ahalo

Your Cocktail Deconstructed

406 posts in this topic

23 hours ago, mmaryland said:

Dexedrine spansules 10mg bid in the morning - ADHD

Zenzedi 10mg bid in the afternoon - ADHD

Lithium ER 450mg x2 qhs - Bipolar NOS, particularly trying to treat my mania*

Xanax 1mg bid - Social anxiety and panic attacks

Ambien 10mg qhs - Insomnia

Valium 5mg qhs - Attempting to taper down of off the benzos because of recent seizures when I had stopped taking Xanax or a week**

Cyproheptadine 4mg bid - Appetite stimulant 

*this past month I have been getting by on a nights worth of sleep for an entire week, and still not feel tired or the need for sleep. lithium was just increased last week, so maybe some more time is necessary for increase dosage to help

**I visit my dr tomorrow afternoon and am going to ask about using Xanax XR, just a 2mg XR once daily, instead of using two different benzos at the same time

Have you tried klonopin?  That can treat seizures also, along with the anxiety.  It is a benzo but maybe you could ask about klonopin instead?  It has the potential to help with seizures, as well as anxiety.

I know you posted this a day ago, but maybe you could still ask your DR about it? 

I apologize, but I am not sure I understand why you are tapering down off of the benzos, but then asking about using xanax XR ... which is a benzo?

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4 hours ago, melissaw72 said:

Have you tried klonopin?  That can treat seizures also, along with the anxiety.  It is a benzo but maybe you could ask about klonopin instead?  It has the potential to help with seizures, as well as anxiety.

I know you posted this a day ago, but maybe you could still ask your DR about it? 

I apologize, but I am not sure I understand why you are tapering down off of the benzos, but then asking about using xanax XR ... which is a benzo?

Ah yes I forgot to mention klonopin. I was prescribed 1mg bid for anxiety as my psyc wanted to get me off the xanax, but over time klonopin gave me anhedonia and an unmotivated state of mind, without much anxiety or panic relief. I have my seizures when I don't take my Xanax as prescribed, when I run out early, or when I simply just consciously don't take them for 5-7 days because I am not feeling particularly panicky during that time.

This is why I wanted to ask about the Xanax XR. Sorry if what I posted was confusing, I am not tapering off the benzos, more or less we are trying to figure out which has the most therapeutic benefit and likelihood of taking as prescribed. I intend to stay on Xanax, I am just wondering if 1mg XR every day and then 1mg IR of xanax PRN would be a more stable combo.

Btw, saw Dr today, prescribed Rexulti to help calm down my current manic episode and hopefully benefit my episode cycles overall. 

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2 hours ago, mmaryland said:

Ah yes I forgot to mention klonopin. I was prescribed 1mg bid for anxiety as my psyc wanted to get me off the xanax, but over time klonopin gave me anhedonia and an unmotivated state of mind, without much anxiety or panic relief. I have my seizures when I don't take my Xanax as prescribed, when I run out early, or when I simply just consciously don't take them for 5-7 days because I am not feeling particularly panicky during that time.

This is why I wanted to ask about the Xanax XR. Sorry if what I posted was confusing, I am not tapering off the benzos, more or less we are trying to figure out which has the most therapeutic benefit and likelihood of taking as prescribed. I intend to stay on Xanax, I am just wondering if 1mg XR every day and then 1mg IR of xanax PRN would be a more stable combo.

Btw, saw Dr today, prescribed Rexulti to help calm down my current manic episode and hopefully benefit my episode cycles overall. 

Oh, ok ... I'm sorry I misunderstood that. 

I hope all goes well with the Rexulti.  Did you ask about the xanax XR and then the IR as needed to help with the seizures?

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On 5/17/2017 at 7:03 AM, melissaw72 said:

Oh, ok ... I'm sorry I misunderstood that. 

I hope all goes well with the Rexulti.  Did you ask about the xanax XR and then the IR as needed to help with the seizures?

So far I do not notice much of a difference since being in Rexulti 2mg for about a week now. I did ask about the xanax XR but doc said she intends to completely switch my over to valium because of its longer half life, and thus I would be less likely to have another seizure if I stopped taking the benzo for about a week. I was told valium might also help me sleep at night combined with the ambien, but it doesn't make much of a difference honestly. I am scared to transition over to valium completely because I have had such great success with xanax controlling my apprehensions, panic, and social anxieties. I really would like to give the xanax XR a try but would prefer to not be on 2 different benzos at the time time in addition to the 'non-benzo' ambien. 

Also, is it unlikely for patients to combine seroquel (low dose) with their night time ambien dose? And is the use of seroquel with other AAPs such as abilify or rexulti warranted is seroquel is being used just for insomnia? One last thing, I haven't noticed any sedation so far from the rexulti, whereas with other AAPs I felt immediate sedation and ended up falling asleep soon after taking seroquel or zyprexa. Are these more sedating AAPs usually preferred when primarily treating bipolar mania, or are AAPs like rexulti or abilify just as effective for treating acute and maintenance bipolar mania (but mostly acute)? I mean I have heard of abilify causing activation and increases in manic like symptoms/behaviors, and wonder if such an AAP would/should be used when trying to control mania. Also, is seroquel, whose effects are felt rather quickly, a treatment that can be used on an as needed basis, for example using seroquel only when one feels manic symptoms coming on or are in a mania and wish to return to baseline and control the mania. 

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1 hour ago, mmaryland said:

Also, is it unlikely for patients to combine seroquel (low dose) with their night time ambien dose?

I'm not sure about that.  I have been on both meds in the past, but not together.

1 hour ago, mmaryland said:

And is the use of seroquel with other AAPs such as abilify or rexulti warranted is seroquel is being used just for insomnia?

I'm sorry, not sure of this either except that seroquel can be used for sleep in smaller doses ... but Idk about the combo of seroquel with the AAPs.

1 hour ago, mmaryland said:

Are these more sedating AAPs usually preferred when primarily treating bipolar mania, or are AAPs like rexulti or abilify just as effective for treating acute and maintenance bipolar mania (but mostly acute)? I mean I have heard of abilify causing activation and increases in manic like symptoms/behaviors, and wonder if such an AAP would/should be used when trying to control mania.

I'm not sure of this either.  I haven't been on Rexulti.  And in terms of treating bipolar, everyone is different so it is hard to say which meds work for any one person's treatment.

(bold) IME,  abilify didn't make me manic/activated ... and it did not increase any manic symptoms/behaviors.  It did keep me awake though, but that side effect eventually went away.  But YMMV on this.

1 hour ago, mmaryland said:

Also, is seroquel, whose effects are felt rather quickly, a treatment that can be used on an as needed basis, for example using seroquel only when one feels manic symptoms coming on or are in a mania and wish to return to baseline and control the mania. 

I don't know ... hopefully other member can chime in on this question as well as the others.

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  • levomilnacipram (Fetzima) 120mg QD - Depression. I don't think I posted in here about titrating past 40mg, but I had titrated up to 120mg by some point in January or February and have stayed there ever since.
  • Adderall IR 20mg QID (80mg total) - ADHD
  • bicalutamide (Casodex) 50mg QD - HRT. New med, literally just started this today as a replacement for the spironolactone (200mg didn't agree with me at all and 100mg literally wasn't doing anything to my T levels), we'll see how it goes, but I have high hopes. Unlike spiro or CPA it isn't supposed to actually lower my T levels, instead, it just acts as a extremely effective antagonist at the androgen receptors, preventing T/DHT from binding to them.
  • estradiol (Estrace) 2mg BID (PO/SL) (4mg total) - HRT
  • temazepam (Restoril) 30mg QD - Sleep
  • diazepam (Valium) 5.0mg QID PRN - Anxiety. I don't bother with splitting pills for 2.5mg doses anymore, it's easier to just take 5mg less often.
  • pantoprazole (Protonix) 40mg QD - Ideopathic chronic gastritis
  • ondansetron (Zofran) 4mg PRN BID - Nausea from meds

The doctor I saw who prescribed the bicalutamide also gave me some sumatriptan for my semi-frequent migraines (have had them since I was a kid) as ibuprofen isn't always enough for those. I didn't really feel it was really necessary but she practically insisted on prescribing it, which felt a bit odd at the time, but in retrospect I suppose me being opposed to trying actual anti-migraine meds for a change despite my long history of (often nasty) migraines is quite stupid to begin with and I'm glad she insisted on prescribing it. I'm still a bit concerned about the side effects and interactions but next time I have a migraine that ibuprofen fails to work on I'll definitely try the sumatriptan to see if it's helpful.

My psych gave me some suvorexant (Belsomra) samples to try out in place of the temazepam when I last saw her, but I haven't tried that yet. It's very likely to just be completely ineffective, but my psych says that both she and the psych who owns the practice have noticed that many of the (small) subset of their patients who've actually responded to suvorexant are the ones with long histories of failed sleep meds, and that they generally respond very well when they respond, so she said to give it a try on the off chance that it's effective for me. I've been delaying too long though, I need to try that soon... It'll be interesting to see if it does anything.

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