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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Christ_empowered on April 23, 2014, at 15:54:36
OK. Abilify has been reasonably good to me, but its not doing much for the depression :-(
Maybe some flavor Seroquel, plus lamictal, maybe plus wellbutrin? Anybody?
Posted by Louisiana Sportsman on April 23, 2014, at 17:07:10
In reply to seroquel+lamictal+ ???, posted by Christ_empowered on April 23, 2014, at 15:54:36
Did you listen to my advice from your earlier thread? I suggest Seroquel and Zyprexa especially as last resorts.
Seriously, why not try clozapine at this point?
If Abilify --> Clozapine doesn't work all the way, how about mirtazapine? You're already on clozapine with a similar side effect profile and you may like it at 30mg.+
Good luck!
Posted by SLS on April 23, 2014, at 20:07:07
In reply to Re: seroquel+lamictal+ ??? » Christ_empowered, posted by Louisiana Sportsman on April 23, 2014, at 17:07:10
> Seriously, why not try clozapine at this point?
That's a pretty good idea.
- Scott
Posted by SLS on April 23, 2014, at 20:10:33
In reply to seroquel+lamictal+ ???, posted by Christ_empowered on April 23, 2014, at 15:54:36
> OK. Abilify has been reasonably good to me, but its not doing much for the depression :-(
>
> Maybe some flavor Seroquel, plus lamictal, maybe plus wellbutrin? Anybody?Major question: What symptoms of your illness does Abilify treat effectively?
- Scott
Posted by Christ_empowered on April 24, 2014, at 6:43:20
In reply to Re: seroquel+lamictal+ ??? » Christ_empowered, posted by SLS on April 23, 2014, at 20:10:33
Abilify helps agitation and doesn't seem to *induce* depression, which is a real bonus. Its also relatively non-sedating, even @ 30.
Seroquel might be too sedating, especially IR. And I don't understand dosing. Psychotic depression and agitation are really problematic, and I need an anti-(hypo)manic.
I just re-started Tofranil. I found some research that used 225mgs/day from the get go for a few days, then went down to 150 or so...
...so, I take 200mgs/nightly. Trileptal apparently boosts Tofranil levels but reduces Abilify levels, so I figure the 200 might be the equivalent of the 225 used in the study.
I've been chasing the agitation with risperidone (3mgs when I need it) and Neurontin, plus supplements (high dose taurine and niacinamide). Doing OK.
I don't see pdoc for a couple weeks. Maybe I'll be on an even keel by then...or maybe I should ask for Remeron @ 30+, since the Tofranil really isn't all that sedating anymore (I take it all in one dose, at night).
Posted by SLS on April 24, 2014, at 7:14:47
In reply to Re: seroquel+lamictal+ ???, posted by Christ_empowered on April 24, 2014, at 6:43:20
You might find Saphris effective, especially if your psychosis includes paranoia. I have seen Saphris exert an energizing antidepressant effect on someone who was already taking Navane as a treatment for schizoaffective disorder. Since starting Saphris, she works two jobs and studied to acquire a nursing certificate. She is not at all manic and sleeps very well. When psychotic, one of her themes is that there is an intruder in the house.
I don't understand your decision to try a TCA, but if it works, you are a genius.
:-)
Wellbutrin?
Good luck.
- Scott
Posted by LouisianaSportsman on April 24, 2014, at 10:03:38
In reply to Re: seroquel+lamictal+ ??? » Christ_empowered, posted by SLS on April 24, 2014, at 7:14:47
> You might find Saphris effective
> Wellbutrin?
>
> Good luck.
>
>I keep forgetting to mention Saphris when suggesting AAPs. I always suggest Abilify and Latuda but 50/50 mention Saphris, it is in the same league, maybe tied with Abilify imo.
And lol to Wellbutrin, it is indeed one of the weaker ADs imo.
Posted by SLS on April 24, 2014, at 11:00:18
In reply to Re: seroquel+lamictal+ ???, posted by LouisianaSportsman on April 24, 2014, at 10:03:38
> > You might find Saphris effective
>
> > Wellbutrin?
> >
> > Good luck.
> >
> >
>
> I keep forgetting to mention Saphris when suggesting AAPs. I always suggest Abilify and Latuda but 50/50 mention Saphris, it is in the same league, maybe tied with Abilify imo.
>
> And lol to Wellbutrin, it is indeed one of the weaker ADs imo.Probably, but it saved my friend from a hideous depression that was triggered by 9/11. Wellbutrin makes me feel worse, and I experience none of the activating effects that others describe. Wellbutrin can make a fine adjunct to SRI antidepressants, and perhaps to Lamictal for bipolar depression.
- Scott
Posted by Christ_empowered on April 24, 2014, at 12:16:30
In reply to Re: seroquel+lamictal+ ??? » LouisianaSportsman, posted by SLS on April 24, 2014, at 11:00:18
I think I've been focusing too much on the AP, not enough on the AD(s).To that end, I think I wanna try adding 30+mgs Remeron and a strictly PRN additional AP...maybe low dose loxapine (?) for the first couple weeks, maybe month, of the additional AD.
My theory is that the paranoia is depression related, so a TCA+remeron+Abilify should take care of that....right? Or no?
Posted by ed_uk2010 on April 24, 2014, at 13:04:16
In reply to Re: seroquel+lamictal+ ???, posted by Christ_empowered on April 24, 2014, at 12:16:30
Hi,
What sort of depressive symptoms are you suffering from right now? And what sort of agitation? I was under the impression Abilify was working for your agitation. How are you sleping?
Posted by Louisiana Sportsman on April 24, 2014, at 14:26:21
In reply to Re: seroquel+lamictal+ ??? » LouisianaSportsman, posted by SLS on April 24, 2014, at 11:00:18
Wellbutrin can make a fine adjunct to SRI antidepressants, and perhaps to Lamictal for bipolar depression.
>
>
> - ScottI certainly suggest it for MDD patients that are not receiving results on their SRI who augmenting an AAP and want to really accelerate it by also adding bupropion.
I also I think the SR is underutilized as you can't tel me that so many patients prescribed XL don't have problems with lethargy or ADHD symptoms?
In terms of bipolar patients, it's a great AD to add to a primary mood stabilizer as it is not likely to trigger mania like a SRI.
Posted by Louisiana Sportsman on April 24, 2014, at 14:27:47
In reply to Re: seroquel+lamictal+ ??? » SLS, posted by Louisiana Sportsman on April 24, 2014, at 14:26:21
I was thinking about the bupropion treating some of the cases on here lol. Not the typical first-line cases.
Posted by phidippus on April 24, 2014, at 18:47:09
In reply to seroquel+lamictal+ ???, posted by Christ_empowered on April 23, 2014, at 15:54:36
Its almost like your scared of depression.
If you're going to trade out abilify for an atypical with antidepressant qualities, I'd recommend Geodon-5ht1a agonist 5ht1b agonist, 5ht7 antaagonist,etc - its even an SNRI.
Eric
Posted by Phillipa on April 24, 2014, at 19:12:21
In reply to Re: seroquel+lamictal+ ??? » Christ_empowered, posted by phidippus on April 24, 2014, at 18:47:09
Wellbutrin at 150mg put me in the hospital was so stimulating at the time. Phillipa
Posted by Christ_empowered on April 24, 2014, at 19:31:35
In reply to Re: seroquel+lamictal+ ???, posted by Phillipa on April 24, 2014, at 19:12:21
Geodon...tell me more...can you ramp up the dose if needed? Is it OK in terms of EPS?
Posted by phidippus on April 24, 2014, at 20:41:17
In reply to geodon, posted by Christ_empowered on April 24, 2014, at 19:31:35
Yes, you can ramp up the dose if needed. It has less of an EPS profile than Abilify.
Eric
Posted by klein on April 25, 2014, at 0:51:42
In reply to geodon, posted by Christ_empowered on April 24, 2014, at 19:31:35
> Geodon...tell me more...can you ramp up the dose if needed? Is it OK in terms of EPS?
Hey, sorry to barge in ;)
I think that the term "atypical anti-psychotic" is too broad, some of them are also jazzy antidepressants and could potentially be classified as such.
I think that Remeron and mianserin are the most effective antidepressants available. Saphris and Geodon are very similar to the tetracyclic's profile:
The difference between Abilify and Saphris / Geodon / clozapine is that Abilify is a partial agonist at 5-HT2C, and the others are very strong 5HT2C inverse antagonists; this usually gives them powerful Remeron-like antidepressant action.
Same goes for the mysterious 5-HT7 receptor, Abilify is a partial agonist and the others are strong antagonists.
Abilify is really complicated, the dose needs to be adjusted continuously. It can work great for a while and then turn on you. It's neither here nor there. The manufacturer wanted to label it a "neuromodulator" (promptly shot down). The whole partial agonism business is strange, sometimes lowering the dose down to 5mg - or even 1mg - can reverse its action.
Saphris and Geodon are more straightforward.
I find that Saphris works almost immediately.
Geodon is usually activating in low doses (20mg BID) and more sedating at higher doses (but it won't knock you out cold like, say, Zyprexa).
Either one could really help with depression.
BTW, even their delivery methods are fancy, when you take them it's really important to follow the directions, otherwise they won't work.
The Saphris pill needs to fully dissolve under your tongue and you can't eat or drink for at least 10 minutes after taking it. Try not to swallow too much either.
Geodon has to be taken with a high calorie snack / meal (at least 500 calories), which can be a pain. But.. potentially really worth it.
Jeez.
Posted by LouisianaSportsman on April 25, 2014, at 21:25:15
In reply to Re: geodon » Christ_empowered, posted by klein on April 25, 2014, at 0:51:42
Now, see, this is excellent advice, klein!
Posted by Zyprexa on April 25, 2014, at 22:59:07
In reply to seroquel+lamictal+ ???, posted by Christ_empowered on April 23, 2014, at 15:54:36
Why not just add an AD?
Posted by Zyprexa on April 25, 2014, at 23:02:41
In reply to Re: seroquel+lamictal+ ???, posted by Zyprexa on April 25, 2014, at 22:59:07
What I'm saying is that if Abilify works so well, why do you want to change it.I can tell you, I made that bad decision once. I will never go off zyprexa again.
Posted by klein on April 26, 2014, at 3:00:50
In reply to Re: geodon, posted by LouisianaSportsman on April 25, 2014, at 21:25:15
> Now, see, this is excellent advice, klein!
>
>Thank you, sir ;-)
Posted by porkpiehat on April 26, 2014, at 13:24:30
In reply to Re: geodon » LouisianaSportsman, posted by klein on April 26, 2014, at 3:00:50
I would just say not to take the decision to come off Abilify lightly. Discontinuing caused the worst case of depression I've had in 10 years. I guess YMMV but I had no idea to expect it.
This is the end of the thread.
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