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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by Christ_empowered on December 21, 2013, at 20:56:45
OK. So I was on 30 Abilify, 1200 trileptal, up to 300 Neurontin. My shrink was all "You need an AD!," since I was having (still kinda am having) mind-numbing depression. I said OK. Initially, she wanted me on Celexa, but I wanted something more stimulating...so, Prozac was prescribed.
Here's the thing: Prozac does something to increase Abilify blood levels. Trileptal may do something to decrease them. I've been so tired, all the time, sleeping, having vivid dreams (usually nightmares), and I suspect my Abilify levels are way up, since my doc told me she adjusts dosage based on observable effects, not on drug-drug interactions.
Keep in mind: this is Public Health. I'm not knocking public health, but I am saying that a lot of what they seem to do is ramp up your antipsychotic to keep people out of mental hospitals. Saves the state money.
What to do??? I skipped Abilify today. Probably not the best idea, but it does have a long half life, and I'm at the highest FDA approved dose. I was thinking to skip it for the next couple days, until I start to feel agitated, and then re-start it @ about 15mgs/day.
Sound like a plan? Nothing against my shrink--she's competent--but I think I may get my parents to shell out for a private practice doc. I get the sense that Public Health is really about making sure "crazy" people without resources don't end up incarcerated or institutionalized. My set of problems--mostly psychotic depression--probably aren't getting the sort of treatment I'd get from someone in private practice. Just a thought.
Posted by Phillipa on December 21, 2013, at 22:42:52
In reply to so...tired...Abilify?, posted by Christ_empowered on December 21, 2013, at 20:56:45
CE if your parents will pay for private give it a go. Very lucky for you that they will pay for private docs!!! Phillipa
Posted by ed_uk2010 on December 22, 2013, at 0:34:07
In reply to so...tired...Abilify?, posted by Christ_empowered on December 21, 2013, at 20:56:45
>Here's the thing: Prozac does something to increase Abilify blood levels. Trileptal may do something to decrease them. I've been so tired, all the time, sleeping, having vivid dreams (usually nightmares), and I suspect my Abilify levels are way up, since my doc told me she adjusts dosage based on observable effects, not on drug-drug interactions.
As you say, there is a pharmacokinetic interacton. A reduction in Abilify to 15-20mg may be possible now you're on fluoxetine 40mg, but this is something of an unknown quantity because the precise increase in your Abilify blood level is not known, and fluoxetine also *decreases* the level of Abilify's active metabolite. I would suggest reducing to 20mg Abilify, if you wish to go down this route, but please discuss this with your pdoc. And avoid skipping more than a few doses! The excess sedation will not disappear suddenly (or at least it's unlikely, so you'll need to wait). Annoying, I know.
Alternatively, you could switch to an non-interacting SSRI (ie. not fluoxetine or paroxetine). Sertraline (Zoloft) would be a very sensible option, and would avoid the need to mess with your Abilify, which appears to be one of the most important contributors to you staying well.
Guidelines for switching from fluoxetine to sertraline are as follows:
1. Reduce fluoxetine down to 20mg for 2 weeks.
2. Stop fluoxetine.3. Wait 4-7 days (fluoxetine is very long-acting). Due to your current situation, I suggest waiting 7 days.
4. Start sertraline at 25mg per day (fluoxetine's active metabolite is still in your system at this point).
5. Increase sertraline to 50mg after 1-2 weeks according to tolerability.
6. Titrate sertraline according to tolerability and response. Avoid more than 100mg per day until you've been on it for several weeks. Rapid titration to higher doses can easily lead to you taking more than you actually need, because the low dose has not been given chance to work.
Hope this is helpful.
This is the end of the thread.
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