Psycho-Babble Medication Thread 1098631

Shown: posts 39 to 63 of 78. Go back in thread:

 

Re: Switching from Abililfy to Saphris. » ed_uk2010

Posted by SLS on June 6, 2018, at 8:32:28

In reply to Re: Switching from Abililfy to Saphris. » SLS, posted by ed_uk2010 on June 6, 2018, at 0:45:00

> Hi Scott,
>
> That is a fast withdrawal! But if you allow yourself flexibility it should be ok.
>
> I can see why you would be keen to start something new, so it makes sense.
>
> Hope it works out well. Let me know.

Thanks, Ed.

:-)


- Scott

 

Re: Switching from Abililfy to Saphris.

Posted by Lamdage22 on June 25, 2018, at 10:27:06

In reply to Re: Switching from Abililfy to Saphris. » ed_uk2010, posted by SLS on June 6, 2018, at 8:32:28

Hey Scott,

how you doing? You are brave. Are you fully withdrawn from Neuroleptics? Just watch out before you get another destructive Mania/Psychosis phase. I think you have lost enough relationships to Psychosis. Me too :(

Keep us posted.

 

Re: Switching from Abililfy to Saphris. » Lamdage22

Posted by SLS on June 25, 2018, at 13:02:46

In reply to Re: Switching from Abililfy to Saphris., posted by Lamdage22 on June 25, 2018, at 10:27:06

Hi Lamdage.

> Hey Scott,
>
> how you doing? You are brave.

:-)

> Are you fully withdrawn from Neuroleptics?

Yes.

> Just watch out before you get another destructive Mania/Psychosis phase.

That's great advice. Thank you. I'll try to be careful. I am relying on family members to recognize the emergence of mania. They know what to look for. I can only hope that I am receptive to their advice. So far, the only manic episodes I've had have been in association with MAOIs. It is likely that Abilify acted as a prophylactic against manic reactions to both Nardil and Parnate. Latuda maybe?

I have mostly recovered from withdrawal effects for having discontinued Abilify and Parnate. I didn't expect that I would be hit so hard. There is some residual anxiety, but the depression has stabilized. I am on day 4 of Trintellix treatment. I'm taking 5.0 mg/day. I felt numb and slowed-down initially, but that seems to be subsiding.

I needed to do something. I was stuck for too many years.

Thanks again.


- Scott

 

Re: Switching from Abililfy to Saphris. » SLS

Posted by Robert_Burton_1621 on July 2, 2018, at 4:42:08

In reply to Re: Switching from Abililfy to Saphris. » Lamdage22, posted by SLS on June 25, 2018, at 13:02:46

I do hope the substitution of vortioxetine for parnate does the trick, Scott.

I tried vortioxetine between stopping parnate and then resuming it, unsuccessfully - the main effects were agitation and hyper-sexuality. However, my psychiatrist at the time, a specialist in TRD, had done his own study of the drug with 100 of his own TRD patients, and overall it was successful.

At one point I had looked into the properties of the drug, and it seemed to be rather similar to Abilify *without* the dopamine antagonism. That was only my initial impression.

 

Re: Switching from Abililfy to Saphris. » Robert_Burton_1621

Posted by SLS on July 2, 2018, at 8:26:56

In reply to Re: Switching from Abililfy to Saphris. » SLS, posted by Robert_Burton_1621 on July 2, 2018, at 4:42:08

Hi, Robert.

> I do hope the substitution of vortioxetine for parnate does the trick, Scott.
>
> I tried vortioxetine between stopping parnate and then resuming it, unsuccessfully - the main effects were agitation and hyper-sexuality. However, my psychiatrist at the time, a specialist in TRD, had done his own study of the drug with 100 of his own TRD patients, and overall it was successful.
>
> At one point I had looked into the properties of the drug, and it seemed to be rather similar to Abilify *without* the dopamine antagonism. That was only my initial impression.

Thanks for the information, Robert. It helps to give me hope. I am on day 10 of treatment. I don't know what to think. I have some background anxiety, which isn't normal for me. Maybe this is how I experience the agitation you describe. Yesterday was not a good day, but not the worst. I will continue at 10 mg/day for two weeks until I see my doctor.

What dosage of vortioxetine did you try? How long did you take it for?


- Scott

 

Re: Switching from Abililfy to Saphris. » SLS

Posted by ed_uk2010 on July 2, 2018, at 14:39:09

In reply to Re: Switching from Abililfy to Saphris. » Robert_Burton_1621, posted by SLS on July 2, 2018, at 8:26:56

> I have some background anxiety, which isn't normal for me. Maybe this is how I experience the agitation you describe.

Might it help to have a small dose of a benzodiazepine for a couple of weeks until you get used to the vortioxetine? Eg. lorazepam 0.5mg twice a day.

 

Re: Switching from Abililfy to Saphris. » ed_uk2010

Posted by SLS on July 2, 2018, at 17:16:00

In reply to Re: Switching from Abililfy to Saphris. » SLS, posted by ed_uk2010 on July 2, 2018, at 14:39:09

> > I have some background anxiety, which isn't normal for me. Maybe this is how I experience the agitation you describe.
>
> Might it help to have a small dose of a benzodiazepine for a couple of weeks until you get used to the vortioxetine? Eg. lorazepam 0.5mg twice a day.

Great idea.

I have been taking lorazepam 1.0 mg 2-3 times a day. It helps, but I am reluctant to depend on it. I probably worry too much about that.


- Scott

 

Re: Switching from Abililfy to Saphris. » SLS

Posted by ed_uk2010 on July 3, 2018, at 16:03:05

In reply to Re: Switching from Abililfy to Saphris. » ed_uk2010, posted by SLS on July 2, 2018, at 17:16:00

>I have been taking lorazepam 1.0 mg 2-3 times a day. It helps, but I am reluctant to depend on it. I probably worry too much about that.

I was just thinking of before. You were able to stop it quite easily via careful reduction based on symptoms, right? Just taking a little bit if symptoms occurred.

 

Re: Switching from Abililfy to Saphris.

Posted by Robert_Burton_1621 on July 11, 2018, at 4:40:22

In reply to Re: Switching from Abililfy to Saphris. » Robert_Burton_1621, posted by SLS on July 2, 2018, at 8:26:56

Scott, I went from 10 to 20 mg quite quickly (over a week), and stayed on 20mg for a month. But, for me, there was no improvement. The side-effects were disturbing: particularly the hyper-sexuality. But it was not pleasurbale. It was an *agitated* hyper-activity.

I ceased the vortioxetine and resumed parnate.

How are you going now?

 

Re: Switching from Abililfy to Saphris. » Robert_Burton_1621

Posted by SLS on July 11, 2018, at 10:11:22

In reply to Re: Switching from Abililfy to Saphris., posted by Robert_Burton_1621 on July 11, 2018, at 4:40:22

> Scott, I went from 10 to 20 mg quite quickly (over a week), and stayed on 20mg for a month. But, for me, there was no improvement. The side-effects were disturbing: particularly the hyper-sexuality. But it was not pleasurbale. It was an *agitated* hyper-activity.

That sounds unpleasant.

> I ceased the vortioxetine and resumed parnate.

Vortioxetine has a 66 hour half-life. How long are you waiting before resuming Parnate? Serotonin syndrome is a concern. I hope everything goes well for you.

> How are you going now?

It has been over a week since I discontinued vortioxetine, and I am still experiencing some residual adverse effects. They include brain-fog, cognitive slowing, and anxiety. They are improving gradually, though. I began taking Effexor two days ago. I am titrating up to 300 mg/day. Fingers crossed.


- Scott

 

Re: Switching from Abililfy to Saphris. » SLS

Posted by ed_uk2010 on July 11, 2018, at 14:01:33

In reply to Re: Switching from Abililfy to Saphris. » Robert_Burton_1621, posted by SLS on July 11, 2018, at 10:11:22

I forgot you had to stop vortioxetine already.

Will you increase venlafaxine quickly? It seems that very high doses can cause a lot of fatigue for some users, so perhaps it is best not to aim for a really high dose initially.

 

Re: Switching from Abililfy to Saphris. » ed_uk2010

Posted by SLS on July 12, 2018, at 9:16:56

In reply to Re: Switching from Abililfy to Saphris. » SLS, posted by ed_uk2010 on July 11, 2018, at 14:01:33

> I forgot you had to stop vortioxetine already.
>
> Will you increase venlafaxine quickly? It seems that very high doses can cause a lot of fatigue for some users, so perhaps it is best not to aim for a really high dose initially.

Thanks, Ed.

I started at 75 mg/day. I'm now up to 150 mg/day. I'm still experiencing some anxiety, although it is dissipating gradually. I took 0.5 mg of Ativan this morning.

Depression is not as bad as it was last week. I am grateful for that.


- Scott

 

Re: Switching from Abililfy to Saphris. » SLS

Posted by ed_uk2010 on July 12, 2018, at 13:12:41

In reply to Re: Switching from Abililfy to Saphris. » ed_uk2010, posted by SLS on July 12, 2018, at 9:16:56

I wonder whether the dose-response relationship of Effexor is quite flat when on an NRI-type TCA such as nortriptyline?

I was wondering whether you should avoid going above 225mg or so initially, just in case it's counter-productive. Maybe give it a few weeks before pushing too high?

I think the anxiety will improve a lot over the next few days since it seems so clearly related to vortioxetine. Hope lorazepam is helping.

 

Re: Switching from Abililfy to Saphris. » ed_uk2010

Posted by SLS on July 12, 2018, at 14:40:31

In reply to Re: Switching from Abililfy to Saphris. » SLS, posted by ed_uk2010 on July 12, 2018, at 13:12:41

> I wonder whether the dose-response relationship of Effexor is quite flat when on an NRI-type TCA such as nortriptyline?
>
> I was wondering whether you should avoid going above 225mg or so initially, just in case it's counter-productive. Maybe give it a few weeks before pushing too high?
>
> I think the anxiety will improve a lot over the next few days since it seems so clearly related to vortioxetine. Hope lorazepam is helping.

I think you are right about the anxiety. My doctor agrees with you. I'm guessing that the Effexor has made it worse temporarily. There is a trill in my voice and my hands are shaky.

Thanks for your contributions here on Psycho-Babble.


- Scott

 

Re: Switching from Abililfy to Saphris. » SLS

Posted by ed_uk2010 on July 14, 2018, at 7:18:55

In reply to Re: Switching from Abililfy to Saphris. » ed_uk2010, posted by SLS on July 12, 2018, at 14:40:31

>I'm guessing that the Effexor has made it worse temporarily. There is a trill in my voice and my hands are shaky.

I think that could easily happen if you increase Effexor too rapidly. I do think the anxiety would respond to lorazepam or diazepam though.

I do believe venlafaxine is a good antidepressant, although hardly first-line with the high incidence of withdrawal symtoms and initial nausea etc. Although higher dose are more effective for a subset, I must admit I'm unconvinced by the usefulness of ultra high doses vs licensed doses - especially since the approved maximum dose is already very high. Increasing beyond the approved dosage range often seems to cause more fatigue rather than more efficacy. I think it's probably more useful to wait longer (on 75mg/day in moderate depression and 150-225mg in severe depression), rather than ramping it up to 300-375mg too fast. I think people usually have fewer adverse effects and comparable response by doing this. Less initial agitation, nausea, tiredness etc.

Oh, and you may find this interesting. Perhaps it is why duloxetine isn't a very good antidepressant compared to venlafaxine!

https://www.ncbi.nlm.nih.gov/pubmed/26437230

 

Re: Switching from Abililfy to Saphris.

Posted by SLS on July 14, 2018, at 11:54:42

In reply to Re: Switching from Abililfy to Saphris. » SLS, posted by ed_uk2010 on July 14, 2018, at 7:18:55

> >I'm guessing that the Effexor has made it worse temporarily. There is a trill in my voice and my hands are shaky.
>
> I think that could easily happen if you increase Effexor too rapidly. I do think the anxiety would respond to lorazepam or diazepam though.
>
> I do believe venlafaxine is a good antidepressant, although hardly first-line with the high incidence of withdrawal symtoms and initial nausea etc. Although higher dose are more effective for a subset, I must admit I'm unconvinced by the usefulness of ultra high doses vs licensed doses - especially since the approved maximum dose is already very high. Increasing beyond the approved dosage range often seems to cause more fatigue rather than more efficacy. I think it's probably more useful to wait longer (on 75mg/day in moderate depression and 150-225mg in severe depression), rather than ramping it up to 300-375mg too fast. I think people usually have fewer adverse effects and comparable response by doing this. Less initial agitation, nausea, tiredness etc.
>
> Oh, and you may find this interesting. Perhaps it is why duloxetine isn't a very good antidepressant compared to venlafaxine!
>
> https://www.ncbi.nlm.nih.gov/pubmed/26437230

Interesting. Thanks, Ed.


- Scott

 

Re: Switching from Abililfy to Saphris. » SLS

Posted by Robert_Burton_1621 on July 15, 2018, at 0:05:30

In reply to Re: Switching from Abililfy to Saphris., posted by SLS on July 14, 2018, at 11:54:42

> > >I'm guessing that the Effexor has made it worse temporarily. There is a trill in my voice and my hands are shaky.
> >
> > I think that could easily happen if you increase Effexor too rapidly. I do think the anxiety would respond to lorazepam or diazepam though.
> >
> > I do believe venlafaxine is a good antidepressant, although hardly first-line with the high incidence of withdrawal symtoms and initial nausea etc. Although higher dose are more effective for a subset, I must admit I'm unconvinced by the usefulness of ultra high doses vs licensed doses - especially since the approved maximum dose is already very high. Increasing beyond the approved dosage range often seems to cause more fatigue rather than more efficacy. I think it's probably more useful to wait longer (on 75mg/day in moderate depression and 150-225mg in severe depression), rather than ramping it up to 300-375mg too fast. I think people usually have fewer adverse effects and comparable response by doing this. Less initial agitation, nausea, tiredness etc.
> >
> > Oh, and you may find this interesting. Perhaps it is why duloxetine isn't a very good antidepressant compared to venlafaxine!
> >
> > https://www.ncbi.nlm.nih.gov/pubmed/26437230
>
> Interesting. Thanks, Ed.
>
>
> - Scott

As it happens, Scott, I can myself confirm the efficacy of Ed's suggestion. When on effexor some years ago, I found no extra benefit in increasing beyond 75mg - 150mg. My psychiatrist (not well-versed in psychopharmacology: when effexor pooped-out, he advised there were no further strategies for me! MAOIs far too dangerous, etc. etc.) advised, however, to keep pushing. I was on over 375mg and developed restless leg syndrome and agitation as a result. I had an excellent response to the lower doses for eight weeks(when the supposed NRI action had not kicked-in). But it pooped-out. This has been my experience with any SRI which worked: quite rapid improvement (very noticeable just a few days after first dose), but inevitable poop-out.

I suppose you'd already be familiar with the strategey of adding mirtazapine to effexor. I tried this without any benefit at all. M is pretty much just an extremely powerful H1 antagonist.

All the best. Sorry to hear the vortioxetine didn't agree with you (my experience was just the same).

R

 

Re: Switching from Abililfy to Saphris. » Robert_Burton_1621

Posted by SLS on July 15, 2018, at 8:20:48

In reply to Re: Switching from Abililfy to Saphris. » SLS, posted by Robert_Burton_1621 on July 15, 2018, at 0:05:30

Hi R_B


> As it happens, Scott, I can myself confirm the efficacy of Ed's suggestion. When on effexor some years ago, I found no extra benefit in increasing beyond 75mg - 150mg. My psychiatrist (not well-versed in psychopharmacology: when effexor pooped-out, he advised there were no further strategies for me! MAOIs far too dangerous, etc. etc.) advised, however, to keep pushing. I was on over 375mg and developed restless leg syndrome and agitation as a result. I had an excellent response to the lower doses for eight weeks(when the supposed NRI action had not kicked-in). But it pooped-out. This has been my experience with any SRI which worked: quite rapid improvement (very noticeable just a few days after first dose), but inevitable poop-out.
>
> I suppose you'd already be familiar with the strategey of adding mirtazapine to effexor. I tried this without any benefit at all. M is pretty much just an extremely powerful H1 antagonist.
>
> All the best. Sorry to hear the vortioxetine didn't agree with you (my experience was just the same).


Thanks for your input. I will try remaining between 75-150 mg/day of Effexor. I began to experience what I can only guess is a form of serotonin syndrome when going up to 150 mg/day after only two days at 75 mg/day. That was silly of me. I became mentally altered. I felt dissociated and detached from my environment. Lots of bruxism. I skipped my dose of Effexor today. I take it in the morning.


- Scott

 

Re: Switching from Abililfy to Saphris.

Posted by Lamdage22 on July 15, 2018, at 23:55:42

In reply to Re: Switching from Abililfy to Saphris. » Robert_Burton_1621, posted by SLS on July 15, 2018, at 8:20:48

Effexor seems to make more sense in the way that you may not need an antipsychotic with it to protect you from mania/psychosis like you would with Parnate. That will help your weight and metabolism.

Have you taken Effexor before?

 

Re: Switching from Abililfy to Saphris. » SLS

Posted by ed_uk2010 on July 18, 2018, at 13:59:56

In reply to Re: Switching from Abililfy to Saphris. » Robert_Burton_1621, posted by SLS on July 15, 2018, at 8:20:48

Hi Scott,

How are you doing? Were you able to restart venlafaxine OK?

 

Re: Switching from Abililfy to Saphris. » ed_uk2010

Posted by SLS on July 18, 2018, at 14:24:59

In reply to Re: Switching from Abililfy to Saphris. » SLS, posted by ed_uk2010 on July 18, 2018, at 13:59:56

> Hi Scott,
>
> How are you doing? Were you able to restart venlafaxine OK?

I'm an idiot. I had 150 mg capsules to work with. On day 1, I took 75 mg using one capsule and dumping out half of its contents. On day 2, I began to take 150 mg/day. I was okay for a few days, but began to feel strange and detached. I didn't expect this. I also experienced bruxism. Perhaps it was a hyperserotonergic state. I skipped two days. I felt very weird and began to deteriorate. Lots of anxietey. I felt like I was hit over the head with a baseball bat and was left dazed and confused. I took a small amount of Effexor, and my head began to clear. What a mess. My poor brain. I will see my doctor tomorrow.


- Scott

 

Re: Switching from Abililfy to Saphris. » SLS

Posted by ed_uk2010 on July 21, 2018, at 15:38:01

In reply to Re: Switching from Abililfy to Saphris. » ed_uk2010, posted by SLS on July 18, 2018, at 14:24:59

Hi Scott,

Have you been able to tolerate a small amount of Effexor now?

 

Re: Switching from Abililfy to Saphris. » ed_uk2010

Posted by SLS on July 21, 2018, at 16:34:56

In reply to Re: Switching from Abililfy to Saphris. » SLS, posted by ed_uk2010 on July 21, 2018, at 15:38:01

Hi, Ed.

> Have you been able to tolerate a small amount of Effexor now?

No. I skipped dosing yesterday morning. My head cleared by evening. The more severe depression reappeared this morning. I took a small amount of Effexor earlier. I had to open a 150 mg capsule and estimate. I am guessing that I took 30-40 mg. The depression lessened, but that weird zombie state emerged again. My head is beginning to clear now. I don't know what to think. I am concerned.


- Scott

 

Re: Switching from Abililfy to Saphris. » SLS

Posted by ed_uk2010 on July 22, 2018, at 5:22:46

In reply to Re: Switching from Abililfy to Saphris. » ed_uk2010, posted by SLS on July 21, 2018, at 16:34:56

Hi,

How long is it since you stopped Parnate? And how long since vortioxetine? It sounds like you're extremely sensitive to Effexor due to the residual effects of other medication taken recently. Also, using the 150mg XR capsules is creating rather haphazard dosages with a prolonged effect, which might not be ideal during this time of hypersensitivity.

How about asking your psych for some plain/non XR venlafaxine 37.5mg tablets? The effects should wear off rapidly if there is a problem. You could take half a tablet (approx 18.75mg) in the morning for a while, and then increase to half a tablet twice a day as tolerated. If things are OK you could then return to Effexor XR. Do you think your doctor would go for that?

On the bright side, being hypersensitive to venlafaxine at least means it is doing something.


 

Re: Switching from Abililfy to Saphris.

Posted by Lamdage22 on July 22, 2018, at 9:03:28

In reply to Re: Switching from Abililfy to Saphris. » SLS, posted by ed_uk2010 on July 22, 2018, at 5:22:46

I hope you can maneuver your way out of this.


Go forward in thread:


Show another thread

URL of post in thread:


Psycho-Babble Medication | Extras | FAQ


[dr. bob] 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.