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Dr. Bob is Robert Hsiung, MD,
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Posted by ed_uk2010 on February 9, 2012, at 19:00:48
In reply to Re: Cariprazine, posted by n_shrimpie on February 9, 2012, at 15:39:02
>no, I never went above 80 on the parnate because I couldn't get through the initial month of side effects
Sorry, that bit was for SLS!
>Is cariprazine available yet?
Not yet unfortunately, it's in development.
Posted by SLS on February 9, 2012, at 19:24:41
In reply to Cariprazine » SLS, posted by ed_uk2010 on February 9, 2012, at 15:26:07
Thank you for posting the information about cariprazine, Ed. I probably would not have come across it myself.
> I think you might be interested in cariprazine.
This is big-time news to me.
I read that cariprazine has a lower affinity for D2/D3 receptors than does Abilify. I like this idea. It might make for a more tolerable drug with a wider therapeutic window. I am hoping that it wouldn't cause hypertriglyceridemia in me as does Abilify. Also, at higher dosages, cariprazine might not produce the cognitive impairments that are sometimes seen. Perhaps cariprazine would be less apt to produce akathisia. Anyway, I am excited about this drug.
> > I am taking Parnate now. It is helping.
> Have you ever taken more than 80mg? I don't know whether it would be beneficial, I just wondered.I have been up to 150 mg with Parnate. It was marginally more helpful than 80 mg. I would consider trying it again, now that other drugs are on-board.
- Scott
Posted by ed_uk2010 on February 10, 2012, at 6:33:14
In reply to Re: Cariprazine - Great news, hopefully. » ed_uk2010, posted by SLS on February 9, 2012, at 19:24:41
>Anyway, I am excited about this drug.
There is information on the Gedeon Richter website. Fortunately, you can click to read in English. My Hungarian is a little rusty. Anyway, you can read about the trials here...
http://www.richter.hu/EN/Pages/Search.aspx?stype=F&query=cariprazine
It seems effective in bipolar mania and probably schizophrenia. They also have some preliminary data in MDD and bipolar depression.
Posted by SLS on February 10, 2012, at 7:39:24
In reply to Re: Cariprazine - Great news, hopefully. » SLS, posted by ed_uk2010 on February 10, 2012, at 6:33:14
> >Anyway, I am excited about this drug.
>
> There is information on the Gedeon Richter website. Fortunately, you can click to read in English. My Hungarian is a little rusty. Anyway, you can read about the trials here...
>
> http://www.richter.hu/EN/Pages/Search.aspx?stype=F&query=cariprazine
>
> It seems effective in bipolar mania and probably schizophrenia. They also have some preliminary data in MDD and bipolar depression.
Thanks, Ed.I reviewed the abstracts to be found on Medline/Pubmed relating to cariprazine. Rats and mice have unanimously endorsed its approval for human use.
But seriously...
The findings of this study are quite salient and worth a look:
http://www.ncbi.nlm.nih.gov/pubmed/21767587
Perhaps cariprazine will be less liable to produce the undesirable cognitive side effects that Abilify (aripiprazole) does in some people, especially at higher dosages. This is probably the result of cariprazine having a greater D3/D2 ratio of binding affinities when compared to Abilify. Perhaps this would increase treatment compliance with cariprazine when treating psychotic disorders and make the drug more tolerable for people using it for depression.
It seems to me that people who are treating MDD with Abilify are more likely to be intolerant of dosages above 2.5 mg/day when compared to people being treated for psychotic disorders. Anxiety and cognitive blunting appear to limit dosage increases. I don't see that this is so much of an issue with people treating bipolar depression. I could be wrong.
I learned recently that 5-HT1a agonism mitigates EPS. Both Abilify and cariprazine have this property. So do Geodon, Latuda, and Saphris. I don't know if akathisia was taken into consideration, though. Abilify does seem to produce akathisia more often than the other atypical antipsychotics.
http://www.ncbi.nlm.nih.gov/pubmed/20571976
Sorry to ramble.
- Scott
Posted by ed_uk2010 on February 10, 2012, at 12:58:56
In reply to Re: Cariprazine - Great news, hopefully. » ed_uk2010, posted by SLS on February 10, 2012, at 7:39:24
>Perhaps this would increase treatment compliance with cariprazine when treating psychotic disorders and make the drug more tolerable for people using it for depression.
In the manufacturer's trials, akathisia was one of the most frequently reported side effects. This does not surprise me. In depression, the risk of withdrawal due to adverse effects is probably dose-dependent, but seems fairly low overall.
The four main trials on the Gedeon Richter website. My summary...
The Phase III trial in acute mania.
Dose: 3-12mg per day.
Outcome: The drug was more effective than placebo.
Withdrawal due to adverse effects: 10% on cariprazine, 7% on placebo.The Phase IIb trial in schizophrenia.
Dose: Fixed dose group on 1.5mg, 3mg and 4.5mg.
Outcome: All doses were statistically better than placebo.
Dose-dependent efficacy: 4.5mg produced a numerically greater reduction in the PANSS score than 3mg, and 3mg produced a numerically greater reduction than 1.5mg. It was not reported whether these differences were statistically significant.
Withdrawal due to adverse effects: Difficult to interpret. More patients in the placebo group dropped out due to adverse effects than in any of the cariprazine groups or the risperidone group. Presumably, the adverse effects reported in the placebo group were actually uncontrolled symptoms of psychosis, or withdrawal symptoms from the antipsychotic that patient's had been on prior to the trial.Phase II study in bipolar depression.
Dose: Two groups, 0.25mg-0.75mg or 1.5-3mg per day.
Outcome: The differences from placebo were not statistically significant.
Dose-dependent efficacy: The low dose did not appear to be effective. There was some evidence that the 1.5mg-3mg group fared better than placebo, even though the results did not achieve statistical significance. Might 4.5mg have been effective? The website says that they are considering performing a new Phase II trial with different doses.
Withdrawal due to adverse effects: 9% on 1.5-3mg, 3% on placebo. The 0.25mg-0.75mg isn't mentioned, but appears subtherapeutic.Phase II study. Cariprazine as an adjunct to an antidepressant in resistant Major Depressive Disorder.
Dose: 0.1-0.3mg or 1-2mg.
Outcome: The differences from placebo were not statistically different.
Dose-dependent efficacy: The very low dose (0.1mg to 0.3mg) did not appear to be effective. The higher dose was numerically better than placebo.
Withdrawal due to adverse effects: 3% on the higher dose and on placebo, 1% in the very low dose group.It seems that we are not going to learn much more about the efficacy of cariprazine in depression until higher doses are tested in clinical trials. 0.1mg-0.75mg did not show efficacy in MDD or bipolar depression. 1-3mg showed slight but non-significant efficacy. Given that 1.5-4.5 showed some efficacy in schizophrenia, this dose range appears to be active. Perhaps somewhere around 4.5mg would be optimal in depression? Up to 12mg was used in mania but might be excessive for depression.
Posted by tensor on February 10, 2012, at 13:00:05
In reply to Cariprazine » SLS, posted by ed_uk2010 on February 9, 2012, at 15:26:07
Posted by stewie on February 10, 2012, at 22:45:14
In reply to Re: Does abilify work for anhedonia, posted by SLS on February 9, 2012, at 6:45:45
I posted a lot in response to an earlier thread.
I will keep this short and say that I do think that Abilify is helping with anhedonia at 1 mg./day.I do not find it to be sedating - quite the opposite. And I really need to sleep more than 5 hours per night!
Something does occur to me: I am so used to not feeling pleasure and staying home and feeling sad and agoraphobic, that I am continuing the habit of sitting around and not taking too many risks. Depression leaves us with scars, I guess...
But when I DO get out and make plans or complete plans, I can joke and smile and even laugh. It's just that getting myself to do these things is not part of my routine anymore. Feeling crappy and staying in bed has been my routine for years.I don't know if this makes any sense to the problems of the original poster...I guess I am wondering if any of it resonates, and hoping very much that you will feel more joy or pleasure, bit by bit.
Today I pissed the day away on this computer and on the phone - missing all of the things I wanted to do. I hope tomorrow will be better. In the end, I DID laugh a few times today, and am less irritable, so, still, better than it has been.
All the best...
Posted by JohnLA on February 10, 2012, at 22:50:09
In reply to Re: Does abilify work for anhedonia, posted by stewie on February 10, 2012, at 22:45:14
stewie-
what time of da or night do you take your 1mg of abilify?
thnx.
john
Posted by stewie on February 10, 2012, at 23:16:24
In reply to stewie, posted by JohnLA on February 10, 2012, at 22:50:09
As soon as I am supposed to wake up... around 7:00. Usually I am up at 5 :(
Posted by n_shrimpie on February 10, 2012, at 23:54:02
In reply to Re: Does abilify work for anhedonia, posted by stewie on February 10, 2012, at 22:45:14
> I posted a lot in response to an earlier thread.
> I will keep this short and say that I do think that Abilify is helping with anhedonia at 1 mg./day.
>
> I do not find it to be sedating - quite the opposite. And I really need to sleep more than 5 hours per night!
>
> Something does occur to me: I am so used to not feeling pleasure and staying home and feeling sad and agoraphobic, that I am continuing the habit of sitting around and not taking too many risks. Depression leaves us with scars, I guess...
> But when I DO get out and make plans or complete plans, I can joke and smile and even laugh. It's just that getting myself to do these things is not part of my routine anymore. Feeling crappy and staying in bed has been my routine for years.
>
> I don't know if this makes any sense to the problems of the original poster...I guess I am wondering if any of it resonates, and hoping very much that you will feel more joy or pleasure, bit by bit.
>
> Today I pissed the day away on this computer and on the phone - missing all of the things I wanted to do. I hope tomorrow will be better. In the end, I DID laugh a few times today, and am less irritable, so, still, better than it has been.
>
> All the best...
This ALL resonates.I've spent 90% of my life on my laptop or in bed, and that pattern is so ingrained and seems so normal that it's very difficult to change. When i was on the nardil, i would think i was joyless, but when i socialized I really was able to experience pleasure, but I'd have to FORCE myself to go do things, was always apathetic, but when i did, i could have fun. Nardil made me tired, so that also caused me to sleep more. And when i was first on the Lamictal, i actively sought out pleasurable experiences, which is of course the ideal. i couldn't believe that people got to feel like this every day instead of just going through the motions of life, but alas, it pooped out on me.I'm now up to 5mg on the abilify, and i've lost the motivation i had at 2mg and in the early 5mg stage. i still have insomnia, but i only feel motivated, wired and restless( which i dislike, but since it contributes to my functionality i tolerate it) for a few hours after i take it but then it subsides and isn't activating, simply gives me insomnia. i doubt that i can afford to remain on the 5mg, and it doesn't seem to be doing much for my mood so I'll probably go down to 2.5. My doctor said i seemed my better today, less confused and i did feel better cognitively this morning than i have in a while, but being atypical, my depression progresses as the day does, so i'm confused and spacey and experiencing complete anhedonia right now.but at least the mornings have improved. i'm really considering exercising in the morning in hopes that it will help my depression. sometimes i fear the depression has caused permanent brain damage,(especially since i've gone pretty much untreated over the past year, just on the lamictal but quite depressed) and i'll never retain my cognitive faculties and that terrifies me.
Posted by SLS on February 11, 2012, at 5:00:49
In reply to Re: Does abilify work for anhedonia, posted by n_shrimpie on February 10, 2012, at 23:54:02
Try to give the higher dosage of Abilify a few more days. You might see the depression and anhedonia improve. Cognitive side effects often dissipate. Making a dosage adjustment is nothing more than an experiment to see how your unique physiology reacts to it. In the absence of acute akathisia, it might be worth the extra time so as to draw reliable conclusions.
Good luck.
- Scott
Posted by stewie on February 11, 2012, at 7:56:36
In reply to Re: Does abilify work for anhedonia, posted by n_shrimpie on February 10, 2012, at 23:54:02
Posted by stewie on February 11, 2012, at 7:59:58
In reply to Re: Does abilify work for anhedonia » n_shrimpie, posted by SLS on February 11, 2012, at 5:00:49
I see Scott's point too... one just never knows. I would never have known what akathisia felt like had I not stayed on those 5 mgs :-). I would always have wondered if I should have just sucked it up more...so you have options.
Yes... Devil and Deep Blue Sea options, it seems, sometimes!
> Try to give the higher dosage of Abilify a few more days. You might see the depression and anhedonia improve. Cognitive side effects often dissipate. Making a dosage adjustment is nothing more than an experiment to see how your unique physiology reacts to it. In the absence of acute akathisia, it might be worth the extra time so as to draw reliable conclusions.
>
> Good luck.
>
>
> - Scott
>
Posted by ed_uk2010 on February 11, 2012, at 8:19:49
In reply to Re: Does abilify work for anhedonia » n_shrimpie, posted by SLS on February 11, 2012, at 5:00:49
Hi Scott,
What do you think of the studies that I posted about above...
http://www.dr-bob.org/babble/20120202/msgs/1009917.html
Thanks.
Posted by stewie on February 11, 2012, at 8:38:04
In reply to Cariprazine » SLS, posted by ed_uk2010 on February 11, 2012, at 8:19:49
Posted by stewie on February 11, 2012, at 8:48:35
In reply to Re: Does abilify work for anhedonia, posted by n_shrimpie on February 10, 2012, at 23:54:02
Well, my long response did not register...
I will try to recap:
I had the same feeling on Nardil - except for during the inevitable 2pm 3 hour nap!I mentioned exercise and how I feel genuinely motivated to go to yoga or I know that if I force myself, I will be happy I did..
Exercise and meds, ideally work in tandem, I think.
Lamictal poops out on me, but can be revisited from time to time with an SSRI.
I would agree that perhaps the lower dose of abilify would be better, I said in the lost post... for me, the insomnia I am dealing with on Abilify causes me to be tired, which makes seeking anything but my bed out, (even though I don't sleep enough in it) rather difficult. That can be depressing.
And on boy - Abilify is one expensive drug, so I hear you - I am happy to be splitting the 2 mg pill.
I do wish you the best...
Diane> This ALL resonates.I've spent 90% of my life on my laptop or in bed, and that pattern is so ingrained and seems so normal that it's very difficult to change. When i was on the nardil, i would think i was joyless, but when i socialized I really was able to experience pleasure, but I'd have to FORCE myself to go do things, was always apathetic, but when i did, i could have fun. Nardil made me tired, so that also caused me to sleep more. And when i was first on the Lamictal, i actively sought out pleasurable experiences, which is of course the ideal. i couldn't believe that people got to feel like this every day instead of just going through the motions of life, but alas, it pooped out on me.
>
> I'm now up to 5mg on the abilify, and i've lost the motivation i had at 2mg and in the early 5mg stage. i still have insomnia, but i only feel motivated, wired and restless( which i dislike, but since it contributes to my functionality i tolerate it) for a few hours after i take it but then it subsides and isn't activating, simply gives me insomnia. i doubt that i can afford to remain on the 5mg, and it doesn't seem to be doing much for my mood so I'll probably go down to 2.5. My doctor said i seemed my better today, less confused and i did feel better cognitively this morning than i have in a while, but being atypical, my depression progresses as the day does, so i'm confused and spacey and experiencing complete anhedonia right now.but at least the mornings have improved. i'm really considering exercising in the morning in hopes that it will help my depression. sometimes i fear the depression has caused permanent brain damage,(especially since i've gone pretty much untreated over the past year, just on the lamictal but quite depressed) and i'll never retain my cognitive faculties and that terrifies me.
>
Posted by n_shrimpie on February 11, 2012, at 8:51:53
In reply to Re: Does abilify work for anhedonia, posted by stewie on February 11, 2012, at 8:48:35
> Well, my long response did not register...
> I will try to recap:
> I had the same feeling on Nardil - except for during the inevitable 2pm 3 hour nap!
>
> I mentioned exercise and how I feel genuinely motivated to go to yoga or I know that if I force myself, I will be happy I did..
>
> Exercise and meds, ideally work in tandem, I think.
>
> Lamictal poops out on me, but can be revisited from time to time with an SSRI.
>
> I would agree that perhaps the lower dose of abilify would be better, I said in the lost post... for me, the insomnia I am dealing with on Abilify causes me to be tired, which makes seeking anything but my bed out, (even though I don't sleep enough in it) rather difficult. That can be depressing.
>
> And on boy - Abilify is one expensive drug, so I hear you - I am happy to be splitting the 2 mg pill.
>
> I do wish you the best...
> Diane
>
> > This ALL resonates.I've spent 90% of my life on my laptop or in bed, and that pattern is so ingrained and seems so normal that it's very difficult to change. When i was on the nardil, i would think i was joyless, but when i socialized I really was able to experience pleasure, but I'd have to FORCE myself to go do things, was always apathetic, but when i did, i could have fun. Nardil made me tired, so that also caused me to sleep more. And when i was first on the Lamictal, i actively sought out pleasurable experiences, which is of course the ideal. i couldn't believe that people got to feel like this every day instead of just going through the motions of life, but alas, it pooped out on me.
> >
> > I'm now up to 5mg on the abilify, and i've lost the motivation i had at 2mg and in the early 5mg stage. i still have insomnia, but i only feel motivated, wired and restless( which i dislike, but since it contributes to my functionality i tolerate it) for a few hours after i take it but then it subsides and isn't activating, simply gives me insomnia. i doubt that i can afford to remain on the 5mg, and it doesn't seem to be doing much for my mood so I'll probably go down to 2.5. My doctor said i seemed my better today, less confused and i did feel better cognitively this morning than i have in a while, but being atypical, my depression progresses as the day does, so i'm confused and spacey and experiencing complete anhedonia right now.but at least the mornings have improved. i'm really considering exercising in the morning in hopes that it will help my depression. sometimes i fear the depression has caused permanent brain damage,(especially since i've gone pretty much untreated over the past year, just on the lamictal but quite depressed) and i'll never retain my cognitive faculties and that terrifies me.
> >
>
> yes, the insomnia makes me tired, but the abilify makes me wired, which isn't a comfortable combo. sometimes i wonder if the cognitive issues are a function of my 400mg lamictal dosage, but everytime i try to reduce it i become more depressed and spacy. maybe it's just withdrawal and i should suffer through it to see if a lower dose eliminates the cognitive impairments.
Posted by SLS on February 11, 2012, at 9:53:07
In reply to Re: Does abilify work for anhedonia, posted by stewie on February 11, 2012, at 8:48:35
> Lamictal poops out on me, but can be revisited from time to time with an SSRI.
Does Lamictal poop-out on you when it is combined with Abilify?
From what I have seen, the combination of Lamictal and Abilify can work well. My guess is that they act synergistically to increase activity in the limbic system.
I hope you find an optimum treatment.
- Scott
Posted by n_shrimpie on February 11, 2012, at 10:07:50
In reply to Re: Does abilify work for anhedonia » stewie, posted by SLS on February 11, 2012, at 9:53:07
nothing has seemed to reactivate the lamictal yet, however, it does continue to act as a mood stabilizer and prevent me from severe downward spirals. Yet my memory/cognitive and anhedonia issues remain (i even had trouble syncing my ipod this morning!) and i feel like i'm not "present" if that makes any sense. however my word retrieval and writing skills have improved marginally. I've only been on 5mg abilify for a week so i suppose i need to give it more time. at one point, my prozac worked as the 20 mg was washing out of my system, so there does seem to be a therapeutic window. 2 weeks ago i went from 20mg to 10 mg, so maybe i'll reach the therapeutic window at 10mg, and if not, i'll probably reduce it more. As usual, i tend to feel best in the morning and deteriorate as the day progresses, which is consistent with my atypical depression. i can no longer sleep as an escape on the abilify so my daytime naps are a thing of the past, which i suppose is a good thing, but i miss the breaks from obsessing over my depression and overthinking my medication issues, and sleep is the only way to get any relief from it.
Posted by SLS on February 11, 2012, at 10:34:28
In reply to Re: Does abilify work for anhedonia, posted by n_shrimpie on February 11, 2012, at 10:07:50
I suffer cognitive impairments when I increase the dosage of Lamictal above 200 mg.
- Scott
Posted by n_shrimpie on February 11, 2012, at 11:41:03
In reply to Re: Does abilify work for anhedonia » n_shrimpie, posted by SLS on February 11, 2012, at 10:34:28
yes, you've mentioned that before. i must try to reduce it and suffer through the withdrawal period in order to test your theory, because i believe that my mood is bad simply because of my cognitive issues. i'm using 400 mg pills. is it too much to reduce it by 100 mg/day? What strategy did you use for withdrawal? on an unrelated note,do you use fish oil pills?
Posted by n_shrimpie on February 11, 2012, at 11:55:57
In reply to Re: Does abilify work for anhedonia, posted by n_shrimpie on February 11, 2012, at 11:41:03
What is the half life of lamictal? how long should i give the dose reduction before deciding on a dosage?
Posted by n_shrimpie on February 11, 2012, at 12:16:18
In reply to Re: Does abilify work for anhedonia » stewie, posted by SLS on February 11, 2012, at 9:53:07
Now i'm tired on the 5mg of abilify, have zero motivation, feel like it's not doing anything. i found the 2mg more activating. does that make sense?
Posted by SLS on February 11, 2012, at 13:23:26
In reply to Re: Does abilify work for anhedonia, posted by n_shrimpie on February 11, 2012, at 11:41:03
> yes, you've mentioned that before. i must try to reduce it and suffer through the withdrawal period in order to test your theory, because i believe that my mood is bad simply because of my cognitive issues. i'm using 400 mg pills. is it too much to reduce it by 100 mg/day? What strategy did you use for withdrawal? on an unrelated note,do you use fish oil pills?
You could reduce the Lamictal by 50 mg every three or four days. I was able to tolerate that pace when I reduced from 450 mg. If you reduce too fast, it is very likely that you will experience a transient increase in depression.
For some odd reason, the fish oil preparations that I have tried made me feel worse. More recently, I tried Carlson's liquid. My guess is that DHA is the culprit. Omegabrite is pure EPA, and is sold as a treatment for depression. I would have no objections to trying it.
- Scott
Posted by SLS on February 11, 2012, at 13:36:51
In reply to Re: Does abilify work for anhedonia, posted by n_shrimpie on February 11, 2012, at 12:16:18
> Now i'm tired on the 5mg of abilify, have zero motivation, feel like it's not doing anything. i found the 2mg more activating. does that make sense?
How many days have you been taking 5 mg for?
What was the reason for increasing the dosage? Remember, you have made a 150% increase in one step. It might take a few days to get used to.
It is not unheard of for people to experience a "therapeutic window" with drugs. Nortriptyline and amisulpride come to mind. It is possible to lose the therapeutic effect of a drug when increasing the dosage beyond a certain point.
- Scott
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