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Trintellix and Bipolar depression/interactions/good fit?

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On 5/24/2018 at 5:22 PM, Eilatan said:

Hi browri 

Thank you for replying. Yes my pharmacy has to order it in as it'''s not very well known. They are quite interested to see if it works well too. I think it does. I'm still cautious but optimistic.... I am doing a few slightly reckless things. Like err ordering stimulants online and getting my address wrong.  I'm  such an idiot. 150 dollars down the drain......

Be mindful of behaviors like this as you're starting on Trintellix. For some people, Abilify really stirs up impulsive behavior like what you're describing. And it is a sign that Abilify may not be for you if it doesn't go away. It's possible that starting on Trintellix may amplify that activity. So keep an eye on it. Try to just take the Trintellix/Abilify and any other medications your doctor has prescribed and avoid any other stimulants except maybe some coffee. 

Looks like based on your writing that you're at about 30 days on 5mg. Now may be a good time talk to your doctor about increasing to 10mg if you're still tolerating it well. Not sure where you live in the world, but if it's Fall heading into Winter it may be worth pushing forward to 20mg with your pdocs supervision. It really does work better for depression at that dose. I just can't say how it works with Abilify because I was never able to tolerate Abilify (only got to 7.5mg and gave up). So I've never taken Trintellix/Abilify together. However, Trintellix/Rexulti is a wonderful combination in my mind, and I think @dtac would agree.

On 5/24/2018 at 5:28 PM, Eilatan said:

I' not sure what clominipeine is!!! I' pretty sure I'm not taking it though. Are you on it?? My thinking is you're wanting to reply to @browri as they seem to know a lot about all these things. 

I'm sorry you'e having anxiety etc. I too have lived with it to a severe degree. 

Actually I think @Ethansmom was referring to clomipramine. It's an older tricyclic antidepressant that's considered the gold-standard for obsessive compulsive disorder in the first generation of antidepressants followed by fluvoxamine, which is the SSRI second generation gold standard for OCD. @Catwoman is actually currently in the process of titrating down on fluvoxamine and may be starting clomipramine shortly if she hasn't already. The two medications can also be used very carefully together in low doses for very treatment resistant cases. The two medications together actually come up with a pharmacological profile that would be very difficult to achieve with the two drugs separately combined with other medications.

@Ethansmom, do you currently take clomipramine now? If so, how does it work for you? I do believe @Catwoman would be curious to know before she starts.

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[email protected] eilatan.

no. I’m currently taking trintellix. Just bumped from 5mg to 10mg and feeling very uneasy today. Today is day 1 of the increased dose. I hope the anxiety calms down this week. How do I cope this weekend when I have lots of parties to go to? Should I Xanax my way through? I have klonopin but that doesn’t always work as well as Xanax. 

I also ran on the treadmill this morning to try to tire myself out. 

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1 hour ago, Ethansmom said:

[email protected] eilatan.

no. I’m currently taking trintellix. Just bumped from 5mg to 10mg and feeling very uneasy today. Today is day 1 of the increased dose. I hope the anxiety calms down this week. How do I cope this weekend when I have lots of parties to go to? Should I Xanax my way through? I have klonopin but that doesn’t always work as well as Xanax. 

I also ran on the treadmill this morning to try to tire myself out. 

It's certainly not uncommon for benzo's to be used while titrating up or down on antidepressants. I find that I still need 0.5mg Xanax from time to time. Just make sure you're keeping your dosage and frequency in check so that you don't develop tolerance or dependence. If this is Day 1 at 10mg, I would say this isn't telling of what 10mg will be like for you in the long run. I know this isn't always possible, but try not to think about it for a week and ask yourself again on Friday how you feel.

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Insurance is changing starting 7/1/18. Found out that Trintellix is on formulary as a non-preferred brand, which I expected. It is on my current insurance, and the savings card covers it. Determined my copay wouldn't change. Then I saw that it was subject to Step Therapy, except is retermed as Restricted Class, because there are other qualifications.

Because Trintellix is only approved for major depressive disorder, the new insurance likely won't cover it, because part of gaining access to a Restricted Access drug is not only that you've tried generic alternatives but also that it isn't being used off-label. :wtf:

Obviously because I'm diagnosed Bipolar 2 (F31.81), my pdoc will likely have to fight with the insurance company to get them to cover it. In reality, I don't generally need antidepressants during the summer. My depression is definitely seasonal, and it's better for me to ease up on the Trintellix in the Spring/Summer or stop entirely and increase the Rexulti. I determined that if my pdoc sends in a 30-day of Trintellix now and a 90-day before my current insurance is up, I would actually have enough of all 3 doses to get me through the Fall/Winter with all the backstock of it that I've built up. And if I get to a point early next year where I'm running out, then my pdoc and I have evidence to go back to the insurance company with to get them to cover it off-label. We'll see.

Trying to stay optimistic about how, yet again, a company is telling me what's good for me when I'm the one who gets to swallow it every day. :angry::cussing:

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Posted (edited)
54 minutes ago, browri said:

Insurance is changing starting 7/1/18. Found out that Trintellix is on formulary as a non-preferred brand, which I expected. It is on my current insurance, and the savings card covers it. Determined my copay wouldn't change. Then I saw that it was subject to Step Therapy, except is retermed as Restricted Class, because there are other qualifications.

Because Trintellix is only approved for major depressive disorder, the new insurance likely won't cover it, because part of gaining access to a Restricted Access drug is not only that you've tried generic alternatives but also that it isn't being used off-label. :wtf:

Obviously because I'm diagnosed Bipolar 2 (F31.81), my pdoc will likely have to fight with the insurance company to get them to cover it. In reality, I don't generally need antidepressants during the summer. My depression is definitely seasonal, and it's better for me to ease up on the Trintellix in the Spring/Summer or stop entirely and increase the Rexulti. I determined that if my pdoc sends in a 30-day of Trintellix now and a 90-day before my current insurance is up, I would actually have enough of all 3 doses to get me through the Fall/Winter with all the backstock of it that I've built up. And if I get to a point early next year where I'm running out, then my pdoc and I have evidence to go back to the insurance company with to get them to cover it off-label. We'll see.

Trying to stay optimistic about how, yet again, a company is telling me what's good for me when I'm the one who gets to swallow it every day. :angry::cussing:

So sorry that they might not cover it. That xbsolutely sucks especially if it' been working for you.  I don't have anything to suggest since I'm in the UK where these situations wouldn't arrive (although it is a rare drug for them to prescribe.  No idea why they thought I should have it. Maybe they are out of ideas lol). 

Really hope you get it sorted soon. 

 

X x 

On 26/05/2018 at 6:25 PM, Ethansmom said:

[email protected] eilatan.

no. I’m currently taking trintellix. Just bumped from 5mg to 10mg and feeling very uneasy today. Today is day 1 of the increased dose. I hope the anxiety calms down this week. How do I cope this weekend when I have lots of parties to go to? Should I Xanax my way through? I have klonopin but that doesn’t always work as well as Xanax. 

I also ran on the treadmill this morning to try to tire myself out. 

I have diazepam for when I need it anyway. I didn't find trinx  (that's what I'm called it now. Much easier to type lol) didn't cause my anxiety to get any worse. Having said that the last few days have been pretty intense paranoia wise. 

 

Hoping you'e feeling better x 

Edited by Eilatan
Edit - I'm bipolar too! !

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Posted (edited)
On 26-5-2018 at 5:28 PM, browri said:

Actually I think @Ethansmom was referring to clomipramine. It's an older tricyclic antidepressant that's considered the gold-standard for obsessive compulsive disorder in the first generation of antidepressants followed by fluvoxamine, which is the SSRI second generation gold standard for OCD. @Catwoman is actually currently in the process of titrating down on fluvoxamine and may be starting clomipramine shortly if she hasn't already. The two medications can also be used very carefully together in low doses for very treatment resistant cases. The two medications together actually come up with a pharmacological profile that would be very difficult to achieve with the two drugs separately combined with other medications.

@Ethansmom, do you currently take clomipramine now? If so, how does it work for you? I do believe @Catwoman would be curious to know before she starts.

Haven't started yet, but I'm almost sure that I will in the second week of June. My pdoc isn't that familiar with the Luvox-Anafranil combo and I think she wants me to stop Luvox entirely once I'm stable.
I've come accross an interesting article which isn't completely positive about the combination. 
It's Dutch but mayble Google Chrome/Translate can help out: https://www.dejongepsychiater.nl/onderzoek/842-fluvoxamine-clomipramine-ocd-depressie

Edited by Catwoman

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My issue with anxiety, panic attacks, fear Off panic attacks, and fear of being home alone (agoraphobia?) I also have obsessive thoughts about the way my heart beating . I also feel some depression. I’m not sure what can help??? I see the psych this afternoon so I’ll report back.

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To update, I've given up on Trintellix. After 4 months and up to 15 mg, I decided it was providing no real noticeable benefit, while constant sexual dysfunction and some weight gain were persistent. Other side effects came and went, but mostly went after a while. 

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11 hours ago, rextasy said:

To update, I've given up on Trintellix. After 4 months and up to 15 mg, I decided it was providing no real noticeable benefit, while constant sexual dysfunction and some weight gain were persistent. Other side effects came and went, but mostly went after a while. 

Sorry to hear that @rextasy. What are you moving on to? I think I'm going to stay at 5mg for a while until I figure out if the new insurance will cover it. Then I might go off for a few months until Fall when I usually have to start an antidepressant again.

@Ethansmom have you ever tried paroxetine (Paxil)?

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Thinking I might go up from 5mg to 10mg of trinx.  I' having awful anxiety and depression is coming back after a few months of respite albeit slightly elevated mood....... 

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1 hour ago, Eilatan said:

Thinking I might go up from 5mg to 10mg of trinx.  I' having awful anxiety and depression is coming back after a few months of respite albeit slightly elevated mood....... 

Give it a try. You'll never know if you don't. 15mg was where I started to really notice a difference but 20mg was a game changer. I just don't have a need for that dose in the Spring or Summer.

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3 hours ago, browri said:

Give it a try. You'll never know if you don't. 15mg was where I started to really notice a difference but 20mg was a game changer. I just don't have a need for that dose in the Spring or Summer.

I'l keep you all updated.  So glad it' helped you! 

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10 hours ago, browri said:

Sorry to hear that @rextasy. What are you moving on to? I think I'm going to stay at 5mg for a while until I figure out if the new insurance will cover it. Then I might go off for a few months until Fall when I usually have to start an antidepressant again.

@Ethansmom have you ever tried paroxetine (Paxil)?

Yes, I've tried them all, which is why I was able to get a PA for trintellix. I do admit the side effects were mild, other than the sexual dysfunction, which is a problem in a relationship, and I had no problem quitting cold turkey, but what is it they say about if it doesn't have much in the way of side effects it probably isn't doing you much good? Just my experience, though. I'm going to live with it for now. I don't feel markedly worse, or really different off of it. Sometimes I think I might like to try ECT again, because I only had one round and have heard so much good about it, but unfortunately I don't have the luxury to get involved with that right now.

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16 hours ago, rextasy said:

what is it they say about if it doesn't have much in the way of side effects it probably isn't doing you much good? Just my experience, though.

Really that "constant" in psychiatric treatment is becoming less and less true because the medications that we're developing these days use the same mechanisms of action that older medications did, they're just more refined. Think about the amount of side effects that tricyclics can cause compared to SSRIs? And think about the difference in tolerability between Abilify and Rexulti. They're incredibly similar medications yet so very different from a tolerability perspective. In the case of Trintellix, its discovery was serendipitous. They were working with a set of a few different candidate compounds with 5HT1A agonism activity. This is because of the positive results that Viibryd had shown in trials and in post-marketing reports. The goal in this discovery was to find an antidepressant that would have fewer side effects like insomnia or nausea. Ultimately, even though they were looking for a combo SSRI/5HT1A agonist, they ended up stumbling upon a SSRI/5HT3 antagonist (vortioxetine), and the only reason they pursued it was because they thought the 5HT3 antagonism would reduce nausea. Little did they know that nausea would be one of vortioxetine's chief side effects but that the 5HT3 antagonism did in other ways dramatically improve antidepressant response combined with its activities at other receptors.

So really, we've settled on this hypothesis of monoamine reuptake inhibition (i.e. SSRIs and SNRIs) but we also know we need to modulate the receptors to both improve tolerability and efficacy (i.e. serotonin modulators and stimulators [SMSs] like Viibryd and Trintellix or noradrenergic and specific serotonergic antidepressants [NaSSAs] like mirtazapine [Remeron]). Viibryd and Trintellix were both a mixed bag. While Viibryd started working much faster than any AD before it, it still did have gastrointestinal side effects that were somewhat unavoidable due to the fact that 80% of the body's serotonin supply is in the gut. And with Trintellix, time to effect was also just as rapid but there was still quite a few reports of nausea and I've heard several people report weight gain. Remeron can help people regain their appetite when their antidepressant reduces their appetite. It can also help people sleep when their AD is causing insomnia.

So really the older mantra of "it's too tolerable to be true" applies less and less these days because we aren't finding any new novel ways to treat things we're just finding ways to do the same thing we've always been doing with fewer side effects (i.e. drugs are getting "cleaner").

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On 5/26/2018 at 11:25 AM, Ethansmom said:

[email protected] eilatan.

no. I’m currently taking trintellix. Just bumped from 5mg to 10mg and feeling very uneasy today. Today is day 1 of the increased dose. I hope the anxiety calms down this week. How do I cope this weekend when I have lots of parties to go to? Should I Xanax my way through? I have klonopin but that doesn’t always work as well as Xanax. 

I also ran on the treadmill this morning to try to tire myself out. 

I think using benzos to help a patient through the rocky first few weeks is exactly what they a ment for, short term use. You an highly highly unlikely to become tolerant or dependent if you take them for a few weeks and especially if you take them as needed. Klonopin is better suited as a med you take all the time and for long periods of time, months to years.  

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4 hours ago, notloki said:

I think using benzos to help a patient through the rocky first few weeks is exactly what they a ment for, short term use. You an highly highly unlikely to become tolerant or dependent if you take them for a few weeks and especially if you take them as needed. Klonopin is better suited as a med you take all the time and for long periods of time, months to years.  

Agreed. Personally I do better with more frequent Xanax than klonipin for short term use. I have used benzos for just that purpose more than once and for me the pros definetly outweighed the cons 

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16 hours ago, Iceberg said:

Agreed. Personally I do better with more frequent Xanax than klonipin for short term use. I have used benzos for just that purpose more than once and for me the pros definetly outweighed the cons 

^^^ this. My pdoc wanted me to just start taking Klonopin every night but we really talked it through and he ended up prescribing me 0.5mg Xanax tablets, and I rarely ever take them. And I usually start with half a tablet first. And he only ever prescribes like 14 at a time so I always sort of "feel" like I'm running out. I keep my benzo use in serious check because I know I would have a propensity to abuse them if I used them more frequently.

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What should i do guys?? The 10MG of trintellix is making me WORSE than the 5MG.  My doctor always tell me to listen to my body and sometimes side effects go away and sometimes they don't. I am so anxious when my klonopin wears off due to the increase in Trintellix. Before the trintellix i could go the whole day without klonopin (until i fall asleep). My next doc appointment is on June 11. I really feeling like cutting my pills in half and seeing if i feel better on the 5MG. maybe i just needed to give the 5MG awhile to work--- i don't seem to respond well to SSRI's, and I am starting to feeling paranoid about everything on the trintellix. help! Thoughts?? suggestions?? It's been over a week on the upped dose. why is it making me feel worse?  I feel like i can't tolerate it.

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Posted (edited)

Honestly Cheese, you may have dodged a bullet with Trintellix.  It worked really well for me, but holy shit I was so nauseated in the mornings.  

My husband takes it and has to keep a trash can next to the bed just in case.  He takes it a few hours before bed, but if he doesn't get enough sleep or eats too late, he'll throw up his toenails.

Edit:  Wooooo necroposting!

Edited by Bad Haiku

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I am loosing my Mind and feel awful on trintellix. I’m going to skip my dose tonight and see how I feel tomorrow. I’m getting the feeling I won’t tolerate any antidepressant. I am already dependent on 2mg of klonopin daily . Time to quit the ssris? 

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17 hours ago, Ethansmom said:

What should i do guys?? The 10MG of trintellix is making me WORSE than the 5MG.  My doctor always tell me to listen to my body and sometimes side effects go away and sometimes they don't. I am so anxious when my klonopin wears off due to the increase in Trintellix. Before the trintellix i could go the whole day without klonopin (until i fall asleep). My next doc appointment is on June 11. I really feeling like cutting my pills in half and seeing if i feel better on the 5MG. maybe i just needed to give the 5MG awhile to work--- i don't seem to respond well to SSRI's, and I am starting to feeling paranoid about everything on the trintellix. help! Thoughts?? suggestions?? It's been over a week on the upped dose. why is it making me feel worse?  I feel like i can't tolerate it.

If you're a week in on the 10mg of Trintellix and you're feeling really anxious, then it might not be for you. For some people, Trintellix feels like placebo. For others, it feels like it makes their anxiety worse. And for others, it's a miracle drug. Makes me think that there are genetic underpinnings that we just don't know about yet that make this work to have such a vastly different effect from person to person.

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On 01/06/2018 at 9:40 PM, Ethansmom said:

What should i do guys?? The 10MG of trintellix is making me WORSE than the 5MG.  My doctor always tell me to listen to my body and sometimes side effects go away and sometimes they don't. I am so anxious when my klonopin wears off due to the increase in Trintellix. Before the trintellix i could go the whole day without klonopin (until i fall asleep). My next doc appointment is on June 11. I really feeling like cutting my pills in half and seeing if i feel better on the 5MG. maybe i just needed to give the 5MG awhile to work--- i don't seem to respond well to SSRI's, and I am starting to feeling paranoid about everything on the trintellix. help! Thoughts?? suggestions?? It's been over a week on the upped dose. why is it making me feel worse?  I feel like i can't tolerate it.

It' making me worse too. Crippling anxiety!!! I' going to try to stick it out for a few weeks.........

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59 minutes ago, Eilatan said:

It' making me worse too. Crippling anxiety!!! I' going to try to stick it out for a few weeks.........

I saw my therapist today and I’m throwing in the towel on antidepressants . They all make me worse off and I can’t tolerate them.  I’m getting fatter and fattter on them and feel so unhealthy mentally and physically. Klonopin helps to a certain point and I wish I never would have started them.  I had to call in to work today since the anxiety was so bad. Seroquel is okay for sleep but does nothing for my anxiety. I need to change my reactions and thoughts to the things I feel inside of my body. The trembling, anxiety, anxious thoughts, heart pounding, churning stomach, etc. has anyone been able to do that by changing their lifestyle?  I have been exercising but not long enough to notice a difference in anxiety. Right now I just scarfed down food and I’m shaking. I’m worried I’m hypoglycemic or something. This is an irrational thought that I don’t know how to change . I’m sure what I’m feeling is the digestion process ! Ugh help! Advice????

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14 hours ago, Ethansmom said:

I saw my therapist today and I’m throwing in the towel on antidepressants . They all make me worse off and I can’t tolerate them.  I’m getting fatter and fattter on them and feel so unhealthy mentally and physically. Klonopin helps to a certain point and I wish I never would have started them.  I had to call in to work today since the anxiety was so bad. Seroquel is okay for sleep but does nothing for my anxiety. I need to change my reactions and thoughts to the things I feel inside of my body. The trembling, anxiety, anxious thoughts, heart pounding, churning stomach, etc. has anyone been able to do that by changing their lifestyle?  I have been exercising but not long enough to notice a difference in anxiety. Right now I just scarfed down food and I’m shaking. I’m worried I’m hypoglycemic or something. This is an irrational thought that I don’t know how to change . I’m sure what I’m feeling is the digestion process ! Ugh help! Advice????

Sorry your 'e feeling this way. And that you've decided to through in the towel.  I know what you mean about the anxiety. I'm not sure if mine will go eventually.  I've been told to give it 3 weeks so that' what I'm going to do. Is there anything else you can try?? Maybe abilify which is the other thing I'm on. I' not sure it does anything for the anxiety but is a pretty decent mood stabiliser. 

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Posted (edited)
16 hours ago, Eilatan said:

It' making me worse too. Crippling anxiety!!! I' going to try to stick it out for a few weeks.........

You're a real champ for coping with it and I applaud your efforts @Eilatan! Try your hardest to stick with it. This may seem counter-intuitive but continuing to increase may actually cause the anxiety to ease up. I found that the higher doses were more calming in some ways, but it was still activating overall.

14 hours ago, Ethansmom said:

I saw my therapist today and I’m throwing in the towel on antidepressants . They all make me worse off and I can’t tolerate them.  I’m getting fatter and fattter on them and feel so unhealthy mentally and physically. Klonopin helps to a certain point and I wish I never would have started them.  I had to call in to work today since the anxiety was so bad. Seroquel is okay for sleep but does nothing for my anxiety. I need to change my reactions and thoughts to the things I feel inside of my body. The trembling, anxiety, anxious thoughts, heart pounding, churning stomach, etc. has anyone been able to do that by changing their lifestyle?  I have been exercising but not long enough to notice a difference in anxiety. Right now I just scarfed down food and I’m shaking. I’m worried I’m hypoglycemic or something. This is an irrational thought that I don’t know how to change . I’m sure what I’m feeling is the digestion process ! Ugh help! Advice????

Because of how Trintellix acts on the 5HT3 receptor, GABA firing is reduced. GABA is the neurotransmitter responsible for inhibiting the brain. Drugs like Xanax and Klonopin enhance the brain's response to the naturally occurring GABA in the brain.

This anxiety you're describing has never been a problem for me because I've always been taking Trintellix with Depakote, and Depakote increases the brain's GABA supply. Depakote is valproic acid which was synthesized from valeric acid, a compound found naturally in Valerian root, which is found in most Sleepy Time teas. I would honestly recommend that when you're feeling anxious to drink some sleepy time tea with chamomile, valerian, lemongrass/balm, etc. It may very well help to calm you down when you're feeling anxious. All of those herbs enhance GABA signaling in the brain similar to benzos. It would be a more natural way of coping with your anxiety.

I would also HIGHLY recommend 4-7-8 breathing. It's the one tool that my tdoc has taught me that has been a gamechanger for my anxiety. Inhale across 4 seconds. Hold your breath for 7 seconds. Then exhale across 8 seconds. Do this 2 or 3 times and then see how you feel. While you're doing this, focus really hard on your counting and your breathing, and shut everything else out. This causes a release of endorphins in the body. It's effectively controlled hyperventilation. It really helps me.

Edited by browri
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