Shown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by LouisianaSportsman on October 16, 2013, at 20:51:19
Hello, everyone! I recently made a topic on this forum that received few responses, unfortunately; however, I did like the responses I did receive. phidippus, Eric, are you there??
Diagnosis:
[301.13] Cyclothymic Disorder
[314.00] Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type
[296.35] Major Depressive Disorder, Recurrent, In Partial Remission
[300.02] Generalized Anxiety DisorderHere is a link to my previous thread:
http://tinyurl.com/bipolarmedsdrbobIf you read through the thread, you'll notice there is the original post and then a follow-up post regarding what the p-doc did the second visit. If I was to post this thread within the old one, this would be my third pdoc visit.
What I'm trying to get at is-- I was trying to get my mood and anxiety meds correct first before moving on to ADHD meds. Isn't this the established way to do it? Instead, the PDOC says it's best to tackle the ADHD first and then maybe the anxiety and depression and mood will be alleviated. Is this true? I never really looked at it that way.
The PDOC wrote me Aplenzin 522mg. (brand-name bupropion hydrobromide salt instead of hydrochloride salt substituted that comes in a 522mg. tablet equipotent to Wellbutrin XL 450mg., it also stops you from taking 3 Wellbutrin XL 150mg.'s to achieve that 450mg. dosage as well). I was on Aplenzin 522mg. in the past and was taken off of it to try Pristiq. I am familiar with the effects of this dosage. I get no side effects. In fact, it has been many hours since I took my first dose after I got it out of the pharmacy today and you might as well have told me I took a sugar pill.
Also, the PDOC wrote #90 Adderall (amphetamine salts) IR 10mg. These stimulants are going on top of the Nuvigil 250mg. I am already taking. Sounds like quite a knock-out punch for ADHD?? LOL.
But for real though is this a good idea you think? I was thinking about: Mirapex (pramipexole), Namenda (memantine), Rilutek (riluzole) and Topamax (topiramate) among others.
Basically, I wanted to tackle my anxiety, depression, and mood symptoms. The PDOC says these may go away with the ADHD being treated properly. I sure hope so!
I honestly believe the advice the PDOC gives me because the PDOC is one of the best and works with me with my medicine suggestions and gives great input.
Secondly, in addition to my ADHD question, I wanted general responses to what do you guys think of this current medication regimen. Also, feel free to ask me any questions about my medicine.
I am now taking:
Abilify (aripiprazole) 10mg. for 296.35; 301.13
Adderall (amphetamine salts) 30mg. [10mg. TID] for 314.00
Aplenzin (bupropion hydrobromide) 522mg. for 314.00; 295.35
Lamictal (lamotrigine) 200mg. for 301.13
Nuvigil (armodafinil) 250mg. for 314.00
Neurontin (gabapentin) 1,800mg. [400mg. QID] for 300.02
Pristiq (desvenlafaxine) 50mg. for 296.35What would you suggest augmenting next if symptoms don't improve? I was thinking that maybe the PDOC is right; ADHD symptom alleviation would help remove "The Sadness". "The Sadness" is my colloquial term for this depressed feeling I get randomly that comes and goes [301.13].
Any suggestions or comments will be greatly appreciated! Feel free to ask me any questions about my medication.
LouisianaSportsman
Posted by rjlockhart37 on October 16, 2013, at 21:26:03
In reply to Is this a normal way for a PDOC to address ADHD?, posted by LouisianaSportsman on October 16, 2013, at 20:51:19
you could add Namenda or Aricept to improve cognitive funcion, there is no noticable effect from them but do impove cognitive function. The adderall can be increased but the Nuvigil cac cause elevated heart beats with amphetamine.....so at least stay at 60mg Max I know some people who take adderall like candy....my friends, they just pop them like advil.
Mirapex could be a good option, just have to work with your doctor on that because its not used for ADHD, but it does improve the dopamine release part of it. there 's this stuff called L-tyrosine you can buy at GNC, guaretee it will increase dopamine levels, its a dopamine precursor....it turns to dopamine and NE in the brain, but too much of it can cause psychosis with amphetamine.
thats about all i can give.....i've posted so many times about ADHD treatment in the past...im kinda rusty.....
Posted by LouisianaSportsman on October 18, 2013, at 14:07:42
In reply to Is this a normal way for a PDOC to address ADHD?, posted by LouisianaSportsman on October 16, 2013, at 20:51:19
The Abilify (aripiprazole) makes me gain weight. One reason, I believe, she prescribed me the Adderall and bupropion was to help counter this weight gain. We were going to try Topamax as an adjunct mood stabilizer for its weight-loss properties as well. I love Abilify, it is the most effective medicine I have ever taken, but I can't deal with the weight gain; I've made many lifestyle changes, but they can't seem to conquer the metabolic effects of aripiprazole.
I've read that lurasidone has the lowest weight-gain of the atypical antipsychotics (AAPs). From Wikipedia:
"low propensity for QTc interval changes, weight and lipid-related adverse effects ... was found to produce the second least (after haloperidol) weight gain, the least QT interval prolongation, the fourth most extrapyramidal side effects and the sixth least sedation (after aripiprazole)."
I've never gotten EP or sedation symptoms from Abilify so I'm hoping Latuda is no different. The weight loss thing sounds crucial.
We chose aripiprazole because it still allows for some endogenous dopamine due to its partial agonism which I also hoped theoretically would mean that it'd allow ADHD stimulants to work better than with other AAPs. How well does Latuda work with stimulants? I've read case reports which suggest they will be attenuated similarly to Abilify but still exert therapeutic value.
Also, according to Wikipedia:
"Lurasidone may be useful for treating the cognitive and memory deficits seen in schizophrenia ... and was found to be superior in doing this to all of the other antipsychotics examined ... Lurasidone has activity at several serotonin receptors that are involved in learning and memory, and unlike most other antipsychotics, lacks any anticholinergic effects (which are known to impair cognitive processes and memory). These properties may underlie its improved effectiveness in treating these symptoms relative to older agents."
I definitely need pro-cognitive effects since I suffer from ADHD. It also has FDA approval for bipolar I depression and I suffer from a form of bipolar depression myself.
Lurasidone even shares aripiprazole's partial agonism at 5-HT1A which is good. It seems similar in every way except that it causes less weight gain. I don't see any reason to not try it instead?
Posted by SLS on October 18, 2013, at 14:50:54
In reply to Also, Switch to Latuda (Lurasidone)?, posted by LouisianaSportsman on October 18, 2013, at 14:07:42
An investigational drug called cariprazine is being developed for schizophrenia, bipolar mania, and depression. It acts like Abilify, but is stronger at D3 than D2 receptors. My guess is that weight gain will be less of a problem with this drug.
- Scott
Posted by baseball55 on October 18, 2013, at 19:45:43
In reply to Also, Switch to Latuda (Lurasidone)?, posted by LouisianaSportsman on October 18, 2013, at 14:07:42
I had the same experience on ability, as I have written before. I worked like magic for my depression -- no EPS or other problems. But I gained crazy amounts of weight. I tried other AAPs and found that either they worked like ability -- rapid improvement, rapid weight gain -- or they had no effect at all (geodon, seroquel).
I take parnate now and that has helped a lot, but not completely. I still have episodes of severe depression. I have started using abilify on a sort of prn basis. If the depression starts to get out of control, where my thoughts get dark and suicidal and I can't get out of bed, I take abilfy for a week to pull myself out. Since I have other things that are working (DBT, parnate) I find that this is enough -- pulling myself out ends the depressive episode.
Posted by rjlockhart37 on October 19, 2013, at 22:57:44
In reply to Also, Switch to Latuda (Lurasidone)?, posted by LouisianaSportsman on October 18, 2013, at 14:07:42
Latunda is a new drug, abilify has been around fairly long....it does work well with depression, but in your case if its causing weight gain, Geodon is an option, they put me on geodon in the psychatric hospital in 2010 on the max dose, its not as effective as Abilify, but it can cause weight loss....couple years before that i was on both geodon and zyprexa together....that was the most potent antipsychotic regime i ever was on....i was on both max doses of both of them.....they ripped me off xanax and put me on that....it was awful....
antipsychotics do reduce dopamine that causes agitation and paranoia.....when i take zyprexa it gives me a relief....of thoughts that are bothering but it is the exact opposite of adderall....adderall opens your intrests, and motivation, it is a good drug, and widely used now in the US.....its a pep pill....but it has many things to increase cognitive function.....
add Namanda to the regime, keep the abilify, but if the wieght is option, go for topamax or geodon
r
Posted by LouisianaSportsman on October 20, 2013, at 12:31:51
In reply to Re: Also, Switch to Latuda (Lurasidone)?, posted by rjlockhart37 on October 19, 2013, at 22:57:44
Scott, you seem to be the most knowledgeable poster on the site, you and Eric. Eric, where are you at? Y'all guys care to give input regarding anything I've posted? Not just the Latuda part.
Rj, how do you like your lamotrigine dose at 400mg.? My PDOC seems to think 200mg. is enough, but I've never "raised the issue". I'm sure I'd get it increased if I just asked. It might help with mood instability.
Also, I'm thinking about adding topiramate for the weight loss of adding mirtazapine 30mg. and raising the Pristiq to 100mg for California Rocket Fuel lol, but it's just an idea. (when I first started Pristiq, it curbed my appetite). I'm having a hard time getting it out of my head to switch to Latuda. Just because it's new I shouldn't mess with it? Call me weird, but I've always just had a "bad feeling" about switching over to ziprasidone; my PDOC has mentioned switching in the past for the weight.
This is the end of the thread.
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