Posted by LouisianaSportsman on October 1, 2013, at 16:06:18
In reply to Re: Augmenting Bipolar 'Cocktail' with Trodenki XR » LouisianaSportsman, posted by phidippus on October 1, 2013, at 15:40:33
> 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?)
>Pristiq at 50mg. has not made me manic and I have taken it for almost two months now. I did not experience anxiety on Wellbutrin.
> Sometimes using Topomax to offset the weight gain of another drug is not the best strategy.
>I loved your scientific explanation to death!
> It would be better to replace the drug causing the weight gain.
>Maybe I will consider transferring to Latuda later on. I can't be making too many changes at once. I just like the partial agonist effects of the Abilify. I'm afraid of a full-blown antipsychotic. Would it do the same benefits as Abilify does for me?
> There is no miracle pill for weight loss.
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 understand. But, I assure you, Vyvanse has helped me lose weight in the past.
>
> 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.
>Interesting AD choices! I'll look into them. Does Latuda do the same thing at that 5-HT1A thing that Abilify does (same 5-HT1A things Buspar does?)
> I recommend Reboxetine.
>Do you think it's better than Wellbutrin?
> 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.
>I just don't see my pdoc doing a 100% increase, and I don't see why it is needed?
> Working as well as it should. Have you heard of Xyrem?
>Yes, I have heard of GHB. I don't think my pdoc is *that* open even though she is progressive.
>
> I'm sure it will help with your anxiety.
>Well, yeah, and weight-loss too, so it sounds like a nice idea, actually, still.
>
> Vyvanse and Nuvigil is a good one-two punch.
>
I will try to get my pdoc to let me have both.
>
> 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.
>That's awesome to hear! Does it have the same anxiety reduction as topiramate? If so, I will go with Keppra over topiramate.
><
> 100 mg, up to 200 mg a day.
>I got you.
>
> Good way to look at it.
>Yeah, but Keppra is a good way to look at it too. If it has anxiolytic effects.
> > 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.
>That's why I'm thinking about a different AD like Savella. But, I'm going to put more research into the ones you just suggested.
> > Bupropion XL 450mg. (522mg. Aplenzin)
>
> Will help with sexual side effects of Pristiq. Good antidepressant for bipolar folk.
>Sounds good!
> > Trodenki XL 200mg.
>
> 300 mg.
>Yes Sir. The pdoc says 200mg., but that's what she takes-- so she's biased.
> > Mirapex ER 2mg.
>
> Be careful with compulsive behaviors! Really don't need it if you're taking Wellbutrin.
>
I read about that. I won't take it in conjunction with Wellbutrin> > Memantine 20mg.
>
> eh,why not?
>Sounds good.
> > Riluzole 150mg.
>
> Up to 200 mg.
>Gotcha.
> >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 got you.
> >I really want the topiramate for weight loss and anxiety.
>
> Very realistic expectations.
>This is what I want.
>
> 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.
>
Good advice, Eric. Solid.> Another strategy that works well with lamictal is to add Lithium-lithium can do wonders for bipolar depression.
>I will consider that. I've always had something against it, idk why...
> 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.I'm scared of weight gain with mirtazapine. I know Viibyrd also hits the Buspar/Abilify 5-HT1A receptor. I may consider Viibyrd if Latuda doesn't hit that receptor.
> Eric
>
>
Thank you!
poster:LouisianaSportsman
thread:1051278
URL: http://www.dr-bob.org/babble/20130930/msgs/1051524.html