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browri

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About browri

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  • Birthday 05/14/1991

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  1. Yeah it still needs more time. Aripiprazole has a half-life of like 75 hours and it's metabolite's is like 94 hours. This means it takes 2 weeks from each dose change to reach steady state. So you have time yet to adjust.
  2. @Matt G honestly it's almost as common to combine Lamictal with an antidepressant as it is to use Lamictal alone really with more mild BP2.
  3. Some are harder than others. Paxil and Effexor are known though for having the hardest withdrawal syndrome. So if you think it's bad, it probably is lol. Compared to Paxil though Lamictal is generally activating so it should be a nice change.
  4. If you're saying that now you seem to be in a good place, then I would say now would probably be the best time to start Lamictal. It's possibly a bit rough starting up for some people. So GI discomfort, headaches that come and go, feeling anxious or antsy. But in my experience for how difficult it was to titrate up on Lamictal in the beginning, it was a dream once I stayed at a dose for a few weeks. And after your body adjusts to it, there are very few side effects. Of course, your mileage may vary, but Lamictal is fairly predictable when it comes to the effects of titration. Compared to Depakote or lithium though it would be considered quite mild to do Lamictal monotherapy for BP2.
  5. Interesting! Certainly took them long enough to figure out how to do it. Lol.
  6. Believe it or not, in the DSM V, even for Bipolar 1 and 2, depressive episodes are still referred to as major depressive episodes not bipolar depressive episodes. And so in that regard, the depressive episodes specifically experienced by people with bipolar disorder wouldn't necessarily have different symptoms than someone with MDD, unless of course we were talking about a mixed episode, which would have a different symptom set. @sming you are right that there are certainly differing opinions on whether Lamictal actually works or not. In my experience it does. I've taken Lamictal before alone and in combination with one AAP at a time. I found that it certainly delayed episodes from occurring both hypomanic and depressive. If something depressed me, I was just kinda able to "get over it" quicker. Things rolled off my shoulders more easily. But I still experienced the feeling of something making me upset which is still important to leading a normal life. If you squash your moods out completely, then you'll just feel like a zombie. Lamictal is nice because after you adjust to it, for many people it can have almost no side effects. I'm starting it back up now because the new insurance company in July may not cover my Trintellix. But I've been feeling "up" the past several weeks and been out of any major depressive episodes for several months. I do think Rexulti has been a big help as well, but I wanted to replace the Trintellix with Lamictal because while Lamictal isn't great at treating things ACUTELY, in the long term it's quite tolerable and for me at least, quite effective. However, I can say that starting back up on it this time has been a bit rough. Noticing some GI discomfort, some headaches that come and go. Kind of an anxious antsy feeling. You may notice with Lamictal that things get worse before they get better. Trust me when I say that if you don't get the rash, you should try your hardest to get to 100mg. You may find it to be a game changer. Like others have indicated, it is becoming more commonplace to use Lamictal alone or in combination with an antidepressant for depression in people that don't appear to have experienced hypomanic episodes. However, like @mikl_pls pointed out, hypomania is subtle and can be difficult to diagnose because it may not be outwardly apparent to the clinician. But it's usually a red flag when you've tried and failed several antidepressants. That was my pdocs red flag for me when he started seeing me ~4 years ago. We immediately started titrating down the Cymbalta and used Prozac to come off of it while I was starting Lamictal. Let me tell you that it was a rough couple of weeks, but when I came out of it, I finally started to feel normal again. As you can see from my signature, we've come a long way from Lamictal monotherapy, but I do believe I have finally found a combo that works for me (Depakote+Trintellix+Rexulti+Vyvanse). Now the goal is to see if I can make it through a winter without an antidepressant and without experiencing one of my typical seasonal depressions. As an FYI, the DSM-V does now acknowledge depressive episodes "with seasonal pattern" for those with bipolar disorder, essentially calling out that there could in fact be some crossover between bipolar disorder and seasonal affective disorder (SAD). May also be why Wellbutrin, which is the one medication that has the most evidence for this indication also happens to be the one antidepressant that seems to have a much lower rate of manic switch. If you're curious about what hypomania might feel like, I actually wrote a post recently in another thread where @Matt G was also wondering if he may be bipolar. I linked it below. It may provide some insight of how simple things that many people do can be associated with bipolar behaviors. Things like DUIs or sleeping around, impulsive shopping. These are things that would likely happen to you between depressive episodes when you're feeling "good" (i.e. if you're really bipolar, "I feel SO much better after starting this medication" is something that could also be a red flag). I can also say that I responded the same way to lithium as you did. I felt ill. Everything about it just made me feel like I was poisoning myself. I was waking up drenched in sweat and I just felt so sick and "off". I only lasted maybe 10 days. Depakote by contrast has been an absolute DREAM. I feel so much more calm on it. Following on what @mikl_pls said, genetics can play a big role in it. For example, I have several SNPs for the MAO-A (monoamine oxidase A) gene that cause me to be under-produce this enzyme, which is important to breaking down monoamines in the brain like serotonin, norepinephrine, and dopamine. In this case, I would have higher levels of those neurotransmitters than most. And as we know in the brain, there is both a too much and a too little. I also have an under-functioning COMT (catechol-O-methyltransferase) gene. See the below article. I'm the "Worrier": https://www.selfhacked.com/blog/worrier-warrior-explaining-rs4680comt-v158m-gene/ The beauty in my med combination is I've actually worked with my pdoc to introduce medications that correct underlying genetic dysfunctions. If I focus specifically on MAO-A and COMT, then I can tell you that Depakote is a fairly strong MAO inducer (the exact OPPOSITE of Nardil). It increases the metabolism of serotonin in the brain and reduces its levels. Additionally, it also reduces the synthesis of catecholamines like dopamine and norepinephrine. Rexulti and Vyvanse both also increase COMT. Additionally, Depakote increases the conversion of glutamate (an excitatory neurotransmitter in the brain) to GABA (a "depressing" neurotransmitter, target of many drugs from Ativan to Rohypnol) and then inhibits the breakdown of GABA to allow more available in the brain, leading to a calming state. This also of course leads to side effects like sedation, but in the long run, your sleep improves and subsequently your mood as well. The recommendations above all seem like good starting points to talk with your pdoc. It would be wise to have your thyroid levels checked to make sure that some of your depression isn't due to hypo- or hyperthyroidism. Additionally, checking B vitamin and folate levels should be a good way of telling if you have a mutation on the MTHFR gene that would negatively impact your body's ability to properly absorb folate which is a necessary precursor to the synthesis of neurotransmitters in the brain. There are various different steps in these neurochemical processes and some of the best pharmacotherapies address the problem at multiple levels, hence the drug cocktails we take. If this reinforces your thinking further that you may be bipolar. I just completed a closed study through 23andMe of people with either depression or bipolar disorder. I was one of <10,000 people selected for the bipolar set. At the end of the 9-month study we received a report of some of the preliminary statistics that came out of their investigation. One of the ones that struck me the most is that of all the people in the study with bipolar disorder almost 50% of were previously misdiagnosed as MDD. It's actually quite common for BP2 particularly to be discovered after someone reporting depression fails multiple medications or they repeatedly poop out within months.
  7. That was certainly the case for the brand name Wellbutrin SR and XL, but what about the generics?
  8. This is probably why it caused me less jitters and anxiety. The smoother release mechanism means you don't get it "all at once" and therefore less major spikes in drug level early in the day that could lead to anxiety or a crash in the afternoon.
  9. I'm sure it is. If this Lamictal is like the Lamictal I remember then this all eventually goes away, and I won't have any side effects from it at all. In fact the only side effect I recall having from Lamictal after I adjusted to it was word recall (no pun intended). I would have the tip-of-your-tongue sensation a few times a month. Nothing serious though. I experienced more confusion from Trileptal than from Lamictal and Depakote really hasn't caused me any cognitive issues that I can speak of.
  10. Out of curiosity, how did you feel about Aplenzin 522 vs the Forfivo 450, @notloki?
  11. Yeah it does seem like some pdocs are concerned about a lawsuit because of the POTENTIAL long-term effects of these medications. I do acknowledge they are very real. However, I started out on the "easier" stuff first and it just didn't provide a level of consistency that I required. We did try lithium before we tried Depakote. Unfortunately, I could not tolerate it at all. I felt so sick and I only got up to maybe 600mg of the CR but I couldn't last longer than 10 days. Compared to that Depakote has been a DREAM. I feel so much more calm, and yeah I've had a fair bit of weight gain from the Depakote+Rexulti combo, but my mood has improved so much (both hypomanic and depressive symptoms) since starting the Depakote+Rexulti combo as a mood stabilizer that the weight gain doesn't bother me as much. Trinellix was supposed to be a permanent fixture in my cocktail until I found out about BCBS of NC's policy on antidepressants being used off-label. My pdoc could certify that I be kept on it because I've been clinically stable for a significant amount of time since starting it, and I'm already taking it going into a new benefit period on a new carrier. That being said, I have been having some breakthrough hypomanic/mixed symptoms on the Depakote+Trintellix+Rexulti+Vyvanse combo. Honestly I've been out of a depressive episode now for some time, it's summer time, and we figured it was time to take a break from ADs to let my brain "reset" a bit. I asked to start on Lamictal as my previous experience with it showed me that it is quite effective at preventing episode onset. I might still get upset or depressed about something but I get over it quicker and move on with life. I didn't plan on really going higher than 50mg because Depakote doubles that to 100mg. I really wanted to keep the Lamictal minimal to moderate in dosing because I'm on other meds as well. My goal is to see if I can get through a winter after stabilizing on Depakote+Lamictal+Rexulti+Vyvanse. Since I started seeing this pdoc in 2014 or so I haven't made it through a single winter without sinking into depression no matter what medication I was on. And if it wasn't a textbook 2-week long pure depressive episode, then it was rapidly cycling, anxious, mixed episodes. But usually just sobbing, call-out-of-work, borderline catatonic depression. Trintellix is the only antidepressant that hasn't had a major impact on my sexual function. Can't say if it's made me gain weight or not because I am taking Depakote and Rexulti, which will cause weight gain, but it also helped to improve my cognition. On the higher doses of Trintellix, I didn't need as much Vyvanse to get through the day. In fact they worked together synergistically. So I want to see if Lamictal can take it's place. If so, that's awesome. If not, then my pdoc can go back to the insurance company and explain to them that coming off of Trintellix and going back on Lamictal ultimately destabilized my condition. We'll have more ground to stand on really. Have to say though that after the decrease of Trintellix from 10mg to 5mg and then starting the Lamictal, I feel SUPER foggy right now. I have felt a lot better as the day has progressed. But I still feel kinda tired/fatigued. I took Imodium this morning before work for diarrhea and it literally had NO effect, which I thought to be very strange. The GI cramping has continued a bit and I'm still having mild lower back ache. No headache at the moment though. So that's nice at least. And no rash to speak of. Didn't have that problem last time, but I acknowledged that this had the potential to be a totally different experience with the Depakote on-board. Thank you very much for posting back @confused. It makes me feel better knowing that someone else tolerated it well enough and got benefit from it. Sorry to hear your pdoc won't let you go back on Depakote when you know it made you feel better.
  12. Your pdoc feels that way for a reason. There are plenty of people who REALLY just can't tolerate Abilify and when it's bad it's bad. Some people get terrible akathisia across all dosages. My pdoc was also very conservative with Abilify, starting me on 2mg then we escalated over 10 days to 7.5mg, but I just couldn't hack it. Made me too agitated. By contrast, Rexulti, which has a chemical structure very similar to Abilify is the total opposite. More sedating at the lower doses, and stimulating at the higher doses, with akathisia starting for some around 1-2mg but for most somewhere between 3-4mg. That being said, Rexulti had a statistically significant lower incidence of akathisia than Abilify overall. It also is more likely to cause weight gain than Abilify. I'm currently taking Rexulti with Depakote. And I'm titrating from Trintellix to Lamictal at the moment. But I like to think that the Vvyanse helps to keep the weight off lol. For me, Rexulti even had a very positive effect on my sleep hygiene and my anxiety at just 0.25mg. At 1mg, I'm seeing even more of the positive effects on my sleep, anxiety, and depression. This is in contrast to Abilify which made me feel like I was poisoning myself with dirty speed lol. To be fair, I was not in a very good place when I started on Abilify, and I was only taking Lamictal at the time. So I wasn't as stable as I should have been.
  13. What day did you start on the 5mg? It would seem that your pdoc is being cautious because of reported tolerability issues for some people with Abilify. For bipolar disorder in adults as monotherapy, the starting dose is actually 15mg, which is also the target dose. As an adjunct to lithium or valproate starting is 10-15mg with a target of 15mg as well. Maximum dose is 30mg For depression on the other hand (as adjunct to an AD) starting dose is 2-5mg per day with a maintenance dose range of anywhere between 2-15mg. The prescribing information says that dose changes can be made in increments of 5mg at no less than 1-week intervals. So if you've been on 5mg for a week already, then going up to 10mg shouldn't be an issue. You may find it more tolerable.
  14. @crow66 I do believe that @mikl_pls recommended the same brand if you were to get it OTC instead of the Deplin brand.
  15. thinking about the pharmacodynamics of it all, psilocybin is a tryptamine. Much like LSD (which, by contrast, is an ergotamine) it is a potent agonist of the 5HT2A receptor, but the difference lies in the ultra-tight binding affinity that LSD has for that receptor. While both psilocybin and LSD have fairly short half-lives, the psychological effects of LSD for whatever reason last far longer. In PET scans they observed that this was because LSD takes a very long time to dissociate from the 5HT2A receptor even after blood plasma levels have tapered off. Psilocybin on the other hand is slightly more intermediate which may explain why subjective reports indicate that the effects last ~5 hours or so whereas LSD can last 12-24. Psilocybin is also an agonist of 5HT1A which should cause downstream dopamine release and activation of the dopamine receptors. This should theoretically have a more calming effect than LSD, which can result in bad trips. At least my understanding is that psilocybin is less likely to cause bad trips. Psilocybin also activates 5HT2C receptors which can make you feel full and maybe even nauseous. Its activation of 5HT1D would make it similar to the triptans that are used for migraines like Imitrex. What's interesting though is that despite the fact that the 5HT2A activation should REDUCE dopamine release, 5HT1A activation INCREASES dopamine release. Clinical studies showed that Haldol could effectively be used to bring someone on psilocybin out of a trip. Whereas it was less effective against LSD which binds to the dopamine receptor to a certain extent where psilocybin does not. All-in-all, psilocybin SEEMS far more "wholesome" (if you can actually call it that) or therapeutic than something like LSD which could have catastrophic consequences and there's really no way for you to know if it will without actually trying it. Like I said earlier though, keep in mind that if you take AAPs, they're all 5HT2A antagonists which will effectively blunt the effects of psilocybin (maybe LSD, but you'll likely need something stronger in that case). Therefore, some of the content would be "wasted" or you would just have to take more to get the same effect. As for whether or not it "resets" brain chemistry, it's hard to say. Theoretically all of these actions should result in reduced outflow overall of dopamine, serotonin, and potentially other neurotransmitters while the substance is in your system. When the activation of those neurotransmitters' respective receptors is reduced due to lower outflow, the brain should naturally and automatically adjust the "pumps" to account for it and then as the psilocybin tapers off, you're left with increased outflow of serotonin and dopamine at the same time which together would provide a level of euthymia that likely would only be achieved using combos of medications. As @mikl_pls was indicating, using these "sessions" to be introspective can potentially have a lasting impact. There's evidence that simply creatively stimulating yourself can have positive impacts on brain activity especially in the limbic system. So perhaps sessions of "chemical reset" combined with therapy may have a longer-lasting effect than the typical maintenance pharmacotherapy or psilocybin without talk therapy sessions. It may be even more useful for people who don't get much out of therapy because they are unable to put themselves into a state of mind that allows them to "train" their brain to function differently. This is why they're looking at psilo- or MDMA-assisted therapy as a genuinely effective clinical option.
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