Jump to content


  • Content count

  • Joined

  • Last visited

1 Follower

About dtac

  • Rank

Profile Information

  • Gender
  • Location

Recent Profile Visitors

1505 profile views
  1. Xanax XR

    So I tried it Friday and Sunday, and while it does have some effect, I find it to be more like Klonopin than Xanax IR. I don't see it being very useful in panic attacks, or in sudden bouts of anxiety, more so for a generalized level... which is usually what Klonopin is used for, but with a substantially reduced half-life. It didn't sedate me, or make me hungry, both of which Xanax IR do. I guess if I was dosing IR twice a day, I might try 1-2mg XR in the AM and use IR for breakthrough anxiety if there was any, but everybody is real sensitive about prescribing Xanax these days, so that prolly wouldn't happen. I'm going to have to give this a longer study, because with the increase in my Rexulti, my anxiety level has tapered off greatly. I only had mild anxiety on those days, and it knocked it right out, with nearly zero side effects, but that's not typical of my anxiety. I was also looking at the side effect profile, which I do find favorable to the IR version. I think this may be another odd use-case scenario drug, that unfortunately tends to get abused.
  2. Xanax XR

    I am curious too. I just switched from IR to XR because of how long my anxiety has been lasting, and the IR was wearing off... I just didn't want to take more, so I would let it slide and just stay anxious the rest of the day. Pharmacy is supposed to have my script filled this afternoon. Dosing guidelines say to take Xanax XR in the morning, and peak absorption is 9h, although it's relatively steady from 4 to 12 hours, with a half-life of 10.7 to 15.8 hours. I'll try it this weekend and see how it goes.
  3. Interesting... Rexulti has no appreciable effect on my appetite, even jumping from 1mg to 2mg.
  4. So after a few months, I finally changed my combo slightly. It's now: Rexulti 2mg - Had to bump from 1mg because I was feeling out of sorts, irritable, unmotivated, and generally just blah. After almost 3 weeks, the increased dose makes me feel normal again, except some anxiety. Paradoxically, 2mg is activating, where 1mg was sedating. Provigil 200mg - Offsets the daytime sedation I have from obstructive sleep apnea. Combined with Rexulti, I can roll from 5:30am until 10-11pm at night almost every day without a nap, unless something is wrong. Xanax XR 1mg - Massive problems with anxiety lately, and it's prolonged. Klonopin and Valium don't work at all for my anxiety unless I go above recommended doses (and then they just sedate me), but Xanax works incredibly well for me. Just moved from IR to XR so I'm not sure how well it works yet, but 1mg IR was doing the trick. Hopefully the XR will do the same, just longer. Trokendi XR 100mg - Just bumped from 50mg to 100mg, supposed to be for migraine prophylaxis. It wasn't doing anything at 50mg; I've kept a headache journal for 2 months and I still get 10+ migraines a month. 100mg is supposed to be the therapeutic dose for migraine prophy anyway, so maybe it will work now. Not sure why my neuro started it so low, but he was fine with upping it. Might even get some appetite suppression, which would be nice too. Restoril 30mg - This one has always been hit or miss, but given that Lunesta has been hit or miss for me, I decided to give it another shot. it's been about 7 or 8 years since I last tried it. It worked last night, but it does take 1-1.5h, which according to the pharmacokinetics is peak absorption. I don't expect miracles with it, but, hey, it worked at least once. Given my crappy history with sleep meds, that's a moderate success -- some (like Ambien and Sonata) do practically zero. Other Stuff: Zomig 5mg PRN - Migraines. This stuff works, but causes some serotonin interaction with the Rexulti, which results in some nasty side effects. It's not in the danger zone, just highly unpleasant for a couple of hours until it all subsides. Still better than Imitrex, which made me feel 10x worse, Axert (quit working), or Relpax (made my head feel like it was on fire.) I know there's Maxalt, and Frova, and a couple of others to try, but for now, my neuro wants to stick with what actually treats the headaches. Zofran 4mg PRN - Nausea from migraines and Zomig. Stupid Zomig exacerbates the nausea that comes with the migraines, but it also breaks the headache, so I just treat the symptom. Non-medical interventions: CPAP - I have OSA, and not only does this thing prolong my life, it makes me feel 1000x better. I'm still kinda sleepy, but I have energy throughout the day, and I can be a productive human being again. It's night and day. My self-reported scores on the tests my sleep doctor administers show marked improvement, and I have no idea what my prior scores are when I go in for a visit, I just see the comparison delta. Having a sleep study done was probably one of the most important medical tests and led to as important of a DX as my bipolar disorder. All the psych meds in the world won't make you feel better if you have OSA/CSA and your body is trying to keep you from dying in your sleep constantly. I roll out of bed with energy to start my day, take my Provigil, and just keep on rocking. After spending years of being tired all the freaking time, it's almost an indescribable difference.
  5. To get back on track, I have noticed that Rexulti really needs to be titrated very slowly in order to minimize side-effects. Unfortunately, sub-therapeutic levels aren't very helpful in treating symptoms, necessitating a more rapid increase in dose. I found that after almost 18 months at 1mg, I need a bump. I've been feeling out of sorts, more anxious, mood has been all over the map, just generally not stable, so I've been trialing 2mg the past week. It's making a noticeable difference, and ironically is activating at 2mg vs being sedating at 1mg. When I did my initial titration 18 months ago, I went from 0.5 -> 1 -> 1.5 over the span of about 2 months, and I started getting noticeable akathisia at 1.5mg, so I dropped back to 1mg and stayed there. After a prolonged period at 1mg, I'm not having any side effects of bumping to 2mg. The activation is kind of nice, I just take it in the AM with my Provigil, and I'm rocking from 5:30am until easily 10pm or later every night. In fact, I've been able to go without Lunesta two of the past three nights, which I haven't been able to do in years without causing rebound insomnia. I see my pdoc next week, so hopefully he'll do a permanent change to 2mg. I think Rexulti isn't very well understood yet, and that the propensity for side effects is dose-dependent (guess that is true for many drugs) and how fast you titrate it. In the psych world, we all want results ASAP, we want to feel better ASAP, and this drug is not an ASAP drug, IMO. The long half-life contributes to this, and the lack of BP indication means no studies done on dosing and efficacy. Practitioners are going by the MDD guidelines, or just winging it. I think that titrating it too fast, or starting too high, causes the most problems with it. It's a low/slow drug, but if you can stick it out, I find it to be absolutely amazing. If I do a permanent titration to 2mg, then I will have spent some decent time at 0.5mg/1mg/2mg dosing, so I have some idea of how it works at the different doses. I wish they had pursued a BP indication so that the proper studies could be done on dosing and titration, because I think it's a misunderstood drug for BP usage. As a MDD adjunct, you're far less likely to rapidly titrate it that for someone who has BP. It's not a subtle difference.
  6. Not totally sure, as I couldn't get above 2mg for any length of time, but the anxiety never went away. Abilify just made my anxiety much more amplified while I was on it. It was a very frustrating side effect.
  7. I cross-tapered intially from 2mg Abilify -> 0.5mg Rexulti over 2 weeks, felt great, then had a dip when I went to just 0.5mg Rexulti by itself for 2 weeks. Once I bumped up to 1mg, I noticed a big difference, and that's where I've stayed. Also, I've found it to be sedating if taken in the AM, but not so much if taken in the PM. From my own experiences, I highly suggest taking it at roughly the same time every day. (Yes, I am aware it has a 75h+ half-life, and it shouldn't make one damn bit of difference, but the side effects tend to manifest when you vary the dose timing.) I did mood tracking for 2 months on Abilify and for 2 months while I transitioned to Rexulti, and it showed a marked improvement in my mood, especially once I bumped to 1mg. Unscientific, but with enough data points, you can help figure out if it's benefitting you or not. Sometimes I have a hard time telling if Rexulti is working or not, because I still have mood changes... then my tdoc reminds me that it's normal to have emotions and I shouldn't be flat emotionally... so I just accept it works
  8. Ahh the joys of seeing a neurologist and a psychiatrist, where the meds overlap, and so do the egos I am fortunate enough that my pdoc and neuro don't touch each other's meds, and will respect the other's choice...just don't tread into their territories. My pdoc was prescribing my mood stabilizers, neuro was fine with that. I stopped Trileptal, neuro started Trokendi, and pdoc will probably be fine with that (we discussed topiramate before, and he said he wouldn't rx it for BP treatment but had no problems if my neuro used it for migraine prophy.) Pdoc is ok with triptans as abortives, even given their primary MOA on serotonin (and Rexulti does touch serotonin more than Abilify does.) Hopefully you get a progressive neuro who doesn't just wipe your slate and start you on his own preferred cocktail. I hate doctors like that, but unfortunately they are pretty common.
  9. FDA monograph says that Trokendi is expected to have the same effect on the formation of kidney stones as IR topiramate. Looking at some of the reported data, that's a *really* low occurring side-effect. Damn psych meds and their side effects!
  10. The constant GI upset prevented me from gaining any weight. My stomach was upset pretty much every day, so I didn't eat nearly as much. Lithium did have a ton of side-effects for me, and I tried it for a solid year before I quit it. Depakote is better for rapid-cycling and killing mania; it did nothing for my depression, but I did gain a ton of weight on it, and started losing hair. My appetite went through the roof when I hit 1000mg, and was insatiable at 1500mg. But I think AEDs don't typically do much for me, as none of them have really done anything for my depression, including Lamictal.
  11. Has anyone ever taken Trokendi XR? I know it's a XR-formulation of topiramate, but with a 31h half-life for once-daily dosing. My neuro is trying it as migraine prophy, but I wanted to see if anyone has tried this specific formulation? I've read as much as I can about topiramate, but I found one resource that says Trokendi XR is not bioequivalent to the ER version, so it's probably not directly comparable to the IR version either.
  12. I believe the technical explanation is "shit works, and we don't fully know why." It appears to be all over the map, but it's also not an engineered drug like most modern pharmaceuticals. It's been trial and error with it over the past century. It generally is better at controlling mania than depression, although for some people it helps even out the cycles. I found it to be extremely rough on my GI system and never could fully tolerate it, even after a year. My last set of labs (while I was on it) showed my thyroid was getting out of line, and I had developed a slight tremor from it. I was on 900mg, split 300 am/600 pm, and I never gained any weight on it. I was extremely glad to get off of it, I had so many side effects, and it did very little for my depression. I hope it works for you!
  13. I think I'm the poster-child for Rexulti here 16 months on it continuously, at 1mg for 15 of those months. It's totally altered my baseline for my mood and makes life great It appears to play nice with just about everything else, so I having nothing but praises for it.
  14. My weight gain related directly to Rexulti at 1mg has been negligible for the past 16 months I've been on it. Since I stopped my mood stabilizer (Trileptal) and I'm just on Rexulti as my only maintenance psych med, I'm slowly losing weight.
  15. Not exactly the same, but I had side-effects every time my dose was adjusted up or down. It took about 5-7 days for my body to adjust and feel somewhat normal again.