browri

Member
  • Content count

    520
  • Joined

  • Last visited

1 Follower

About browri

  • Rank
    Member
  • Birthday 05/14/91

Profile Information

  • Gender
    male
  • Location
    Bethlehem, PA

Recent Profile Visitors

937 profile views
  1. I keep a separate psychiatrist and psychologist as well because my psychiatrist doesn't do therapy. He's also my boyfriend's pdoc and my boyfriend has known him since he was very young. He said that he used to do therapy at one point but it was only on the weekends and it was self-pay at that point. He wouldn't do therapy if it went towards insurance because he would get so little for it.
  2. I've certainly heard plenty of stories where people had this issue with antidepressants but not as much so with antipsychotics. I've only tried an AAP more than once and that was Latuda. Both times the activation period was too agitating and panicky but the second time I couldn't tolerate it and we ended up going for olanzapine which was just what I needed at the time. Switched olanzapine to loxapine because of the weight gain, all of which I lost. But I ran into an issue with the loxapine where it was calming my thoughts when I took it but simultaneously stimulating my fight or flight response. Everything caused an adrenaline rush and I just found myself taking Xanax all the time. Currently titrating across to Rexulti (Day 3) and it's much more calming closer to olanzapine but not as sedating. Now I am taking it with Vyvanse so take that with a grain of salt.
  3. Fetzima is interesting. It's classified as an SNRI but it really should be called an NSRI because it affects norepinephrine much more strongly than Effexor, Pristiq, or Cymbalta. Effexor doesn't even touch norepinephrine until you get to 150mg. Pristiq always does but has a much lower affinity for it than serotonin. Cymbalta is the only SNRI that is an even 50/50 between serotonin and norepinephrine. So Fetzima should arguably be just as if not more stimulating than Cymbalta. Look out for that excessive sweating!
  4. This article outlines a lot of reasons to not bother with the orotate form: http://psycheducation.org/treatment/mood-stabilizers/the-big-three-for-bipolar-depression/lithium/lithium-orotate/ However, lithium orotate seems to be pretty misunderstood. There was one study where they gave lithium orotate to mice in the same doses that would be required to attain the elemental lithium amounts of the carbonate form. As you can see from the chart on the link above, it takes A LOT of the orotate form to get to what are considered therapeutic levels of the carbonate form. In the mice study, the kidney damage was worse than that caused by the carbonate form. BUT, my understanding from reading about the orotate form is that it appears to cross the blood-brain barrier more readily than the carbonate form thus necessitating less elemental lithium. Additionally, this would mean that the typical blood level ranges for lithium get thrown out the window because a super low level could theoretically be just as or almost as therapeutic as the normal level for the carbonate form. And at levels that low, there's a possibility, albeit not proven, that the kidney damage may be just as bad or less so in the orotate form than in the carbonate form. I'm not a doctor though. And despite this information, if you think you want to try lithium or need to take it to control mood swings, you should be taking the carbonate form that has YEARS of data and experience behind it instead of a form that isn't regulated in any way and doesn't have a whole lot of data to back it up.
  5. Not that I'm aware of. Almost everything you get OTC is a combo of EPA/DHA. But the makers of Vascepa have some pretty compelling reasons to use their prescription fish oil: https://www.vascepa.com/prescription-vs-supplements.html Most importantly from those points is that OTC fish oil can have a really high saturated fat content which can be bad for some people. Additionally, they can increase LDL or "bad cholesterol". And also, you can take fewer pills to get the full dose of EPA. I also haven't known the Vascepa pills to spoil even for the week that they're sitting in my pill case instead of in the original bottle. Over the course of a week they got slightly softer as they are quite hard when they first come out of the bottle. But they never get stinky or spoil. Additionally, there is a savings card for Vascepa. Generally, because Lovaza is generic they want you to try it first but my insurance didn't require step therapy for Vascepa even though it's a brand. It's preferred though. So my copay is $30/30-day and the savings card makes it $9. So it really is worth it to go the prescription route if your doctor will write for it and your insurance will cover it. I can second this a bit. Latuda worked fairly effectively for bipolar depression, and I was only taking it with lamotrigine at the time. However, there were more difficult symptoms of mania like irritability and some agitation that didn't get better even at 60mg and 80mg even though the overall mania baseline was mildly improved. Additionally, the doses I had to be at for sufficient anti-manic effect caused me quite a bit of akathisia. For bipolar depression, the dose is usually 20-40mg. The first time I took it my pdoc started me out right at 40mg and it dropped in fairly well but the initial activation period was a bit difficult. After I was at 40mg for a while, we realized there were residual manic/mixed symptoms that weren't responding well at which point we went up to 60mg then 80mg. Those doses were a bit too much for me. Something else to keep in mind is that you'll likely want to take the 20mg and 40mg doses in the morning as they can be slightly activating. Whereas 60mg+ is sedating and should be taken at night.
  6. I second these. Wellbutrin definitely didn't feel like your run-of-the-mill SSRI even after several weeks. The antidepressant effect was definitely different. But at the cost of my anxiety which never really got better on Wellbutrin even if my depression did. I also was not taking benzos at that point so I can't attest either as to whether or not they would work. But theoretically the anxiety you feel, especially tightness or feeling like an elephant is sitting on your chest is likely the effects on norepinephrine and the only way to block that would be something that blocks alpha or beta adrenergic receptors. Something else to consider is that Seroquel is a fairly strong norepinephrine reuptake inhibitor itself. Additionally, while 75mg of Effexor on its own likely wouldn't have much effect on norepinephrine, it may be additive when combined with Wellbutrin and Seroquel. This all being said, you should still wait 2-3 weeks to see if those adrenergic effects ease up a bit because in some people they do and Wellbutrin can become calming. Paradoxical I know, but it does happen to some people. Just not me. Lol.
  7. I just wish Zyprexa didn't have such a terrible metabolic syndrome even in low doses. Like not only did I gain almost 25 lbs buts my lipid panels were horrible and my blood sugar was on the cusp of being high. You're right. I definitely think a lot of it is the adrenergic effects. I don't feel as much of a fear response to things. Less adrenaline. That's very interesting. If you stumble across it again send it my way! Abilify made me really activated and agitated in low doses. Definitely don't feel that way on Rexulti. Exact opposite actually.
  8. The lithium/Seroquel/Klonopin combination is a potent one. I can see why you're so sedated. Perhaps getting stabilized on lithium, if you tolerate it, will allow you to come down on Seroquel and Klonopin which may ease the sedation.
  9. I had to do a double take because I thought I was reading one of my own posts when I read your description of how it feels. So far it's been quite settling. I haven't even had the desire for my normal mid-day dose of loxapine. You really don't need much of this stuff. I'm having less fight-or-flight adrenaline like reactions to things around me. Rexulti is a potent alpha-adrenergic blocker even at low doses. But I can also see some of the stimulation too. But it's controlled stimulation. Very subtle. All-in-all I have moments where I feel "a little funny" but it's still quite tolerable. So far the only two things that have settled me well were olanzapine and loxapine. In fact I was going to just go back to olanzapine but we decided to make a pit stop at Rexulti to see if it could work. My pdoc has also said that in his actual use of it, it's pretty different from Abilify. At this point, my overall outright hypomania is well-controlled with Depakote like when the thoughts race or become disjointed and you become euphoric, but intrusive thoughts, obsessive preoccupations, and agitation I've always dealt with using antipsychotics because anticonvulsants haven't been as effective for these specific symptoms. Like I said, only olanzapine and loxapine have really worked to calm my agitation and quiet my internal monologue enough to focus on what's going on around me. Olanzapine had a good antidepressant and anxiolytic effect. Loxapine might work for some people at 10mg as an augment to an antidepressant but I didn't find loxapine's antidepressive effects to be nearly as effective as olanzapine's. And loxapine has metabolites that are potent norepinephrine reuptake inhibitors so I would take one to calm my thoughts but it would heighten my fight-or-flight response which would in turn just make me more agitated. Then I would take a Xanax and feel REALLY doped up. I'm more prone to mixed states and hypomania as well. It's when I let them go untreated that they turn into depressive episodes. I can definitely see how Rexulti has antidepressant effect. It makes you feel content really.
  10. Well there are two different brands of prescription fish oil. There's the typical Lovaza that you generally get started on which contains a combination of EPA and DHA. Currently available as a generic. However, the problem is DHA which doesn't help much with triglycerides and in some studies actually made the LDL worse. Vascepa is the other options which is currently available brand-only and is pure EPA. That's the one I take. As for updates to my meds: Depakote ER (divalproex sodium) 1000mg qhs - mania baseline Trintellix (vortioxetine) 20mg qAM - depression Vyvanse (lisdexamfetamine) 40mg qAM - ADHD Loxitane (loxapine) 5mg qhs (currently slowly titrating across to Rexulti) - intrusive thoughts/rumination Rexulti (brexpiprazole) 0.5mg qAM - intrusive thoughts/rumination/depression Xanax (alprazolam) 0.5mg 1/2 bid PRN - anxiety Truvada (emtricitabine-tenofovir disoproxil fumarate) 200mg-300mg qAM - HIV PrEP Clarinex (desloratadine) 5mg qAM - allergies Vascepa (icosapent) 1g 2 bid - hypertriglyceridemia, possible antidepressant and mood stabilizing qualities Vitamin D3 5000IU qAM - D insufficiency
  11. Indeed I have found plenty of literature indicating that aripiprazole does have functional activity at D2S just can't find the affinity or intrinsic activity.
  12. See this is what I get for relying on Wikipedia to be accurate. Do you know of a source with that information so we can update the page cuz that's a pretty crucial pharmacological action. lol.
  13. It depends on what of your symptoms is more problematic I suppose. I've recently moved to Depakote because my manic symptoms are more difficult to treat. But if I keep those under control I usually don't stumble down into a depression. I can also attest to the positive effects of oxcarbazepine, which I believe also had anti-anxiety and some anti-depressive effects when combined with an antidepressant. I've never taken it without one. Lithium made me downright ill though. I wasn't even on it long enough to have a blood level done. Titrated up to 600mg CR over 10 days and quit it. Would wake up at night drenched in sweat and would just feel so sick throughout the day. I wasn't myself at all. But in regards to mood stabilizing efficacy it did work and it did quickly. If mania isn't a primary problem for you, then I would second @sbdivemaster, lamotrigine would be a solid try. For me when I was on lamotrigine, the things that would normally get me worked up, were far less likely to get me worked up, but when they did, it was much more short-lived and I was able to get over things faster. It just wasn't calming enough though. It was good for mood swings and even helped with depression but didn't help with pure mania or agitation/irritability.
  14. Can you tell us everything you're taking? At this point I think we know lithium, Klonopin, and Buspar. Anything else?