Posted by med_empowered on October 18, 2005, at 0:22:46
In reply to SSRI + Low Dose Antipyschotic for TRD, posted by CK1 on October 17, 2005, at 22:54:37
hi. "poop-out" doesn't necessarily mean you're bipolar, especially if you've been on SSRIs long-term..poop-out has been observed with most antidepressants, some more than others (paxil is actually a pretty bad one), and it doesnt mean there's a problem with **you**. That said..the SSRI+atypical combo can be extremely helpful. Of all the atypicals (risperdal, geodon, seroquel, zyprexa, abilify, clozapine), I prefer **low-dose** abilify. Its usually non-sedating, especially at low doses, it is more or less weight neutral, and it doesn't seem to cause major metabolic problems (diabetes and such). Some people have a problem with start-up anxiety/akathisia that usually goes away after a bit. I didn't; from day 1, I went from being miserable, depressed, unable to leave my apt. due to anxiety to...happier, more productive, able to leave my house **without fear**. That said..there are some downsides. The dose should be carefully calibrated, because overdoing it with an AP can cause more akathisia, EPS, raise the risk of TD, cause cognitive impairment, and pretty much negate the benefits of the combo. Because of their unique profiles, low-dose atypicals are pretty well tolerated and effective for antidepressant augmentation; at higher doses, though, you lose some of those advantages...when my abilify dose climbed to 15mgs, for example, I began to develop low-level akathisia, I was slowed down mentally, and I generally felt a little too "tranquilized". It wasn't sedation--abilify is non-sedating--it was just that at higher doses, the antipsychotic effects become more pronounced, while at lower doses the mood-stabilizing/lifting properties are more pronounced (especially when used w/ an antidepressant). Also keep in mind that SSRIs tend to boost the blood levels of antipsychotics sooo...you may be taking, say, 5mgs of zyprexa or abilify daily, but the combo is making your blood levels higher, so its actually like youre taking 7.5, 10mgs (I just made those numbers up, but you get the point). Antipsychotics can be added to ANY antidepressant regimine--I got good effects adding mine to a pre-existing Tofranil and Cymbalta combo--so this might be a good time to experiment with an antidepressant outside the realm of SSRIs. You could try Effexor, Cymbalta, Wellbutrin...lots of stuff (many people respond to a Wellbutrin+SSRI combo really well). This way you could get an **amazing** response...its also possible that you could only have to use the atypical for a little while, and then perhaps use it as-needed to maintain repsonse. Anyway, sorry this was soooo long...I wish you the best of luck, and plese keep us all here posted.
poster:med_empowered
thread:568393
URL: http://www.dr-bob.org/babble/20051017/msgs/568412.html