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mikl_pls

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  1. Absolutely! I've been having to do that since September. She's been giving me Zyprexa, but this past appointment this month I asked her to switch it to Geodon. Even though it's a prn, I've been taking it as a daily med, and it has been helping with my washout period from the MAOI to the Effexor XR I'm about to start in addition to the Abilify.
  2. Maybe you could ask your pdoc for a prn antipsychotic for when you feel extra "crazy?" She may say Zyprexa would be perfect for that, but may say something like low-dose Haldol would be better. I don't know.
  3. My pdoc said something that made me suspect that she can tell when I fill scripts, but I think it might be controlled substances only. Whether she knows or not, you are filling it only on a "just in case" basis, and if your pdoc blasts you with questions, just tell her that you were filling it just in case. That's all you can tell her. You're being honest.
  4. mikl_pls

    Sleep Medication Overhaul?

    You sound a lot like me sleep-wise... There's nothing wrong with having to take a "sleep cocktail..." Well, with PTSD patients, it's actually commonly recommended to not prescribe benzodiazepines because it can disinhibit memories, but I do fine with them, so go figure... It does sound like you do need a benzo that actually calms you down, something with good affinity for the α2 and α3 GABAA subunits (responsible for anxiety) instead of just the GABAAα1 subunit (responsible for sleep). Klonopin does have α2 and α3 affinity, but it's long-acting, and you said you were developing a tolerance to it. Unfortunately, it's one of the most potent benzos out there... Temazepam (Restoril) has mostly affinity for the α1 subunit but happens to have high affinity for the α3 subunit too; it's a great sleep medicine, but IME it's not great for when your mind is running a million miles per second. It's definitely worth a try though! You may need a really high dose though, like 30 mg or even higher, as Klonopin 1 mg = Restoril 60 mg... Some alternatives might be diazepam (Valium) 10-20 mg, which is long-acting and might not really be suited for use for sleep, but I figured I'd list it anyway; lorazepam (Ativan) 2-4 mg, which has the least drug-drug interactions of all benzos; and alprazolam (Xanax) 1-2 mg, which works extremely well IME... (I use 1 mg for anxiety and 2 mg for sedation...) One of those ought to help you out. Trazodone (Desyrel) is good for some people for a long time, and for others it kinda fizzles out. For me, it quickly fizzled out. If you wanted to try an alternative, I would recommend something like low-dose doxepin (Sinequan) (10-50 mg) or low-dose trimipramine (Surmontil) (25-100 mg). Both of these are very potent antihistamines. Surmontil has potent 5-HT2A antagonism, which causes dopamine release and improves sleep quality (increases slow wave sleep I think?), and has presynaptic D2 autoreceptor antagonism, which causes dopamine release. I second Belsomra, which is an orexin receptor antagonist. Orexin is a neuropeptide that regulates arousal, wakefulness, and appetite. The most common forms of narcolepsy is caused by a lack of orexin in the brain due to destruction of the cells that produce it. Belsomra blocks the receptors to which orexin binds, allowing you to fall asleep. One caveat, it can cause sleep paralysis and nightmares. I like this medicine though. You may need to taper up on it with samples. It comes in four doses: 5 mg, 10 mg, 15 mg, and 20 mg. There's another new medicine called Rozerem, which is a melatonin receptor agonist. It just stimulates melatonin receptors in the absence of melatonin. It's basically like taking melatonin really... Personally I never found it that effective. As for melatonin, you actually don't want to take high doses of melatonin. Your brain doesn't know what to do with high doses of exogenous melatonin because your body doesn't produce that amount of melatonin at once endogenously, so it's like, "what's this? What do I do with this? Whatever..." and doesn't really use it. The lower the dose of melatonin you can get, the better. 300 mcg (0.3 mg) is probably the best dose to get for sleep supplementation. It most closely mimics that of endogenous melatonin release. You can also get some sustained release (SR) tablets/capsules to take with the IR tablets/capsules, like 1 mg SR + 300 mcg IR would be good. I like this website to get supplements from if I can: http://nootropicsdepot.com/melatonin-capsules/ Lemon balm is also great for sedation: http://nootropicsdepot.com/cyracos-lemon-balm-extract-capsules/ (this is just the lemon balm supplement) Ashwagandha: http://nootropicsdepot.com/ashwagandha-capsules/ http://nootropicsdepot.com/sensoril-optimized-ashwagandha-extract-125mg-capsules-withania-somnifera-root-and-leaf-extract-10-withanolides/ http://nootropicsdepot.com/ksm-66-ashwagandha-extract-300mg-capsules/ L-Theanine: http://nootropicsdepot.com/l-theanine-capsules/ Valerian, especially with lemon balm... (they don't sell it on nootropicsdepot, but any brand will, just pay attention to the valerenic acid content).
  5. Here's a post I made about a study linking low levels of acetyl-L-carnitine to treatment-resistant depression. http://www.crazyboards.org/forums/index.php?/topic/95817-new-study-says-acetyl-l-carnitine-related-to-trd/ ALCAR is a great supplement, I love it!
  6. Just wanted to add that buspirone, in low doses, antagonizes preferentially the presynaptic dopamine D2 autoreceptor, which would cause dopamine release, but in high doses, it, as browri says, antagonizes the postsynaptic dopamine D2 receptors as well, just as an antipsychotic does. It actually has higher affinity for the D3 and D4 receptors though. Its active metabolite, 1-(2-Pyrimidinyl)piperazine (AKA 1-PP) is also a potent α2A antagonist, so you get some serotonin and norepinephrine release there. (This is an active metabolite of gepirone too.) Also, whether it's sedating or stimulating depends on the dosing and the individual. It's kind of a mixed bowl... Anyway, as you guys were saying...
  7. My regimen changes all the time because, as I'm bipolar, meds are constantly stopping working... especially antidepressants. Plus, to make things more complicated, I'm very treatment resistant.
  8. Maybe they'll both disappear with Vyvanse. See what happens with switching back to Vyvanse and then if tics still happen let's cross that bridge if we need to. Make sense? Just keep in mind the clonidine and guanfacine. Antipsychotics work well too.
  9. You're probably more likely to get the tics from Vyvanse/Dexedrine because they're more dopaminergic and more active on the CNS. But meds like clonidine (Catapres) or guanfacine (Tenex) can not only help the tics but also help ADHD.
  10. Yes, well... Adderall is a bit more noradrenergic than Vyvanse, so you're likely to get that more likely than from Vyvanse or Dexedrine. It can go away, and it will likely last probably about a week or so I'd guess, if it's going to go away. But the tics and whatnot may or may not go away.
  11. If I were you and I were as desperate as you are, I would go ahead and start the washout process, and start the Rexulti as a bridging agent, bad past experiences aside. What have you got to lose? Well it could help you or it could be a very bad thing for you... I mean, you don't know unless you try, but you're at the point where you have exhausted most 1st and 2nd line options, so again, what have you got to lose? I have very treatment-resistant bipolar depression, and I've done several washouts for MAOIs numerous times and washouts after the MAOI to get back on regular antidepressants. If I can do that, YOU can do it too! You got this! Go for it!
  12. Yes urinary retention is a noradrenergic side effect... I have it too. 😕 I've found that beta-blockers kinda help it a little but not much.
  13. Not likely at that low a dose for that short a duration.
  14. OH I see... Yeah that makes more sense. Definitely works for that.
  15. Interesting, never heard of propranolol for that indication. Propranolol is a β-blocker, while guanfacine is an α2-agonist.
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