Posted by LouisianaSportsman on October 1, 2013, at 22:49:31
In reply to Re: In Defense of Savella, posted by LouisianaSportsman on October 1, 2013, at 19:30:07
Hi Eric,
Thanks so much for helping me out.
This is what I wrote to print out to bring to the PDOC. It might sound a bit biased to get what I want out of her.
------------------I want to leave the Abilify where it is at for now, and I only want to increase when its necessary so it will be a long-lasting part of my medication regimen. We can go up to 30mg., of course.
The Nuvigil works well, when it is working. I have done research and some narcoleptic patients are prescribed 2 250mg. tablets a day. Im asking for 150mg. twice a day. It simply does not last that long. I want to take one 150mg. tablet in the morning and one 150mg. tablet later in the afternoon. This is a net increase of a mere 50mg. It is nowhere close to be as effective as Vyvanse 60 which I have had in the past and I would like to replace it with Vyvanse 60. I think having Nuvigil and Vyvanse conjointly would be therapeutic.
I am interested in Topamax; however, I dont think I need it if Im able to get Vyvanse. If Im able to get Vyvanse, I want to try to increase my dosage of Lamictal to 400mg. to see if this works to stabilize my mood better before beginning Topamax. It is a perfectly normal increase according to literature Ive read and does not lead to an increased risk of severe rash, e.g. dosages are commonly doubled, e.g. Pristiq 50 to 100, Abilify 5 to 10, etc. I see no reason why prescribing #60 200mg. tablets of Lamictal would be an issue. Dr. Williams had me at 400mg. from 200mg. before going down when I started taking the Abilify. The PI sheet suggests 400mg but then also says 500mg may be used. Some bipolar patients even take 600mg. I really would like to try 400mg. again. It worked well for awhile and then the Abilify was added and I didnt need that dose. But now, the Lamictal is starting to poop out on me. If I do have a problem, and I likely wont I can split the scored tablet. I have an extra bottle of Lamictal and have already begun taking 400mg. lately in an attempt to control my mood, and it is really working for my mood swings. If I am unable to get the Vyvanse and youre not willing to go up to 400mg. on the Lamictal, then I would like to begin titrating on the Topamax.
I have an alternative suggestion to gabapentin to help my anxiety in the form of Rilutek. Riluzole possesses both glutamatergic modulating, antiepileptic, and neuroprotective properties, all of which make it a promising candidate for the treatment of mood and anxiety disorders. Clinical use and clinical investigations support riluzoles antidepressant and anxiety properties. These reports comprise either case series or open-label studies in patients with treatment-resistant conditions, especially bipolar depression and generalized anxiety disorders. The anti-anxiety effects of riluzole have been postulated to be the result of postsynaptic GABAA receptor function potentiation in hippocampal neurons. This is the exact same thing that gabapentin does! Recently, Mathew and colleagues (2008) found, in an eight-week open-label study, that riluzole 100 mg/day was effective in treating anxiety symptoms in patients with GAD. In this study, 80% of completers responded to riluzole, and 53% met remission criteria at eight weeks. One unique aspect of riluzole is that it does not require dose titration and the suggested initial dosage of 100mg. is indicated as effective in all-day anxiety treatment. It is taken 50mg. every 12 hours, morning and night.
The Nuvigil works well, when it is working. I have done research and some narcoleptic patients are prescribed 2 250mg. tablets a day. Im asking for 150mg. twice a day. It simply does not last that long. I want to take one 150mg. tablet in the morning and one 150mg. tablet later in the afternoon. This is a net increase of a mere 50mg. It is nowhere close to be as effective as Vyvanse 60 which I have had in the past and I would like to replace it or use with Vyvanse 60mg. I think having Nuvigil and Vyvanse conjointly would be as I have in the past would be extremely therapeutic and almost result in complete remission of ADHD symptoms. I also read that it is OK to begin adding Vyvanse and Wellbutrin (Aplenzin) at the same time, but I really want to try out Rilutek if you let me.
Remember, I guess we are being slightly experimental with the Rilutek, but I have spent six-seven hours researching what I think would be best for me. I will add more on Rilutek. I dont see why it would hurt to try Rilutek. If it works well, then I would be taking a single pill everyday instead of many.
My Goal:
Abilify 10mg.
Lamictal 400mg.
Pristiq 100mg.
Nuvigil 250mg.
Vyvanse 60mg. or Topamax Titration
Rilutek 100mg. (hopeful replacement for gabapentin)
Aplenzin (Wellbutrin 450mg. XL) 522mg.If you want to be conservative:
Keep Abilify, Gabapentin, Lamictal, Nuvigil and Pristiq the same. And, I want to do the Topamax and Wellbutrin like we discussed last time.
Abilify 10mg.
Lamictal 200mg. (raise it though?)
Pristiq 100mg. (increase like we talked about)
Gabapentin 400mg. QID
Nuvigil 250mg.
Topamax Titration
Aplenzin (Wellbutrin) 522mg. as I had with my previous doctor. (Yes, Im aware of seizure, but Im on Lamictal, but there is a reason why I was on such a high dosage I didnt respond to Wellbutrin 300mg. XL until this Aplenzin 522mg. It would be pointless to give me a lower dose. Also, I had zero side effects from any dose, even when I started it.) Once again, I had four extra Aplenzin 522s I have been taking the best four days before my visit to see how my body would adjust. I see no reason not to go ahead and go on this dosage. It works best for me. With the ER formulation, the rate is 0.4% (4/1000) at doses of 300 to 450 mg/day; however, the rate increases substantially at doses above this level. Also, if you allow me to try Rilutek, it is an additional anticonvulsant to the Lamictal. Please use the dosage that works best for me.All, in all, I hope you consider my suggestions.
---------------------------------------------I sorta lied when I told her I've been on 400mg. before and I've been taking 522mg. tablets the past few days, but I know how she is-- she'd never dose me that high. I know it's not right to lie, however.
I will definitely recap you on what happens, Eric! Thanks for caring!
poster:LouisianaSportsman
thread:1051278
URL: http://www.dr-bob.org/babble/20130930/msgs/1051558.html