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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 29. This is the beginning of the thread.
Posted by Maximus on May 29, 2015, at 19:26:43
Hello everybody,
I need some advices and testimonials about Latuda. I have been diagnosed bipolar II a long time ago. I'm now 47 years old.
I'm taking Effexor 300 mg with Lamictal 200 mg. I need a small dose of antipsychotic for insomnia, irritability and anxiety.
- Seroquel. I've been on it for a while but i can't stand the heavy sedation.
- Zyprexa. Great and magic but the weight gain was unbearable.
- Geodon. Made me anxious and angry.
I'm curious about Latuda. Its profile looks very good. I need your experiences. Thanks.
Posted by baseball55 on May 29, 2015, at 20:14:32
In reply to Latuda. Need advices please!, posted by Maximus on May 29, 2015, at 19:26:43
Don't have any experience with latuda, but let us know. I had similar reactions to you - sedation or weight gain with all AAPs, except geodon, which did nothing at all for me (not even the negative sx you mentioned). Would love to hear about an AAP that has that "magic" effect without bloating you up like a balloon.
Posted by Phillipa on May 29, 2015, at 20:24:45
In reply to Re: Latuda. Need advices please!, posted by baseball55 on May 29, 2015, at 20:14:32
I'll stick with benozs 46 years and no weight gain at all.
Posted by Christ_empowered on May 29, 2015, at 22:52:47
In reply to Re: Latuda. Need advices please!, posted by Phillipa on May 29, 2015, at 20:24:45
can you just take a sedative? add in a lil trileptal? Increase the lamictal?
AAP/AP drugs are serious business.
Posted by Horse on May 29, 2015, at 23:18:03
In reply to Latuda. Need advices please!, posted by Maximus on May 29, 2015, at 19:26:43
Hmm. I didn't like Latuda...it did not agree with me! It seemed weight neutral, but I didn't find it helpful for sleep.
Lyrica, gabapentin, tizanadine?
Posted by ihatedrugs1 on May 30, 2015, at 3:16:46
In reply to Re: Latuda. Need advices please! » Maximus, posted by Horse on May 29, 2015, at 23:18:03
Latuda didn't help with sleep nor my (unipolar) hard to treat depression.
Best of luck,
ihatedrugs
Posted by ihatedrugs1 on May 30, 2015, at 3:17:03
In reply to Re: Latuda. Need advices please! » Maximus, posted by Horse on May 29, 2015, at 23:18:03
Latuda didn't help with sleep nor my (unipolar) hard to treat depression.
Best of luck,
ihatedrugs
Posted by SLS on May 30, 2015, at 9:22:16
In reply to Re: Latuda. Need advices please!, posted by ihatedrugs1 on May 30, 2015, at 3:17:03
> Latuda didn't help with sleep nor my (unipolar) hard to treat depression.
>
> Best of luck,
> ihatedrugsDespite having had the promise of producing robust antidepressant effects, I am disappointed with the numbers of people on Psycho-Babble who have responded well to Latuda. It should be noted that its major metabolite is an antagonist at NE alpha-2 receptors - similar to Remeron. I was not surprised that I felt worse on Latuda. Both Remeron and idazoxan (an investigational drug) exacerbate my depression (bipolar). Believe it or not, the major metabolite of Buspar also blocks NE alpha-2 receptors. Perhaps this property accounts for its reputation to act as an augmenting agent to antidepressants. Certainly, 5-HT1a partial agonism has not shown robust antidepressant activity (Viibryd; Brintellix).
Two people here have reacted badly to Saphris with a worsening of depression, including me. However, I have seen it work wonders as an antidepressant in schizoaffective disorder It can have a positive effect on sleep - at least in the beginning. I have not seen it produce weight gain nor sedation beyond the startup period.
- Scott
Posted by Maximus on May 30, 2015, at 23:45:19
In reply to Re: Latuda. Need advices please! » Maximus, posted by Horse on May 29, 2015, at 23:18:03
> Hmm. I didn't like Latuda...it did not agree with me! It seemed weight neutral, but I didn't find it helpful for sleep.
>
> Lyrica, gabapentin, tizanadine?
>Thanks. I tried gabapentin and it wasn't effective. I'll take a look at Lyrica.
Posted by Maximus on May 30, 2015, at 23:48:05
In reply to Re: Latuda. Need advices please! » ihatedrugs1, posted by SLS on May 30, 2015, at 9:22:16
Thanks Scott. I have noted your precious advices.
Posted by Maximus on May 30, 2015, at 23:50:46
In reply to Re: Latuda. Need advices please!, posted by ihatedrugs1 on May 30, 2015, at 3:16:46
> Latuda didn't help with sleep nor my (unipolar) hard to treat depression.
>
> Best of luck,
> ihatedrugs
>Oh i see. But it is helpful to know. Thanks.
Posted by SLS on May 31, 2015, at 4:56:01
In reply to Re: Latuda. Need advices please! » SLS, posted by Maximus on May 30, 2015, at 23:48:05
> Thanks Scott. I have noted your precious advices.
Thanks, Maximus. I have noted your precious affirmation.
:-)
I hope you find your healing soon.
- Scott
Posted by ihatedrugs1 on May 31, 2015, at 20:33:47
In reply to Re: Latuda. Need advices please! » ihatedrugs1, posted by SLS on May 30, 2015, at 9:22:16
> > Latuda didn't help with sleep nor my (unipolar) hard to treat depression.
> >
> > Best of luck,
> > ihatedrugs
>
> Despite having had the promise of producing robust antidepressant effects, I am disappointed with the numbers of people on Psycho-Babble who have responded well to Latuda. It should be noted that its major metabolite is an antagonist at NE alpha-2 receptors - similar to Remeron. I was not surprised that I felt worse on Latuda. Both Remeron and idazoxan (an investigational drug) exacerbate my depression (bipolar). Believe it or not, the major metabolite of Buspar also blocks NE alpha-2 receptors. Perhaps this property accounts for its reputation to act as an augmenting agent to antidepressants. Certainly, 5-HT1a partial agonism has not shown robust antidepressant activity (Viibryd; Brintellix).
>
> Two people here have reacted badly to Saphris with a worsening of depression, including me. However, I have seen it work wonders as an antidepressant in schizoaffective disorder It can have a positive effect on sleep - at least in the beginning. I have not seen it produce weight gain nor sedation beyond the startup period.
>
>
> - Scott
>Interesting. I did respond to Remeron but its weight gain side effects prompted me to quit. This was years ago. I tried Saphris but it didn't work either and gave me severe akathisia. I'm on Abilify 2mg which works for the agony aspect of my depression, but produces restlessness which I try to tolerate. I'm also taking Effexor 150, Wellbutrin 300, Vyvanse 40 mg, and for sleeping Xanax, Gabapentin Trazodone and Ambien. Despite these many meds I still feel blah; no motivation, no interest in things I used to love doing and severe fatigue.
Be well,
ihatedrugs
Posted by SLS on May 31, 2015, at 20:59:08
In reply to Re: Latuda. Need advices please! » SLS, posted by ihatedrugs1 on May 31, 2015, at 20:33:47
I'm sorry that you really feel like crap.
1. Can you tolerate Effexor 300 mg/day?
2. Can you tolerate Remeron 45 mg/day?How about combining them? I'm not sure, but I think the higher dosages of Remeron do not promote weight gain. If you haven't tried this, and you can tolerate higher dosages, you might consider:
1. Increase Effexor to 300 mg/day.
2. Evaluate response after 2 weeks.
3. Continue Wellbutrin 300 mg/day.
4. Introduce Remeron and titrate to a minimum of 45 mg/day (range = 45-90 mg/day).
5. If you respond well to the addition of Remeron, attempt to discontinue Wellbutrin gradually. If you relapse, return to 300 mg/day.I find Focalin (dexmethylphenidate) to be more of an energizer than amphetamines. Of course, this is just one person. I did not respond well to Ritalin (methylphenidate).
It's too bad that Abilify is causing you chronic restlessness.
Have you ever tried Lamictal?
- Scott
Posted by ihatedrugs1 on May 31, 2015, at 22:51:20
In reply to Re: Latuda. Need advices please! » ihatedrugs1, posted by SLS on May 31, 2015, at 20:59:08
> I'm sorry that you really feel like crap.
>
> 1. Can you tolerate Effexor 300 mg/day?
> 2. Can you tolerate Remeron 45 mg/day?
>
> How about combining them? I'm not sure, but I think the higher dosages of Remeron do not promote weight gain. If you haven't tried this, and you can tolerate higher dosages, you might consider:
>
> 1. Increase Effexor to 300 mg/day.
> 2. Evaluate response after 2 weeks.
> 3. Continue Wellbutrin 300 mg/day.
> 4. Introduce Remeron and titrate to a minimum of 45 mg/day (range = 45-90 mg/day).
> 5. If you respond well to the addition of Remeron, attempt to discontinue Wellbutrin gradually. If you relapse, return to 300 mg/day.
>
> I find Focalin (dexmethylphenidate) to be more of an energizer than amphetamines. Of course, this is just one person. I did not respond well to Ritalin (methylphenidate).
>
> It's too bad that Abilify is causing you chronic restlessness.
>
> Have you ever tried Lamictal?
>
>
> - ScottHi Scott,
I do get a lift from Vyvanse but it wears off after 4 hours. I may also take Adderall when Vyvanse wears off, but I do it only when it's absolutely necessary. I did try Concerta, however, it didn't work as well as Vyvanse. I've never tried Focalin but will keep it in mind when I see my pdoc next.A couple of years ago, I tried Remeron again, but it didn't do anything for depression nor help as a sleep aid like it did before.
I began Effexor 4 weeks ago and noticed a slight lift in the first few days, but my depression was already going into full swing and had to ask the doctor to add Abilify as it works fast on the crying and agony aspects of my depression. I would've liked to have taken only Effexor and see if I didn't need the Abilify, but I grew desperate and couldn't wait for Effexor to reach therapeutic levels. If it goes well, I may try to discontinue Abilify and see if Effexor monotherapy is a possibility, though probably not. I'll ask the doctor about increasing Effexor and perhaps stopping the amphetamines. Would be nice if I could.
I took Lamictal for several months up to 200 mg but I felt it made me very angry. So I discontinued it.
Hope you are doing well.
ihatedrugs
Posted by SLS on June 1, 2015, at 9:36:55
In reply to Re: Latuda. Need advices please! » SLS, posted by ihatedrugs1 on May 31, 2015, at 22:51:20
> A couple of years ago, I tried Remeron again, but it didn't do anything for depression nor help as a sleep aid like it did before.
Most doctors are clueless as to the true therapeutic dosage range for Remeron when treating severe depression. In my opinion, 45 mg/day is the minimum. Most doctors stop at 30 mg/day. Dumb. You don't start getting the antidepressant effect that comes from NE alpha-2 blockade at low dosages. Remeron is almost exclusively antihistaminic at dosages less than 45 mg/day. It does block a few serotonin receptors, but hypersomnia and hyperphagia prevail. Interestingly, there is a tendency for both of these effects to wane as the dosage is increased. In other words, although possibly effective for you, Remeron had no chance of working at low dosages.
Has the bipolar spectrum ever been discussed with you as a possible diagnosis?
If you were responsive to treatment at one time, I would not capitulate to pessimism or cynicism just yet. Even when you lose optimism, resilience, and positive energy, try to be constructive rather than ruminating and projecting negative energy. It might help you from finding yourself in dark places.
Don't give up.
I am doing pretty well so far today (all things considered). Thanks for asking :-) I am grateful for a reprieve from the worst of it.
- Scott
Posted by ihatedrugs1 on June 1, 2015, at 13:13:17
In reply to Re: Latuda. Need advices please! » ihatedrugs1, posted by SLS on June 1, 2015, at 9:36:55
> > A couple of years ago, I tried Remeron again, but it didn't do anything for depression nor help as a sleep aid like it did before.
>
> Most doctors are clueless as to the true therapeutic dosage range for Remeron when treating severe depression. In my opinion, 45 mg/day is the minimum. Most doctors stop at 30 mg/day. Dumb. You don't start getting the antidepressant effect that comes from NE alpha-2 blockade at low dosages. Remeron is almost exclusively antihistaminic at dosages less than 45 mg/day. It does block a few serotonin receptors, but hypersomnia and hyperphagia prevail. Interestingly, there is a tendency for both of these effects to wane as the dosage is increased. In other words, although possibly effective for you, Remeron had no chance of working at low dosages.
>
> Has the bipolar spectrum ever been discussed with you as a possible diagnosis?
>
> If you were responsive to treatment at one time, I would not capitulate to pessimism or cynicism just yet. Even when you lose optimism, resilience, and positive energy, try to be constructive rather than ruminating and projecting negative energy. It might help you from finding yourself in dark places.
>
> Don't give up.
>
> I am doing pretty well so far today (all things considered). Thanks for asking :-) I am grateful for a reprieve from the worst of it.
>
>
>
>
> - ScottI have been evaluated for Bipolar spectrum but do not fit the bill. I only get depressed, never manic. I'm wary of Remeron's weight gain side effect, even though it's supposed to be less likely at higher doses. I'm pre-diabetic and need to stay as healthy as I can. The last thing I need is more health problems.
I'm feeling a little better each day; hopefully, it'll continue. However, if things don't improve to my expectations, I will consider discussing adding Remeron at a higher dose with my pdoc or increasing Effexor.
I try to stay positive. It's just hard when I experience no enjoyment at all. I recently came from vacation to Paris and Spain and was unable to enjoy it. I'd observe other people's ease and happiness, including my family's, and it felt so foreign. I had to pretend amusement for my family's sake. That is what gets to me most. I used to find joy in even the smallest of things. Can't wait for that feeling to return.
In the meantime, it's just another waiting game.
I want to thank you for always being so generous with your advice. I think I can speak for everyone in this forum when I say that your insight and contributions are highly regarded and helpful to many of us.
I'm glad you're feeling better.
Well wishes,
ihatedrugs
Posted by SLS on June 1, 2015, at 14:20:31
In reply to Re: Latuda. Need advices please! » SLS, posted by ihatedrugs1 on June 1, 2015, at 13:13:17
> I'm feeling a little better each day; hopefully, it'll continue.
If the trajectory of your illness is towards improvement right now, I don't see the rush in adding another agent. If you plateau or question the rate of improvement, the easy answer is to increase the Effexor if you can tolerate it. Raise the dosage gradually if you need to. Very few people with your level of depression respond to 150 mg/day. 300 mg/day is more common. The drug company now recognizes the maximum effective dosage as being 375 mg/day. This is quite a bit more than the original 225 mg once suggested.
As you say, it can be a waiting game. I experienced only one long-term remission from depression. I was 27 years old, and managed to squeeze in 6 months of euthymia before the drug treatment triggered a severe mania. The drugs were withdrawn, and, unfortunately, never restarted once I relapsed into depression. It is important to know, though, that the process of improvement of depression took months, not weeks. I was patient, though, because the trend was clearly towards improvement. With many of these antidepressant drug treatments, it is not the acute effect of the drug on the brain that actualizes the improvement. Otherwise, an improvement would be instantaneous. It is the changes that the brain makes to itself in response to being challenged by exposure to these drugs that produces the improvement.
It is excruciatingly hard to be patient when you are in so much pain. It is like having your hand being held over a flame. Your natural reaction is to do anything you can to pull your hand out immediately. Change dosages, change drugs, change diagnoses, change doctors, change to herbs or dietary supplements, change to magnetic or electrical stimulation, change spiritual beliefs, change jobs, etc. Anything! Just make it stop!
For me, I find it difficult to keep my hands out of the cookie jar. If a low dose of drug works a little, then a large dose ought to work a lot. Obviously, this is a mistake in thinking. What about time? If a little time works a little, then more time ought to work a lot. This, too, can be a mistake in thinking. The reality seen in each type of treatment will differ in the balance between dosage and time. This is why a doctor's education and clinical experience is so valuable. Still, there is a very real need to make educated guesses and experiment using trial-and-error. Unfortunately, that's about the best that the average psychiatrist can do when so little is known about the illnesses and mode of action of successful treatments. The future holds the promise of more precision in diagnosis and making treatment decisions.
- Scott
Posted by ihatedrugs1 on June 3, 2015, at 12:29:30
In reply to Re: Latuda. Need advices please! » ihatedrugs1, posted by SLS on June 1, 2015, at 14:20:31
I'm beginning to feel somewhat better. It's been around five weeks on Effexor so hopefully I'll see a further boost in mood in the weeks to come (fingers crossed). I really want to ditch Abilify. It makes me so shaky, I can't barely hold a glass of water, and I'm so afraid of developing a permanent movement disorder, even though I know the odds are low. Once I'm more stable, I'll discuss with my pdoc stopping it and see how I fare.
At least, for the moment, tomorrow is not looking so bleak.Take care,
ihatedrugs
Posted by Horse on June 3, 2015, at 18:58:35
In reply to Re: Latuda. Need advices please! » SLS, posted by ihatedrugs1 on June 3, 2015, at 12:29:30
I'm glad you're moving toward improvement. I have been on pleasureless vacations before. Anyways, I've been having good luck with Daytrana, a transdermal methylphenidate. Gentler and lasts all day. I have cfs/fibro something, so fatigue is related to my depression. I'm doing ok right now...responding to Lexapro. I recall you were on that a while. Wish you well...Beckett x
Posted by ihatedrugs1 on June 4, 2015, at 15:07:44
In reply to Re: Latuda. Need advices please! » ihatedrugs1, posted by Horse on June 3, 2015, at 18:58:35
> I'm glad you're moving toward improvement. I have been on pleasureless vacations before. Anyways, I've been having good luck with Daytrana, a transdermal methylphenidate. Gentler and lasts all day. I have cfs/fibro something, so fatigue is related to my depression. I'm doing ok right now...responding to Lexapro. I recall you were on that a while. Wish you well...Beckett x
Hi Beckett,
I was on Lexapro for several years and was effective, but it stopped working. I tried Concerta, but it didn't help with my fatigue. Wonder if Daytrana would work differently. For now, I'm sticking with Vyvanse for the time being despite it not lasting all day. At least, it gives me four hours to get through the day. I'm giving my cocktail (Effexor, Abilify, Wellbutrin, Vyvanse) time since I've only been on Effexor for about four weeks.I hate to be so overmedicated. It just complicates things more. I never know what med is causing what. I just came from my doctor and my cholesterol is a whooping 365 (total) and my sugar levels are in pre-diabetes range. I barely eat and don't lose weight. And to add to the mix, I've fainted about four times in the last year. I think it's the Abilify but not sure. I have an appt with a neurologist to rule some things out.
I was also diagnosed with Fibromyalgia so the fatigue may be explained by that. However, I know many people with Fibro who do not have as much of a problem with fatigue as I do (even my 86 years old mother in law can run circles around me). This all began three years ago, aside from depression, I used to be healthy and slimmer. Since starting med cocktails, all has changed.Glad you are doing well,
ihatedrugs
Posted by Horse on June 4, 2015, at 22:37:36
In reply to Re: Latuda. Need advices please! » Horse, posted by ihatedrugs1 on June 4, 2015, at 15:07:44
I've been prediabetic for a few years even though weight isn't an issue. Today my shrink of all people suggested metaforim (sp?). I'll ask my gp about that. I think my depression is very much tied to fatigue...unfortunately. Very glad to talk with you again...you have my continued support.
(Apologies for hijacking this thread.)
Posted by ihatedrugs1 on June 5, 2015, at 16:15:43
In reply to Re: Latuda. Need advices please!, posted by Horse on June 4, 2015, at 22:37:36
Posted by Lamdage22 on June 8, 2015, at 13:12:46
In reply to Re: Latuda. Need advices please! » SLS, posted by ihatedrugs1 on May 31, 2015, at 20:33:47
I'm on Abilify 2mg which works for the agony aspect of my depression, but produces restlessness which I try to tolerate.
Could become permanent. Just saying.
I'm also taking Effexor 150, Wellbutrin 300, Vyvanse 40 mg, and for sleeping Xanax, Gabapentin Trazodone and Ambien. Despite these many meds I still feel blah; no motivation, no interest in things I used to love doing and severe fatigue.
Despite?
For somebody who hates drugs, you sure take alot of them.
Posted by SLS on June 8, 2015, at 14:22:19
In reply to Re: Latuda. Need advices please!, posted by Lamdage22 on June 8, 2015, at 13:12:46
> I'm on Abilify 2mg which works for the agony aspect of my depression, but produces restlessness which I try to tolerate.
>
> Could become permanent. Just saying.
>
> I'm also taking Effexor 150, Wellbutrin 300, Vyvanse 40 mg, and for sleeping Xanax, Gabapentin Trazodone and Ambien. Despite these many meds I still feel blah; no motivation, no interest in things I used to love doing and severe fatigue.
>
> Despite?
>
> For somebody who hates drugs, you sure take alot of them.
Sometimes there is no better choice available but to take everything you need to in order to get even a partial response - as you well know. I think many of us have a love/hate relationship with drugs. They kinda suck, but I'm glad they exist.Just a few comments:
What is the reason why you don't take 300 mg/day of Effexor? The Wellbutrin makes a good addition to the Effexor, but I wonder if it isn't aggravating your sense of restlessness when combined with Abilify. If you are bipolar, I am not sure that you will get the most from Abililfy unless you take 10 mg/day. If you have a true anxiety disorder, you might substitute Effexor for Paxil. Actually, you can't truly evaluate anything about Effexor until you raise the dosage. Effexor is also good for anxiety disorders. Did you have trouble sleeping before adding Wellbutrin and Vyvanse? If both anxiety disorders and insomnia predominate, you might want to explore the idea of taking Klonopin. You might be able to get rid of the some of the other sleeping medication you take. Trazodone can be fatiguing. Klonopin has its problems, though. It can cause depression in some people and can be difficult to discontinue. However, discontinuation might not be an issue if the stuff works. If Klonopin helps with anxiety and/or akathisia, you can take it throughout the day and add Ativan at bedtime. This combination worked well for me.
For bipolar depression, Abilify and Lamictal often work well together. Lamictal can actually be energizing.
- Scott
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