Posted by phidippus on October 1, 2013, at 15:40:33
In reply to Re: Augmenting Bipolar 'Cocktail' with Trodenki XR, posted by LouisianaSportsman on October 1, 2013, at 12:50:27
Hey,
>Pristiq was added to help out my "lows", but maybe more Lamictal will make the Pristiq useless.
I've been on Pristiq at a 100mg dose and all it did was trigger mania. What you want is an antidepressant that has little risk of 'switching' like Reboxetine or Wellbutrin (did it cause you anxiety?)
> WEIGHT-LOSS!! Abilify is causing severe weight loss.
Sometimes using Topomax to offset the weight gain of another drug is not the best strategy. The involvement of lowered blood glucose level, which may stimulate eating through an effect on the hypothalamus, constitutes one of the possible mechanisms. Lowered blood glucose levels may result from a competition between the binding of the drug and long chain fatty acids. An increased availability of the latter stimulates insulin production and lowers the serum glucose levels. Another possible explanation for lowered blood glucose may be a deficiency in carnitine directly caused by the drug, that would result in a reduction of fatty acid metabolism and an increase in glucose consumption. An enhancing effect of gamma-aminobutyric acid-mediated neurotransmission may increase appetite for carbohydrates and reduce energy expenditure.
It would be better to replace the drug causing the weight gain.
> I disagree. I really want a medication to help with the weight-loss, but I might decide to forgo topiramate if I decide to get Vyvanse.
There is no miracle pill for weight loss.
> Yes, but didn't you see me wanting to lose weight?
Yes, I get that. I just don't think adding another chemical to your regime is going to benefit you. I would remove the offending agent, namely the abilify. Try Latuda instead.
> I am definitely going on Pristiq 100mg.
Have you tried Mirtazapine or (there's a new one I can't remember the name-starts with a B)? Antidepressants I've used with no 'switching'-Clomipramine, Mirtazapine, Viibryd and Luvox.
> I understand that; however, I do want the NE action as possibly treating my symptoms better.
I recommend Reboxetine.
>I think I will be fine with a stimulant medication in conjunction with my Abilify.
I think you will be too. I've been on all the atypicals and none have impeded my ADHD medications, except for Seroquel.
> I believe it increases histamine, oxerin, and dopamine to some extent, but you're right-- it's still a mystery.Oxerin is the main neurotransmitter affected by by Nuvigil.
> So it is good to increase it since it does improve my mood? I notice you suggest 20. What about 15?I would go for the %100 increase, although 15 mg isn't a bad target dose either. Remember, Abilify is a dopamine partial agonist AND a 5ht1a agonist, both actions help to treat depression.
> It is not, but it does help with my fatigue. And, it has helped my stay awake in class.
Working as well as it should. Have you heard of Xyrem?
>I actually prefer to Concerta for ADHD. I swear.
I believe you!
> I need the anxiety relief and weight loss which is why I still think the topiramate is beneficial
I'm sure it will help with your anxiety.
>, and I may stay with Nuvigil for my ADHD since it sincerely helps with that.
Vyvanse and Nuvigil is a good one-two punch.
> I was also hoping for cognitive benefits as well?
Memantine can provide some cognitive boosting, but if you really want improve your thinking, I would have to recommend Keppra-studies show it enhances cognitive function. In fact, you could take it instead of Topomax-it has more data supporting its use as a mood stabilizer than does Topomax.
> Augment with Riluzole. This is the exact sort of medication advice I was thinking of! What dosage?100 mg, up to 200 mg a day.
> I still want to augment with topiramate for weight-loss and anxiety relief...since I'm already taking Lamictal, and I want it to be an add-on.
Good way to look at it.
> Therefore, in conclusion, I'm aiming for:
>
> Abilify (aripiprazole)20mg.Trade for Latuda to reduce weight gain issues.
> Nuvigil (armodafinil) 300mg.(150mg.x 2)
Will work best as augmentation to Vyvanse.
> Vyvanse (lisdextroamphetamine) 60mg.
Might as well just do 70 mg
> Lamictal (lamotrigine) 400mg.
Perfect.
> Neurontin (gabapentin) 1,800mg. [400mg. QID]
I would exchange this for Lyrica-it will provide better mood stabilization and stronger relief from anxiety.
> Pristiq (desvenlafaxine) 100mg.Doesn't seem to be that effective for you.
> Bupropion XL 450mg. (522mg. Aplenzin)
Will help with sexual side effects of Pristiq. Good antidepressant for bipolar folk.
> Trodenki XL 200mg.
300 mg.
> Mirapex ER 2mg.
Be careful with compulsive behaviors! Really don't need it if you're taking Wellbutrin.
> Memantine 20mg.
eh,why not?
> Riluzole 150mg.
Up to 200 mg.
>Which should I add first?
Well, up your Lamictal first. Then add Topamax. Then add back the Wellbutrin. Vyvanse, Wellbutrin and nuvigil can all be added at the same time...
>I really want the topiramate for weight loss and anxiety.
Very realistic expectations.
>
> What do you think, Eric, about mirtazapine with the Pristiq? It's nicknamed "California Rocket Fuel". >>Another question I have for you-- in the past when I took Wellbutrin (Aplenzin) alone, I needed a secondary antidepressant to help with my constant lows.
Its not unusual to experience lows when taking antidepressants as bipolar person-it usually means the antidepressant may be causing some cycling. It is moi important to stabilize your mood first then treat remaining depression. For that reason I recommend you stop the Pristiq until you are up on your Lamictal.
Another strategy that works well with lamictal is to add Lithium-lithium can do wonders for bipolar depression.
> What would be a good antidepressant to switch Pristiq out for? I was thinking Savella milnacipran)Read a great review of it here: http://www.dr-bob.org/babble/20110630/msgs/990711.html
It is not approved for the clinical treatment of major depressive disorder in the USA, but it is in other countries.
Also it causes major sexual side effects.
I'd recommend Mirtazapine or Viibryd. Also, there's new one that starts with a B.
Eric
poster:phidippus
thread:1051278
URL: http://www.dr-bob.org/babble/20130930/msgs/1051519.html