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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by tepiaca on August 16, 2005, at 12:04:10
I have found that when I restart or suspend a medicine I feel a little better.
Do you have any thoughts about the possibility that Abilify could work in a similar way due to its characteristic to regulate the dopamine levels?
By the way, how does abilify knows when there is too much dopamine in the brain and when there isn´t ??
Any comments are well received
Tep
Posted by med_empowered on August 16, 2005, at 18:25:57
In reply to Could Abilify work as when being ON and OFF meds?, posted by tepiaca on August 16, 2005, at 12:04:10
hey! I imagine going on-and-off abilify could be helpful...zyprexa is being used a good bit "as-needed" for those with bipolar disorder, some people with anxiety and/or depression, and those with Borderline Personality Disorder. In borderline in particular, antipsychotics (Zyprexa and Abilify among them) are sometimes used strictly as-needed to calm down uncontrollable emotions and help with "dysphoric episodes". As for how exactly Abiify works its antagonist/agonist magic...I've read a couple possible explanations, but none of them are considered the "true" reason (like most other psychiatric drugs, the exact mechanisms of abilify remain unknown). One is that Abilify regulates dopamine differently dependning on the *region* of the brain. So, in the frontal lobes it can boost dopamine (potentially alleviating depression and "negative symptoms") and in other parts of the brain it can damped dopamine (presumably leading to a calming action and control of "positive symptoms"). The other I've heard is that because of the serotonin anatagonist/agonist action AND the similar action at dopamine, Abilify is able to maintain a steady rate of serotonin/dopamine...since blocking serotonin can boost dopamine, it can do that as well as then dampening or slightly boosting dopamine, and vice versa. Anyway, the levels of dopamine+serotonin antagonsim/agonism seem, from my experience, to be very depenedant upon dosage. At sub-therapeutic (under 10mgs) dosages, Abilify seemed to me to do a good bit of mild serotonin blockage (reduced anxiety, kind of like Buspar,only more effective and faster-acting) and a pleasant amount of dopamine agonism (increased alertness and energy, more happiness overall). At 10mgs, it seemed ideal for more severe disorders (I had a very severe depressive episode ath time);antidepressant action, with more pronounced dopamine action (definite mood-stabilizing qualities, with a little bit of apathy). At 15mgs, Abilify was much more like the other atypicals on the market I've taken; less antidepressant action, more flatness. Above 15mgs, it wasn't a good medication *at all,* though I imagine it would compare well to higher-end doses of Zyprexa or Risperdal. The great EPS profile of Abilify I think will hold true mostly for low-end doses; at a certain point, I doubt it will be much more tolerable than other atypicals or low-dose conventional antipsychotics. As for starting/suspending...since it is an antipsychotic, your brain would theoretically adapt to it after a couple weeks, then return more or less to baseline functioning with regards to serotonin and dopamine after a washout period. But...since it does agonism and antagonsim, it seems like Abilify would work *with* your brain chemistry rather than doing the kind of one-size-fits-all modifications with most other psychiatric drugs...but some people have reported a kind of tolerance to Abilify, so stopping-and-restarting might work...then again, with some antidepressants it seems that starting-and-stopping will make the med *less* effective, so who knows.
Posted by tepiaca on August 18, 2005, at 8:44:10
In reply to Re: Could Abilify work as when being ON and OFF me, posted by med_empowered on August 16, 2005, at 18:25:57
thank you very much for your response Med empowered !
> hey! I imagine going on-and-off abilify could be helpful...zyprexa is being used a good bit "as-needed"
med , do you have any report that doing this could be dangerous ? maybe having more chances to develop EPS ????As for how exactly Abiify works its antagonist/agonist magic...I've read a couple possible explanations, but none of them are considered the "true" reason (like most other psychiatric drugs, the exact mechanisms of abilify remain unknown). One is that Abilify regulates dopamine differently dependning on the *region* of the brain. So, in the frontal lobes it can boost dopamine (potentially alleviating depression and "negative symptoms") and in other parts of the brain it can damped dopamine (presumably leading to a calming action and control of "positive symptoms"). The other I've heard is that because of the serotonin anatagonist/agonist action AND the similar action at dopamine, Abilify is able to maintain a steady rate of serotonin/dopamine...since blocking serotonin can boost dopamine, it can do that as well as then dampening or slightly boosting dopamine, and vice versa.
thank you for that explanation !>Anyway, the levels of dopamine+serotonin antagonsim/agonism seem, from my experience, to be very depenedant upon dosage. At sub-therapeutic (under 10mgs) dosages, Abilify seemed to me to do a good bit of mild serotonin blockage (reduced anxiety, kind of like Buspar,only more effective and faster-acting) and a pleasant amount of dopamine agonism (increased alertness and energy, more happiness overall). At 10mgs, it seemed ideal for more severe disorders (I had a very severe depressive episode ath time);antidepressant action, with more pronounced dopamine action (definite mood-stabilizing qualities, with a little bit of apathy). At 15mgs, Abilify was much more like the other atypicals on the market I've taken; less antidepressant action, more flatness. Above 15mgs, it wasn't a good medication *at all,* though I imagine it would compare well to higher-end doses of Zyprexa or Risperdal. The great EPS profile of Abilify I think will hold true mostly for low-end doses;
>it seems a good option for me, I migth try it in the future.
Med, so which were your worst side effects on Abilify ?
I´ve heard that very often causes Akathisia. did abilify cause this on you?Thank you very much !
Posted by med_empowered on August 18, 2005, at 18:32:32
In reply to Re: Could Abilify work as when being ON and OFF me » med_empowered, posted by tepiaca on August 18, 2005, at 8:44:10
hey! Early on, I did notice a little bit of drug-induced apathy or...something on Abilify. Its hard to describe...I felt somehow less spontaneous and less connected both to my inner self and the outside world...it felt like things were filtered a bit, like through a windshield. But...when I started the really low doses, I couldnt even walk down the street without going into panic mode, so getting rid of that was a *big* improvement...plus, it seemed to help boost my mood a bit, so that was nice. At 15mgs I lost some of the antidepressant effects and the "glassy" feeling intensified a bit; I thought at the time that it might just be antidepressant poop out, but I later came to think that the dosage increase was creating a sort of "neuroleptic induced dysphoria". Anyway, I have a kind of odd variant of bipolar, which has also been diagnosed as mood disorder nos w/ anxiety nos and psychotic disorder nos (notice all the "not otherwise specifieds"? You'd think I'd fit in *some* diagnosis in the DSM). My shrink at the time wanted to go above 15mgs to take care of the mixed episodes and occasional paranoia (not fully psychotic, but definitely *NOT FUN*) *and* get rid of the anxiety, which she said had to have some sort of psychotic component because of its severity. Anyway, "the road to hell is paved with good intentions," as they say...when I hit the 20-30mg mark, I was flattened out, apathetic, and shaking (my doc considered it a pre-exisiting "essential tremor" and RX'd propranolol and upped my benzo). I stopped taking it, had weird withdrawal-emergent muscle jerks and shakes and what not, but nothing permanent. If you have depression, I'd recommend *only* very low dose abilify for a *limited* amount of time--2-4 weeks, then taper. The new meds are better than, say, Haldol, but tardive dyskinesia, EPS, etc. are still a definite problem. For mania/mixed-episodes, I'd say low-dose it till the episode is over, then taper. But infrequent, low-dose, as needed use seems like it could help. When I took 5mgs or so, my depression lifted in less than a week; it wasn't until I hit 10mgs+ that problems started to pop up. Abilify seems to make some people anxious...I did develop a sort of akathisia/"neuroleptic-induced dysphoria" after a while, but it seems that lots of people get "start up anxiety," which I did not. I don't know what the effects of PRN dosing would be on neuroleptic side-effects...my wild guess would be that if you keep it at a low-dose, especially with abilify, and take the med relatively infrequently, you'd get a boost w/ little, if any, risk of EPS. I read a study once where they found that with Abilify the big jump in EPS came when people were moved from 10 to 15mgs in treatment for social phobia...I suppose at that point the D2 blockade got a little out of hand. If EPS has been a problem for you, but you still think you need to use an atypical for an as-needed "boost," I bet you could get your doc to RX some Cogentin or propranolol...you could also take some Benadryl or a benzo. But...I'm prone to EPS at low doses (100mgs seroquel, 2.5mgs zyprexa), so I've opted to avoid all neuroleptics.
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