Hi everyone. I’ve been dealing with unbearable symptoms for over 4 years. Insomnia, racing thoughts (OCD), derealization, irritability, brain fog and depression.
I have tried so many medications, but none help. My insomnia and anxiety are through the roof and I have 24/7 derealization. Years ago, 2007, when I was struggling with depression, my psych talked about starting an MAOI, but we instead we added geodon to Zoloft and it worked (for awhile)
Long story short, I developed sudden onset ruminating thoughts (in form of OCD), insomnia and Anxiety in 2009. After many trials of meds (I’m adverse and paradoxical to most) I finally was put on remeron which got me sleeping again and in turn helped my other symptoms.
From 2010-October 2014 I did relatively well, that is until remeron stopped working and all my symptoms came back.
Since I have been inpatient several times trying every sleeping med , bipolar med, SSRI etc with no relief.
Mom wondering if an MAOI could help me? Can MAOI’s treat anxiety? Racy brain? I’ve read they can make insomnia worse, which I don’t need.
Symptoms: severe insomnia, lucid dreams/nightmares, 24/7 derealization, severe anxiety and panic, major depression, brain fog, dizziness, migraines.
I believe, like in 2009-2010, many of my symptoms are from sleep deprivation. I am very desperate to get control over my anxiety and sleep. I’m at the end of my rope.
Could an MAOI help me as a last ditch effort to get some kind of quality of life back?
Current meds: weaning off Zoloft, weaning off remeron, geodon 20 mg X2, Ativan 5 mg per day (please don’t jump down my throat about this, it will give me a panic attack. I know it’s a high dose and I need to taper this too), prazosin 2 mg.
Welbutrin (Bupropion) is a dopamine-norepinephrine reuptake inhibitor; its occupancy at dopamine transporter (DAT) is 23%; whereas over 75% causes euphoria (ex. cocaine). A dopamine reuptake inhibitor (DRI) is a class of drug which acts as a reuptake inhibitor of the monoamine neurotransmitter dopamine by blocking the action of the dopamine transporter (DAT). Reuptake inhibition is achieved when extracellular dopamine not absorbed by the postsynaptic neuron is blocked from re-entering the presynaptic neuron. This results in increased extracellular concentrations of dopamine and increase in dopaminergic neurotransmission.
I am currently taking Abilify 400 mg every 3 weeks (~ 20 mg / day) and 300 mg of Welbutrin.
I was complaining to my psychiatrist about the side effects of Abilify I was suffering from; depression (low mood), sexual dysfunction, anhedonia, from a condition called "Neuroleptic Induced Deficit Syndrome" . I complained that I had totally lost my motivation, drive, and initiative and was experiencing anhedonia (lack of pleasure), emotional suppression, etc. It is like living in a mental restraint "straigthjacket". So my psychiatrist added Welbutrin. Abilify dampens down dopaminergic activity in three of the four dopaminergic pathways; It is the only Antipsychotic that I know of that can increase mesocortical dopaminergic activity. Other partial agonists like Brexiprazole and Cariprazine might do this also, whereas a silent antagonist cannot. Welbutrin has treated my low mood; I am euthymic now, but I am still anhedonic from Abilify being so frequent for such a dose; I am taking the daily equivalent of 20 mg: 400 mg per 3 weeks. At lower doses Abilify has a more stimulating effect. The Welbutrin he added certainly helps; but is unfortunately not enough.
I am considering adding a dopamine full agonist such as Ropinirole, Rotigotine, Cabergoline and Pramipexole to my prescription meds. Some dopamine agonists are useful at treating depression resistant to SSRI-treatment. Dopamine agonists can be given to counteract the side effects of antipsychotics and serotonergic antidepressants. No doubt that dopamine antagonism has a negative effect on mood. In the mesolimbic pathway *(reward pathway)* Aripriprazole reduces dopaminergic activity; which reduces motivation - salience (liking, rewarding), which can be identified as a major source of anhedonia. Aripriprazole does not reduce dopamine transmission in the mesocortical pathway in people whose mesocortical pathway has .less than normal activity. The dopamine boost that Welbutrin provides keeps me stable; counterbalances some of the negative effects of Abilify. I just need more help in alleviating this zombified state of existence in which I am alienated from my own real self. and cannot enjoy the things I used to enjoy; food, drugs, sex. I live in anhedonia, a state of a loss of pleasure; due to the neurological inhibition caused by Abilify. Welbutrin works as a wakefullness promoting agent, a mild stimulant.
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.
I worked my way up to 5mg of Zyprexa last 10 days, but still very irritable. I snap at everyone, so everyone is naturally leaving me alone. I don't like living this way. Left a message with my prescribing doctor about this irritability issue. Update, prescribing doc called and suggested I go up 1/4 of a tablet and get the irritability and mood swings under control before I start the Lamictal. So, took another 1/4 tablet which makes 1/2 of a 5 mg tablet I have taken so far this morning.
Seizure doc prescribed Lamictal, but holding off starting that until I feel more stable on Zyprexa.
Zyprexa used to calm my mind, not sure why it's not working so well this time around. I have been on all the other anti-psychotics and Zyprexa is the only one I can tolerate. Anti-depressants don't work for me, can't tolerate any of the SSRI's.
In the middle of a card game last Monday, I got mad at one of the players, threw my cards down on the table and left. That is not like me, I never display anger towards anyone. Very upset over all this irritability and moodiness and now what happened at the card game, very ashamed of my behavior. I have since apologized to the person I offended, will attend the card game this evening and see how I do. Gulp !!
It's the week before Thanksgiving and not one person has invited me to their home or to get together to celebrate Thanksgiving.
I go thru this every year and suddenly Thanksgiving is 4 days away.
I usually prepare my own special dinner to ward off feelings of isolation during this holiday, this year, I was too depressed to even think ahead.
Now it's 4 days away, no one has invited me and I didn't buy any food to prepare. I have to have food delivered because I am disabled and cannot drive.
It's too late to order thru my grocery delivery as I'm sure the store is out of most of the things I usually get to make.
So, now depression is inking in big time and my thinking is that since no one invited me, I must not be regarded as a close enough friend to be considered to sit at their table for Thanksgiving and causing me to rethink who is on my friend list. I feel soo abandoned and very sad.