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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Christ_empowered on September 5, 2011, at 11:13:45
I take 30mgs Abilify and 50mgs Lamictal, with a target dose of 200 for the lamictal. The plan is to get me up to 200 lamictal and decrease the Abilify to 15.
Overall, I'm starting to feel better. The "voices"-more like thoughts I can hear and that distract and bother me-have become less frequent and less intense. I have more energy. My sleep patterns seem to have normalized after a period of sleeping entirely too much, too often.
The thing is, I'm really, really tired of hearing these voices and having these thoughts. I hate to say I want a magic pill to take it all away, but I do sometimes think a low-dose SSRI might be beneficial. I was thinking low-dose Prozac, since I'm prone to a bit of lethargy. Also, with the Prozac on board I could further decrease the Abilify to 7.5 mgs b/c of its interaction with Abilify.
But I don't know. I don't want to be overmedicated or tranquilized into oblivion. I just want to be a little more stable and less tortured.
Posted by Phillipa on September 5, 2011, at 11:18:05
In reply to Add an antidepressant? or wait?, posted by Christ_empowered on September 5, 2011, at 11:13:45
CE didn't you post in another thread that lamictal would now be your ad? I didn't know it worked as an ad also thought just mood? Or booster to an ad? Would prozac be to stimulating? Seems like you would love to be off the abilify. But isn't that the med that took the voices away? Phillipa
Posted by Christ_empowered on September 5, 2011, at 12:09:16
In reply to Re: Add an antidepressant? or wait? » Christ_empowered, posted by Phillipa on September 5, 2011, at 11:18:05
hey phillipa,
I've made my peace with being on Abilify. The only question is dosage, because right now I'm at the FDA-approved max and I'd like to go lower. I guess its something other than straight up psychosis/schizophrenia/whatever, because add-on meds, like celexa and now lamictal, not only improve my mood and anxiety levels, they also help with the voices that are left over from the Abilify treatment.
Once I hit 200 of the Lamictal, I'll go down to 15 of Abilify, which according to my doc is a good dosage for someone like me, who is technically bipolar but runs more on the depression/psychotic depression end of things.
With Prozac, you're supposed to cut your Abilify in 1/2, so if my target dose is 15mgs, then it will be 7.5 mgs on Prozac.
I just don't know. Honestly, today I'm feeling better than I have in a long, long time, but I still feel like I might need some chemical assistance to get to where I need to be.
Posted by polarbear206 on September 5, 2011, at 13:48:58
In reply to Add an antidepressant? or wait?, posted by Christ_empowered on September 5, 2011, at 11:13:45
> I take 30mgs Abilify and 50mgs Lamictal, with a target dose of 200 for the lamictal. The plan is to get me up to 200 lamictal and decrease the Abilify to 15.
>
> Overall, I'm starting to feel better. The "voices"-more like thoughts I can hear and that distract and bother me-have become less frequent and less intense. I have more energy. My sleep patterns seem to have normalized after a period of sleeping entirely too much, too often.
>
> The thing is, I'm really, really tired of hearing these voices and having these thoughts. I hate to say I want a magic pill to take it all away, but I do sometimes think a low-dose SSRI might be beneficial. I was thinking low-dose Prozac, since I'm prone to a bit of lethargy. Also, with the Prozac on board I could further decrease the Abilify to 7.5 mgs b/c of its interaction with Abilify.
>
> But I don't know. I don't want to be overmedicated or tranquilized into oblivion. I just want to be a little more stable and less tortured.
>
>
I don't think it would be a very wise decision to introduce an AD while your titrating with the Lamictal. You see improvements, so be patient.
Posted by morgan miller on September 5, 2011, at 14:12:24
In reply to Add an antidepressant? or wait?, posted by Christ_empowered on September 5, 2011, at 11:13:45
Definitely wait till you reach the Lamictal target dose.
A low dose of Prozac or Zoloft could be helpful in the future.
I wonder if a low to moderate dose of Lithium would help...hmmm
Posted by rene5150 on September 5, 2011, at 16:51:53
In reply to Add an antidepressant? or wait?, posted by Christ_empowered on September 5, 2011, at 11:13:45
if you are bi polar or scizo affective disorder
anantipressant is the worst thing to do. it could throw u into a severe manic swing. Im still singing the praises of Trilifon with cogention
Posted by jono_in_adelaide on September 5, 2011, at 17:40:18
In reply to Add an antidepressant? or wait?, posted by Christ_empowered on September 5, 2011, at 11:13:45
Ask your doc about a trial of an antidepressant - though I'd go for one of the "cleaner" ones such as Zoloft or Effexor my self
Provided it doesnt swing you towards mania, you have potentialy a lot to gain
Posted by morgan miller on September 5, 2011, at 23:36:40
In reply to Re: Add an antidepressant? or wait?, posted by rene5150 on September 5, 2011, at 16:51:53
> if you are bi polar or scizo affective disorder
> anantipressant is the worst thing to do. it could throw u into a severe manic swing. Im still singing the praises of Trilifon with cogentionThis is not always true. There are plenty of people with schizophrenic disorders and bipolar doing very well on a combination of antidepressants and mood stabilizers/antipsychotics.
Posted by creepy on September 5, 2011, at 23:37:42
In reply to Add an antidepressant? or wait?, posted by Christ_empowered on September 5, 2011, at 11:13:45
You might get more racing thoughts on SSRIs. They do this to me a lot. constant inner dialogue that never shuts up. Celexa drove me up the walls for awhile and Im not even dx'd as bipolar.
prozac can cause some dysphoric, mixed stuff during startup. Made me very anxious and irritable as hell.
I think your doc has a great plan. use the abilify to smooth out the lamictal titration. If you still have anxiety, racing thoughts or hypo symptoms maybe ask for a PRN AAP like zyprexa.
Posted by morgan miller on September 6, 2011, at 1:28:35
In reply to Re: Add an antidepressant? or wait?, posted by creepy on September 5, 2011, at 23:37:42
You guys are missing the fact that CE said he has done well on Celexa.
Posted by floatingbridge on September 6, 2011, at 11:51:42
In reply to Add an antidepressant? or wait?, posted by Christ_empowered on September 5, 2011, at 11:13:45
"You guys are missing the fact that CE said he has done well on Celexa."
CE, is this true?
At any rate, I cast my vote with the majority on waiting it out until you hit the 200mg target dose.
When do you hit that 200mg lamictal mark?
You know, the flipping rash thing can be set off be any number of new chemical introductions.... Prozac might be fine, (would you hold onto it, or self taper it when at 200 lamictal?), but what if it does provoke a rash response?
Is the 30mg abilify pulling you down? But not stopping, quieting the intrusive thoughts/voices?
I guess I don't know the ways abilify works.
Waiting is tough. I'm sorry I can't really advise, only ask questions.
fb
Posted by Christ_empowered on September 6, 2011, at 13:23:12
In reply to Re: Add an antidepressant? or wait? » Christ_empowered, posted by floatingbridge on September 6, 2011, at 11:51:42
Today has been better so far, and I don't think I'm going to ask for an antidepressant. Celexa worked for the agitation, paranoia, and voices from psychotic depression, but once all the problems had passed I was left feeling a bit over-tranquilized.
I think I may cut the Abilify to 15. At 30, it keeps most of the voices at bay and minimizes agitation, but I'm concerned about TD and being over tranquilized. Abilify is the only neuroleptic I can tolerate, because of its mildly stimulating (or at least non-sedating) properties. My thoughts are clearer. I read somewhere online that the dopamine agonism follows an inverted U in terms of dosage, so maybe if I drop it to 15 I'll be more stimulated and still get adequate symptom control (30 isn't usually better than 15 for core symptoms, its just more tranquilizing, so its good for agitation and acute mania).
Honestly, I think I should try to keep my cocktail down to 2 drugs or less if I can. Nothing against polypharmacy when its needed, but I'm not in dire straits, so it isn't exactly necessary at this point. I might end up with more side effects for very few (if any) benefits.
Posted by floatingbridge on September 6, 2011, at 15:56:57
In reply to I think I'll wait, posted by Christ_empowered on September 6, 2011, at 13:23:12
That's a tough decision, CE. Waiting this out sounds like the pits.
I think letting the lamictal get in place is conservative and sound course of action.
When do you expect to hit the target on lamictal.
My fingers are crossed for you....
Posted by Christ_empowered on September 6, 2011, at 17:17:24
In reply to Re: I think I'll wait » Christ_empowered, posted by floatingbridge on September 6, 2011, at 15:56:57
I hit 100 on the Lamictal today. 9 more days of 100, then I start at 200. Honestly, I do feel better. I'm not quite as lazy or slowed down and the voices are minimal. I honestly don't know to what extent these voices are caused by "psychotic depression" and to what extent they're caused by being in a really rough situation for a really long time.
I'd like to keep my meds down to a minimum, but sometimes adding something that I know will help at least for a while, like Celexa, seems so appealing.
Posted by Phillipa on September 6, 2011, at 19:18:13
In reply to Re: I think I'll wait, posted by Christ_empowered on September 6, 2011, at 17:17:24
CE you say positively that you know the celexa will help. If so then don't listen to anyone but you and doc and do what's best for you. Phillipa
This is the end of the thread.
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