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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 17 to 41 of 41. Go back in thread:
Posted by Roslynn on August 30, 2010, at 16:33:25
In reply to Nardil + lithium = serotonin syndrome, posted by SLS on August 29, 2010, at 6:19:45
Scott,
I'm sorry about the weight gain. I am fighting that too. Best of luck to you as you decrease the Abilify.
Roslynn
Posted by morgan miller on August 30, 2010, at 17:18:04
In reply to Re: Nardil + lithium = serotonin syndrome » emmanuel98, posted by SLS on August 30, 2010, at 5:11:16
Scott, have you ever thought about just taking a small amount of lithium orotate once or twice a day for the continued neuroprotection? You may even still get some subtle mood stabilizing benefit from it. I don't think this will interact with Nardil the way 600 mg of lithium carbonate did.
Morgan
Posted by SLS on August 30, 2010, at 17:19:25
In reply to Re: Nardil + lithium = serotonin syndrome » SLS, posted by ed_uk2010 on August 30, 2010, at 15:06:11
Hi Ed.
> Do you think it's definitely Abilify which is causing your weight gain, not Nardil or nortriptyline?
Yes. Substituting desipramine for nortriptyline didn't help with the weight gain. Neither did swapping Parnate for Nardil. I was very much dismayed that I did not lose any of the 50 extra pounds when I switched to Parnate and desipramine. The weight gain did not occur immediately upon initiating Abilify therapy. It was a latent effect that emerged insidiously. It seems that this is not an uncommon phenomenon from what I see on Psycho-Babble.
> I think it's probably a good idea to try to come off Abilify. You might feel temporarily worse but that could be followed by an improvement.
Okay. I'll do it. Let's see what happens.
> I just wonder whether your energy levels might improve without the antipsychotic on board.
Actually, one of the reasons I remained on Abilify for so long is that it increased my mental energy and motivation.
- Scott
Posted by SLS on August 30, 2010, at 17:24:46
In reply to Re: Nardil + lithium = serotonin syndrome » SLS, posted by morgan miller on August 30, 2010, at 17:18:04
> Scott, have you ever thought about just taking a small amount of lithium orotate once or twice a day for the continued neuroprotection? You may even still get some subtle mood stabilizing benefit from it. I don't think this will interact with Nardil the way 600 mg of lithium carbonate did.
>
> Morgan
You are probably right. I'll give it some thought. I might attempt to discontinue Abilify first.
- Scott
Posted by morgan miller on August 30, 2010, at 17:25:04
In reply to Re: Nardil + lithium = serotonin syndrome » ed_uk2010, posted by SLS on August 30, 2010, at 17:19:25
Scott, how about just trying a lower dose, maybe 2 or 3 mg, of Abilify, at least for a few months.
Morgan
Posted by SLS on August 30, 2010, at 17:31:06
In reply to Re: Nardil + lithium = serotonin syndrome » SLS, posted by morgan miller on August 30, 2010, at 17:25:04
> Scott, how about just trying a lower dose, maybe 2 or 3 mg, of Abilify, at least for a few months.
>
> MorganMy main concern with Abilify is weight gain and elevated triglycerides. So far, I haven't seen any evidence that weight gain with Abilify is dosage related. I'll try to taper slowly.
Thanks.
- Scott
Posted by morgan miller on August 30, 2010, at 17:45:53
In reply to Re: Nardil + lithium = serotonin syndrome » morgan miller, posted by SLS on August 30, 2010, at 17:31:06
Good luck!
Posted by SLS on August 30, 2010, at 17:50:35
In reply to Re: Nardil + lithium = serotonin syndrome » SLS, posted by morgan miller on August 30, 2010, at 17:45:53
> Good luck!
Thanks.
- Scott
Posted by morgan miller on August 30, 2010, at 18:07:47
In reply to Re: Nardil + lithium = serotonin syndrome » morgan miller, posted by SLS on August 30, 2010, at 17:50:35
Oh yeah I forgot to mention that if you do try lithium orotate, Vitamin Research Products, they evidently have one of the more reliable high quality lithium orotate products out there.
Morgan
Posted by Phillipa on August 30, 2010, at 19:45:06
In reply to Re: Nardil + lithium = serotonin syndrome, posted by morgan miller on August 30, 2010, at 18:07:47
Scott is it possible your response to meds has changed same as mine did when got older. Not a fun topic. But weight gain seems more common as we age. And like now benzos making me tired and ad's feel nothing. I wonder if the mind also ages and becomes resistant to meds? Not like poop out like habits are more resistant to change we get set in our ways so they say. Don't know if this makes sense or not Phillipa
Posted by SLS on August 31, 2010, at 5:21:18
In reply to Re: Nardil + lithium = serotonin syndrome, posted by Phillipa on August 30, 2010, at 19:45:06
> Scott is it possible your response to meds has changed same as mine did when got older. Not a fun topic. But weight gain seems more common as we age. And like now benzos making me tired and ad's feel nothing. I wonder if the mind also ages and becomes resistant to meds? Not like poop out like habits are more resistant to change we get set in our ways so they say. Don't know if this makes sense or not Phillipa
I think it does make sense, and yes, I think my brain has changed in ways that affect my reactivity to drug treatment.
- Scott
Posted by ed_uk2010 on August 31, 2010, at 5:23:32
In reply to Re: Nardil + lithium = serotonin syndrome » ed_uk2010, posted by SLS on August 30, 2010, at 17:19:25
>Actually, one of the reasons I remained on Abilify for so long is that it increased my mental energy and motivation.
I suppose it's difficult to know whether it's still helping. Are you planning to taper off it over a few weeks?
Posted by SLS on August 31, 2010, at 5:57:20
In reply to Re: Nardil + lithium = serotonin syndrome » SLS, posted by ed_uk2010 on August 31, 2010, at 5:23:32
> >Actually, one of the reasons I remained on Abilify for so long is that it increased my mental energy and motivation.
>
> I suppose it's difficult to know whether it's still helping. Are you planning to taper off it over a few weeks?I'm going to try tapering Abilify within two weeks. However, I will make adjustments along the way according to how I feel. It might take much longer. I'll try not to be too stubborn. I would like to have information to bring in with me when I see my doctor in two weeks. It would be ideal to be off of Abilify by then.
- Scott
Posted by ed_uk2010 on August 31, 2010, at 6:51:27
In reply to Re: Nardil + lithium = serotonin syndrome » ed_uk2010, posted by SLS on August 31, 2010, at 5:57:20
>I'm going to try tapering Abilify within two weeks. However, I will make adjustments along the way according to how I feel. It might take much longer. I'll try not to be too stubborn. I would like to have information to bring in with me when I see my doctor in two weeks. It would be ideal to be off of Abilify by then.
Do you think you might feel worse if you taper too quickly? That could make you feel that you still need to be on Abilify, when perhaps you don't. Just a thought. I wouldn't want you to reduce too quickly because I don't think there are any advantages in doing so.
Due to its long half life, it makes sense to reduce the dose in relatively large 'steps' but at fairly long intervals eg. you could go straight from 10mg to 5mg ...but stay on 5mg for several weeks before reducing any further. You could then reduce to 2mg for a couple of weeks before stopping.
Even if you are still taking Abilify when you go for your appointment, you'll still be able to tell your doctor how you are feeling on the lower dose - you will still have something to discuss.
Posted by SLS on August 31, 2010, at 7:00:05
In reply to Re: Nardil + lithium = serotonin syndrome » SLS, posted by ed_uk2010 on August 31, 2010, at 6:51:27
> >I'm going to try tapering Abilify within two weeks. However, I will make adjustments along the way according to how I feel. It might take much longer. I'll try not to be too stubborn. I would like to have information to bring in with me when I see my doctor in two weeks. It would be ideal to be off of Abilify by then.
> Do you think you might feel worse if you taper too quickly?
Probably.
> That could make you feel that you still need to be on Abilify, when perhaps you don't.
Yes. That is a concern of mine.
> Just a thought. I wouldn't want you to reduce too quickly because I don't think there are any advantages in doing so.
I am ambivalent as to the best way to proceed.
> Due to its long half life, it makes sense to reduce the dose in relatively large 'steps' but at fairly long intervals eg. you could go straight from 10mg to 5mg ...but stay on 5mg for several weeks before reducing any further. You could then reduce to 2mg for a couple of weeks before stopping.
That makes a great deal of sense.
> Even if you are still taking Abilify when you go for your appointment, you'll still be able to tell your doctor how you are feeling on the lower dose - you will still have something to discuss.
You are too damned logical.
:-)
Thanks, Ed.
- Scott
Posted by ed_uk2010 on August 31, 2010, at 12:50:23
In reply to Re: Nardil + lithium = serotonin syndrome » ed_uk2010, posted by SLS on August 31, 2010, at 7:00:05
>You are too damned logical.
Not with respect to my own problems unfortunately.
Posted by amdew717 on September 2, 2010, at 9:53:08
In reply to Re: Nardil + lithium = serotonin syndrome » angels78, posted by SLS on August 29, 2010, at 9:04:34
> > What dose of nardil are you on?
>
> My treatment regime comprises:
>
> Nardil 90mg
> nortriptyline 150mg
> Lamictal 100mg
> Abilify 10mg
>
>
> - ScottWOW, i didn't think it was possible to take ANY Tricyclics or Lamictal while taking an MAOI like Nardil. I take Nardil and i had to go off it for at least 4 weeks when we decided to try Lamictal.
James
Posted by SLS on September 2, 2010, at 11:54:29
In reply to Re: Nardil + lithium = serotonin syndrome, posted by amdew717 on September 2, 2010, at 9:53:08
> > > What dose of nardil are you on?
> >
> > My treatment regime comprises:
> >
> > Nardil 90mg
> > nortriptyline 150mg
> > Lamictal 100mg
> > Abilify 10mg
> >
> >
> > - Scott
>
> WOW, i didn't think it was possible to take ANY Tricyclics or Lamictal while taking an MAOI like Nardil. I take Nardil and i had to go off it for at least 4 weeks when we decided to try Lamictal.
> JamesRegarding TCAs, they aren't all compatible with MAOIs. Certainly, clomipramine and imipramine are drugs to stay away from. I have used either desipramine or nortriptyline to avoid serotonin issues. I am not aware of any contraindication in combining Lamictal and an MAOI. Did your doctor give you any details regarding this?
- Scott
Posted by emmanuel98 on September 2, 2010, at 19:27:07
In reply to Re: Nardil + lithium = serotonin syndrome, posted by SLS on September 2, 2010, at 11:54:29
I stared taking lamictal this spring with parnate. My p-doc said it was fine. I was hospitalized in McLean over the summer and they said it was fine too. Abilify, though, everyone said is contra-indicated with MAOIs.
Posted by SLS on September 2, 2010, at 20:21:51
In reply to Re: Nardil + lithium = serotonin syndrome, posted by emmanuel98 on September 2, 2010, at 19:27:07
> I stared taking lamictal this spring with parnate. My p-doc said it was fine. I was hospitalized in McLean over the summer and they said it was fine too. Abilify, though, everyone said is contra-indicated with MAOIs.
Did anyone say why?
- Scott
Posted by ed_uk2010 on September 3, 2010, at 10:23:04
In reply to Re: Nardil + lithium = serotonin syndrome » emmanuel98, posted by SLS on September 2, 2010, at 20:21:51
>Did anyone say why?
Hearsay, I imagine.
Posted by ed_uk2010 on September 3, 2010, at 15:19:53
In reply to Re: Nardil + lithium = serotonin syndrome » emmanuel98, posted by SLS on September 2, 2010, at 20:21:51
>Abilify, though, everyone said is contra-indicated with MAOIs.
Apparently, Abilify has weak/moderate affinity for the 5-HT transporter. I suppose this might be of relevence in some cases.
Posted by SLS on September 3, 2010, at 15:27:56
In reply to Re: Nardil + lithium = serotonin syndrome » SLS, posted by ed_uk2010 on September 3, 2010, at 15:19:53
> >Abilify, though, everyone said is contra-indicated with MAOIs.
> Apparently, Abilify has weak/moderate affinity for the 5-HT transporter.Hmm. That sounds logical.
Perhaps SERT inhibition adds to the akathisia risk Abilify exhibits.
- Scott
Posted by ed_uk2010 on September 3, 2010, at 15:47:20
In reply to Re: Nardil + lithium = serotonin syndrome, posted by SLS on September 3, 2010, at 15:27:56
>Perhaps SERT inhibition adds to the akathisia risk Abilify exhibits.
Maybe, but I suspect it's mainly down to aripiprazole's very high affininty for dopamine receptors, and comparatively modest affinity for 5-HT2a receptors.
Posted by emmanuel98 on September 3, 2010, at 19:22:14
In reply to Re: Nardil + lithium = serotonin syndrome » emmanuel98, posted by SLS on September 2, 2010, at 20:21:51
Nope. That just seems to be the consensus at the Harvard psychiatry department. Seroquel, otoh, they deem alright to mix with MAOIs
> Did anyone say why?
>
>
> - Scott
This is the end of the thread.
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