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Re: Reducing meds. PDOC advise trial of any AAP Ideas? » LouisianaSportsman

Posted by klein on May 4, 2014, at 14:24:43

In reply to Re: Reducing meds. PDOC advise trial of any AAP Ideas?, posted by LouisianaSportsman on May 1, 2014, at 19:40:04

> Hey, Klein! You're now on SLS (been inactive lately) and Eric status to me. Sorry if I was rude to you on that SSRI empathy thread.
>
> Well, I've admitted this deep in this forum before, but I guess I'll admit it again-- I just really enjoy changing up, reading up and trying different medications as my hobby.
>
> I can say that I do not know much about depot injections. I thought that it might have offered metabolic benefits even, but I was kinda skeptical about that. I figured it was just exclusively for non-compliant patients or people who didn't seem so eager to be taking their medication.
>
> I was on Abilify at 5mg. to augment sertraline (Zoloft) at the time and noticed that it was a sugar pill so I raised the dosage to 10mg. which was something my old PDOC seemed very reluctant to do. (Thank God I have my current PDOC) I noticed about three days later that I had a definitive positive effects from Abilify that were not placebo at 10mg. and I stuck with it. It made me gain weight so bad. I was on Abilify when I switched to my new, awesome PDOC and she switched me to Latuda per my request (very tough choice to switch since I thought Abilify did work) and added Topamax for weight and mood.
>
> Very much so want to try Saphris! I might trial it for a month and see what happens. It might be better than Latuda! If I do good at Abilify 10mg./ Latuda 40/60mg.-- what dosage of Saphris should I try? I'm pretty for real about switching. I'm pretty for real about Invega too. :/ But Saphris just looks more appealing. It's my third favorite AAP.
>
> Olanzapine looks like a nice, safer sequel to clozapine if I was going to try that right route, and I've always wanted to see what the hype is about. The Zydis form seems to cause less weight gain.
>
> I'm going to basically ask my PDOC, who I know who is a fan of Saphris, Invega, and Zyprexa what she thinks would be best to try out for a month. I'm pretty positive she'd be down to let me try something different, and if I like it better-- I'll stick with it.
>
> The insurance letter said to cut back down on the medications used for stimulation, CNS depressants, and concomitant usages. I'm not sure why they sent that-- they're still continuing to pay. I believe the Gralise, Xanax XR and the Desoxyn raised a red flag in someone's department. The letter did state that narcolepsy was no associated with the Nuvigil script and it exceeded the quantity dispensed limit of #30 (I was getting #60 for 500mg. armodafinil ~600mg. modafinil). The letter stated that shingles was not associated with the Gralise. The Lamictal XR was singled out due to the fact that I am already on an extended-release anticonvulsant. The Desoxyn was mentioned as being for narcolepsy and while approved for ADHD, anyone prescriber who prescribes Desoxyn is under a monthly review process.
>
> Basically, in the future, I guess we're going to have to stay on-label. I think we could still get away with some stuff however as it was just was just an "Advisement" and not a warning or anything, but my PDOC still took it seriously.
>
> I tried the Oleptro ER 300mg. last night and didn't experience much next-day sedation or even nightly sedation with my clonazepam, but I do miss the armodafinil a lot. That's why I'm thinking may be desipramine for energy. I'm also thinking about mirtazapine at night, but I'm scared of weight now that I no longer have the Nuvigil on board. I'm not sure what to think about the Oleptro just yet.
>
> I go back in two weeks, I have in mind: desipramine, mirtazapine, and what else?

Hey Louisiana,
Sorry for not answering your posts sooner.

I took no offense whatsoever re: your comments on the apathy thread because:

Everybody has an opinion. Some are more adamant than others, probably due to their own personal experience. Everybody has a bad day, I know I've lost my cool posting on opther boards several times. Also, lest we forget, this is after all a mental health forum (I certainly don't mean that in a bad way ;) a lot of people here are quirky and eccentric, lol). I might sound chummy cos I've lurked a lot so I'm familiar with a few posters. And, I'm constantly working on my self-esteem issues, I've learned to NOT take things so personally all the time :) Thanks for your apology though, I appreciate it.

I'm flattered by your comparison, Eric and SLS are much more seasoned than me. I'm just an amateur nerd, lol, I took a few biochemistry classes and that's about it.

Enough about me. What did you decide to take?

A few thoughts:

- Mirtazapine is an amazing AD (by far the best one I've tried) but not usually "weight friendly". A good way to counteract weight gain and sedation is to take it the European way, start right off at 60mg.

- Asenapine is like a stripped down Remeron. It has the tetracyclic's AD power, with a different side effect profile (little, if any weight gain, heavy sedation tat wears off quickly due to it's short half life and a few others). Apparently it's not as good an AAP as others for positive symptoms, but it works very well on negative symptoms.

- Ziprasidone is very similar to asenapine. It's activating at low doses, and sedating at higher doses.

- Zyprexa at 5mg-20mg did nothing for me except drain my pocket. Thankfully the sedation I got was minimal, no weight gain, nothing. Maybe I was a bit zombified. Keep in mind that I'm unipolar, I was only put on AAPs to control the racing thoughts I started getting whilst doing psychoanalytic therapy (my doc put me on Risperdal, then we switched to Zyprexa etc).

- I have no experience with Invega, Latuda and a few others you mentioned. I avoid Invega like the plague because I had a paradoxical reaction when I took Risperdal.

- I managed to get my hands on brand name Desyrel, PI and all (very hard to find where I live). According to the manufacturer, it should only take 2 weeks to *ss*s if trazodone is working or not. I don't know if this is accurate. I imagine the same holds true for Oleptro.

- I really got no additional benefit from dissolving wafers ie: Zyprexa Zydis and Remeron Soltab. These two are the most weight-unfriendly meds out there, so I suspect the labs were trying to find an alternate form of delivery to avoid weight gain - if so, fail!

- To me, Abilify is a pain, the long half life and constant dosage tweaking is not worth the effort. Taking 2mg for a few days once in a while will give me a boost though.


Okay.. once again, please bear in mind that my dx is unipolar MDD with melancholic and schizoid features, and GAD. Not a trace of bipolar. Recovered alkie too which might be relevant. At the moment I'm smoking heavily, which I know affects several medication's metabolism (ie Zyprexa).

Okay, hth. Warm regards =)


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