![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Prefect on August 17, 2018, at 18:59:50
I'm considering augmenting my current useless serotonin drug (Trintellix) with Abilify and see if that'll get me anywhere with anxiety, agitation, and depression.
One thing that frightens me about Abilify is that it's a dopamine agonist (at least partial). But pot is a dopaminergic drug, and pot makes me worse on every possible account. If POT turns me into a basketcase, wouldn't Abilify too?
Or am I looking at this too simplistically and the pharmacology between the two substances are different enough to have almost opposite impact?
Posted by Christ_empowered on August 17, 2018, at 20:01:31
In reply to POT and Abilify, posted by Prefect on August 17, 2018, at 18:59:50
i take abilify. pot made me paranoid after a while. abilify helps w/ paranoia...
but i often seem stoned. seriously.
the big deal with abilify seems to be that its easier for a lot of people to tolerate than many other options. TD is still a very real risk, weight gain, etc...just not as bad as many other options.
have you ever tried Buspar (buspirone) ? its used to boost serotonin antidepressants, sometimes. not as often now with the 'atypicals' (read: $$$). I'd personally ask about that before resorting to a tranquilizer.
Posted by linkadge on August 17, 2018, at 20:16:01
In reply to Re: POT and Abilify, posted by Christ_empowered on August 17, 2018, at 20:01:31
Short answer NO.
The mechanism of the drug is often a distant second to the clinical action of the drug. In other words, abilify is an antipsychotic. It reduces the symptoms of schizophrenia including paranoia.
It is effective in blocking psychotic reactions to pot (should they occur).
Being a partial D2 agonist may just fit into the 'dopamine stabilization' theory of abilify's actions.
Your brain NEEDS dopamine to function. If you didn't have dopamine, your fingers could not move and type. The key is having the right amount. By being a partial agonist, abilify better help negative symptoms like anhedonia and cognitive dysfunction.
Linkadge
Posted by ed_uk2010 on August 17, 2018, at 20:18:13
In reply to POT and Abilify, posted by Prefect on August 17, 2018, at 18:59:50
>But pot is a dopaminergic drug, and pot makes me worse on every possible account. If POT turns me into a basketcase, wouldn't Abilify too?
The two drugs are so completely different that they cannot possibly be compared.
Your response to cannabis doesn't reveal anything at all about your likely response to Abilify.
>I'm considering augmenting my current useless...
Adding more meds on top of 'useless' meds is not normally a good idea. If it really isn't helping at all, at any dose, it would be worthwhile to discuss whether it should be stopped.
Posted by Prefect on August 17, 2018, at 20:40:13
In reply to Re: POT and Abilify » Prefect, posted by ed_uk2010 on August 17, 2018, at 20:18:13
Oh yes, I'm taking Trintellix at highest available dosage and it's not doing anything, in fact I think it's making me worse. But do non-schizophrenic people take abilify on its own? I thought it was strictly an augment for people with mood disorders.
Posted by Christ_empowered on August 17, 2018, at 20:46:56
In reply to Re: POT and Abilify » ed_uk2010, posted by Prefect on August 17, 2018, at 20:40:13
ive seen ridiculous range in doses for the moody amongst us...from something like 1 or 2mgs/day all the way up to 30, maxed out.
if psychosis and/or agitation are not a constant problem, I think some people take tranquilizer just as-needed (PRN). Tranquilizers work fast on some problems, so...they can be a good PRN option for some people, with certain problems.
maybe psych drugs just aren't for you? I don't know if I should put that on this board, but...well, they're OK for severe problems, if you define "severe" going by DSM or ICD criteria. I"m in the "severe" category, and I respond to and tolerate Abilify.
thing is...no one knows what causes mental illness. not that pills don't help. they do, sometimes. sometimes...they cause more harm than good.
I'm not trying to criticize you or anything, but maybe...just an as-needed Ativan and an understanding counselor, psychotherapist...even a (gasp) real friend? (admittedly, real friends are a rare find in 21st century America...).
sorry you're going thru this.
Posted by Prefect on August 17, 2018, at 20:47:46
In reply to Re: POT and Abilify » ed_uk2010, posted by Prefect on August 17, 2018, at 20:40:13
I responded very well to fluvoxamine 20 yrs ago, and it was only 25 mg a night, so I doubt it was the serotonegic action, but rather the sigma 1 agonism. I am so tempted to try fluvoxamine again, but this time with low dose abilify, but have read they can be a toxic combo due to the fact that they inhibit eachother's clearance, but at lower doses I don;t think that should be a problem?...
Posted by Christ_empowered on August 17, 2018, at 20:50:03
In reply to Re: POT and Abilify, posted by Prefect on August 17, 2018, at 20:47:46
-any- dose of abilify carries risk. td, eps, nms. true of all tranquilizers.
what about...luvox and gabapentin, or luvox and an as needed benzodiazepine? cheaper, easier to tolerate, no TD or NMS risk.
Posted by Phillipa on August 17, 2018, at 21:00:35
In reply to Re: POT and Abilify, posted by Christ_empowered on August 17, 2018, at 20:50:03
That's what I still take after all these year but down to 12.5mg of luvox, 2.5mg of lexapro,7.5mg of valium, and .5mg of xanax all taken at night.
Posted by Prefect on August 17, 2018, at 21:43:12
In reply to Re: POT and Abilify, posted by Christ_empowered on August 17, 2018, at 20:46:56
Just to give some context so that the severity of my problem can be ascertained...?
20 yrs ago I was I had no mental health problems. I came down with some infection of unknown origin that shot my liver enzymes through the roof (which went back down after a few months). Two weeks after this "infection" I couldn't think, I was constantly dizzy, had balance problems, cognitive problems so severe I dropped out of university and went on government welfare for a year. Was put on 25 mg Fluvoxamine. Gradually "adapted". Went back to college after a couple of years, got myself an engineering degree, still always felt like I'm walking on a mattress rather than solid ground (literally), but paid no attention. Had an 18 yr okay run. Bit of agoraphobia, that's about it. Got married, had a kid, divorced, couple of yrs ago driving to the same grocery store I go to every week, I couldn't find it. I kept driving around and finally ended up on my ex-wife's porch telling her I didn't know how to find the store. It wasn't that I was still hung up on my ex-wife. By then I had found a new girlfriend I was crazy about. Life was beautiful. My brain was back where it was 20 yrs ago. There was a chemical shift. I had to think how to put my underwear on, make my breakfast, and boy the drive to work was a sensory overload nightmare. Pdoc took me off Fluvoxamine, put me on Zoloft. Didn't work. I would dissociate when my amazing new girlfriend showed up until I'd had a half a bottle of wine, and only then could I put a sentence together. After she got fed up with whatever it is I have (took her two yrs of this before she left), I went on a bender. 750 ml of whiskey a day. Lost my driver's license, went on short term disability. Detoxed myself at home, went back to work, got my license back, and I still feel like sh*t and have a bout of alcohol abuse every week or two. I just know how to hide it better now. I hardly see my kid anymore, talking to people agitates me, and I'm constantly in this altered state that I no longer recognize anymore. I DIED two years ago. This guy is nothing but a shadow who gets agitated by light, a TV show, a conversation, oh and DRIVING. I can no longer even put my music on in the car unless I'm completely shitfaced with alcohol, otherwise I get sensory overload. All I know is when I drink alcohol, stuff starts moving again in my head and I start paying attention, and enjoying...and tolerating...rest of the time I'm in a jittery daze. A dissociative nightmare. The only thing that keeps me alive is I don't want my boy asking where I am when I don't show up anymore.
Severe enough?
Posted by Lamdage22 on August 18, 2018, at 4:41:23
In reply to Re: POT and Abilify » Christ_empowered, posted by Prefect on August 17, 2018, at 21:43:12
POT makes me batshit delusional. I will not touch it ever again.
Posted by linkadge on August 18, 2018, at 8:31:52
In reply to Re: POT and Abilify, posted by Lamdage22 on August 18, 2018, at 4:41:23
The purpose of this board is not to diagnose, or to question the severity of peoples' illnesses.
If somebody has taken multiple antidepressants (say for depression or anxiety) then it is not unreasonable to try an antipsychotic.
Of course, one must understand the pros and cons of every treatment before taking it.
Ability has been approved as a depression adjunct, but there are certainly people who take it alone for an unspecified mood disorder.
Linkadge
Posted by ed_uk2010 on August 18, 2018, at 19:08:06
In reply to Re: POT and Abilify » ed_uk2010, posted by Prefect on August 17, 2018, at 20:40:13
Hi Prefect,
>Oh yes, I'm taking Trintellix at highest available dosage and it's not doing anything, in fact I think it's making me worse.
In that case, I would definitely discuss stopping vortioxetine with your doctor. There really isn't any justification for trying to augment a drug which is potentially making you feel even worse.
>But do non-schizophrenic people take abilify on its own?
Yes, sometimes, especially in bipolar disorder. In depression, Abilify is only officially approved as an add on to conventional antidepressants, but I wouldn't personally worry about this. For a start, it doesn't sound clear that 'major depression' is necessarily even an accurate diagnosis for you. Although depressive illness is exceptionally heterogeneous, your symptoms do sound particularly atypical. From what you described, you seem to be suffering from a complex neuropsychiatric illness of initial medical/organic origin characterised by frequent dissociative symptoms and some form of sensory processing disorder. Problems with sensory processing normally begin in childhood rather than after an infection, which makes your situation slightly unusual. Sensory processing issues are particularly common in children on the autistic spectrum, for example, and also in a subset of children with ADHD. In adults, extreme sensitivity to sensory stimulation can be seen due to withdrawal from benzodiazepines or alcohol - symptoms improve after a few weeks of abstinence.
1. When did you last try fluvoxamine on its own? It is possible that you may respond to it again after the treatment break. If your doctor prescribes it, I would suggest allowing vortioxetine to completely clear from your system first, to reduce the potential for adverse effects. Sigma-1 agonism is theorised to improve cognitive functions, so you could be right that this is what helped, rather than the SSRI effect. Alternatively, it might not have been anything to do with sigma receptors. Unfortunately, it is not really possible to know. It is still possible than a different SSRI could be beneficial even though sertraline didn't help. Escitalopram often helps anxiety so you could consider that.
2. With respect to aripiprazole, I think it would be worth trying it on its own to find out whether or not it helps. The feeling of sensory overload might potentially be reduced by an antipsychotic.
3. It is possible to take fluvoxamine (Luvox) and aripiprazole together - with caution. Fluvoxamine is a moderate CYP 3A4 inhibitor and may increase aripiprazole levels to some extent, so it would be wise to be cautious with the aripiprazole dosage. In rats, the combination causes elevation of liver enzymes. In humans, liver problems are rare with aripiprazole.
Posted by Christ_empowered on August 18, 2018, at 22:25:32
In reply to Re: POT and Abilify » Christ_empowered, posted by Prefect on August 17, 2018, at 21:43:12
hi. im not trying to make it seem like you have no "real problems" or anything. here's what I should have written...
the data is best for -severe- problems. hear voices? take a tranquilizer. got severe and/or psychotic depression? take an antidepressant. other than that...
when one starts treating more moderate conditions, things get tricksy. some benefit, and the benefits outweight risks, costs, etc. others are harmed, with no discernible benefit. branch out even further, into treating the so-called 'personality disorders' with drugs, and its basically...chemical restraints, pills to subdue and, at best, take a short cut.
i don't have any major advice for you, personally. to me--as a "mental patient" and also a complete and total non-professional--I'm kind of thinking that (like a lot of people...) your problems may have been made worse, over time, by continued treatment. happens...its definitely not just you, not your "fault" or anything. if you'll notice...
not only is "depression" more common in the post-Prozac era, its also more severe, more disabling, and more people/patients end up with the "treatment-resistant" label. at least some of this is probably because of the modern pharmaceuticals. similar trends can be seen in bipolar and in Schizophrenia...well, Schizophrenics may actually be doing -worse-, overall, than 100 years ago, even 50 years ago. is it society? the economy? the pills?
the 1st thing that popped in my mind in terms of pills would be buspirone (buspar), because it would spare you a tranquilizer and its cheap and generic. remeron, maybe? very sedating, weight gain can be an issue, but...it is often used to boost other psych drugs.sorry you're going thru this. i once had facial tics from 'treatment,' plus psych 'issues' that were either not there originally or not as severe...
but, hey; life goes on. my tics are now gone, my psych problems don't require too much in the way of 'treatment,' etc. there is hope. :-)
Posted by Prefect on August 19, 2018, at 16:30:30
In reply to Re: POT and Abilify, posted by ed_uk2010 on August 18, 2018, at 19:08:06
>Sensory processing issues are particularly common in children on the autistic spectrum, for example, and also in a subset of children with ADHD. In adults, extreme sensitivity to sensory stimulation can be seen due to withdrawal from benzodiazepines or alcohol - symptoms improve after a few weeks of abstinence.
It's interesting you mention that. My brother is severely autistic. My son has mild autism. I, on the other hand, had absolutely no problems till this infection at the age of 27. I've always wondered if autism presents itself differently when its onset is in adulthood due to a genetic predisposition. If you already have language and social skills, when your brain suddenly sets of the same pathology, you wouldn't become autistic. You would have a severe anxiety disorder...? BTW I suffered from this for a yr and a half before I accidentally realized alcohol helps (I wasn't drinking much during that time). So it can't be alcohol. As for benzos, I never tried them till a few months ago. They don't do a thing for me for some reason.
>When did you last try fluvoxamine on its own? 2 yrs ago. I had worked up to 100 mg over 20 yrs. I stopped it at my "relapse" assuming it had pooped out. Perhaps a mistake? I'm now almost convinced my problem is not of serotonin deficiency...
Posted by bleauberry on August 25, 2018, at 18:30:33
In reply to POT and Abilify, posted by Prefect on August 17, 2018, at 18:59:50
I do not think it is possible to armchair-quartback predictions between pot and abilify. To say either one does this or that on dopamine is such a small slice of their overall mechanisms. It's way too complicated. Both of them. I think only personal trials will tell. You may end up being correct and maybe it makes you feel worse. But you really cannot predict that based on whatever happens with pot.
It could be the exact opposite of what you think. I've seen that happen plenty of times with myself and many other people. Sometimes we are sorely disappointed with something that we thought for sure was going to work nicely, and sometimes we are pleasantly surprised that something that was to be a disaster turned out really great.
Posted by Prefect on August 25, 2018, at 18:40:54
In reply to Re: POT and Abilify » ed_uk2010, posted by Prefect on August 19, 2018, at 16:30:30
Also, Interestingly, I've started discovering xanax helps with my agitation and sensory processing. But later in the day I get a little depressed, which surprizes me since xanax is supposed to have antidepressant properties.
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.