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dtac

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About dtac

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  1. Been a while, some minor adjustments made: Nuvigil 250mg qAM - Helps with daytime sleepiness from sleep apnea. It also serves to regulate my sleep-wake cycle, so when I'm not stressed, I can fall asleep without any meds. Trintellix 20mg qHS - Depression. Works great, only some nausea from time to time. Rexulti 0.5mg qHS - Depression/mood swings. Works great in conjunction with the Trintellix. Trokendi XR 100mg qHS - Migraine prevention. Tried 200mg for a month, got 4 kidney stones the next month. The prior 6 months on 100mg, zero kidney stones, so back to 100mg. Zanaflex 4mg PRN - Muscle tension relating to headaches. Evidently I tense up my shoulders and neck real bad and exacerbate my headaches. Tried cyclobenzaprine and methocarbamol, neither did anything to help, but Zanaflex works. Esgic PRN - Tension headaches. Don't use it very often, as it can cause rebound headaches. Tramadol 50-100mg PRN - Tension headaches. Minimal usage, to avoid rebound headache problems (even though it's typically related to NSAID usage.) Zofran 8mg PRN - Nausea from migraines and Trintellix. 4mg doesn't cut it. Relpax 40mg PRN - Migraines. This is the fourth triptan I've been on; the prior ones either caused harsh side effects or stopped working. Xanax 1-3mg PRN - Anxiety. Since it's short-acting, I only take it when I need it, sometimes twice a day (usually 2mg, then 1mg later.) Some days I don't need it at all. Amitriptyline 25-50mg - Insomnia. I just added this one 3 days ago, and it looks promising for lots off-label reasons (insomnia, migraine prophy, tension headache prophy.) 25mg is enough to kick my ass right now, and I'm usually pretty resistant to sleep-inducing meds. Not a fan of TCAs, but so far this one is working well. Been battling tension headaches for months now, finally determined stress is my trigger. When it gets really bad, it sets off migraines, and my insomnia gets out of control, so I'm seeing my tdoc weekly right now and working on stress management to keep things from spiraling out of control. I've lost 35lbs over the past 18 months, since I started CPAP therapy, but I have such a narrow airway I'll probably always need it if I want quality sleep. I've only slept without it twice in the past 18 months, and once was this week. Felt like crap, and was tired all day, so it definitely helps, despite not being overweight anymore. Oh well, add it to the list of shit I'll be on for the rest of my life.
  2. Rexulti. It single-handedly stopped my suicidal depression and has kept me from getting that far gone since. For people like me who are hyper-sensitive to APs, it's the equivalent of a miracle. I tried Abilify multiple times, and can't tolerate more than 2mg without intractable insomnia and panic attacks. There's enough of a difference between the two drugs that I metabolize them completely differently, and I don't give a shit about the "Rexulti is just an Abilify copy-cat because it went off-patent" argument. The difference is real. Right behind Rexulti is Xanax. For me, it works exactly as it is designed to, and I have zero problems with tolerance or addiction. It's a shame it has such a bad stigma with it and a lot of pdocs won't write for it, because used correctly, it can be a very effective tool against anxiety.
  3. I love me some Trintellix. I started taking it in April, titrated from 5mg, to 10mg, then 20mg, and that's where I've been since June. Only side effect is some occasional nausea. It's allowed me to decrease my Rexulti from 2mg to 0.5mg and remain stable, although I did experience a mood shift with each step-down of the Rexulti dosage. I still think there is some sort of synergistic effect between the two drugs, because I went from 5mg Trintellix/2mg Rexulti to 20mg Trintellix/0.5mg Rexulti and have remained equally balanced, with fewer side effects, thanks to the decrease in Rexulti. I may try to step down to 0.25mg of Rexulti, but right now my life is too unstable to risk it. Trintellix seems to be one of those drugs that you don't really notice is working until you've gone a few months and realize that your feelings are no longer irrational.
  4. dtac

    Provigil questions

    Provigil is more effective at 200mg, although studies have shown that there isn't much benefit beyond 200mg/day. Nuvigil is a bit more potent, and I much prefer it, although I did have to bump from 150mg to 250mg a bit after switching. If you have sleep apnea, I would suspect your insurance would cover it as well, as it's one of the only "approved" uses for Nuvigil. CPAP + Nuvigil can be a great combo for treating that daytime fatigue from sleep apnea, but it takes time for your body to adjust, especially depending on your AHI. If you're looking for an amphetamine-type effect, this is not the drug for you.
  5. So it's been a fun 2 months of chronic headaches and kidney stones (probably brought on by med changes) along with psych med changes. Feeling pretty good at the moment, adjusted my cocktail a bit: Rexulti (2mg->1mg->0.5mg) qHS - Still the backbone of my cocktail, stops my depression, but if I can get by with less of an AAP, I'm all for it. Trintillix (5mg->10mg) qHS - Added this to keep my mood stable as I've reduced the Rexulti, and even at a low dose, it's been quite effective. Nuvigil 250mg qAM - Excessive sleepiness due to sleep apnea. Works as expected, and when it wears off, I generally feel naturally tired. Xanax 0.5mg - Trying Klonopin again for anxiety maintenance. Klonopin 1mg qHS + 2mg qAM - Was on 1mg for sleep maintenance, and it was working just fine, so after some discussion with my pdoc, we agreed to try 2mg as a daytime dose for anxiety management, since Xanax was causing sedation and Klonopin does not (for me.) Non-Psych Trokendi XR (100mg->200mg->100mg) qHS - I was on 100mg for 7 months with no problems, developed a nasty chronic headache that wouldn't go away, so my neuro upped the Trokendi to see if it would help. After a month, I ended up with 4 kidney stones, so I'm back down to the 100mg dose. Zomig 5mg PRN - migraine triptan Zofran 4mg PRN - nausea from migraine and from Zomig. I hate triptans, but I tolerate Zomig the best. Tramadol 50mg PRN - headache Esgic Tab PRN - headache I've spent weeks trying to chase down this nasty chronic headache, and between my neuro, pdoc, and tdoc, we think it's a combo of drug and stress related. Some days I do fine, other days I need 100mg of Tramadol + 2 Esgic + 2 Zomig to break it. MRI was normal, have no other risk factors (even got my eyes checked -- rx is perfect/unchanged, no damage or issues with my vision.) Strangely the only non analgesic that helps is tizanidine, which has a very specific mechanism of action -- other muscle relaxers don't help. Unfortunately it's also quite zombifying and renders me non-functional for a good 90min after taking it. Headaches are a common side effect of Rexulti, and although it's odd that I would begin experiencing them 2 years after starting it, the headaches have decreased as we've lowered the dose, so it may be the culprit. However, there is still some unknown trigger that will cause them to flare up uncontrollably -- probably stress. Rather than acutely treating it with Xanax, we're trying Klonopin as a maintenance therapy. Had one mood shift during the Rexulti titration, and I countered it with the bump in Trintillix. Saw results in 4 days. Everybody wants instant fixes, myself included, but I've remained stable since then, so it's a win.
  6. I get some relief from 0.5mg but only because I'm on Klonopin 1-2mg QHS. The long half-life carries over and gives me some relief into the daytime for anxiety. Although on a day like today when things are bad, 0.5mg is a joke.. now 0.25mg I don't understand. I get nada from that.
  7. dtac

    Changing benzos

    Depending on your cocktail and what's going on in your life, I've found changing up benzos can make a difference. I take 1-2mg Klonopin QHS insomnia, and it's doing wonders for my sleep and anxiety too, yet a couple of years ago I was on 1mg BID and it did absolutely nothing for my anxiety. But I had different APs, mood stabilizers, life situation, etc. But if you're facing tolerance, that's a whole different issue... changing around benzos isn't going to do much more than make you miserable, especially since you're on Klonopin.
  8. I'll throw in a vote for Rexulti, based on my success with it, but for mania you will probably need a higher dose (2-4mg) and it does take a long time to hit steady-state due to the long half-life (91h primary, 88h metabolite.) While the mfg doesn't outline specific dosing for mania, only schizophrenia, it's a titration up to 4mg, so I'm guessing treatment for mania would fall into that range as well. I've never had problems with mania, only hypomania, and I don't know that I've even been hypomanic since I started Rexulti. I can speak directly to it's efficacy in treating depression, though. It's been weight-neutral for me at 2mg. It has a copay coupon on the manufacturer's website too that makes it extremely affordable if you have private insurance.
  9. If you tolerate Abilify well, and depression is your main issue, perhaps switching to Rexulti instead of Abilify would help? It has worked absolute wonders for my depression, with fewer side effects than Abilify had. At various times I've been on most of the meds you're on (Abilify, Seroquel, Lamictal, and Wellbutrin) and none of them did much for my depression (nor did Depakote.) I've been on Rexulti for 2 years now and had very few depressive episodes. Nothing is perfect, but it has been by far the most effective med I've been on.
  10. I just added Trintellix three weeks ago, and I'm noticing the same combo effect. I'm taking waaaay less Xanax too, although some of mine could be related to Klonopin QHS (but not BID, only QHS). I'm on the flip dosing of the drugs as you (heavy on the Rexulti/light on the Trintellix) but there is definitely something to the combo. I was taking 1mg of Xanax probably 4-5 times a week, and if I stay at 0.5-1mg of Klonopin, I generally don't need any Xanax. If I cut back to 0.25mg Klonopin, I may need 0.5mg Xanax 1-2 days a week. Comparatively, my last trial of Klonopin was 1mg BID, and it didn't do anything for my anxiety, so the Rexulti/Trintellix combo is definitely doing something to lower my anxiety and curb my depression. Rexulti has been 90% effective alone at stopping it, and I'm hoping Trintellix can knock out that last 10%. I'm seeing very positive benefits from the combo, with negligible side effects -- highly recommended for depression and anxiety as a primary mix! Add a PRN benzo for breakthrough anxiety (or Klonopin for maintenance) and it's a winner. Sorry for the derailment, but I think Rexulti + Trintellix is a combo worth further investigating.
  11. Seroquel at 50mg is good for sleep, and not much else. It really doesn't affect much other than H1 until you get into the 150-200mg range. I would either titrate it up to 200mg or ditch it entirely, since you're not having problems sleeping. I took Remeron for about 2 years, started at 15mg and titrated up to 45mg over the time period. It was sedating and caused me to gain weight as well due to its' nature of blockading H1 as well. It did help my depression in bursts, but ultimately was a failure. Your body builds some tolerance to histamine sedation over time, but I found it sedating at all doses. Perhaps Klonopin would be more useful for managing the anxiety? Starting once a day at a low dose may provide some more constant relief than Xanax, and if you stay low enough it's usually not sedating either. Since you're on an SNRI, your choices are adding a mood stabilizer like Lamictal or an antipsychotic, like perhaps Abilify or Rexulti. Both of the latter drugs are approved as adjuncts for MDD (not saying it's your diagnosis) and can be stimulating. I think if you're already depressed and sleeping a ton and having problems getting out of bed, adding an AD that is sedating is just going to compound the problem (speaking from experience.) You could go the TCA or MAOI route, but I would put those as secondary choices due to the prevalence of side effects (not that APs are great drugs, but the newest ones are much better.) I found Abilify extremely activating -- to the point that I couldn't sleep at doses above 2mg, but I'm an extreme case. I've been on Rexulti for almost 2 years now, and it has killed 90% of my depression --- better than any other single med -- and has practically zero side effects for me.
  12. To clarify, I wasn't on all of those APs at once, those were just the most sedating. Now I'm on 2mg Rexulti, 5mg Trintellix, 250mg Nuvigil, 100mg Trokendi XR, with up to 2mg of Klonopin for sleep (and Xanax PRN.) Rexulti was sedating at 1mg, but not really at 2mg. I take the Nuvigil + Trintellix in the AM, and Trokendi + Rexulti in the PM.
  13. I used to sleep 8-12h a day, depending on what I had to do, including naps. After almost a year of being on CPAP and Provigil/Nuvigil, I'm at the point I can get 6-7h, be awake all day, and function adequately. It took several months of getting up within the same 1-2h time window every day to start getting accustomed to not sleeping until 10-11am when I don't work. I have chronic insomnia, so sometimes despite being tired, I can't fall asleep, but that has been improving as of late. Unless I'm depressed, in which case I can take Nuvigil, drink an energy drink, a cup of coffee, and go take a 4h nap, because none of that overrides depression. If I'm depressed, I'll sleep 9-12h a day through the worst of it, no matter what. The right meds have made a huge difference. Heavily sedating meds make functioning 10x harder. I used to nap every day on Geodon, Lithium, Seroquel, and Latuda, and taking any of them at bedtime just made me hungover the next morning (sleeping through alarms too.)
  14. Halcion worked for my insomnia, but man did it cause some rebound insomnia when I stopped it. I found 40mg of Valium to be sedating, but anything less didn't feel like much of anything.
  15. Seroquel's primary affinity at doses under 200mg is for H1, so until you've cleared it all out, transient insomnia remains probable. I know it took 4 days after I stopped it before I could sleep normally again. Seroquel had the heavy sedating effect on me too, and caused a flat affect that I was unaware of, but other people noticed. I brightened up considerably once I stopped it. But not all APs are so sedating; Seroquel just happens to be one of the most sedating ones.
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