mikl_pls

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  • Birthday 09/11/87

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  1. That's super strange that Abilify affected your appetite in the way it did, but I know that it can affect people in an antipodal manner in that regard. To be honest, Geodon wasn't that great of a medicine for depression for me... That was just my experience. I gained weight on Rexulti, but apparently, I'm one of the rare ones to do that with that medication. Most people either stay the same weight or even lose weight with it, so don't let my case make you run away from Rexulti. There's also Vraylar which isn't approved for MDD but has shown to be effective in trials at 1.5 mg (the lowest dose) for bipolar depression, so that's an option too. For me, I lost weight initially, but just gained it back not too long after that. Like @Iceberg said, Latuda can help, but its mechanism of action is slightly different from Abilify, Rexulti, and Vraylar (it's a dopamine antagonist as opposed to a dopamine partial agonist, and really the rest of the antipsychotics are, for that matter). Latuda is very metabolically and weight friendly. When I first started it, I actually lost 7 lb. While not indicated for MDD, personally, I've had good luck with Saphris for depression and anxiety. It took a little while, but the response did come, albeit subtly. Just a warning that the sublingual tablets taste pretty bad... But like you said, you really might not need an adjuvant antipsychotic anymore. You might be able to get by with Zoloft alone. But if you're still experiencing anxiety with Zoloft at 200 mg, you might consider asking your pdoc what s/he thinks about: ...BuSpar adjuvant therapy ...switching benzos (Klonopin is one of the slowest to cross the blood-brain barrier) If you want to be on a long-acting one, Valium acts quicker. Possibly Tranxene. If you want to be on a short-acting one, either Xanax or Ativan would probably be the choices. ...starting taking a long-acting benzo regularly along with a short-acting one as needed for breakthrough anxiety Many pdocs do this with their patients with bad anxiety. Low dose of long-acting + low dose of short-acting E.g. Klonopin 2-3x/day + Xanax 1-3x/day as needed Valium 3x/day + Ativan 1-3x/day as needed These dosing regimens are examples based on my past experiences, I'm not in anyway trying to say how much of what you should be taking. Your pdoc will be the one to decide upon that or if you should even be taking 2 benzos. ...adjuvant gabapentin with Klonopin (either around the clock gabapentin regularly, every day, or as needed) 100 mg ot 300 mg 3x/day to start is very common If all else fails, you and your pdoc may have to have a talk about switching antidepressants and which one to go to. Again, those are things to ask your pdoc about and see what s/he thinks. I'm not telling you to take these medicines, these are mere suggestions. I hope this has been helpful. Good luck to you!
  2. Stelazine did become sedating as the dose escalated, so I guess you could say it eventually did help with sleep. I started with 1 mg 2x/day, went up to 1 mg 3x/day, then went up to 2 mg 3x/day before I discontinued it. My current antipsychotic is Abilify 10 mg. I love Asendin. I wish my pdoc would have dosed me properly at a therapeutic dose of that when I tried it last. It's on my list of last resort re-visits if my few last remaining untried options fail. Very calming, soothing, tranquilizing (in a good way), and mellow.
  3. Stelazine was a miracle drug for me. It obliterated my anxiety and agoraphobia. I went from being too afraid to leave the house to do simple things like pick up meds at the pharmacy, go to the grocery store, or go to a friend's house to enjoy myself, to doing all that and then some, not just because I felt I had to, but because I WANTED to. It had a very strong anxiolytic effect, but also a very potent antidepressant effect. It made things easier for me to make my mind up on things (whereas before that was a problem for me), and seemed to really glue my brain back together. Then my pdoc wanted me off of it because it's a typical and she isn't a fan of those apparently. Sad she won't let me back on it, I did so well with it.
  4. Despite not having it in my signature, I am still taking it, but am down-titrating it, so yes I am in the process of not taking it, lol. I am having some side effects like brain/body shocks/jolts and had a few seizures but that's related to my epilepsy. After starting Topamax, that has not been an issue, and hope it won't be as I go down to 50 mg and 25 mg. I also had been on a higher dose, this time 300 mg, another time 400 mg, both times causing side effects that I eventually found intolerable for how little to no benefit I was getting from it. I had a horrible time with Trintellix both times I tried it. Glad you didn't have any bad side effects from it.
  5. Combo recently changed and at the time didn't have the motivation to post about it, but am feeling slightly better. Adzenys XR-ODT (amphetamine ER ODT) 12.5 mg q AM (ADHD, hypersomnia) - I'm not so sure I like this med, I don't feel it working at all, and my stimulant dose was brought from 60 mg Adderall to the equivalent of Adderall 20 mg with this med... aripiprazole (Abilify) 10 mg q AM - so far so good, no irritability like in the low doses, no akathisia like at 15 mg clomipramine (Anafranil) 50 mg 1 qhs x1wk then 2 qhs (100 mg) - never taken this TCA, for treatment-resistant depression, OCD, panic, what have you... diazepam (Valium) 5 mg tid (15 mg) - 'round the clock Valium for anxiety, sometimes I split it in half it for 2.5 mg because it makes me so drowsy... imagine that... a benzo actually affecting me! topiramate ER (Topamax ER) 150 mg q AM - partially for bipolar II, partially for seizures, don't know what kind yet because my neurologist appointment is in November... but this option will have to change whether I stay on Topamax or switch to something else because the "generic" topiramate ER was $256... zonisamide (Zonegran) 100 mg 2 bid (400 mg) - reason and indication same as Topamax fluphenazine (Prolixin) 5 mg prn - for breakthrough psychosis (psychotic depression) ondansetron (Zofran) 4 mg prn - handy medicine to have for nausea oxazepam (Serax) 15 mg 1-2 prn - anxiety Zolpimist (zolpidem oral spray ) 5 mg/5 mL 2 sprays (10 mg) - a nonbenzo sleep medicine that really works for me at a normal dose! Of course my insurance wouldn't pay for it without a PA, and my pdoc's office can't seem to get a PA to save someone's life... [Plus other misc. meds]
  6. I just stepped up to 10 mg from 5 mg and I've noticed I feel much calmer and less irritable than when I was on 5 mg. That's just me though, I understand YMMV.
  7. Well of course! I like to try; after all, this is the field I'm studying to go into. I hope you and your pdoc figure something out that works. I don't know why this didn't occur to me earlier but another possibility would be a beta-blocker like propranolol or nadolol, but unfortunately blocking the beta-adrenergic receptors is blocking part of the antidepressant effect of Effexor too, and blocking them with or without an antidepressant has a chance of causing/exacerbating depression. But hey, I've taken propranolol up to a pretty high dose, nadolol, and acebutolol with no problems of depression exacerbation, so don't let that turn you away from that option. You could start real low like 10 mg propranolol or something (not saying how to take medicine or anything, just giving an example).
  8. Yes, what you said is precisely what I was thinking. It's almost like one one side, the noradrenergic effects are necessary for the mood lifting effects because the serotonergic effects are maxed out, but on the other hand, that same effect is causing negative side effects, especially peripherally. I'm not an expert, but these are just some ideas... Your doctor might try a lower dose of Effexor that is still in the range of being noradrenergic and combine it with at least 30 mg of Remeron, which would hopefully boost both serotonin and norepinephrine in a way that lifts your mood but doesn't make you jittery. Or you could stay on your current dose and ask about some sort of peripherally-acting adrenergic antagonist (you wouldn't want the centrally-acting effects to be blocked since that would abolish the mood effects), not sure which meds those would be. You could also try a different SNRI like Cymbalta, Pristiq, or Fetzima. Or, like you were saying, try an antidepressant with a different mechanism of action, like Trintellix (Trintellix sure does seem to be popular lately). Another possibility is to lower the Effexor back to a tolerable dose and add an atypical antipsychotic (not Seroquel) like Abilify, Rexulti, Vraylar, Latuda, etc. I would say go ahead with Seroquel but it's super sedating and causes weight gain and for antidepressant adjunct requires 150-300 mg (XR). Also Zyprexa, but omg diabetes and weight gain. I'm kind of running out of ideas. Oh, Effexor + Wellbutrin? Have you tried that before? I can't remember. There's also always Effexor + stimulant, but I highly doubt that anyone would go for that.
  9. Mmmmmmmmmm......... I would personally give it 2-4 weeks, but that's just me. What problems are you having? If you don't want to publically say, you can PM me. Or if you don't want to tell me or anyone on here, that's understandable too... lol. Effexor's actual max dose is 375 mg, but it is prescribed as high as 450 mg and even 600 mg in "heroic" cases as Stahl refers to them as. Past 600 mg, I think they start doing blood tests to check levels of venlafaxine versus O-desmethylvenlafaxine, and depending on the ratio of the parent and metabolite of the drug, they may recommend an increase or if it's not working at like 1050 mg and they see an abnormality in the ratio of the two agents, then they may call it quits on Effexor and start tapering you down/cross-tapering you to something else. I have felt dosage increases as early as 2 days afterwards, but there have of course been many, many times with many meds where my pdoc would increase, increase, increase, increase, and I would never feel anything. Or I would get to the max dose and only then start to feel something, and would ask her if she would go past the max dose and she never will.
  10. Trintellix works completely different from Effexor, but it causes the release of the same, actually more, neurotransmitters, but I don't know if it matches the volume and rate of Effexor. I personally didn't like it, it didn't make me feel anything at first, and then worsened my depression. But I'm weird and have weird side effects and reactions to meds... lol. Don't listen to me! I really hope you find something that works, or that your dose of Effexor starts agreeing with you.
  11. Make sure you do this with your doctor's permission (it goes without saying but it always is a good thing to remind I suppose). Well, the fatigue/sleepiness could be both from stopping Vyvanse and from meds, especially Remeron and trazodone (but I think you mentioned that trazodone wasn't as sedating as it used to be?) I know how you feel about waking up feeling very tired. My sleep is disrupted by seizure activity (despite being on anticonvulsants) and I'm supposed to see a neurologist about it but my first appointment isn't until November. Depression can have a lot to do with fatigue and sluggishness too, especially throughout the day. Even on low dose Remeron, your depression can improve just by your sleep improving, and it still does have psychoactive properties at that dose (just not as strong as higher doses). I was on my knees begging my pdoc for ECT this time last year and she was extremely reluctant to agree after having tried practically every medicine and every possible combination of medicines... I don't know why she was so reserved about it. But it never went through. She dragged ass when it came to contacting the pdoc who would be administering it (took her from August/September until December/January just to call him the first time... then she couldn't get his schedule right... it really pissed me off because I waited a year off to go back to school for ECT and it never happened, so I pretty much threw away a year of my life doing nothing... but I did get a little better though with meds...) ECT has a very, very high remission rate, something like in the 70's of percent... it's crazy. No medication has nearly that rate of remission. ECT can also be used for such a wide range of things, like depression, mania, psychosis, etc. I'd be all about the ECT if it were me in your position, but I'm not trying to push you or anything. I'm just trying to speak positively of it even not having had it before. I will say that I have read that memory problem can be a big side effect, mostly surrounding the treatment time (patients might not remember things that happened during the time they are receiving their ECT treatments) but will regain their ability to retain memories once they stop ECT, but if they need maintenance ECT I suppose memory problems are something to stay. I've read that meds like donepezil (Aricept) can be used during ECT to lessen the memory problems though with good results. If you still want to try medications, then at the point you're at, your pdoc needs to be trying combinations that are known to be very potentiating. Some examples of combos that would potentiate each other would be like Remeron + Effexor (or any SNRI for that matter), Zoloft + Wellbutrin, SNRI + Stimulant, SNRI + modafinil (Provigil)/armodafinil (Nuvigil), etc. Adding an atypical antipsychotic helps which you already have. There are some treatments that are more "experimental" and not approved, like using dopamine agonists (Requip, Mirapex, Neupro patch). Adding L-methylfolate, especially as the brand "Deplin," can help for some people a pretty good bit, or it may not (15 mg helped me get out of a deppressive episode over a weekend, but lost its magic over time). All it is folic acid in its active form (since some people have genetic mutations that prevent them from metabolizing it to that form which is used for many things in the body, including generation of neurotransmitters like serotonin, norepinephrine, dopamine, etc) One thing that definitely does complicate your treatment is your PTSD, because it could be that your depression hinges on your PTSD, and as your PTSD symptoms worsen, your depression may worsen independent of how aggressively your depression is treated at a chemical level. It could be that what you need is intensive therapy (of course I'm probably going up a trail many people have done before with you by mentioning therapy). Therapy + medicine is always better than either one alone, but just therapy is usually better than just medicine. But depending on how you feel when you get back from vacation, think about whether you want to try meds or ECT. If you want to try meds, it's my very humble and uneducated opinion that you're in a perfect place to try "California rocket fue,l" as Stahl calls it, a combination of Remeron and an SNRI (Effexor, Cymbalta, Pristiq, Fetzima, it's your choice; however, Fetzima is brand-name only, but there are co-pay coupons, but the other 3 are generic, just in case that influences your decision). You've tried Effexor before, maybe you could try it again, maybe even at a higher dose this time? (225 mg? 375 mg? 450 mg?) Cymbalta, if you only went up to 60 mg, maybe you could try 90 mg or 120 mg? If you haven't tried Pristiq, you could start with 50 mg and try 100 mg if you need; despite 100 mg being the max dose, sometimes peoples' doctors try them on doses up to 400 mg. Fetzima? Whatever the case, whichever you and your doctor decide, I really hope that you find a treatment plan that helps both your PTSD symptoms and your depression, as well as your feelings of sluggishness when getting out of bed (I know all too well how that is, and have stayed in bed and just "existed" for the day far too many times). Wishing you the best!
  12. I don't think water weight has anything to do with seizures.
  13. So I saw my pdoc yesterday and asked about Mydays, and we discussed it a little. She already had switched me to Adzenys XR-ODT this visit, but she offered me to try it. I didn't, thouguh, since I didn't think there were any copay coupons of it, but I just didn't know it was already out.
  14. In increased Remeron dose would definitely help as it becomes more "antidepressant-like" (the antidepressant qualities match or overcome the antihistamine properties, which is what makes you sleepy and hungry), like 30-45 mg. If you really wanted to make the antidepressant effect stronger, it's very common to put this medicine together with an SNRI (Effexor XR, Pristiq, Cymbalta, Fetzima, Savella (really only indicated for FM )). With the combination of the two, you get a potent boost in serotonin and norepinephrine, and with norepinephrine reuptake from the SNRI, you also get a little boost of dopamine in the frontal cortex. The norepinephrine and dopamine help you with any decreased positive affect, motivation, cognition, etc., and the serotonin will help with any increased negative affect, anxiety, and PTSD symptoms.