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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 36. This is the beginning of the thread.
Posted by porkpiehat on October 31, 2012, at 15:35:27
I am VERY med-sensitive, and we're hoping the adding a small amount of abilify will help us simplify this weird mix of Celexa (5mg) Zoloft (12.5mg) Lamictal (200mg) and Klonipin (.5mg).
I had a terrible experience when we added Risperdal to Serzone some 10 years ago. But when I've used Seroquel for sleep occasionally it has really helped with a sense of self-possession and cut down on interpersonal/sexual fears.
Without getting into my diagnosis or why I am on all this stuff, I'd welcome others' experience on this "adjunct" theory and why it was added in the first place.
thanks!
Posted by jono_in_adelaide on October 31, 2012, at 22:37:41
In reply to anyone have luck adding Abilify to AD?, posted by porkpiehat on October 31, 2012, at 15:35:27
atypical antipsychotics are usualy added to antidepressant drugs because of their activity at the 5HT2 receptors, which mediates an antidepressant and anxiolytic effect
Posted by Zyprexa on October 31, 2012, at 22:43:11
In reply to anyone have luck adding Abilify to AD?, posted by porkpiehat on October 31, 2012, at 15:35:27
Those are incredably low doses of ADs. Why not try a higher dose of zoloft or celexa first? Not sure why you need to take 2? Abilify is very expensive too. If seroquel worked why not take that?
Posted by Zyprexa on October 31, 2012, at 22:47:05
In reply to anyone have luck adding Abilify to AD?, posted by porkpiehat on October 31, 2012, at 15:35:27
I did find abilify to be good at ADing, but had a lot of bad sideffects. It also did not work as an AP for me which was the real reason I was taking it. I found the ADing effects to be greatest in very low doses, like 2mg, not necessarily every day.
Posted by phidippus on October 31, 2012, at 23:12:00
In reply to anyone have luck adding Abilify to AD?, posted by porkpiehat on October 31, 2012, at 15:35:27
>we're hoping the adding a small amount of abilify will help us simplify this weird mix of Celexa (5mg) Zoloft (12.5mg) Lamictal (200mg) and Klonipin (.5mg).
1. Usually you subtract drugs from the recipe if you want to simplify. Not add.
2. What symptom or symptoms are you attempting to treat with the Abilify? I use Abilify as an adjunct to lessen intrusive and recurrent thoughts (OCD).
3. What's with the low doses of ADs and why 2?
Eric
Posted by phillipa on October 31, 2012, at 23:16:30
In reply to Re: anyone have luck adding Abilify to AD? » porkpiehat, posted by phidippus on October 31, 2012, at 23:12:00
There was a time when I could only take 2.5mg of paxil & 12.5mg of luvox. At the time was in hospital with lymes disease undergoing IV antibiotic treatment. So I have been there also. Phillipa
Posted by Christ_empowered on November 1, 2012, at 12:13:44
In reply to anyone have luck adding Abilify to AD?, posted by porkpiehat on October 31, 2012, at 15:35:27
I would think that you might be able to get an AD effect out of just low dose Abilify, maybe every 2nd or 3rd day. Maybe then you could drop the SRI drugs.
Posted by porkpiehat on November 1, 2012, at 15:08:14
In reply to Re: anyone have luck adding Abilify to AD?, posted by Zyprexa on October 31, 2012, at 22:47:05
My diagnosis is a floating one, depending on who you talk to. It started out with Depression/Anxiety/Social Anxiety.
The depression has always been there but the intense social anxiety and semi-paranoia started toward the end of college. Sprinkle in possible BPII (father and sister) and PTSD from childhood stuff.
The SSRI's (first Prozac, then Celexa) did a fine job of handling these issues, but they also numbed me out and made me prone to drinking/drugging/manic behavior, plus the sexual effects, etc etc.
Lamictal helped with some of the depression and manic behavior, but had its own side effects like concentration, headaches, trouble sleeping etc.
first Buspar and then klonopin were added to help with the concentration. Buspar ultimately made me angry and sad.
We switched the SSRI to Zoloft to see if it would help with focus, obsessiveness (over meds ironically) and sexual SE's. It helped with these but was terrible as an AD for me. Angry and suicidal!
Soooo....We dropped down to 12.5 zoloft which felt like a great place for me. I felt a natural range of emotions, but it only lasted for 3 weeks or so. I lost any notion of "self possession" and couldn't ask for change at the market without feeling shame and combative. Didn't feel I deserved anything. I felt "cowed" and obsessively nervous. Couldn't focus.
So then by tinkereing and adding 5mgs of celexa these symptoms went away largely. However I'm just kind of trudging along without much sex drive or inspiration.
My pdoc and I had spoken before about simplifying all of this and trying a small amount of AP to a) combat my "hypervigilence" over meds; b) address some of the fearful "self possessivenes" problems and avoidance issues; and c) to cut out some mix of the celexa, zoloft, and or klonopin and "simplify"
I took 1mg yesterday at noon and felt a little cloudy and nauseous when I ate. Automatically felt a little less "possessed" be other people but also a little detatched.
I took none today in favor of take it tonight to avoid to hazy effect. I will say today I've felt short-tempered and pervasively sad. I just had a schwarma and felt tired and sick again. Today I feel worse than before taking any Abilify, so my doubts are creeping in.
Ultimately I'd like to take two months off from work and wean off EVERYTHING.
Posted by phidippus on November 1, 2012, at 15:35:29
In reply to Re: anyone have luck adding Abilify to AD?, posted by porkpiehat on November 1, 2012, at 15:08:14
>Depression/Anxiety/Social Anxiety...BPII...PTSD...obsessiveness
With so much anxiety, an AD without all the sexual side effects and numbing is going to be your best friend.
I would reccommend you look at Mirtazapine or Viibryd, as they carry the least risk for the kinds of side effects you want to avoid.
You only need one AD at a higher dose to address your anxiety issues. Taking Celexa and Zoloft together at such low doses is only going to increase your risk for side effects and will ultimately be subtherapeutic.
>Lamictal helped with some of the depression and manic behavior, but had its own side effects like concentration, headaches, trouble sleeping etc.
Have you tried any other mood stabilizers?
>We switched the SSRI to Zoloft to see if it would help with focus, obsessiveness (over meds ironically) and sexual SE's.
I see it helping with obsessiveness, but not focus or sexual side effects.
>We dropped down to 12.5 zoloft...I lost any notion of "self possession" and couldn't ask for change at the market without feeling shame and combative. Didn't feel I deserved anything. I felt "cowed" and obsessively nervous
These are all anxiety symptoms and probably increased because you dropped the Zoloft.
>5mgs of celexa these symptoms went away largely. However I'm just kind of trudging along without much sex drive or inspiration.
I think you're having troubles with inspiration goes you don't feel good overall.
>trying a small amount of AP to a) combat my "hypervigilence" over med
I don't think adding an AP will help you with your hypervigilance. Again I think you need to be one high dose AD.
>I will say today I've felt short-tempered and pervasively sad.
Again, the right AD is going to help you more with these symptoms than an AP.
>Today I feel worse than before taking any Abilify
um-hmmm
>Ultimately I'd like to take two months off from work and wean off EVERYTHING.
If you'r e bipolar that would be a bad idea.
Eric
Posted by Zyprexa on November 1, 2012, at 18:16:01
In reply to Re: anyone have luck adding Abilify to AD?, posted by porkpiehat on November 1, 2012, at 15:08:14
Abilify is more likely to increase anxiety. You say you were worse than before the abilify. The same happened to me, I got off it and felt worse than before also. It wears off after a while, but the longer you took it the longer it takes to wear off. For me it took longer than I was on it. I think you should go for a low dose of seroquel. And stay on zoloft. Seroquel will help you sleep better and help with the anxiety/drinking. I would try that before going off everything, which probably won't work. As I have tried many times with my meds, mainly zyprexa. Just to let you know I myself have never taken seroquel, but know others who have and from what I read it is similar to zyprexa.
Posted by porkpiehat on November 2, 2012, at 13:01:43
In reply to Re: anyone have luck adding Abilify to AD?, posted by Zyprexa on November 1, 2012, at 18:16:01
So I took it for ONE DAY at ONE mg. Felt foggy, nauseous, somewhat unexciteable. No fear or excessive anger in dealing with people. The next day I felt awful like I was coming down from acid or meth.
What could I really be experiencing in this small a trial? I'm scared to continue. I don't want to be a zombie. Is this the desired effect or just side effects? My current regimen isn't terrible and you wouldn't say "that guy needs an anti-psychotic" but its not a sustainable mix.
Posted by porkpiehat on November 2, 2012, at 13:02:54
In reply to Re: anyone have luck adding Abilify to AD?, posted by Zyprexa on November 1, 2012, at 18:16:01
I'm curious, why would you suggest the Zoloft over the celexa?
Posted by porkpiehat on November 3, 2012, at 8:00:14
In reply to Re: anyone have luck adding Abilify to AD? » porkpiehat, posted by phidippus on October 31, 2012, at 23:12:00
> >we're hoping the adding a small amount of abilify will help us simplify this weird mix of Celexa (5mg) Zoloft (12.5mg) Lamictal (200mg) and Klonipin (.5mg).
>
> 1. Usually you subtract drugs from the recipe if you want to simplify. Not add.
>
> 2. What symptom or symptoms are you attempting to treat with the Abilify? I use Abilify as an adjunct to lessen intrusive and recurrent thoughts (OCD).
>
> 3. What's with the low doses of ADs and why 2?
>
> Eric
>
> Hi Eric:Initially I was on Celexa and Lamictal but still had problems with concentration...added klonopin...Switched the SSRI to Zoloft in hopes of lessening the hedonistic/indulgent qualities I got from Celexa.
Zoloft was great for concentration and self-possession but made me very sad/angry/detached at anything over 12.5/25mgs.
I was very happy for about a month in a (normal/non-medicated feeling way) at 12.5 but anxiety/interpersonal fear/concentration issues crept back in, as did some compulsive spending.
On my own I added 5mgs Celexa back into the mix and it helped with these things.
I'm kinda left without much drive (sex/relationship) on this mix, and it seems absurd. I'm also obsessing over it like crazy.
Doc thinks adding Abilify will smooth me out and stop the obsessing so we can remove one or both SSRIs and maybe the klonopin.The only thing is I'm worried about the Abilify making me more agitated. I can't say I really feel "depressed" now, just like a rat in a maze.
Something makes me think I should go back to just the low dose of zoloft and low dose of seroquel for the interpersonal fear.
>
>
>
Posted by Christ_empowered on November 3, 2012, at 11:29:03
In reply to Re: anyone have luck adding Abilify to AD? » phidippus, posted by porkpiehat on November 3, 2012, at 8:00:14
I take 30mgs/day Abilify. That's the anti-manic, anti-agitation, psychosis-controlling dose. Actually, 10 and up is good for psychosis, although some schizoaffective patients take less.
1mgs/day seems like it might be stimulating for some people. I forget how it works...the D2 receptor partial agonism seems to result in mild stimulation at low doses. It *does* have a very long half life, so you might not need/want to take it every day.
I forget how much is used to augment ADs. I think 1-below 10, unless there's significant agitation and/or psychosis on board. Then more. But I don't think there's one set dosage that's the *it* dosage for sad people.
Honestly, I think Abilify has kind of been oversold for depression and what not. I mean, I need an antipsychotic so I can stay out of a mental hospital (where they would give me...antipsychotics...), but if you have the option of *not* taking a neuroleptic, I'd take that option. Have you tried BuSpar?
Posted by phidippus on November 3, 2012, at 14:49:28
In reply to Abilify, posted by Christ_empowered on November 3, 2012, at 11:29:03
I take Abilify to control intrusive and recurrent thoughts. It does a good job of controlling my OCD.
I have not been on Buspar.
Eric
Posted by phidippus on November 3, 2012, at 15:00:39
In reply to Re: anyone have luck adding Abilify to AD? » phidippus, posted by porkpiehat on November 3, 2012, at 8:00:14
My honest opinion is that you're experiencing alot of symptoms because the dosing of your medication isn't high enough, particularly the antidepressants. MOREOVER, I don't think the antidepressants you are taking aren't right for you.
As for the Abilify, I believe its a bad choice.
Eric
Posted by Emme_v2 on November 3, 2012, at 17:02:41
In reply to anyone have luck adding Abilify to AD?, posted by porkpiehat on October 31, 2012, at 15:35:27
> I am VERY med-sensitive, and we're hoping the adding a small amount of abilify will help us simplify this weird mix of Celexa (5mg) Zoloft (12.5mg) Lamictal (200mg) and Klonipin (.5mg).
>
> I had a terrible experience when we added Risperdal to Serzone some 10 years ago. But when I've used Seroquel for sleep occasionally it has really helped with a sense of self-possession and cut down on interpersonal/sexual fears.
>
> Without getting into my diagnosis or why I am on all this stuff, I'd welcome others' experience on this "adjunct" theory and why it was added in the first place.
>
> thanks!Hi. I'm curious about why the 2 SSRIs. But anyway, I too am extremely sensitive to meds and was having a difficult time finding the right thing to augment Lamictal for my depression. Adding 2.5 mg Abilify to Lamictal was astonishingly effective for me. It was cleaner and provided a far more durable antidepressant effect than traditional ADs. I had several years of benefit from the combo. In the last year, things have been more difficult, and adding minocycline to the mix has been very effective.
I also find Abilify extremely effective for anxiety, and not in a sedating way. It just tones down excessive mental worry.
Good luck.
emme
Posted by Porkpiehat on November 3, 2012, at 17:43:04
In reply to Re: Abilify » Christ_empowered, posted by phidippus on November 3, 2012, at 14:49:28
> I take Abilify to control intrusive and recurrent thoughts. It does a good job of controlling my OCD.
>
> I have not been on Buspar.
>
> EricBuspar worked wonders for me with celexa and lamictal...for about a week. Then it made me extremely irritable to the point of blind rage, and sad
Posted by Porkpiehat on November 3, 2012, at 17:56:29
In reply to Re: anyone have luck adding Abilify to AD?, posted by phidippus on November 3, 2012, at 15:00:39
> My honest opinion is that you're experiencing alot of symptoms because the dosing of your medication isn't high enough, particularly the antidepressants. MOREOVER, I don't think the antidepressants you are taking aren't right for you.
>
> As for the Abilify, I believe its a bad choice.
>
> Eric
>
sorry maybe you missed my above post. zoloft at higher doses makes me angry suicidal and devoid of interest in hobbies. =
celexa makes me hypomanic drinky and insensitive, hedonistic.thats why i'm tyrying to mininmize the ADs. doc just gave me the Ok to do either abilify or seroquel. If they help with the anxiety ii'd love to lose the klonopin at the least
>
Posted by Emme_v2 on November 3, 2012, at 18:49:09
In reply to Re: anyone have luck adding Abilify to AD?, posted by Porkpiehat on November 3, 2012, at 17:56:29
> > My honest opinion is that you're experiencing alot of symptoms because the dosing of your medication isn't high enough, particularly the antidepressants. MOREOVER, I don't think the antidepressants you are taking aren't right for you.
> >
> > As for the Abilify, I believe its a bad choice.
> >
> > Eric
> >
> sorry maybe you missed my above post. zoloft at higher doses makes me angry suicidal and devoid of interest in hobbies. =
> celexa makes me hypomanic drinky and insensitive, hedonistic.
>
> thats why i'm tyrying to mininmize the ADs. doc just gave me the Ok to do either abilify or seroquel. If they help with the anxiety ii'd love to lose the klonopin at the leastI'm actually a fan of both Abilify and Seroquel in many ways. Seroquel kills anxiety very well, but it's sedating. When I've used it, I've titrated the dose very carefully to watch for too much sedation. Actually, 6.25 mg puts me to sleep and carries over some calming effect into the next day.
As I noted above, Abilify kills anxiety without being particularly sedating. Some people get antsy on it, but I don't. Abilify did give me startup insomnia for several weeks, but that resolved. I have had a slow weight gain with Abilify, so I am hoping to find another alternative; not everyone gains weight with it though. The great thing about Abilify was that the antidepressant and anti-anxiety effects kicked in within 4-5 days. When you're suffering, the rapid relief is just so amazing. It was like flipping a switch.
Posted by phidippus on November 3, 2012, at 19:38:24
In reply to Re: Abilify, posted by Porkpiehat on November 3, 2012, at 17:43:04
Strange reaction. Are you sure those weren't just symptoms?
Eric
Posted by phidippus on November 3, 2012, at 19:46:18
In reply to Re: anyone have luck adding Abilify to AD?, posted by Porkpiehat on November 3, 2012, at 17:56:29
>zoloft at higher doses makes me angry suicidal and devoid of interest in hobbies.
I'm not surprised. You are bipolar correct? Antidepressants run the risk of destabilizing your mood.
>thats why i'm tyrying to mininmize the ADs.
The problem is you have some obsessive(OCD) symptoms you are trying to treat and that requires high doses of antidepressant.
>doc just gave me the Ok to do either abilify or seroquel. If they help with the anxiety ii'd love to lose the klonopin at the least
Studies have shown Abilify tends to cause anxiety. Studies show Seroquel has a positive effect on anxiety.
Eric
Posted by Emme_v2 on November 3, 2012, at 19:56:59
In reply to Re: anyone have luck adding Abilify to AD? » Porkpiehat, posted by phidippus on November 3, 2012, at 19:46:18
> >zoloft at higher doses makes me angry suicidal and devoid of interest in hobbies.
>
> I'm not surprised. You are bipolar correct? Antidepressants run the risk of destabilizing your mood.
>
> >thats why i'm tyrying to mininmize the ADs.
>
> The problem is you have some obsessive(OCD) symptoms you are trying to treat and that requires high doses of antidepressant.
>
> >doc just gave me the Ok to do either abilify or seroquel. If they help with the anxiety ii'd love to lose the klonopin at the least
>
> Studies have shown Abilify tends to cause anxiety. Studies show Seroquel has a positive effect on anxiety.
>
> EricFor some people Abilify can cause anxiety, but my pdoc had told me that it can also help anxiety. It does help anxiety for me - a lot.
If Porkpiehat's doctor suggests trying Abilify or Seroquel, there's no reason he could not try each and see which he prefers. If there is startup anxiety with Abilify, it might even make sense to use a dash of Seroquel for a little while until the Abilify settles in. I guess I'm pro-Abilify because it doesn't put me to sleep.
Seroquel is definitely a big, effective gun for anxiety and may be just the thing for Porkpie. Abilify REALLY helps keep a lid on the "freak-out" anxiety without the sedation effects. So I don't think it should be discounted.
Posted by phidippus on November 3, 2012, at 21:44:32
In reply to Re: anyone have luck adding Abilify to AD? » phidippus, posted by Emme_v2 on November 3, 2012, at 19:56:59
>It does help anxiety for me - a lot.
It helps diminish my obsessions.
Its a potent partial agonist of the 5ht1a neurotransmitter, which affects anxiety and mood.
Eric
Posted by Christ_empowered on November 4, 2012, at 0:26:30
In reply to Re: anyone have luck adding Abilify to AD? » Emme_v2, posted by phidippus on November 3, 2012, at 21:44:32
I could see low dose Abilify helping anxiety, at least for some people. My concern--speaking as someone who takes abilify--would be all the long term stuff you get with neuroleptics, plus the acquisition costs.
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