![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 3 to 27 of 27. Go back in thread:
Posted by SLS on December 14, 2015, at 5:48:40
In reply to Re: Still waiting for Vraylar (cariprazine), posted by Lamdage22 on December 14, 2015, at 4:10:51
> No idea.
>
> How high is the tardive dyskinesia risk? I may try brexpiprazole or cariprazine or both to see if they too give me akathisia like Abilify or if they are beneficial.I agree that the only way to know at this point is to try them. I don't think there is enough clinical experience to characterize the relative risk of akathisia with the two newer drugs.
I was looking at the binding profiles of all three drugs. They all do a whole bunch of things, so it is difficult for me to come to any conclusions. My remarkably uneducated guess is that brexpiprazole is less likely than Abilify and cariprazine to produce akathisia. This is based only upon their potencies as partial agonists at the dopamine D2 receptor. However, there may be some variablity in akathisia risk due to differences in serotonergic receptor activity along with the ratio of D3/D2 receptor affinities. Of course, there is the possiblity that cariprazine, being derived from a different molecular family than Abilify and brexpiprazole, acts in a manner very different and produces less akathisia than its D2 binding might indicate.
> However currently on SJW i cant sleep without a shitload of sedating pills :(Total insomnia has always been a good sign for me that I would eventually respond to treatment. I had no problem taking sleeping medication in order to live a life in a state of remission. I needed to take two benzodiazepines to be able to sleep through the night.
- Scott
Posted by Lamdage22 on December 14, 2015, at 6:16:48
In reply to Re: Still waiting for Vraylar (cariprazine), posted by SLS on December 14, 2015, at 5:48:40
I need to talk to my doctor urgently.
Posted by SLS on December 14, 2015, at 8:08:59
In reply to Re: Still waiting for Vraylar (cariprazine), posted by Lamdage22 on December 14, 2015, at 6:16:48
> I need to talk to my doctor urgently.
Why?
- Scott
Posted by Lamdage22 on December 14, 2015, at 8:33:36
In reply to Re: Still waiting for Vraylar (cariprazine) » Lamdage22, posted by SLS on December 14, 2015, at 8:08:59
the insomniais so bad i have no choice but to reduce SJW.
Posted by Lamdage22 on December 14, 2015, at 9:01:56
In reply to Re: Still waiting for Vraylar (cariprazine), posted by Lamdage22 on December 14, 2015, at 8:33:36
i Dont want to be addicted to benzos for sleep.
Posted by SLS on December 14, 2015, at 10:51:00
In reply to Re: Still waiting for Vraylar (cariprazine), posted by Lamdage22 on December 14, 2015, at 9:01:56
> i Dont want to be addicted to benzos for sleep.
I wasn't.
I experienced mild withdrawal when I weaned myself off of Ativan and Halcion. That's not addiction, though. It is physical dependence, not cravings. I would avoid Klonopin, though. It is very difficult to discontinue. Xanax is perhaps the BZD with the most true addictive potential.
What about the "Z" drugs? Zolpidem (Ambien); zaleplon (Sonata); eszopliclone (Lunesta) - a version of zopiclone (Zimovane or Imovane).
Trazodone (Be aware of the possibility of serotonin syndrome when combined with SJW).
Low-dose sedating TCA - amitriptyline; doxepin; trimipramine
Low-dose Remeron
Low-dose Seroquel
There is the new sleep-aid, Belsomra (suvorexant). It works via a very different mechanism. It blocks orexin receptors. I understand the mechanism, but I don't know how effective it is in the real world.
You might as well try melatonin first if you wish to stay away from pharmaceuticals. Maybe valerian root.
Cost vs benefit. For me, it was a no-brainer to take the benzodiazepines. Then again, I didn't have the option of reducing the dosages of the antidepressants I was taking. I cared more about remission from a paralyzing depression than the possible "addiction" to sleeping pills. I couldn't care less if I had to take them for the rest of my life.
I hope you can retain the therapeutic benefits of SJW as you reduce the dosage.
- Scott
Posted by Lamdage22 on December 14, 2015, at 14:12:14
In reply to Re: Still waiting for Vraylar (cariprazine), posted by SLS on December 14, 2015, at 10:51:00
>I couldn't care less if I had to take them for the rest of my life.
>
> I hope you can retain the therapeutic benefits of SJW as you reduce the dosage.
>
>
> - ScottYou are pretty drastic with your treament. I will pass this question on to my Doctor on thursday.
Posted by SLS on December 14, 2015, at 14:19:01
In reply to Re: Still waiting for Vraylar (cariprazine), posted by Lamdage22 on December 14, 2015, at 14:12:14
> >I couldn't care less if I had to take them for the rest of my life.
> >
> > I hope you can retain the therapeutic benefits of SJW as you reduce the dosage.> You are pretty drastic with your treament.
My condition is rather drastic.
> I will pass this question on to my Doctor on thursday.
Good luck. I will be interested to know what the two of you come up with.
- Scott
Posted by Lamdage22 on December 15, 2015, at 1:04:01
In reply to Re: Still waiting for Vraylar (cariprazine) » Lamdage22, posted by SLS on December 14, 2015, at 14:19:01
mine too, but some side effects are just not worth it. Yes, depression is better but then you are being pissed off equally by something other than depression.
I am looking for something which pisses me off less than depression and thats just not easy.
I am thinking Neurontin or Baclofen and maybe they will help me raise the SJW dose.
Posted by Christ_empowered on December 15, 2015, at 11:22:26
In reply to Re: Still waiting for Vraylar (cariprazine), posted by Lamdage22 on December 15, 2015, at 1:04:01
Sometimes high dose neuroleptics can cause and/or worsen depression, and anxiety, too. I read a case report out of some Asian country...a bunch of Schizophrenia patients developed panic attacks because of the neuroleptic, so they added xanax xr and switched to an atypical. Problem solved.
I forget the exact conversion rate, but you're probably at or near the equivalent of 1 gram Thorazine per day, which is a lot. Is there anyway you could work with your doc on a slo-mo dosage reduction, instead of adding more meds? Of course, if you can get your mood things under control, that might help reduce the neuroleptics.
I forget...have you tried anti-convulsants? I read somewhere that Lamictal can help mood issues in people w/ psychotic disorders. I vaguely recall reading it can also help with the treatment and prevention of tardive psychosis, which is a very, very good thing.
Ever tried Abilify? Even if you still need another AP/AAP on top, it could help the mood problems...maybe the new D2 partial agonist drugs would be of some benefit to you, too.
Good luck.
Posted by Lamdage22 on December 15, 2015, at 13:39:22
In reply to Re: Still waiting for Vraylar (cariprazine), posted by Christ_empowered on December 15, 2015, at 11:22:26
I have talked about the high dose neuroleptics before..
The same applies now.
Im already doing it.
Posted by B2chica on December 19, 2015, at 0:48:16
In reply to Still waiting for Vraylar (cariprazine), posted by SLS on December 13, 2015, at 18:03:23
Hey Scott.
its not out as of now, and i cant seem to find out 'when' but i did come across a web site that looks real time and you could just check it once and a while..
http://www.goodrx.com/vraylarwishing you well my friend.
-b2
Posted by SLS on December 19, 2015, at 6:26:01
In reply to Re: Still waiting for Vraylar (cariprazine), posted by B2chica on December 19, 2015, at 0:48:16
> Hey Scott.
> its not out as of now, and i cant seem to find out 'when' but i did come across a web site that looks real time and you could just check it once and a while..
> http://www.goodrx.com/vraylarThanks!
> wishing you well my friend.Ditto.
:-)
- Scott
Posted by Mogger on January 1, 2016, at 21:06:25
In reply to Re: Still waiting for Vraylar (cariprazine) » B2chica, posted by SLS on December 19, 2015, at 6:26:01
Scott, what about trying Rexulti? Seen some positive feedback on the medication.
Posted by SLS on January 1, 2016, at 21:51:11
In reply to Re: Still waiting for Vraylar (cariprazine) » SLS, posted by Mogger on January 1, 2016, at 21:06:25
> Scott, what about trying Rexulti? Seen some positive feedback on the medication.
I would definitely consider it. What have you read?
Thanks, Mogger.
- Scott
Posted by Mogger on January 1, 2016, at 22:05:22
In reply to Re: Still waiting for Vraylar (cariprazine) » Mogger, posted by SLS on January 1, 2016, at 21:51:11
I am going to ask my pdoc if I can try it. He is open and is positive about it. I have seen some reviews of patients online who have experienced a somewhat rapid lift in mood and increased motivation. Supposed to be less of a weight gainer than other APs and less chance of restlessness. My fingers and toes are crossed that shows som benefit for the both of us should we try it,
Mogger
Posted by SLS on January 2, 2016, at 6:34:15
In reply to Re: Rexulti » SLS, posted by Mogger on January 1, 2016, at 22:05:22
> I am going to ask my pdoc if I can try it. He is open and is positive about it. I have seen some reviews of patients online who have experienced a somewhat rapid lift in mood and increased motivation. Supposed to be less of a weight gainer than other APs and less chance of restlessness. My fingers and toes are crossed that shows som benefit for the both of us should we try it,
>
> MoggerI'm just about ready to stop taking Abilify solely for the weight gain. I appreciate your investigating this.
- Scott
Posted by Mogger on January 4, 2016, at 18:15:05
In reply to Re: Rexulti » Mogger, posted by SLS on January 2, 2016, at 6:34:15
Did you try metformin? Very effective at curbing atypical appetite/weight gain.
Posted by Lamdage22 on January 9, 2016, at 14:22:58
In reply to Re: Rexulti » SLS, posted by Mogger on January 4, 2016, at 18:15:05
> Did you try metformin? Very effective at curbing atypical appetite/weight gain.
i second that
Posted by porkpiehat on April 5, 2016, at 22:18:12
In reply to Re: Rexulti » Mogger, posted by SLS on January 2, 2016, at 6:34:15
Scott, etc...
Anyone with an update on Rexulti?
I left my pdoc's office with a box of Rexulti and two of saphris. She called Saphris "Seroquel light" and called Rexulti as smoother Abilify. She should write beverage ads lol
I'm supposed to research and choose one. I'll probably wait at least a day as I have early clients tomorrow and can deal without any surprises. Trying to gain the benefit (concentration, mood, anxiety) of buspar plus some sleep without the agitation.
Posted by Mogger on April 5, 2016, at 23:26:43
In reply to Re: Rexulti » SLS, posted by porkpiehat on April 5, 2016, at 22:18:12
I have heard good things about Rexulti fingers crossed. I had to discontinue Saphris as it worsened my depression. Not to say it would do that in every case but just want to let you know my experience. If buspar is of help to you my doctor recommends I take 120mgs as he says he only sees benefits at high doses.
Posted by SLS on April 6, 2016, at 6:43:30
In reply to Re: Rexulti » SLS, posted by porkpiehat on April 5, 2016, at 22:18:12
> Scott, etc...
>
> Anyone with an update on Rexulti?
>
> I left my pdoc's office with a box of Rexulti and two of saphris. She called Saphris "Seroquel light" and called Rexulti as smoother Abilify. She should write beverage ads lolI agree with your doctor's characterization of Rexulti. Akathisia is less likely to occur with Rexulti. I would have to disagree with her description of Saphris, though. I found it antidepressive at first, but not so much later on. However, Saphris was the key to remission for a friend of mine with schizoaffective disorder and depression. She lost all the weight she gained on Seroquel. Saphris is not as soporific (producing sleepiness) as is Seroquel. In fact, it can be energizing. My friend was not functional on Seroquel. After switching to Saphris, her energy increased and her mind cleared such that she is now in college and holding a job.
I am not as familiar with the net effect of high dosages of Buspar. However, its metabolite, 1-PP, is a NE alpha-2 antagonist - a property it shares with Remeron. Drugs like Remeron make me feel pretty bad. For others, Rermeron produces a good antidepressant effect when used at higher dosages than what doctors usually prescribe. I will say this, though. The anti-anxiety of Buspar can take several weeks to emerge.
- Scott
Posted by porkpiehat on April 6, 2016, at 9:11:43
In reply to Re: Rexulti » porkpiehat, posted by SLS on April 6, 2016, at 6:43:30
I feel something from the buspar within a few days. I don't know if I've been over 30mgs but that was with celexa so that has its own agitation.
Scott, don't you take Prozosin which is an alpha antagonist? I'm contemplating trying trazodone during the day as I can't sleep on it, but I feel great emotionally the next day. Perhaps it would be different with time.
sorry for hijacking the thread I'm holding off on the Rexulti and Sapphris for now I think. Abilify made me feel more disconnected than seroquel I think, but we're talking 2.5 mgs. Even Latuda gave a disconnected feeling, althought emotionally more open. Not sure it's possible to avoid disconnection on AAP which is why Buspar seemed for attractive. I became very destabilized and depressed even stopping Buspar from 5mg, and increasingly agitated on it, so Docs think its either a bipolar response to the serotonin or a rare rage response that trauma people can have, ie. the anxiety that was protecting you is stripped away and you are left with rage at your experiences.
Posted by SLS on April 8, 2016, at 1:47:31
In reply to Re: Rexulti » SLS, posted by porkpiehat on April 6, 2016, at 9:11:43
> I feel something from the buspar within a few days.
Has Buspar improved depression, anxiety, or both? How long did it take to improve anxiety the first time you took it?
> Scott, don't you take Prozosin which is an alpha antagonist?
Yes, prazosin is a norepinephrine NE alpha-1a/b/d antagonist. I haven't ascertained what type of depression it is best suited to treated, though. My depression is bipolar with drug-induced mania. My history is one of chronic multiple traumas
> I'm contemplating trying trazodone during the day as I can't sleep on it, but I feel great emotionally the next day. Perhaps it would be different with time.
Wow. That is indeed interesting. I hope it works out for you. Let me know what happens.
> sorry for hijacking the thread
Don't be silly. No apologies necessary.
> I'm holding off on the Rexulti and Sapphris for now I think. Abilify made me feel more disconnected than seroquel I think, but we're talking 2.5 mgs. Even Latuda gave a disconnected feeling, althought emotionally more open. Not sure it's possible to avoid disconnection on AAP which is why Buspar seemed for attractive. I became very destabilized and depressed even stopping Buspar from 5mg, and increasingly agitated on it, so Docs think its either a bipolar response to the serotonin or a rare rage response that trauma people can have, ie. the anxiety that was protecting you is stripped away and you are left with rage at your experiences.
Just curious - does Remeron make you feel the same agitation and rage that Buspar does?
I wonder if Viibryd would work better than Buspar for you, but without provoking rage. Like Buspar, Viibryd is a 5-HT1a partial agonist. However, it is a potent serotonin reuptake inhibitor as well.
- Scott
Posted by porkpiehat on April 8, 2016, at 11:10:05
In reply to Re: Rexulti » porkpiehat, posted by SLS on April 8, 2016, at 1:47:31
> Has Buspar improved depression, anxiety, or both? How long did it take to improve anxiety the first time you took it?Compared to being on nothing but Lamictal, it seemed to increase my motivation and quell a lot of obsessive thinking, which to me feels less depressed. But then when it started turning on me after a week I felt very "sour" and ragey. The day I took it, it slowed my thoughts down quite a bit, but I'm not naive to the drug. I ran four miles for the first time in a year without my brain slipping into a "I can't take this anymore, make it stop" spin-out. Impossible? who knows.
> Yes, prazosin is a norepinephrine NE alpha-1a/b/d antagonist. I haven't ascertained what type of depression it is best suited to treated, though. My depression is bipolar with drug-induced mania. My history is one of chronic multiple traumas
>
My dx is almost identical, but I think my pdoc sees the symptoms as BPII/cyclothymic, but my therapist sees the same things as complex trauma. Same symptoms, different treatments. I'm getting both, which confounds me b.c. one takes serotonergics (potentially helpful in trauma) off the table and mandates neuroleptics to act as AD. With the other I'm ideally on very minimal drugs so I can feel, process, meditate, and drink green tea, and do yoga.> > I'm contemplating trying trazodone during the day as I can't sleep on it, but I feel great emotionally the next day. Perhaps it would be different with time.
>
> Wow. That is indeed interesting. I hope it works out for you. Let me know what happens.
>
>>>Is it really that peculiar? I can't believe no one else hasn't tried it. I want to try it on a day when I have nothing vital planned. I'm worried that over time it will feel like Serzone which was a lame drug for me, although it stopped my IBS. It almost seemed to work like an MOA inhib. I'm worried about hitting so many neurotransmitters if in fact I am bipolar.> Just curious - does Remeron make you feel the same agitation and rage that Buspar does?
>>>I took remeron once for two days but i couldn't really work the next day. I think it's really meant for depressed nursing home patients that don't eat, not active young men.
>
> I wonder if Viibryd would work better than Buspar for you, but without provoking rage. Like Buspar, Viibryd is a 5-HT1a partial agonist. However, it is a potent serotonin reuptake inhibitor as well.>>>I tried Viibryd. At one point I felt very good but I was always tired as hell on it. I think in retrospect it was from Lamictal, which I now think has adverse effects when mixed with a serotonergic (for me, after being on it for 10 years). I felt very disinterested in people I just wanted to stay home and do homework. I also remember being very scattered on it.
I might try again. 37.5 mgs Seroquel knocked me on my *ss for a day (although it turned off the hypervigilance for half a day while I drooled on myself). stopped that last night.
I think my trial process looks like this...see if beta blocker gets me through my panic/tantrums when I get overloaded by tasks or schoolwork-->assuming this is too sedating/impractical, try daytime trazodone with a stimulant safety net-->Try viibryd maybe at night, and without the lamictal to see if that's the problem-->I can try latuda again and hope the nightmares stay at bay and the zoney feeling disappears.
without the AD's I think I've got a better grip/view on my psychological processes and sadness, etc., but I don't know that traditional therapy is going to actually work. I know I can't run a business and go to grad school if I'm flipping out during every exam or screaming at my clients for no reason.
>
>
> - Scott
>
>
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.