feeling better. » SLS, posted by mogger on November 5, 2014, at 11:12:59
Hi Mogger.
> Good to hear you are feeling better Scott.
Thanks.
:-)
> Have you added metformin to help your Abilify weight gain?
I completely forgot to ask my new GP to let me try it. I am waiting to see my blood test for lipids.
> It has completely stopped my zyprexa weight gain.
That's amazing. There are several clinical studies of metformin that report similar results.
> When do you think cariprazine will be released?
It would have been approved by the FDA by now if they had produced more dosage-finding data. Efficacy is not an issue with cariprazine. Once sufficient dosing data is received, I believe that the drug will be allowed to come to market.
> Hope you continue to improve and it sounds like you will.
I am trying to stay out of my head more and live in the moment. Perhaps making some psychological adjustments will help foster further improvement. It can't hurt.
- Scott
Posted by SLS on November 6, 2014, at 7:36:54
In reply to Re: Restarted Abilify - Feeling better. » SLS, posted by oceansun on November 4, 2014, at 23:03:23
> > "I have not tried Brintellix, nefazodone, or Luvox. However, at this juncture, I am not inclined to discontinue Parnate in order to try them. If I were to see Brintellix produce magic for people, I would consider it. So far, I haven't."
> I haven't seen much luck for Brintellix either. Or Viibryd for that matter. Quite the opposite -- nasty side effects with no efficacy. I'm thinking of nefazodone too. 5HT2A antagonism. Is the liver stuff preventing you from trying it?
> > "I would first try intranasal ketamine. It is convenient, inexpensive, and effective. I have seen it work."
> Where would you get intranasal ketamine? How is it used?
I know of a psychiatrist who works with it. I hope she still does. I haven't made an appointment yet. I want to allow enough time for my current therapeuric response to stabilize in order to assess the maximum degree of improvement and stability my current regime affords me. I see my doctor next Monday. He is aware of ketamine, and is now disposed to let me try it. Until now, it is not something that he feels comfortable doing himself. I should probably make an appointment to see the other doctor anyway in order to get a second opinion.
> > "I then chose to fight to be constructive in order to nurture this positivism rather than to passively allow my depression to create a mind infected with a malignant perpetual negativism."> I strive for your actively positive thinking and am impressed by it. It shows tremendous strength. Your fight to be constructive has lent caring and intelligence to this board for many years, and I'm sure many are grateful for it, as am I.
The decision-making process was rather simple to follow. I used a sort of dichotomous flow-chart. That doesn't mean that it was easy to do.
- Scott
Posted by mogger on November 6, 2014, at 11:17:01
In reply to Re: Restarted Abilify - Feeling better. » SLS, posted by oceansun on November 4, 2014, at 23:03:23
I thought Ketamine was $450 a dose? Where can you get the intranasal cheaply? That is good to hear if it is cheap as that is what I would like to try next.
Posted by phidippus on November 8, 2014, at 5:36:38
In reply to Re: Restarted Abilify - Feeling better. » oceansun, posted by mogger on November 6, 2014, at 11:17:01
You're better off getting Ketamine off the street.
None of the folk I know who have tried the intranasal stuff don't have much to say for its efficacy.
Eric
Posted by phidippus on November 8, 2014, at 5:45:29
In reply to Re: Restarted Abilify - Feeling better. » mogger, posted by SLS on November 5, 2014, at 21:33:43
>I am trying to stay out of my head more and live in the moment.
Good for you, Scott. I'm glad to hear this.
What are you doing to accomplish this?
Eric
Posted by phidippus on November 8, 2014, at 6:17:49
In reply to Re: Restarted Abilify - Feeling better., posted by SLS on November 4, 2014, at 23:36:47
>Pindolol? Buspar?
> I haven't tried any of these. I did try Viibryd, though. Regarding Buspar, I am reluctant to try any drug that blocks NE alpha-2 receptors.You should see then if Pindolol might augment your current regiment. There's definitely data backing its efficacy.
How did Viibryd work out for you?
>Unfortunately, Brintellix caused me to cycle and I could not take it anymore.
>
> What was the nature of your cycle? Mania? OCD?Mania.
> > > However, at this juncture, I am not inclined to discontinue Parnate in order to try them.
And trying them in small doses alongside the Parnate is too dangerous?
>I am thinking of returning to work if I can maintain this improvement.
What do you work as?
> Are you afraid switching it out will lead to crushing depression?
>
> Yes.Have you tried any other MAOIs?
> One of the major motivators for me to remain alive is that I know what it is like to live without depression. I hold tightly my memories of remission.
Do you ever stress yourself out trying to gain rremission, thereby leading to more depression.
>
> > I am also convinced you are not as depressed as you think you are.>I am uncomfortable disclosing these things, but they do represent professional and objective impressions.
I am so very proud of you for having fought so hard and so long to attain sanity. You have an incredible mind and I have all the faith in the world you will win this war in your brain. You have already won so many battles.
> I'd be happy just to be able to make a living selling cars.
You sell yourself short.
What happens when you become manic?
Eric
Posted by SLS on November 11, 2014, at 6:29:52
In reply to Re: Restarted Abilify - Feeling better. » SLS, posted by phidippus on November 8, 2014, at 5:45:29
> >I am trying to stay out of my head more and live in the moment.
>
> Good for you, Scott. I'm glad to hear this.
>
> What are you doing to accomplish this?When I "feel" myself allocating every thought to comparing my dysfunctional depressive state against that which I know would be healthy and functional for me, I try to recognize this bad habit and change my focus of attention on interacting directly with my environment without any filters. These filters served an important purpose when I first realized that my thoughts, and feelings were being dictated by a biological illness that I had been diagnosed of, and that I had no control of. It also vindicated me from my inability to complete school and hold a job. It preserved my self-esteem. It stopped me from committing suicide. However, this filter strategy had become a division of attention and a form of multitasking which depleted my mental energy.
My guess is that my change in focus might be accomplished though a combination of things resembling mindfulness and biofeedback training. I don't know. Of course, my current biological treatment has produced a degree of improvement that allows me to do this.
- Scott
Posted by phidippus on November 11, 2014, at 12:45:18
In reply to Re: Restarted Abilify - Feeling better. » phidippus, posted by SLS on November 11, 2014, at 6:29:52
>I first realized that my thoughts, and feelings were being dictated by a biological illness that I had been diagnosed of, and that I had no control of.
You have more control over your thoughts than you think. Are you familiar with cognitive restructuring?
Cognitive restructuring involves four steps:
1. Identification of problematic cognitions
known as "automatic thoughts" (ATs) which are dysfunctional or negative views of the self, world, or future based upon already existing beliefs about oneself, world, or the future.2. Identification of the cognitive distortions in the ATs
3. Rational disputation of ATs with the Socratic method
4. Development of a rational rebuttal to the ATsThere are six types of automatic thoughts:
1. Self-evaluated thoughts
2. Thoughts about the evaluations of others
3. Evaluative thoughts about the other person with whom they are interacting
4. Thoughts about coping strategies and behavioral plans
5. Thoughts of avoidance6. Any other thoughts that were not categorized
learning to identify and dispute irrational or maladaptive thoughts known as cognitive distortions helps one to control one's thoughts. So you may have an automatic thought that is depressive you immediately should be able to observe and identify the cognitive distortions in that thought and discard it as erroneous.
All-or-nothing thinking (splitting), magical thinking, filtering, over-generalization, magnification, and emotional reasoning are examples of cognitive distortions.
If you've heard all this before, let me know, I just think it pertinent to the statement you make regarding your illness controlling you. Your automatic thoughts and feelings are not reliable.
Eric
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