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About mikl_pls

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  • Birthday 09/11/87

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    Alabama, US

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  1. There are reports of people going up to 400 mg of sertraline, so if you want to stick with it, and if your pdoc is willing to try supratherapeutic doses... But if you go that high, you'll definitely need to titrate back down to a more manageable dose before switching to another antidepressant. E.g. (don't quote me on these dose equivalents) Sertraline 400 mg = Fluoxetine 160 mg (which can be taken but not right away...) Titrate sertraline down to 200 mg = Fluoxetine 80 mg But since Prozac is so stimulating, your pdoc may want you to start at like 20 mg or 40 mg... which will probably cause withdrawal symptoms from 200 mg sertraline...
  2. In addition to the above suggestions, sometimes the anticonvulsant oxcarbazepine (Trileptal) has been shown to improve mood and help with anxiety. It's a CYP inducer, but not so much like carbamazepine, so I dunno if you'd need to raise your Lamictal dose. That'd be something for your pdoc to answer. Another anticonvulsant that's sometimes used for anxiety is levetiracetam (Keppra), but it has a higher risk of adverse psychiatric reactions (but it works for me to help my OCD for some reason...) https://www.ncbi.nlm.nih.gov/pubmed/17685735 Divalproex sodium (Depakote) can help with anxiety, but it can cause weight gain as well as a slew of other serious side effects. Tiagabine (Gabatril) is often used off-label for anxiety. https://www.ncbi.nlm.nih.gov/pubmed/14658975 There shouldn't be any drug-drug interactions with any of these drugs between them and Lamictal.
  3. Trazodone used to be effective for me, but then I started needing higher and higher doses, until I finally got to 300 mg, and it wasn't even working anymore. Recently, I switched to doxepin 75 mg, and it helps a lot better than trazodone, but I still find myself having difficulty falling asleep and maintaining sleep. I take Restoril 30 mg with it, but to my understanding, if I remember correctly, you aren't allowed to take benzos because of your pain meds. Quetiapine (Seroquel) in low doses (25-100 mg) is a good sleeping med, but I had to take 300 mg for it to work and it caused me weight gain. Olanzapine (Zyprexa) (in the doses I've taken, 5-10 mg) makes me sleep for 15+ hours, which I just can't handle. Plus it makes me binge eat all next day. I've also used chlorpromazine (Thorazine) at 100 mg, which at first, was so much that it made me sleep for 15+ hours and then I couldn't walk right or talk right for several hours the next day, but then I actually developed a tolerance to it and it quit working! It also made me gain weight. Saphris (asenapine) 5-10 mg (sublingual tablets, they taste baaaad!) at bedtime used to knock me out within 5 minutes—it was by far the fastest working sleeping med I've ever taken! But I started developing dysphoria upon waking the next day. Benzos and even Z-drugs I guess are off-limits too. One thing you could do is try increasing your trazodone to 150-200 mg and see how you do. I don't know how much Vistaril you're on, but 100 mg is a good sedative dose, generally.
  4. I think the office staff doesn't even bother with them... Because any time I've ever gone to my gdoc for it before, it gets approved within a day or two... Their office staff is a little... well... busy... and their fax machine is loaded with requests from lawyers and whatnot, and something may get in in the middle of those requests and they won't see it. It's not really my insurance I don't think.
  5. As far as I've heard, the side effects are much milder than those of Risperdal's.
  6. My pdoc can NEVER get PAs to go through. I could probably get it through my gdoc though...
  7. Thanks! Unfortunately, as far as my insurance is concerned, they don't want me to have it. They only want me to have it if I have narcolepsy.
  8. If Zoloft doesn't work for you, Prozac might be a good next step for you. Did you know you can go up to 300 mg of Luvox? On Lexapro, you can go as high as 40 mg and 60 mg as the very highest dose.
  9. What was your Luvox dosage before you quit? Have you tried Prozac? I forget...
  10. I have idiopathic hypersomnia, but unfortunately, they don't recognize that as a legitimate diagnosis for the use of meds like Nuvigil or Provigil. So I just use Adderall. Plus I'm on the MAOI Parnate which is pretty stimulating. You could lower your Seroquel dose to 25 mg, or switch to something else like trazodone or doxepin perhaps, too, which might be less profoundly sedating?
  11. Good to hear she listened to you! Glad to hear you're getting off the Haldol, it's kind of a risky drug to be on as far as TD goes. That's strange that no pharmacies carry Invega... It's generic now, as far as I know.
  12. Not necessarily true, all SSRIs have varying pharmacology. So if one SSRI doesn't work for one, then another may work for another. If SSRIs, in general, don't work, SNRIs are usually tried next. Say you have Lexapro. It's the (S)-enantiomer of citalopram, the active "half" of the molecule. It has less side effects, is more effective at lower doses (more potent), and is generally more tolerable. Then you have Celexa, the racemic (R) and (S) version of citalopram. The (R)-enantiomer contains pharmacological properties that cancel out the (S)-enantiomer's attempts to bind to the serotonin transporter, inhibition its inhibition if you will. This is why low doses, like 10 mg, work so unpredictably, and 20 mg is usually started. The sad thing is that the dose response curve flattens out generally at 20 mg. You don't get much more SERT occupancy at 40 mg, and you get even less more at 60 mg. Plus it has rather relatively potent binding to the histamine H1 receptor. Then you have Luvox, an SSRI with potent σ-receptor binding, which is said to be effective against anxiety and psychosis. Then there's Zoloft, an SSRI with slight dopamine reuptake inhibition plus slight σ-receptor binding, not at robust as Luvox's though. Plus Zoloft's metabolite, desmethyl sertraline is a triple reuptake inhibitor. Then you have Prozac, an SSRI with 5-HT2C inhibition, which disinhibits norepinephrine and dopamine, hence why it's generally so stimulatory to so many people. In high dosages, it's theorized to have norepinephrine reuptake inhibition too. Last but not least, you have Paxil, an SSRI with relatively potent anticholinergic effects and in higher dosages norepinephrine reuptake inhibition. This is why one SSRI may work for one but not another, and why when one SSRI doesn't work for one, another one works better for them. The Lexapro suddenly stopping is an effect called tachyphylaxis (poopout), and it's a terrible, terrible thing. I hate it. I don't know why it happens, someone else may be able to step in and answer that. I don't think it would've caused Zoloft to be less effective, it could just be that Zoloft isn't really your cup of tea. Don't worry, I overanalyze things into the ground until they're unrecognizable... lol.
  13. Just some ideas of non-antipsychotic adjunctive ideas... Carbamazepine (Tegretol, Tegretol XL, Carbatrol, Equetro) Lamotrigine (Lamictal) (study says 50 mg/day) Divalproex sodium (Depakote) Clonazepam (Klonopin) ? Topirmat (Topamax) Lyrica (pregabalin) Celecoxib (Celebrex) Sildenafil (Viagra/Revatio) Glycine D-Serine D-Cycoserine Sarcosine https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353603/ Glycine Transporter Inhibitors Sarcosine (mentioned above) D-serine (mentioned above) Metabotropic Glutamate Receptor Agonists "Pomaglumetad" Second Messenger Activity Sodium nitroprusside http://link.springer.com/article/10.1007/s40473-015-0032-7 (lists a lot more than I'm listing)
  14. Not much has changed despite asking my pdoc for a number of things to be changed, first and foremost for my Parnate dose to be increased. She claimed 30 mg was "a high dose." I'm calling BS on that. She wrote my Adderall script for 30 but said to take 1 twice daily, so I'm having to split them in half. I do have a new sleeping pill, doxepin, wich is much better than trazodone, and I'm on a significantly higher dose of Lamictal. She also increased my Mirapex. I'm also almost done titrating off Emsam. Halcion wasn't covered by my insurance... mixed amphetamine salts (Adderall) 10 mg ½ po bid (10 mg) — stimulant to potentiate the MAOI, for ADHD, and idiopathic hypersomnia, works great with Parnate! alprazolam (Xanax) 2 mg 1 po qd prn — for anxiety ***tranylcypromine (Parnate) 10 mg 1 po bid (20 mg) — antidepressant for bipolar treatment-resistant depression lamotrigine ER (Lamictal XR) 300 mg 1 po q AM — mood stabilizer for bipolar treatment-resistant depression pramipexole (Mirapex) 0.75 mg 1 po tid (2.25 mg) — adjunct medicine for bipolar treatment-resistant depression zonisamide (Zonegran) 100 mg 1 po tid (300 mg) — mood stabilizer for bipolar treatment-resistant depression doxepin (Sinequan) 75 mg 1 po qhs prn — sleep med Doing very well without an antipsychotic this time. Every once in a while I take a Stelazine for anxiety, but that's about it. ***Parnate cross-titration schedule 2/17/17 Emsam 6 mg—LAST DOSE! Meds I'm taking that aren't current prescriptions: trifluoperazine (Stelazine) 1-2 mg 1 po bid-tid (3-6 mg) — anxiety adjunct med/mood stabilizer temazepam (Restoril) 30 mg 1 po qhs prn — sleep med (augments doxepin) clonidine (Catapres) 0.1 mg 1-3 po q30min prn up to 0.8 mg — for hypertensive crisis