Aripriprazole: Intrinsic activity = 60% on post-synaptic D2 ; up to 75% on pre- synaptic D2 receptors.
Brexiprazole: Intrinsic activity = Up to 46% 
Cariprazine: Intrinsic activity = Up to 71% 
Aripriprazole is a partial agonist with functionally antagonist activity on receiving neurons and functionally agonist activity on firing neurons; both of which dampen down dopaminergic neurotransmission. Aripriprazole can increase dopaminergic activity in the mesocortical pathway, unlike dopamine blockers, Aripriprazole partially agonizes D2, D3, 5HT1A and to a lesser extent D4 receptors; antagonist at 5HT2A, as other atytpical antipsychotics.
Brexpiprazole has more blocking and less stimulating activity at the dopamine receptors than its predecessor, aripiprazole, which may decrease its risk for agitation and restlessness. Specifically, where Aripiprazole has an intrinsic activity or agonist effect at the D 2 receptor of 60%+, Brexpiprazole has an intrinsic activity at the same receptor of about 45%. 
Cariprazine is a dopamine D2- and D3-receptor partial agonist, with higher affinity for D3 receptors, as opposed to the D2antagonism of most older antipsychotic agents.Cariprazine has lower intrinsic activity at D 2 receptors than aripiprazole. Its intrinsic activity is up to 71% [3 ]
Hi everyone, it's been a while.
So, I took the full 6 months of my short term disability, and I just started a new job. It's a little stressful, but it pays well. It is a contract job, and it required me to move to the location of the contract. I'm salaried though, and my company is putting me up in an extended stay hotel, and they are flying my home once a month and getting me a rental car when I am home...so I can come home and see my sisters and parents. That is a blessing. I can see my best friend too.
I am struggling with the never ending anxiety that I can never beat. I take a lot of meds for my bipolar. I think mine is really non specified because I'm so hard to treat. I take geodon, gabapentin, topamax, klonopin and lunesta plus vitamins. If I could wean off klonopin I could probably wean off everything but geodon. I'm just not ready to wean off klonopin, and I take .5 mg even though I'm prescribed 1 mg.
I am doing therapy online with betterhelp since I am on the road, and it is going pretty good. I just selected and therapist, and am sticking with her. I don't like her as much as my IOP therapist, but it is online, so I acknowledge the quality of therapy won't be as good but it is consistent.
I did go no contact with my ex boyfriend because that relationship was slowly killing me. He'd been abusive in the past, and was a narcissist. I loved him so much that it contributed to my breakdown in a serious way, and taking this job moved me out of state and away from him and helped me go no contact, so I am working through that with my therapist. It's hard. I've had ptsd over the past couple months since my short term disability was about to run out and I wasn't sure what I was going to do about money, and I knew I had to do something about him. I was waking up with nightmares and night terrors thinking someone was trying to kill me or I was going to die or the world was going to end. I don't know how to describe it. It was terrifying. I felt completely untethered from this world and it felt like I was threatened and like I was going to not live or survive or maybe subconsciously didn't want to. That was the scariest thing. I slowly started to feel disconnected from everything. Like I am just meaningless and one of billions of people and what does it matter? Those weren't my thoughts but my feelings. I was fighting that daily. I have been fighting that.
ive also been fighting some mortality issues with my age. Since I just broke up, I just turned 39, and I am traveling and single again. I am scared I won't meet anyone again or fall in love again. I worry about my parents aging. All of a sudden this stuff is in my head. I think because I have leaned on them so much this year since it has been so hard.
'I guess the good news is, I stopped having nightmares a few nights ago. No more night terrors and waking up thinking I'm going to die. I enjoyed music at work today. I went to a recovery group at church last night and that was helpful to talk and heal about what I went through with my ex. I'm trying to do the best I can at work. If it works out, great. If it doesn't, life will go on, and hopefully, so will I. I am trying to live more in the moment and practice mindfulness to help with my anxiety. Trying to take things one day at a time and if I can't do that, take things one moment at a time.
I know bipolar is for life, but I think recovery is possible, and it is possible to function with this illness, but maybe we just have to modify our lifestyles. Right now I just come to the hotel, take it very easy and am very gentle with myself and rest at night. I try to exercise when I feel like it. I need to be a little better with my diet. But it's not that bad. I'm not pushing myself working late or volunteering to work longer hours even though I know I can. I know what that leads to...cycling. My goal is boring stability. I take turmeric and magnesium to keep brain fog at bay but I wish I knew what I could do about these feelings of despair and loneliness. Maybe that's not mental illness. Maybe that's just heartbreak, and will take time to heal on its own.
Love to you guys and to everyone living with mental illness.
Just an update based on my posts earlier during this year. I ultimately wound up remaining on the oral antipsychotic (Latuda 20mg) which I started taking after completing my 2nd probation term in this decade in January 2018 stemming from a January 2015 motor vehicle offense which ultimately slammed me with a 3rd degree felony (after already acquiring a misdemeanor for resisting arrest on foot in June 2012) related to having schizoaffective disorder and experiencing manic episodes and hallucinations. I was previously diagnosed with Bipolar 1 With Psychotic Features after the 1st incident I was involved in back in June 2012.
My main issue the entire time I was serving both probation terms was that I was always court ordered by a judge to continue taking the antipsychotics by injection and to continue my psychological treatment. My primary concerns with the antipsychotic medication was always having intolerable akathisia (inability to sit still), tremendous amounts of weight gain (My height is 5'8 with a small to medium frame and my weight maxed out in January 2018 at almost 310lb after being around 155lb until after June 2012, severe gynecomastia (recently won Risperdal / Invega class-action lawsuit), anxiety, depression, and disorganized speech (currently seeing a speech pathologist to suppress language disorder).
Following the completion of my 2nd probation term, I was initially placed on Latuda 40mg taken with food at night and then tested out Fanapt 6mg. I was still experiencing most of the side-effects and was still outright desperate to eliminate all of the symptoms I just mentioned. By the beginning of March 2018, I did ultimately try consulting with my psychiatrist about switching to a mood-stabilizer as monotherapy acting in place of an antipsychotic and accepted the risk that if I actually suffer from schizoaffective disorder and it wasn't Bipolar 1 With Psychotic Features that I would probably relapse and hallucinate again and I was even in agreement to keep a bottle of antipsychotics as a PRN and to just eat them like crazy if anything happened.
I discussed everything with him (I never considered him to be a control freak) and he said that he would eventually be willing to try my suggestion but asked me if I had any other idea in mind that involved remaining on an antipsychotic for slightly longer. I suggested to him that I'd be willing to try taking the Latuda at 20mg instead of 40mg before switching to a completely different class of drugs.
In retrospect, I'm not even completely certain if any of the oral antipsychotics including the higher dosage of Latuda or Fanapt were even that badly tolerated.. Now, I'm not condemning an entire class of drugs because I now support some of the low-dose oral antipsychotics for myself but I ultimately think that my former overall disgust and intolerance for the antipsychotics was because I was only ever taking them when I was either locked up in county jail and the overall quality of the drugs was really bad and primarily because the only time I was ever actually taking them was when I was taking court-ordered injections. That basically explains why my experience with the mental health system always sucked up to that point.
I'm not trying to speak to highly of myself here but my psychiatrist has always said that he considers me to be one of his higher functioning patients, therefore the reason why he thinks I was always so vocal about all the underlying side effects from the injections and was more sensitive to them than the majority of his patients, even at 260, 280 or 310 pounds, my weight was never really a factor for me in terms of reacting to the meds with less sensitivity.
It simply didn't matter what injection he would put me on. I was on so many of them including Invega, Aristada, and Invega and they always caused more damage than they did anything positive for me. I always felt like the compromises I had to make to not hallucinate and remain out of legal trouble were simply too much to take. The slow-release form of the injections was always too intense for me but I was honestly being completely forthright when I admitted that I didn't want another episode involving the boys in blue to occur ever again.
At the time of my last post, my dosage was already reduced to 20mg and I was still complaining on a regular basis about everything I was still feeling but it wasn't until the end of March when the restless / walking on hot sand feeling finally began to subside. My overall appetite decreased enough to where I lost over 50 pounds by the beginning of the summer (since then the weight loss has stopped at around 260lb unfortunately but I have remained generally stable in terms of my weight). I won a class-action lawsuit against Risperdal / Invega in February and my weight became low enough where my plastic surgeon agreed to perform male-breast reduction surgery on me after denying me previously because I became so overweight / obese after I was released from county jail and the results were very successful without needing revision surgery thus far.
My speech disorder did improve a little but unfortunately wasn't completely going away by the end of the summer. I still felt like I had something like aphasia where I couldn't think of common words or name common objects and the words wouldn't return to my mind until 10 or 20 minutes after the conversation took place. The speech pathologist I eventually saw for this referred me to the audiology department at my local hospital for Central Auditory Processing Testing and it was revealed that I do in fact have a language decoding disorder (my intuition was right all along) which is certainly aggravated by having schizoaffective disorder and maybe even still by the medication.
I only become somewhat anxiety-ridden and become depressed right after I take the medication with some food, therefore I normally take it right before I go to sleep. By the time I wake up, I am no longer experiencing the anxiety and paranoia but I never become psychotic.
Still, the most important thing is that I'm no longer experiencing any of that indescribable akathisia and thank god the weight gain reversed before I hit 350 and I no longer have to walk around with female-like breasts anymore.
This is easily the most balanced I've felt since I developed the mental illness in the beginning of this decade. I'm not a morbidly obese zombie with female-like breasts pacing all day and night with akathisia but I'm also not hallucinating and running away from the local police department during a welfare check or speeding from the state troopers on major highways either. The delusions are still there at certain times except mild enough where I just laugh them off most of the time and don't believe the majority my own deception.
Maybe a random place to post, but I'm wondering if anyone here has had kidney disease/failure or other kidney problems suddenly arise, due to taking a lot of psych meds? I hear of ppl having liver problems, but not often kidney...
My GP is concerned about my elevated creatine levels (and other related symptoms) and says she sees this frequently when people take psych meds for many years... She is ruling out other causes, as this doesn't run in my family at all.
I started seeing a new pdoc last year as I was unhappy with my previous one. Okay, 2 pdocs ago I had a tentative diagnosis of Cyclothymia. I started having issues and needed help but I wasn't going to be able to get in to see my pdoc at the time again until 6 months later so I switched. The next one had me take an evaluation? The one that is on paper and takes 3 hours or so to complete. She diagnosed me with Bipolar 1. I was really not happy with how she talked to me and was viewing my reactions to different medications so after a year or so, I switched to the doctor I have now. I love him! He's great.
What I am confused about, they just started a patient portal and I was just skimming through until I got to the diagnosis section. So am I now diagnosed as bipolar 2 instead of 1? Can you have cyclothymia as well bipolar? Sorry I'm just confused.
Bipolar Ii Disorder Active 01/19/2017 Major Depression, Recurrent Active 01/19/2017 Cyclothymic Disorder Active 07/03/2018