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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by sigolene on February 22, 2010, at 8:43:34
For negativ symptoms I have Solian, but I have prolactin excess problems. And solian lost it's efficiency with time.
What other med could I try for negativ symptoms ?
(I also have for depression: cymbalta, ritalin, lamictal, and 25mg seroquel for sleep)
Posted by Phillipa on February 22, 2010, at 10:46:53
In reply to med for negativ symptoms, posted by sigolene on February 22, 2010, at 8:43:34
You don't mention your diagnosis and with excess prolactin what causes that does it mean you produce milk? Phillipa
Posted by Viking on February 22, 2010, at 10:48:01
In reply to med for negativ symptoms, posted by sigolene on February 22, 2010, at 8:43:34
You could try Abilify. I have found it very effective at low dose (2 mg/day). In my experience it is far better than Solian.
Posted by bleauberry on February 22, 2010, at 19:46:42
In reply to med for negativ symptoms, posted by sigolene on February 22, 2010, at 8:43:34
Decrease or eliminate the lamictal.
Add Savella to the ongoing mix.
And you'll be all set.
Well, I would be confident with that, but obviously mileage varies and there is no predicting anything.
But, you are talking specifically about anhedonia. Savella by itself or with cymbalta can be good for that.
Any mood stabilizer including lamictal is going to work against you in terms of anhedonia. It can blunt any potential of you feeling the ups and excitements of normal life. Along those same lines, if your dose of cymbalta is too high, that can also blunt things. Too much serotonin can blunt anyone's emotions. Cymbalta is very strong on serotonin. Its norepinephrine action is very weak in comparison. Savella is about equal on serotonin and NE but also increases dopamine levels in the region of the brain associated with anhedonia.
It's not easy switching around meds. But farther out on the horizon you might want to think about a Savella+low dose Risperdal combination.
Posted by bleauberry on February 22, 2010, at 19:53:55
In reply to med for negativ symptoms, posted by sigolene on February 22, 2010, at 8:43:34
Actually, after I made my posting, I read Viking's post, and yeah, I totally agree with it.
Lower or eliminate lamictal.
Lower or eliminate cymbalta.
Add Savella.
Abilify with or without Amisulpride (in pubmed studies it was combined with Amisulpride...in one study it lowered prolactin, in another it did not), but they have been combined so you wouldn't be the first.The key with any of these however is....LOW doses. Amisulpride needs to be 50mg, maybe 100mg max, but I felt a lot of blunting at 100mg. I know we all respond differently, but just the starting dose of cymbalta created worse negative symptoms for me. Savella can be dosed 25mg to 150mg per day. Abilify seems to become more blunting at doses above 5mg, so that's probably why it works better on negative symptoms in doses lower than that.
Posted by sigolene on February 23, 2010, at 3:05:45
In reply to Re: med for negativ symptoms » sigolene, posted by Phillipa on February 22, 2010, at 10:46:53
> You don't mention your diagnosis and with excess prolactin what causes that does it mean you produce milk? Phillipa
I have had several diagnosis, so at the end I don't really know. I have chronic depression associated with negativ symptoms. (never experienced positiv symptoms)
Posted by X-ray on February 23, 2010, at 8:31:49
In reply to med for negativ symptoms, posted by sigolene on February 22, 2010, at 8:43:34
Hi,
You might try a low dose of Fluanxol.
This is a typical antipsychotic
that has antidepressant and mood-enhancing actions.I'm on 0,5+0,5 mg every day,
but it's okay to take 1+1 mg/day.Higher doses of this drug are for schizofrenics.
Best regards,
X-rayWellbutrin 150 mg
Remeron 45 mg
Lyrica 50 mg
Buspar 40 mg
Fluanxol 1 mg
Posted by Viking on February 23, 2010, at 10:16:39
In reply to Re: med for negativ symptoms, posted by X-ray on February 23, 2010, at 8:31:49
Fluanxol sure is a cheaper solution than Abilify.
Out of curiousity, which effects and side-effects did you experience from Fluanxol?
Posted by X-ray on February 23, 2010, at 13:09:54
In reply to Re: med for negativ symptoms » X-ray, posted by Viking on February 23, 2010, at 10:16:39
Hi,
1 mg of Fluanxol is an extremely small dosage,
but nevertheless, the drug does a good job with my anxiety.Fluanxol stabilizes my mind, have a soothing effect.
Most important of all, I sleep better when I'm on this drug.The side effects are negligible,
but the drug may have a small effect on libido.I don't have much of a sex life anyway,
but I could probably function under the right circumstances.I have been considering Abilify myself,
since this drug doesn't elevate the prolactin levels.Best regards,
X-ray1 mg Fluanxol = 6-7,5 mg Seroquel = 0,25-0,5 mg Zyprexa
Posted by X-ray on February 23, 2010, at 13:20:45
In reply to Re: med for negativ symptoms » sigolene, posted by Viking on February 22, 2010, at 10:48:01
> You could try Abilify. I have found it very effective at low dose (2 mg/day). In my experience it is far better than Solian.
Hi,
Abilify is supplied at 5 mg, 10 mg, 15 mg, 20 mg, and 30 mg
(Medication Fact Book, The Carlat Psychiatry Report).How can you be on 2 mg of this drug?
Best regards,
X-ray
Posted by Viking on February 23, 2010, at 14:34:02
In reply to Re: med for negativ symptoms, Viking, posted by X-ray on February 23, 2010, at 13:20:45
I buy 15 mg pills and take 2x7.5 mg / week. This should be ok, as Abilify has a halflife of 3-4 days.
Posted by bleauberry on February 23, 2010, at 18:59:31
In reply to Re: med for negativ symptoms, Viking, posted by X-ray on February 23, 2010, at 13:20:45
> > You could try Abilify. I have found it very effective at low dose (2 mg/day). In my experience it is far better than Solian.
>
> Hi,
>
> Abilify is supplied at 5 mg, 10 mg, 15 mg, 20 mg, and 30 mg
> (Medication Fact Book, The Carlat Psychiatry Report).
>
> How can you be on 2 mg of this drug?
>
> Best regards,
> X-rayYou cut it to whatever size you want with a razor blade or a pill splitter. It has a halflife of about a week, so minor inaccuracies in dosage from day to day are a non-factor clinically.
Another option is to crush it with a spoon, then mix the powder with some rice flour, divide into whatever equal-size piles/doses desired, and scoop them into empty gelcaps with the end of a knife. The pills are small, so mixing with rice flour fluffs it up for greatly reduced inaccuracy.
Posted by desolationrower on March 3, 2010, at 1:22:57
In reply to med for negativ symptoms, posted by sigolene on February 22, 2010, at 8:43:34
> For negativ symptoms I have Solian, but I have prolactin excess problems. And solian lost it's efficiency with time.
> What other med could I try for negativ symptoms ?
> (I also have for depression: cymbalta, ritalin, lamictal, and 25mg seroquel for sleep)hi
i think NAC might be helpfulyou might try higher dose of seroquel, or mirtazapine, both of them are mostly antihistamines at low doses, but are alph2 antagonists at higher doses, which can be energizing.
might try adderal instead of ritalin.
-d/r
Posted by sigolene on March 3, 2010, at 2:03:10
In reply to Re: med for negativ symptoms, posted by desolationrower on March 3, 2010, at 1:22:57
> > For negativ symptoms I have Solian, but I have prolactin excess problems. And solian lost it's efficiency with time.
> > What other med could I try for negativ symptoms ?
> > (I also have for depression: cymbalta, ritalin, lamictal, and 25mg seroquel for sleep)
>
> hi
> i think NAC might be helpful
>
> you might try higher dose of seroquel, or mirtazapine, both of them are mostly antihistamines at low doses, but are alph2 antagonists at higher doses, which can be energizing.
>
> might try adderal instead of ritalin.
>
> -d/rPlease can you tell me what is "NAC" ?
Posted by desolationrower on March 5, 2010, at 23:04:50
In reply to Re: med for negativ symptoms, posted by sigolene on March 3, 2010, at 2:03:10
N-Acetyl-Cysteine
i've posted on it here if you search for it with my posting name, if you've questions let me know
-d/r
Posted by Economist on March 13, 2010, at 17:43:58
In reply to Re: med for negativ symptoms, posted by desolationrower on March 5, 2010, at 23:04:50
I've been on NAC for a month now. Hasn't done crap for anhedonia or negative symptoms.
Posted by SLS on March 20, 2010, at 18:43:29
In reply to Re: med for negativ symptoms, posted by Economist on March 13, 2010, at 17:43:58
> I've been on NAC for a month now. Hasn't done crap for anhedonia or negative symptoms.
Do you have schizophrenia or bipolar disorder?
I think NAC has been suggested as a treatment for these two maladies, and is currently being investigated for these indications. I don't know to what extent it has shown efficacy in treating [unipolar] major depressive disorder.
- Scott
Posted by SLS on March 20, 2010, at 18:59:24
In reply to Re: med for negativ symptoms » Economist, posted by SLS on March 20, 2010, at 18:43:29
> > I've been on NAC for a month now. Hasn't done crap for anhedonia or negative symptoms.
>
> Do you have schizophrenia or bipolar disorder?
>
> I think NAC has been suggested as a treatment for these two maladies, and is currently being investigated for these indications. I don't know to what extent it has shown efficacy in treating [unipolar] major depressive disorder.
It might take 8 weeks before you see improvements with NAC. It might be worth sticking with it for a little while longer.
- Scott
--------------------------------------
Biol Psychiatry. 2008 Sep 15;64(6):468-75. Epub 2008 Jun 5.
N-acetyl cysteine for depressive symptoms in bipolar disorder--a double-blind randomized placebo-controlled trial.Berk M, Copolov DL, Dean O, Lu K, Jeavons S, Schapkaitz I, Anderson-Hunt M, Bush AI.
The Mental Health Research Institute of Victoria, Victoria, Australia.
Comment in:
* Biol Psychiatry. 2008 Nov 1;64(9):e1.
BACKGROUND: Treatment-resistant subthreshold depression is a major problem in bipolar disorder. Both depression and bipolar disorder are complicated by glutathione depletion. We hypothesized that treatment with N-acetyl cysteine (NAC), a safe, orally bioavailable precursor of glutathione, may improve the depressive component of bipolar disorder. METHODS: A randomized, double-blind, multicenter, placebo-controlled study of individuals (n = 75) with bipolar disorder in the maintenance phase treated with NAC (1 g twice daily) adjunctive to usual medication over 24 weeks, with a 4-week washout. The two primary outcomes were the Montgomery Asberg Depression Rating Scale (MADRS) and time to a mood episode. Secondary outcomes included the Bipolar Depression Rating Scale and 11 other ratings of clinical status, quality of life, and functioning. RESULTS: NAC treatment caused a significant improvement on the MADRS (least squares mean difference [95% confidence interval]: -8.05 [-13.16, -2.95], p = .002) and most secondary scales at end point. Benefit was evident by 8 weeks on the Global Assessment of Functioning Scale and Social and Occupational Functioning Assessment Scale and at 20 weeks on the MADRS. Improvements were lost after washout. There was no effect of NAC on time to a mood episode (log-rank test: p = .968) and no significant between-group differences in adverse events. Effect sizes at end point were medium to high for improvements in MADRS and 9 of the 12 secondary readouts. CONCLUSIONS: NAC appears a safe and effective augmentation strategy for depressive symptoms in bipolar disorder.
Posted by Economist on March 24, 2010, at 10:01:54
In reply to Re: med for negativ symptoms » Economist, posted by SLS on March 20, 2010, at 18:43:29
I was diagonsed schizophrenia when I had my initial psychotic break, however my doctors now for some reason are not diagnosing me with a formal illness. They say I'm too lucid and functioning to be schizophrenic? I find that strange, since there seem to be a lot of people with schizophrenia who are able to hold down jobs and responsibilities and even win a Nobel Prize.
Posted by Sigismund on March 27, 2010, at 0:04:00
In reply to Re: med for negativ symptoms » SLS, posted by Economist on March 24, 2010, at 10:01:54
>They say I'm too lucid and functioning to be schizophrenic? I find that strange, since there seem to be a lot of people with schizophrenia who are able to hold down jobs and responsibilities and even win a Nobel Prize.
Lucidity in psychosis is common.
If by lucidity you mean clear.
This is the end of the thread.
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