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mikl_pls

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About mikl_pls

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  • Birthday 09/11/1987

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  1. I know that feel all to well, very sorry to hear that... You can take it with an MAOI, just not too much... Very sorry to hear you had a bad experience... That's got to be rough!! I loved Saphris! At first... I took it with Abilify, 5 mg at bedtime, for sleep. It worked wonders for anxiety, and then depression, but then after about a month or so, I started to feel very dysphoric. I wonder what the 2.5 mg dose would've done? It might not have helped me as well for sleep, but it might have helped me a little with anxiety and depression a little better possibly without the dysphoria. It also tastes very nasty! They're sublingual tablets that are supposed to taste like black cherry, and they taste like a "very disappointing cherry liquor" to quote a friend who also took it. It also has something that numbs your mouth in it which just adds to the whole experience of taking it. But all in all, it's a pretty great medicine! The pharmacodynamics of it are really great. The 5-HT2A/2C and α2A/2C antagonism are greater than that of the D2 antagonism, which should increase serotonin, dopamine, and norepinephrine quite nicely. You could also get some nice psychiatric assays from them just for the fun of it. Also, a nice methylation and drug detox profile. That's a bummer! I loved the Parnate + Adderall combo, well, while it lasted... Parnate 20 mg + Adderall 30 mg was great, then when I asked to increase the Parnate because it quit working, my pdoc took away the Adderall, and everything went to hell. I had already gained 50 lb anyway, so to hell with it... Which TCAs have you tried? I'm on desipramine at just 50 mg and really love it. I do wonder what 75-100 mg would feel like, but at this point, I kinda don't want to rock the boat. Really? Interesting... I'll have to see if I can find that... Man, that's brutal... I wonder if it's because you were on Vyvanse, an ER stimulant? Then again, I was on the Dexedrine Spansules with Emsam (different ER mechanism though...), but Emsam is kinda a weak MAOI compared to Nardil and Parnate... Do you remember what dose of Vyvanse you were on? See, that's how Emsam was for me. That's why I quit it the first time. I tried it a second time, and just to see, I pushed the dose up to 15 mg (beyond the max dose) on my own and only then did I feel anything, but my pdoc refused to even prescribe the max dose, even if we ditched the stimulant. Don't know why... It's like, why bother make the 12 mg patch if no one would prescribe it? Plus, many pdocs prescribe two patches for their patients because it's apparently so weak. Like 9 mg + 6 mg for 15 mg, 2x9 mg for 18 mg, even up to 2x12 mg for 24 mg... See, even euthyroid patients can be prescribed thyroid hormone supplements. That's why I was mentioning taking super low doses. Cytomel (T3) works better than Synthroid (T4) generally, even though Synthroid is converted into T3 peripherally... (but some people have issues with peripheral conversion of T4 to T3). So just 2.5 to 5 mcg shouldn't be a problem. I started on 25 mcg, which really is too high of a dose for a euthyroid patient, and even that didn't really help much, but I was super depressed at the time. Did you try just modafinil or armodafinil or both? Personally, armodafinil (250 mg) worked way better than modafinil (400 mg), but both meds' effects were extremely subtle. Like you, even armodafinil's effects worked great at first for me and then vanished, though. It was an idea, though. Yeah, that was a bit overly aggressive, I admit, though I was just thinking back to when I was in my most depressed state, and what I was taking for it. Tweaking it would be an art that would be up for an expert pdoc to do. My pdoc was very good at managing my MAOI+TCA+stim cocktail (plus AAP and mood stabilizers). You're quite welcome! I just hope it helps! Michael
  2. Yes, I'm on Rexulti right now for like, the 4th (?) time lol. I agree that it can be very helpful. I would definitely recommend a trial if dopamine partial agonists help. I did mention that if OP responded well to Abilify, then most likely dopamine partial agonists like Rexulti and Vraylar would also be good options. I also forgot to mention dopamine agonists, like you mentioned, Mirapex (pramipexole), which was something else I also tried... (my friends who know about my medical conditions and my medicine history tell me I'm a walking pharmacy T__T). I've also tried Requip (ropinirole) and Neupro patch (rotigotine transdermal), as well as Sinemet and Rytary (both carbidopa/levodopa) for tremor, but both are the same drug, just the latter is a combination of IR and ER beads in a capsule that is a dopamine precursor with a drug that inhibits premature levodopa conversion in the periphery, which theoretically should act the same as a dopamine agonist. I didn't really get much results from any of them, though, except maybe Mirapex. Cytomel did the most for me, but at a dose of 50 mcg which put me into severe hyperthyroidism! I had to stop taking it. Be super careful with this, as I mentioned in my previous post, and start at the lowest dose possible! (2.5-5 mcg, and if you need to take it long term, take it with levothyroxine in a ratio of 4:1 with levothyroxine to liothyronine).
  3. Oh god no, Depakote will most likely make you a zombie! Perhaps Keppra, but that has a potential to cause the "Keppra rage..." I have personally tolerated Trileptal very well (oxcarbazepine).
  4. Any antipsychotic with dopamine partial agonism is likely to cause the least sexual dysfunction. That means Abilify, Rexulti, and Vraylar. However, Latuda at 20 mg is not very likely to cause sexual dysfunction; in fact, it may enhance it due to its 5-HT2A antagonism causing dopamine release, and being such a low dose, it would likely preferentially cause this over D2 antagonism.
  5. This sounds like Abilify could be the cause. I believe propranolol (Inderal) is used to treat head tremors more often, if not that, then probably benztropine (Cogentin) or trihexyphenidyl (Artane) since it would be considered an extrapyramidal side effect.
  6. I have misplaced my DSM-V and absolutely cannot find it (my room is a complete mess...) but, to me, it sounds like this could be depression with atypical features. @sming, with your depression, do you have "mood reactivity?" That is, does your mood brighten in response to positive stimuli, and then return back to depression? Also, do you have two or more of the following? Significant weight gain/increase in appetite (as opposed to weight loss/anorexia) Hypersomnia (sleeping too much, as opposed to the insomnia present in melancholic depression) "Leaden paralysis" (i.e., heavy, leaden feelings in arms or legs) Long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment Also, psychomotor retardation tends to be prevalent rather than psychomotor agitation (i.e., movement tends to be slower and you may tend to become more of a "couch potato" so much more so that others may notice, rather than the opposite, wherein you can't stay still long enough...) It is possible to be bipolar type 2 without experiencing much hypomania at all. Sometimes hypomania disguises itself very cleverly. I really wish I had my DSM-V because I don't have the criteria memorized off-hand, but hypomania can manifest either euphorically or dysphorically (i.e., mixed episodes). I tend to have mixed episodes almost exclusively when I have hypomania. I also almost exclusively tend to respond to stimulants. Lithium was a disaster for me. MAOIs sorta worked for me, but the side effects were worse than the benefits (if any) I received. Emsam was okay, Parnate was great with Adderall, but it pooped out. Never tried Nardil. Marplan was... meh... I had anger issues with Marplan. Very emotionally labile. Out of almost all the atypical antipsychotics I've tried, Abilify has worked the best for me. I've had to discontinue it very recently, however, because of a possible compulsive spending habit, though. Not sure yet, though, if switching has fixed it though. Time will tell. I definitely empathize with you for wanting to get to the bottom of all this suffering. I wish we could tell you, but we can't diagnose. I think either atypical deppresion or bipolar 2, of which the depressive episodes most often feature atypical features anyway. I believe that it is possible there are some genetic make up issues that has prevented you from achieving remission from all the therapies you have tried like ECT and dTMS, even ketamine. I forget which genes are involved, but it would probably be looking into. A standard Genesite test wouldn't be able to check for this. I've done 23andme and analyzed my own raw data with Selfdecode.com and other 3rd party sites to help me analyze it and have found various genes that explain why it has been so difficult to achieve remission from standard therapies, and some genes that show that it would be probably futile to try ECT and other therapies like that. I think Lamictal + Nardil would be a good option to try as for a medicine combination. Have you ever tried a combination of an MAOI (Nardil) + a tricyclic antidepressant or an MAOI (Nardil) + a stimulant? They're classically contraindicated, but they can safely be used together. The secondary amine tricyclics (TCAs) like nortriptyline, desipramine, and protriptyline can be combined with MAOIs, both in low doses. They both have to be started at the same time, otherwise you run the risk of hypertensive crisis. I think the TCA can already be started before the MAOI too, and the MAOI added on top of it, but otherwise, the MAOI has to be washed out before starting this combination. https://books.google.com/books?id=wwP1iOanWAAC&pg=PA168&lpg=PA168&dq=maoi+tca+combination+25+mg+amitriptyline&source=bl&ots=gM2kCSJrp5&sig=OcaTvRI1Kt7ZZCZi3Xi4b9jjChE&hl=en&sa=X&ved=0ahUKEwiJo5OgtdTKAhVE2D4KHXh7C6QQ6AEIHDAA#v=onepage&q=maoi tca combination 25 mg amitriptyline&f=false Stimulants like methylphenidate and dextroamphetamine can be used in combination with MAOIs as well. Methylphenidate is supposedly safer to use in combination with MAOIs because it doesn't increase serotonin levels, but it is a 5-HT1A agonist (but then again, serotonin syndrome arises from excessive 5-HT2A stimulation, if I'm not mistaken...). But methylphenidate can be used in doses of up to 60 mg and dextroamphetamine in doses up to 30 mg in combinations of an MAOI when titrated very sloooowly and very carefully. https://books.google.com/books?id=_I7LBQAAQBAJ&pg=PA71&lpg=PA71&dq=maoi+tca+stimulant+combination+treatment&source=bl&ots=vGbJPCI7si&sig=Wt6aQCwM9RGhYQ6JSqvqIuOwero&hl=en&sa=X&ved=0ahUKEwiT7u7Bh5rKAhXKPiYKHesvBBIQ6AEITDAI#v=onepage&q=maoi tca stimulant combination treatment&f=false https://www.ncbi.nlm.nih.gov/pubmed/3997787 I personally was on a combination of an MAOI + TCA + stimulant a few years ago, which is a mega-nono according to classical contraindications! I was on Emsam 9 mg/24 hr, nortriptyline 50 mg, and dextroamphetamine ER 30 mg. It actually didn't do that much for me. Emsam, to me, is a very weak MAOI. I needed the 12 mg patch, but my pdoc wouldn't prescribe it. The second time I took Emsam, I experimented and used a 6 mg + 9 mg patch for 15 mg (greater than the max dose!) and only then did I start to feel something... but again, my pdoc wouldn't hear of it. That was when I switched to Parnate (tranylcypromine), which cause immense weight gain, + Adderall 30 mg. On top of all this, Lamictal should have no problem being added to this combination. So one of the articles mentioned the combination of thyroid hormine (T3). That would also be a possible combination therapy, if you haven't already tried it. I would recommend trying the lowest dose possible, like 2.5-5 mcg of liothyronine (Cytomel). You don't want to mess up your thyroid hormone balance. I would also recommend taking it for the shortest amount of time possible, and if you need it long term, you need to take liothyronine with levothyroxine (Synthroid) in a ratio of 4:1 of T4:T3 (e.g., 12.5 mcg + 2.5 mcg of levothyroxine and liothyronine, respectively). Also, the newer eugeroics/stimulants, Nuvigl/Provigil, which you mentioned that you respond to well would be good options to augment with as well, but good luck getting your insurance to cover them without a diagnosis of a sleep disorder like narcolepsy or OSA (unless you have them, in which case go ahead and try them with your MAOI! They'd be a safer option than the classic stimulants... perhaps less effective though). If you responded well to Abilify, it might be worth considering adding it to your cocktail. Might I ask why you stopped it? If you don't tolerate Abilify well, you might consider Rexulti. It's not "Abilify 2.0" as people keep calling it around here. It's a separate entity to its own with different pharmacodynamics all to itself. It may feel somewhat similar at higher doses as low doses of Abilify, but at low doses, it feels like a completely different medicine--very calming, sedating even for some. I actually can't tolerate it at low doses, I need higher doses. Vraylar is another med that is somewhat related and is even a phenylpiperazine like Abilify and Rexulti, but works a little differently than Rexulti and Abilify. It is more selective for the D3 receptor than the D2 receptor, but is also a partial agonist for the two receptors like Abilify and Rexulti. So if Rexulti doesn't appeal to you, there's always that option. So if I were you in your position, I would consider the following cocktail: Phenelzine (Nardil) Either TCA (nortriptyline (Pamelor), desipramine (Norpamin), possibly protriptyline (Vivactil)) or stimulant (methylphenidate (Ritalin/Ritalin LA/Metadate CD/Concerta/etc...), dextroamphetamine (Dexedrine/Dexedrine Spansule), amphetamine/dextroamphetamine (Adderall), modafinil (Provigil), armodafinil (Nuvigil)), or both at once Atypical antipsychotic with dopamine partial agonism (aripiprazole (Abilify), Rexulti (brexpiprazole), or Vraylar (cariprazine)) Lamotragine (lamotrigine) Liothyronine (Cytomel) (low dose, 2.5-5 mcg) (and if successful and needs to be taken long term, add levothyroxine (Synthroid, Levothroid, Unithroid) in a ratio of 4:1 of T4:T3, so liothyronine 2.5-5 mcg + levothyroxine 12.5-25 mcg) I think that might put quite a dent in your depression, and if not, I would definitely reconsider ECT while on this combo, making sure to try bilateral ECT (while it may have more adverse effects, it may have better effects on depression). If you ask your pdoc about trying donepezil (Aricept), it may prevent adverse effects on memory while doing ECT. There are ways to potentiate the seizures induced by ECT that may help the outcome of ECT, but I forget. Like, I think taking something like Thorazine (chlorpromazine) before the ECT treatments helps relax you and also helps potentiate the seizures. Also, using ketamine as the anesthetic also helps potentiate the effects of ECT. Hope this helps!
  7. Yes, I have taken that brand. I got it from their website. It looks like their prices has gone up though. http://www.methylpro.com/L-Methylfolate/L-Methylfolate-15-mg-2/
  8. Trazodone actually can enhance sexual function due to the 5-HT2A antagonism and, in higher doses, 5-HT2C antagonism. It can cause priapism in both sexes, and It can actually cause spontaneous orgasm in women. I don't think it's trazodone. But then again, this source mentions that trazodone can cause ejaculatory inhibition that can be resolved from discontinuing trazodone: https://www.ncbi.nlm.nih.gov/pubmed/17454520 It's possible that it could be the clonazepam too, however. https://www.ncbi.nlm.nih.gov/pubmed/9160580 They didn't mention ejaculatory dysfunction, but it may have been a problem in the patients since it mentioned "sexual dysfunction" in general. I doubt it could be the Latuda at 20 mg.
  9. Wow! Congrats! So glad to hear it!
  10. I'm currently taking rhodiola rosea standardized to 3% salidrosides (as opposed to being standardized to rosavins). The salidrosides has a more stimulating effect, and I can definitely notice this. I take 500 mg TID (3x/day). It's not too stimulating, but it's just enough to boost my Dexedrine. It also reduces my anxiety.
  11. Have you ever tried Belsomra for sleep? It may or may not be covered by your insurance, but I thought I'd mention it.
  12. Typically with most SSRIs, either no weight gain or maybe even weight loss acutely occurs, but in the long run, sometimes weight gain can occur, whether that is just putting on weight that was lost initially, or if that means putting on weight in addition to baseline weight, but this is typically no more than 5 lb or so in most patients; however, that can sometimes be more. I've never taken Celexa before, but I've taken Lexapro, its "offspring" medicine, and personally, I did gain quite a bit of weight (20+ lb), but I was 15 and 16 years old at the time and was eating however I wanted and didn't care about my diet. Since my mid 20s, I've been on numerous SSRIs and SNRIs with minimal to no weight gain, even some weight loss for some, but I've been really watching my diet and being careful and conscientious about what I eat.
  13. Yeah, I second what @BipolarSpinster said. I'm glad you said no... Zyprexa was horrible for me. I took it for sleep briefly and I'm surprised I ever woke up from it. Sleeping 15+ hours and gained 20 lb in a matter of weeks... UGH! I tried Thorazine and, despite the initial acute dystonic reaction I had (probably because I was on too high a dose, 100 mg QHS PRN--believe me, that was not fun at all!), it was a good med for sleep until the nightmares started. Weight gain was very minimal, and it didn't completely knock me off my ass.
  14. My pdoc told me that yes, a tiny dose like 25 mg can, indeed, cause weight gain, but it's more likely to occur over a period of time of one to two years or so, and it's likely to be about 5 lb or so. Of course, it depends on the individual, though. I never took Seroquel long enough to really get an idea of what my experience would be like with it though. I just knew that in order to be sedated by it, I needed 300 mg... No tiny dose would sedate me. Also, it made me eat the house and gain weight like crazy at that dose, so I stayed away from it. But it didn't hold a candle to the weight gain that Zyprexa caused me...
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