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  1. Provigil questions

    Provigil is more effective at 200mg, although studies have shown that there isn't much benefit beyond 200mg/day. Nuvigil is a bit more potent, and I much prefer it, although I did have to bump from 150mg to 250mg a bit after switching. If you have sleep apnea, I would suspect your insurance would cover it as well, as it's one of the only "approved" uses for Nuvigil. CPAP + Nuvigil can be a great combo for treating that daytime fatigue from sleep apnea, but it takes time for your body to adjust, especially depending on your AHI. If you're looking for an amphetamine-type effect, this is not the drug for you.
  2. So it's been a fun 2 months of chronic headaches and kidney stones (probably brought on by med changes) along with psych med changes. Feeling pretty good at the moment, adjusted my cocktail a bit: Rexulti (2mg->1mg->0.5mg) qHS - Still the backbone of my cocktail, stops my depression, but if I can get by with less of an AAP, I'm all for it. Trintillix (5mg->10mg) qHS - Added this to keep my mood stable as I've reduced the Rexulti, and even at a low dose, it's been quite effective. Nuvigil 250mg qAM - Excessive sleepiness due to sleep apnea. Works as expected, and when it wears off, I generally feel naturally tired. Xanax 0.5mg - Trying Klonopin again for anxiety maintenance. Klonopin 1mg qHS + 2mg qAM - Was on 1mg for sleep maintenance, and it was working just fine, so after some discussion with my pdoc, we agreed to try 2mg as a daytime dose for anxiety management, since Xanax was causing sedation and Klonopin does not (for me.) Non-Psych Trokendi XR (100mg->200mg->100mg) qHS - I was on 100mg for 7 months with no problems, developed a nasty chronic headache that wouldn't go away, so my neuro upped the Trokendi to see if it would help. After a month, I ended up with 4 kidney stones, so I'm back down to the 100mg dose. Zomig 5mg PRN - migraine triptan Zofran 4mg PRN - nausea from migraine and from Zomig. I hate triptans, but I tolerate Zomig the best. Tramadol 50mg PRN - headache Esgic Tab PRN - headache I've spent weeks trying to chase down this nasty chronic headache, and between my neuro, pdoc, and tdoc, we think it's a combo of drug and stress related. Some days I do fine, other days I need 100mg of Tramadol + 2 Esgic + 2 Zomig to break it. MRI was normal, have no other risk factors (even got my eyes checked -- rx is perfect/unchanged, no damage or issues with my vision.) Strangely the only non analgesic that helps is tizanidine, which has a very specific mechanism of action -- other muscle relaxers don't help. Unfortunately it's also quite zombifying and renders me non-functional for a good 90min after taking it. Headaches are a common side effect of Rexulti, and although it's odd that I would begin experiencing them 2 years after starting it, the headaches have decreased as we've lowered the dose, so it may be the culprit. However, there is still some unknown trigger that will cause them to flare up uncontrollably -- probably stress. Rather than acutely treating it with Xanax, we're trying Klonopin as a maintenance therapy. Had one mood shift during the Rexulti titration, and I countered it with the bump in Trintillix. Saw results in 4 days. Everybody wants instant fixes, myself included, but I've remained stable since then, so it's a win.
  3. I get some relief from 0.5mg but only because I'm on Klonopin 1-2mg QHS. The long half-life carries over and gives me some relief into the daytime for anxiety. Although on a day like today when things are bad, 0.5mg is a joke.. now 0.25mg I don't understand. I get nada from that.
  4. Changing benzos

    Depending on your cocktail and what's going on in your life, I've found changing up benzos can make a difference. I take 1-2mg Klonopin QHS insomnia, and it's doing wonders for my sleep and anxiety too, yet a couple of years ago I was on 1mg BID and it did absolutely nothing for my anxiety. But I had different APs, mood stabilizers, life situation, etc. But if you're facing tolerance, that's a whole different issue... changing around benzos isn't going to do much more than make you miserable, especially since you're on Klonopin.
  5. I'll throw in a vote for Rexulti, based on my success with it, but for mania you will probably need a higher dose (2-4mg) and it does take a long time to hit steady-state due to the long half-life (91h primary, 88h metabolite.) While the mfg doesn't outline specific dosing for mania, only schizophrenia, it's a titration up to 4mg, so I'm guessing treatment for mania would fall into that range as well. I've never had problems with mania, only hypomania, and I don't know that I've even been hypomanic since I started Rexulti. I can speak directly to it's efficacy in treating depression, though. It's been weight-neutral for me at 2mg. It has a copay coupon on the manufacturer's website too that makes it extremely affordable if you have private insurance.
  6. If you tolerate Abilify well, and depression is your main issue, perhaps switching to Rexulti instead of Abilify would help? It has worked absolute wonders for my depression, with fewer side effects than Abilify had. At various times I've been on most of the meds you're on (Abilify, Seroquel, Lamictal, and Wellbutrin) and none of them did much for my depression (nor did Depakote.) I've been on Rexulti for 2 years now and had very few depressive episodes. Nothing is perfect, but it has been by far the most effective med I've been on.
  7. I just added Trintellix three weeks ago, and I'm noticing the same combo effect. I'm taking waaaay less Xanax too, although some of mine could be related to Klonopin QHS (but not BID, only QHS). I'm on the flip dosing of the drugs as you (heavy on the Rexulti/light on the Trintellix) but there is definitely something to the combo. I was taking 1mg of Xanax probably 4-5 times a week, and if I stay at 0.5-1mg of Klonopin, I generally don't need any Xanax. If I cut back to 0.25mg Klonopin, I may need 0.5mg Xanax 1-2 days a week. Comparatively, my last trial of Klonopin was 1mg BID, and it didn't do anything for my anxiety, so the Rexulti/Trintellix combo is definitely doing something to lower my anxiety and curb my depression. Rexulti has been 90% effective alone at stopping it, and I'm hoping Trintellix can knock out that last 10%. I'm seeing very positive benefits from the combo, with negligible side effects -- highly recommended for depression and anxiety as a primary mix! Add a PRN benzo for breakthrough anxiety (or Klonopin for maintenance) and it's a winner. Sorry for the derailment, but I think Rexulti + Trintellix is a combo worth further investigating.
  8. Seroquel at 50mg is good for sleep, and not much else. It really doesn't affect much other than H1 until you get into the 150-200mg range. I would either titrate it up to 200mg or ditch it entirely, since you're not having problems sleeping. I took Remeron for about 2 years, started at 15mg and titrated up to 45mg over the time period. It was sedating and caused me to gain weight as well due to its' nature of blockading H1 as well. It did help my depression in bursts, but ultimately was a failure. Your body builds some tolerance to histamine sedation over time, but I found it sedating at all doses. Perhaps Klonopin would be more useful for managing the anxiety? Starting once a day at a low dose may provide some more constant relief than Xanax, and if you stay low enough it's usually not sedating either. Since you're on an SNRI, your choices are adding a mood stabilizer like Lamictal or an antipsychotic, like perhaps Abilify or Rexulti. Both of the latter drugs are approved as adjuncts for MDD (not saying it's your diagnosis) and can be stimulating. I think if you're already depressed and sleeping a ton and having problems getting out of bed, adding an AD that is sedating is just going to compound the problem (speaking from experience.) You could go the TCA or MAOI route, but I would put those as secondary choices due to the prevalence of side effects (not that APs are great drugs, but the newest ones are much better.) I found Abilify extremely activating -- to the point that I couldn't sleep at doses above 2mg, but I'm an extreme case. I've been on Rexulti for almost 2 years now, and it has killed 90% of my depression --- better than any other single med -- and has practically zero side effects for me.
  9. To clarify, I wasn't on all of those APs at once, those were just the most sedating. Now I'm on 2mg Rexulti, 5mg Trintellix, 250mg Nuvigil, 100mg Trokendi XR, with up to 2mg of Klonopin for sleep (and Xanax PRN.) Rexulti was sedating at 1mg, but not really at 2mg. I take the Nuvigil + Trintellix in the AM, and Trokendi + Rexulti in the PM.
  10. I used to sleep 8-12h a day, depending on what I had to do, including naps. After almost a year of being on CPAP and Provigil/Nuvigil, I'm at the point I can get 6-7h, be awake all day, and function adequately. It took several months of getting up within the same 1-2h time window every day to start getting accustomed to not sleeping until 10-11am when I don't work. I have chronic insomnia, so sometimes despite being tired, I can't fall asleep, but that has been improving as of late. Unless I'm depressed, in which case I can take Nuvigil, drink an energy drink, a cup of coffee, and go take a 4h nap, because none of that overrides depression. If I'm depressed, I'll sleep 9-12h a day through the worst of it, no matter what. The right meds have made a huge difference. Heavily sedating meds make functioning 10x harder. I used to nap every day on Geodon, Lithium, Seroquel, and Latuda, and taking any of them at bedtime just made me hungover the next morning (sleeping through alarms too.)
  11. Halcion worked for my insomnia, but man did it cause some rebound insomnia when I stopped it. I found 40mg of Valium to be sedating, but anything less didn't feel like much of anything.
  12. Seroquel's primary affinity at doses under 200mg is for H1, so until you've cleared it all out, transient insomnia remains probable. I know it took 4 days after I stopped it before I could sleep normally again. Seroquel had the heavy sedating effect on me too, and caused a flat affect that I was unaware of, but other people noticed. I brightened up considerably once I stopped it. But not all APs are so sedating; Seroquel just happens to be one of the most sedating ones.
  13. 6h.... is not bad. My sleep doc says 7h is the average target. Some people need more, some need less, but 7h is the general number. I average 5-7h during the week, and 7-8h on weekends, and generally do fine, unless I'm depressed. That will blow all the numbers out of the water. I tried trazodone for sleep and all it did was make me feel weird and unsettled, it never actually put me to sleep. Seroquel caused zombie-like sedation and hangover the next day, to the point that I was continually late for work. Discontinuing Seroquel can cause rebound insomnia, and boy does that suck. I've been through that a couple of times. If you've been taking the Seroquel for a few days, I wouldn't abruptly stop it because of the rebound insomnia. Recently my insomnia was so bad I was taking Restoril, Lunesta, and sometimes Xanax to fall asleep (not a good combo, I know) so I finally went back to my sleep doc for an adjustment. Put me on 1mg Klonopin, pdoc adjusted it to 1-2mg QHS, and my insomnia has improved greatly, to the point that after 2 weeks I really only need 0.5-1mg. My point being not that Klonopin is the solution for insomnia, but if your sleep meds aren't working, you definitely need to switch them up. Those of us with intractable insomnia react differently to sleep meds and it's an uphill battle to find something that works (for example, Ambien works about 10% of the time for me, the rest of the time, nada.)
  14. I always add a big disclaimer to this. I was on 300mg XL, and it didn't do a damn thing for my depression, appetite, energy, weight loss, or AP-induced sexual side effects. It was pretty much placebo. My SO was on it at the same dose along with 60mg of Cymbalta, and it made no difference to her either. YMMV.
  15. Not major changes, but some adjustments... Rexulti 2mg (same) - Still the backbone of my cocktail. Kills my depression 90% of the time. I will fight you if you try to take this from me. Trintellix 5mg (new) - Adjunct for depression, since my last depressive episode was pretty severe. Pdoc thinks it will be enough of a boost to keep me from slipping. Trokendi XR 100mg (same) - Migraine prophy. Works pretty damn well, went from 8-10 a month to maybe 1 a month. I can live with that. Xanax 0.5mg (same) - PRN up to 1.5mg/day for anxiety. Works as described, except it makes me sleepy at doses of 1mg and higher. Kills anxiety like nothing else. Nuvigil 250mg (was 150mg) - For excessive sleepiness due to sleep apnea. Keeps me going for a good 12-14h a day before it rolls off, unless I'm depressed, in which case, I can sleep through it. Klonopin 1-2mg (new) - QHS insomnia/anxiety. Had a rough week of rebound insomnia and transition off of Lunesta and Restoril, but now that the Klonopin has leveled out, my general anxiety is lower, and my sleep is good. Non-Psych: Zomig 5mg (same) - PRN migraine Zofran 4mg (same) - PRN nausea from migraine + from Zomig (stupid triptan makes the nausea worse) Sleep doc hopes that with CPAP and Nuvigil my level of wakefulness will be high enough that I will be naturally tired by the end of day and my mind will basically wear itself out. I've only been on the higher doses for less than a week, but prior to now, that didn't happen. Yesterday, though, I was able to get up and function from 6am - 9pm, take 1mg of Klonopin, and sleep well until 6am again. I might not have even needed the Klonopin as tired as I felt, but I wasn't willing to risk waking up in the middle of the night because of insomnia (which has been completely horrible the past few weeks.) I've done Klonopin 1mg BID anxiety before, and it didn't work, but for some reason in this combo it is working. I haven't touched Xanax in over a week, and that's only dosing the Klonopin QHS. The long half-life of Klonopin does mitigate some of the effects of Nuvigil, but not enough that I'm sleepy, I'm just not super-energized, which really isn't an effect of Nuvigil anyway.