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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Christ_empowered on January 13, 2015, at 18:34:30
OK. I'm no expert on brain stuff, at all. I sometimes read old school psychopharmacology, back when things were more drug-centered, as opposed to the disease-model that reigns supreme now...
...anyway, I was wondering...is there a point in mixing Abilify with other APs, like I do when I take a little bit (2mgs-4mgs) risperidone on top? I mean, yeah, it works, more for agitation than anything else, but...
...its not my doc's long term strategy. Its a tolerable PRN thing. With all those D2 receptors "occupied" or whatever by the Abilify, would I be better off just taking a non-neuroleptic sedative?
Posted by ed_uk2010 on January 14, 2015, at 1:04:21
In reply to Abilify + other APs, posted by Christ_empowered on January 13, 2015, at 18:34:30
>...anyway, I was wondering...is there a point in mixing Abilify with other APs, like I do when I take a little bit (2mgs-4mgs) risperidone on top? I mean, yeah, it works, more for agitation than anything else, but...
Considering your high dose of Abilify, I expect that taking additional antipsychotics on a regular basis would not be very helpful. Due to the high potency of risperidone, it may be able to displace aripiprazole temporarily (at the receptor level) when you take a PRN dose and act as a full D2 antagonist to reduce agitation. Its actions at 5-HT2 receptors may also be helpful for this purpose.
>would I be better off just taking a non-neuroleptic sedative?
You could alternatively use a PRN benzo, but only if you find that strategy effective. If you find risperidone effective as a PRN I don't see any particular reason to switch to anything else.
>
> ...its not my doc's long term strategy. Its a tolerable PRN thing. With all those D2 receptors "occupied" or whatever by the Abilify, would I be better off just taking a non-neuroleptic sedative?
Posted by SLS on January 14, 2015, at 5:43:51
In reply to Re: Abilify + other APs, posted by ed_uk2010 on January 14, 2015, at 1:04:21
Hi Ed.
Would propranolol be of any help?
I had another thought: add Saphris (asenapine) and then taper/discontinue the Abilify. Saphris produces a significant antidepressant effect along with its antipsychotic effects. It should be less likely to produce akathisia and agitation. I've seen it work well in someone with schizoaffective disorder.
- Scott
Posted by ed_uk2010 on January 15, 2015, at 13:08:01
In reply to Re: Abilify + other APs » ed_uk2010, posted by SLS on January 14, 2015, at 5:43:51
>Would propranolol be of any help?
Perhaps, but I can't say I rate it highly overall. A few people seem to respond really well though. C_E seems to do quite well with PRN risperidone so I'm not sure there's much reason for him to change. Another choice would be lorazepam 1mg, or 2mg if needed.
>I had another thought: add Saphris (asenapine) and then taper/discontinue the Abilify.
I get the impression Abilify has treated C_E very well though, apart from occasional breakthrough symptoms. I think switching to something else entirely would represent a risk. That's why I like the idea of sticking with in and just optimising the PRNs if needed.
What do you think C_E?
Posted by Christ_empowered on January 15, 2015, at 19:30:35
In reply to Re: Abilify + other APs » SLS, posted by ed_uk2010 on January 15, 2015, at 13:08:01
I was just curious about how 2 APs, especially when one is high dose Abilify, play together in my brain.
I thought about switching out. I'm prone to EPS, so I was thinking seroquel. It'd have to be XR, because 2x daily dosing would = absent minded non-compliance on my part.
Anyway, I didn't see the point. Not only is Seroquel sedating, I need to lose weight, so I'm probably better off on Abilify. I think its going generic in the US in a year or so, so...that's a good thing.
The PRN risperidone works well for me. I almost always take the tablet(s) at night, with some neurontin (200-300mgs), and that lulls me to sleep. Any more than 4mgs/Risperidone, though, and I wake up with a puffy face, and fuzzy-headed :-( .
I read a case report on some people w/ schizophrenia. They were in long-term treatment. Their intial medication was what seemed (to me) huge doses of loxapine, but they started having breakthrough symptoms, so the doc added full dose Abilify, and they got better. So, I guess Abilify+ some other APs can work, for some people.
Posted by SLS on January 16, 2015, at 2:10:03
In reply to Re: Abilify + other APs, posted by Christ_empowered on January 15, 2015, at 19:30:35
> > Would propranolol be of any help?
> Perhaps, but I can't say I rate it highly overall. A few people seem to respond really well though. C_E seems to do quite well with PRN risperidone so I'm not sure there's much reason for him to change. Another choice would be lorazepam 1mg, or 2mg if needed.
>
> >I had another thought: add Saphris (asenapine) and then taper/discontinue the Abilify.
>
> I get the impression Abilify has treated C_E very well though, apart from occasional breakthrough symptoms. I think switching to something else entirely would represent a risk. That's why I like the idea of sticking with in and just optimising the PRNs if needed.
>
> What do you think C_E?That's a reasonable question.
The question I have for you C_E is why have you, on numerous occasions, discontinued or reduced your dosage of Abilify until you ultimately relapsed? What have you been unhappy with?
Do you experience paranoia when you are ill?
I don't like the idea of treating the side effects of one AP by adding another, although that might be the only option available. It may be that Abilify is not such a great drug with which to treat schizoid psychoses and paranoid delusions, and can actually reduce the effectiveness of other antipsychotics, particularly those with low binding affinities. I believe this is because it out-competes drugs like Seroquel for binding sites and acts too much like an agonist.
Ed makes a great deal of sense. His ideas will provide adequate, if not familiar results. Personally, if I were inclined to look for something better, I would do the Saphris thing and simply add it to the Abilify and avoid the Risperdal. Depending on your results, you could then attempt to reduce the dosage of Abilify. I won't guarantee anything, of course. After all, this is medicine, not rocket science. However, I know one person who was able to cut her dosage of Seroquel in half after she discontinued Abilify. She was able to lose all of her Abilify-induced extra body weight once she added Saphris. I don't know how typical this is.
- Scott
Posted by SLS on January 16, 2015, at 21:50:22
In reply to Re: Abilify + other APs » Christ_empowered, posted by SLS on January 16, 2015, at 2:10:03
Just to clarify:
I am not against the use of two antipsychotics in order to maximize therapeutic effects.
- Scott
Posted by Christ_empowered on January 17, 2015, at 7:59:27
In reply to Re: Abilify + other APs, posted by SLS on January 16, 2015, at 21:50:22
The PRN thing works well. I was just curious, you know, since Abilify is apparently relatively high potency and basically takes over your D2 receptors at full doses.
Lately, I haven't needed to do the PRN risperidone thing, nor have I needed Neurontin. I think it was largely situational.
Also, in the future, I may see about a low dose antidepressant instead of popping the PRN stuff. Some of the issues--anxiety, agitation, sleep weirdness, etc.--could probably be dealt with by taking some kinda SRI drug, maybe celexa or something. I could do PRN risperidone during start up.
Thanks again!
Posted by SLS on January 17, 2015, at 8:10:59
In reply to Re: Abilify + other APs, posted by Christ_empowered on January 17, 2015, at 7:59:27
Go with what works for you, I guess.
- Scott
Posted by ed_uk2010 on January 17, 2015, at 13:58:40
In reply to Re: Abilify + other APs, posted by Christ_empowered on January 17, 2015, at 7:59:27
>Abilify is apparently relatively high potency and basically takes over your D2 receptors at full doses.
Aripiprazole certainly has a high binding affinity. Bear in mind, risperidone has a high binding affinity for D2 receptors too, so it might potentially be able to displace aripiprazole and act as a full antagonist. In addition, risperidone greater affinity for serotonin receptors (mainly 5-HT2) might also be of benefit to you.
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