Posted by Irishjean on December 22, 2003, at 23:29:44
Go easy on me, I'm new here :-) I have been searching the web relentlessly trying to get solid info about the meds my husband has been prescribed for his recurrent depression and possible bipolar issues.
I'll put my questions up here for those who want to cut to the chase - the whole long story follows for those who have the time - I welcome any input at all on our situation... Thanks, Jen
Does anyone know if the nausea, akathesia side effects of Abilify truly go away over time? If so, how MUCH time - how long do we struggle before calling it quits? Will a dose change help?
Does anyone else take Prozac and Abilify? How much of a dose adjustment was needed for you? I am wondering if he took 5 mg of Abilify if that would give him the benefits without the side effects.
To add to this - he has seen a neurologist and had all kinds of tests to rule out other causes for the seizure, and we will get those results tomorrow, but they are talking about adding Lamictal to the mix and I'm wondering how that might affect everything.
Does anyone have an opinion on using Wellbutrin after a seizure? He took 400 mg daily before for a year with no problems, and 150 mg daily for 5 weeks with no problem - he wants to go back to it but the pdoc is flat out against it.
And now for the background:Family history of bipolar and anxiety disorders on both sides. Seizure at age 16 from never determined causes (he's now 32). Otherwise normal physical health. 6 years ago, he had a major depressive episode after we were transferred out of state for a promotion in his job. It began with vomiting every morning before work and progressed until he was physically unable to get out of the car and had to resign. At that time, he was very resistant to treatment of any kind but I nagged him into trying therapy (which had been very helpful for me) and he was consequently started on Wellbutrin at 400 mg daily. His mood improved and he stopped therapy but continued the meds for a year. You could say that the bandaid did a good job of covering the wound but did nothing in the way of healing the underlying problem. 4 more years passed, all marked by depressive moods, rage and irritability, paranoia and many many fights. Finally, he succeeded in finding a job that would bring us back home to the East Coast last July.
Within 2 weeks at the new job (Aug 02), he had a complete breakdown again. He began vomiting due to extreme anxiety not only in the morning but at other odd times during the day, stopped sleeping, lost weight and became impossible to be around. He was unable to function in the new job and called in sick until he was asked to resign - about 1 month after he started. I forced him back into therapy with the intention of making him deal with the underlying issues. He was started on Effexor and Remeron which had only moderate effect. He was sleepy all the time and continued to have a very depressed affect.
In Feb of 2003, I had to have surgery (it had been planned for some time). Somehow, during the days before I had to arrive at the hospital, he missed several doses of his effexor and became a raging maniac - he was screaming at me and verbally abusing me while I was in the pre-op area until the nurses threatened to call security. Once we realized that he had skipped his meds and that this was the result of abrupt withdrawl of Effexor - the pdoc decided to wean him off onto just Remeron (which sucked). He was coasting along on Remeron for about 6 months feeling ok (but also not doing any of the things that seem to provoke these meltdowns - like working). He also quit seeing the therapist because he hated talking about himself.
July 03 rolled around and he found another job. After 2 weeks at this job, he had faced down a few anxiety producing events and we thought it was going to be ok, but then the other shoe dropped. He had an emergency appendectomy in the beginning of August and had to miss work for a week. This made him anxious so the pdoc prescribed Xanax .25mg prn. He went back to work and all seemed ok initially but them the anxiety got much worse - to panic attack level- and he became unable to perform at the new job (sales). I forced him back to the same therapist and MD, who then decided he should increase the Xanax to .5mg 5x/day. After 2 weeks of that dosing, my husband was a totally different person and not in a good way. He would take the Xanax when he woke up and feel good for about 1 hour after it kicked in, and then he would have a massive panic attack, worse than the original one. This would go on all day with a cycle of attack, Xanax, attack, Xanax...and so on. I brought him back to the pdoc and told him I was worried sick about this and that his depression was getting much worse. The doc decided to wean him off remeron and start paxil.
The next day, I left with our 5 year old son to go to the grocery store and came back to find a suicide note and an empty bottle of Xanax. The pharmacy had filled 150 0.5 mg tabs 10 days before and it appears as if he took about 75 or more while I was gone for 2 hours. He was unarousable and barely breathing when the ambulance came but was not permamnently harmed by his attempt. He was sent to an inpatient psych hospital where he began intensive therapy and a whole new drug regimen. They started him on Paxil 20 mg, Zyprexa 7.5 mg and Trazadone. He was weaned off Xanax completely and it is the opinion of those doctors that he was totally mismanaged and overmedicated which led to a psychotic break and the suicide attempt. He doesn't remember much, only that he wanted the "noise" in his head to stop and that he was so tired of the anxiety.
This was the first time he complained of noises - he describes them as the sound of his own voice thinking out loud - but apparently he's been having them for years and just thought it was normal. He was dc'd from the hospital after 10 days ready to commit to therapy and whatever it would take to get back on his feet. Needless to say, we did not go back to the original MD or therapist and finding a new one was next to impossible. He lost the job he had gotten in July and has been unemployed since. After about 3 weeks on Paxil, he had terrible akathesia and that was dc'd. He was started on Prozac 40 mg/day and the Zyprexa was increased to 20mg. This helped some but his mood was still very irritable and depressed. after weeks ont he Prozac and a decreased dose of Zyprexa - back down to 15 mg - he was beginning to improve except for one major problem - sexual dysfunction (an idea that can cause depression all by itself). The new pdoc prescribed wellbutrin 150 mg daily in addition to the Prozac and Zyprexa...and it was like magic! The man I married was back after 6 years of agony! Things were going so well that his MD increased the wellbutrin Xl to 300 mg and told him to take (2) 150 mg tabs in the morning. On Thanksgiving, 3 days after the increase, he had a massive grand mal seizure in the kitchen. We are devastated at the setback. As it turns out, it would seem that the combo of the Wellbutrin and Zprexa lowered the seizure threshold enough to provoke the seizure. Now the ONLY med that has made him feel normal is off limits. On top of that, the visit to the MD the day after the seizure revealed a change in his EKG (new since June) and an enlarged thyroid. So now he's depressed, can't have sex AND can't drive. With the Wellbutrin gone and the Zyprexa being weaned off, the pdoc started him on Abilify 15 mg 2 weeks ago. All seemed well for the first week but then he started with the nausea - a queasy feeling that comes aroubnd lunchtime and stays until after dinner. It gets markedly worse if he rides in the car. When I started to research the abilify, I saw that this was not an atypical response and usually went away in time. I also noted that people who take Prozac are supposed to reduce their Abilify dose by 1/2 because of a potentiating effect. I called the pdoc and he decided to cut the dose in half to 7.5 mg. That was going along ok until 2 days ago when he started to become very fidgety and noticeable irritable. He is complaining of all the classic signs of Akathesia and getting very discouraged about ever finding the right med.
Here come the questions:
Does anyone know if the nausea, akathesia side effects truly go away over time? If so, how MUCH time - how long do we struggle before calling it quits?
Does anyone else take Prozac and Abilify? How much of a dose adjustment was needed for you? I am wondering if he took 5 mg of Abilify if that would give him the benefits without the side effects.
To add to this - he has seen a neurologist and had all kinds of tests to rule out other causes for the seizure, and we will get those results tomorrow, but they are talking about adding Lamictal to the mix and I'm wondering how that might affect everything.
Does anyone have an opinion on using Wellbutrin after a seizure? He took 400 mg daily before for a year with no problems, and 150 mg daily for 5 weeks with no problem - he wants to go back to it but the pdoc is flat out against it.
poster:Irishjean
thread:292606
URL: http://www.dr-bob.org/babble/20031219/msgs/292606.html