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About mikl_pls

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  • Birthday 09/11/87

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  1. TRD = treatment resistant depression http://www.medilexicon.com/abbreviations?search=trd&target=abbreviations
  2. Yeah, if he did that I'd be like, "I think I'm going to leave now and get my copay refunded..." There are two neurologists in the clinic. Perhaps if one wants to do that, maybe the other one would be more progressive. One is an MD and the other is a DO.
  3. Updating my cocktail: Amphetamine salts (Adderall) 30 mg 1 po bid — ADHD, depression, hypersomnia, BED Atomoxetine (Strattera) 80 mg 1 po q AM — ADHD, depression, hypersomnia, BED Fluoxetine (Prozac) 40 mg 1 po bid — OCD, Bipolar II depression, BED Lamotrigine ER (Lamictal XR) 300 mg 1 po q AM — Bipolar II depression/mood stabilizer, BED Levocarnitine (Carnitor) 330 mg 3 po tid (2970 mg) — Hypersomnia, supplementation Lithium carbonate (Eskalith) 300 mg 1 po qhs — Bipolar II mood stabilizer Oxazepam (Serax) 15 mg 1 po bid PRN or 2 po qd prn — Anxiety/panic attacks Zaleplon (Sonata) 10 mg 1 po qhs prn — Insomnia Ziprasidone (Geodon) 60 mg 1 po bid + 20 mg 1 po bid PRN — Bipolar II depression/mood stabilizer Zonisamide (Zonegran) 100 mg 1 po q AM + 2 po qhs (300 mg) — Bipolar II depression/mood stabilizer, BED Non-psych meds (still mostly the same): Acebutolol (Sectral) 400 mg 1 po q AM — Essential tremor Esomeprazole (Nexium) 40 mg 1 po q PM — GERD Levothyroxine (Synthroid) 50 µg 1 po q AM 1h ac — Hypothyroidism Montelukast (Singulair) 10 mg 1 po qhs — asthma/allergies Victoza (liraglutide) 1.8 mg SC q AM — pre-diabetes Vitamin D2 (Drisdol) 1.25 mg/50,000 IU 1 po q wk — hypovitaminosis D Breo Ellipta (fluticasone furoate/vilanterol) 100 µg/25 µg/act. DPI 1 puff qd — Asthma, maintennce ProAir RespiClick (albuterol) 90 µg/act. 2 puffs qid prn — Asthma, rescue Levalbuterol (Xopenex) inhalation sol 1.25 mg/3 mL (0.042%) neb 1.25 mg NEB q6h prn — Asthma, rescue Minocycline (Dynacicn, Minocin) 100 mg 1 po bid — acne ] alternate between Trimethoprim/Sulfamethoxazole (Bactrim DS) 160 mg/800 mg 1 po bid — acne ] these two Metaxalone (Skelaxin) 800 mg 1 po qid prn — back pain Diclofenac sodium topical gel (Voltaren gel) 1% apply to affected area — Red ear syndrome
  4. She wouldn't raise either of my mood stabilizers past 300 mg (Lamictal or Zonegran) during my last visit because she's trying to stabilize me by making as few changes to my regimen at a time as possible, but she has had me on up to Lamictal 400 mg before, but I didn't like it—I had so many memory problems, cognitive issues, and brain fog, it was almost as bad as Topamax. But that's when I started Zonegran, which seemed to cheer me up better than Lamictal and even cleared up the brain fog and cognitive issues Lamictal was causing me. She titrated me down to 100 mg Lamictal and up to 300 mg Zonegran (which is the one she has refused to increase past that dose for the 2 years I've been on it) and eventually discontinued Lamictal altogether and just had the Zonegran which worked fine. I recently was put back on it because of a massive major depressive episode, but it doesn't seem to be doing anything except give me side effects. I'd like to just be on Zonegran again, but a higher dose, but she won't increase the Zonegran. When I see a new neurologist (just got a referral about 30 minutes ago), I hope he'll increase the Zonegran and if need be put me on something other than Lamictal.
  5. No, I'm not in a clinical trial. It's just that it is used in TRD and BPD among some pdocs. Mine tried it on me and it worked but I had to discontinue it due to side effects (impulsivity). I'd be willing to give it another try if I had to. Requip is also used, but not as often. Not as much research has been done with it.
  6. Supposedly it has pro-cognitive effects with its preferential D3 partial agonism over D2 partial agonism. I don't understand why, but that's what has been proposed. When I was on it I didn't necessarily feel "pro-cognated." lol
  7. I've thought about trying that one, but I worry about side effects like induced seizures and weight gain. I do appreciate you giving it thought though! I'm fixing to have a new neurologist, and what I'm hoping he'll do is just let me try Zonegran monotherapy for my seizures and bipolar, but just raise the dose anywhere from 400-600 mg and my pdoc won't have a say in it (she might alter my regimen though). If that doesn't stop my seizures (complex-partial) and/or help my bipolar, then maybe add something I've tried before but only tried low doses of, like Trileptal, or something new like Aptiom (which is sorta related).
  8. http://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2015.15060788
  9. https://www.healio.com/psychiatry/bipolar-disorder/news/online/{ba2baa0d-5541-4865-acca-653f83cd205f}/vraylar-effective-for-acute-bipolar-i-depression
  10. Well, I had some good results. Tegretol seemed like it could've helped my depression had I taken a larger dose, but then again it could've just caused more side effects and more depression. Trileptal made me feel more at ease, but it was such a low dose I couldn't possibly have predicted how I would've responded to a larger dose. I know Trileptal increases serotonin and dopamine in the hippocampus, so it has to have some positive effect on mood, but my pdoc insisted that any higher of a dose would depress me. Overall, Trileptal was more pleasant and easier on side effects than Tegretol though.
  11. It doesn't matter if I drink a gallon of water a day while I'm on Topamax, it's not a matter of "if" I'm going to get kidney stones, it's a matter of "when" I'm going to get them... lol.
  12. That's what I've read as well. But I went up to 0.75 mg 3x/day (2.25 mg) because 0.5 mg 4x/day (2 mg) quit working as well. I wonder why he's not spacing out your doses 3x/day like it's taken for PD? Is it because of sedation? At least it's helping a little. I can definitely empathize with frustration with slow titration! There's no reason for that, it can be titrated much faster. Perhaps you could ask her for a smaller dose but take more at a time and ask for a titration schedule, like 0.5 mg, take 2 for 1 mg for 1-2 weeks, then 3 for 1.5 mg for 1-2 weeks, then if needed, go up to 4 for 2.0 mg, etc. That would be something I might ask for from my pdoc if she were titrating me like yours is. No, it's not... it can be increased every week as indicated for PD according to Epocrates. See image attached. I mean, maybe she doesn't want to destabilize you what with being bipolar, but if I recall, there wasn't any induction of mania/hypomania in the studies, but I don't remember what the titration protocol was. I think it was every week, but don't hold me to that. I originally put myself on Requip because my dad had a whole bunch of it left over from when he was taking it and quit when he started Neupro (I'm not condoning self-medicating with others' prescription drugs by any means!!!) out of desperation to get some relief from my depression. It worked miracles, but I wanted to get on Mirapex because it had actually had studies done with it and bipolar depression (Requip had studies done on MDD apparently). She switched me to a roughly equivalent dose of Mirapex (0.5 mg 4x/day) and switched me to the MAOI Parnate (which I think carried most of the weight but the Mirapex was wonderful alongside it). Then, a month later, she increased it to 0.75 mg 3x/day, just a 0.25 mg increase/day, and then I started having problems with pathological compulsive binge eating (which I've had problems with before), so I had to come off of it, unfortunately. But when I came off of it, I didn't really notice a change in mood, which made me wonder just how much it really was doing for my mood...
  13. Clonidine can actually induce depression. The opposite mechanism of action of clonidine, presynaptic α2A antagonism, will disinhibit norepinephrine release and enhance serotonin neurotransmission if I remember correctly, so something like Remeron (mirtazapine, watch out for weight gain!!) or an atypical antipsychotic that hits that receptor well (like Saphris, Latuda, Invega, or Risperdal) might help out with that and discontinuing clonidine might help too. As for what to do with the anxiety, I think getting off Wellbutrin would help—it tends to cause anxiety in people without a norepinephrine and dopamine dysfunction. SSRIs and SNRIs might be better suited for you. If Zoloft caused sexual side effects, perhaps an SNRI would be better for you, like Effexor XR, Cymbalta, Pristiq, or Fetzima (although I personally didn't have such a great time with Fetzima personally). I hope you find a solution soon. I know what it's like to be so depressed you cry every day several times, I've been in that boat with you before. Best of luck to you!
  14. Paroxetine is said to also be effective for anxiety and is very calming but has a bad withdrawal syndrome should you ever chose to switch or discontinue it. Sertraline is too, but it can also be a bit stimulating. Like @browri said, duloxetine is stimulating too, but it does have an indication for generalized anxiety disorder. Venlafaxine ER does too, but it's also an SNRI and is thus likely to be stimulating.
  15. Typically when these side effects appear at first when taking an antipsychotic, they're temporary, but if they don't go away, you can take something like Cogentin/Artane, a beta blocker like propranolol, a benzo like Ativan, or just switch agents. I personally found it very activating at 3 mg and at 4.5 mg it caused pretty bad akathisia.