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About browri

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  1. Typically the mood stabilizing effects of Latuda are felt pretty quickly. However its effect on depression and anxiety can take much longer to surface because of the difficult activation period. Once you get past that though, Latuda is one hell of a drug. If it wasn't for the akathisia, I would still be on it with Lamictal and maybe Prozac.
  2. @wookie how have things been for you these past weeks? Did you get the opportunity to talk with your doctors?
  3. tailing on what @mikl_pls suggested, I find that oxcarbazepine at 1200mg does a lot for my anxiety along with loxapine. However, I don't think that oxcarbazepine on its own would be enough. Combining it with an antidepressant that's good for anxiety or a low dose antipsychotic would be more effective. It definitely feels to me like it's meant to be an adjunct, not something that you take on its own. But hey you know what they say: YMMV. There's also a trend of loxapine being prescribed PRN in 5mg and 10mg doses for racing thoughts or anxiety. With 25mg and 50mg being reserved for maintenance treatment.
  4. @johnpete1993 @Swamp56 has a point. Lamictal is only historically good at preventing mood episodes from occurring not stopping or slowing down existing mood episodes. It would make sense to take your doctor's advice and add the Latuda and go up to the 40mg so that you can get up to a higher dose of Lamictal. Then titrate off the Latuda if you can once you've normalized. You may find that you like Latuda. Lots of people think it's the greatest thing since sliced bread. The only reason I went off of it was because the dose I needed to manage my symptoms caused too much akathisia. I learned later that using a combination of anticonvulsant and antipsychotic in low doses was more tolerable to me than either of those on their own in high doses.
  5. In my experience trialing Latuda twice (first time about 9 months, second time only 2 weeks) the activation period is hard to get past. I've heard a lot of stories of panic and anxiety from people and my experience was similar. If Latuda is going to work for you, you have to make it past the activation period which can last 2 weeks or more. This is most likely why the OPs doctor prescribed a benzo because the Latuda has the potential to cause a lot of anxiety and panic at first before you stablize for many people.
  6. I find loxapine to be the only antipsychotic that both controls my mania and also is tolerable. I quit Latuda (akathisia), Saphris (akathisia), Fanapt (cardiac side effects / pounding heart), Abilify (emotional blunting), Zyprexa (weight/cholesterol/triglyceride gains). Loxapine at 25mg has had next to no side effects and pretty much knocks my mania on its ass. It also boosts the Prozac to help with my depression because loxapine is broken down to the antidepressant amoxapine.
  7. The one I have is the 5th Edition of his Prescriber's Guide, but the 6th Edition just came out. I've gotta get it.
  8. @Catwoman I actually have an idea that you might be interested in. And @mikl_pls check my work on this one because I know I can count on you Clomipramine and fluvoxamine may both be the answer here if you're finding that anxiety and OCD-like symptoms are difficult to treat along with your depression: Clomipramine (as a molecule hereby referred to as CMI) is extensively metabolized by CYP1A2 to desmethylclomipramine (DCMI). While CMI is a strong serotonin reuptake inhibiter, DCMI is mostly a norepinephrine reuptake inhibitor. CMI has a shorter half-life ranging from 19 to 37 hours while DCMI ranges from 54 to 77. This means clomipramine as a whole at steady state has a higher affinity for the norepinephrine transporter. Luvox happens to be a strong CYP1A2 inhibitor (as well as an SSRI of course) and by taking it with clomipramine, you can increase the levels of CMI in your system and this fluvoxamine/clomipramine combination would be a much stronger serotonin reuptake inhibitor combined with the potency of fluvoxamine's sigma receptor properties. In fact, Stephen Stahl goes into this combination in some detail in his Essential Psychpharmacology PDR. Thoughts?
  9. The effects on norepinephrine can have positive effects on anxiety and attention as well as motivation and vigilance. But despite how little we know about it, the sigma receptor theory still seems to make more sense to me. You are correct about the Ki value. The lower the number, the higher the affinity it has for that receptor. If this were me, and I stress that heavily because your doctor may want to do otherwise, I would drop Zoloft from 150mg to 100mg and immediately add 20mg of Prozac. I would take that for Week 1. Then I would drop the Zoloft down to 50mg and do that and 20mg of Prozac for Week 2. Then for Week 3 I would either drop down to 25mg or eliminate the Zoloft completely depending on how I feel. I have learned to wait until Week 4 before I decide if I need to go up to 40mg of Prozac. But it is important here to cross-titrate because it will take a long time to build up the blood levels of Prozac. Effexor and Cymbalta are good for generalized anxiety disorder but I don't think they have an indication for OCD the way that several of the SSRIs do. My only caution with Luvox is that it messes with liver enzymes so make sure you check any other medications that you are prescribed to take with it to ensure they don't interact.
  10. It would seem that if Zoloft doesn't work out Prozac might be your next best bet.
  11. I actually found ONE fabulous study that lists the SSRIs tested in order by potency to the sigma 1 receptor: fluvoxamine>sertraline>fluoxetine>escitalopram>citalopram>paroxetine>duloxetine. So in this case if Zoloft doesn't work and you do want to keep trying new medications instead of going back to something that might not work anymore (Luvox), Prozac would be your next logical try. Sigma receptors have been implicated in anxiety and panic. It could be integral to your treatment depending on how your brain works. I know it's a woefully overused phrase by YMMV
  12. You may find that the tiredness goes away as you go up on Abilify since it can be so stimulating. It wouldn't be the first time I've heard heartburn as an odd-ball side effect but can't remember if it occurs with APs.
  13. One thing that is unique about Luvox is that it is a fairly potent sigma receptor agonist. Zoloft and Prozac are both as well although to a lesser degree. I have a problem with intrusive, compulsive thoughts and other than Lexapro, that kind of anxiety has only responded to Prozac for me so far.
  14. Let me know how the Rexulti works for you. I remember you had a failed Vraylar trial and am curious if this will be any different for you.
  15. If it's worked for you in the past, its always worth another trial, especially after so long a period of time. Alternatively, have you ever tried some plain ole Prozac?