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18 hours ago, centaurus said:

I also had this side effect about music, it will not fade,but you'll get accustomed to it

I hope so. I'm a very musical person. I love to sing. And coming from valproate which actually improves a person's absolute pitch, this is not only polar opposite but now I'm self-conscious when I'm singing because I'm not sure if I'm off-pitch or not. I suppose a good question would be if this only impacts external sounds or if it also impacts how you hear yourself. Because we hear ourselves very differently than others hear us.

18 hours ago, centaurus said:

Yes,that's a  right ratio

Okay awesome. Then I'm on the right track.

Took just 250mg of Depakote last night instead of waiting until tomorrow night for the next decrease. I'll make tomorrow night my last night of Depakote. Pdoc gave me discretion to decrease the Depakote as I see fit and was only specific about how to titrate up the CBZ.

I definitely feel under-stimulated and am thinking I may already need a dose increase of Vyvanse. I don't see the pdoc again until 2/11 though so I'm just going to wait it out I guess unless I get to next week and I can't focus at work in which case I'll just call him and ask if I can go back to 40mg of Vyvanse.

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So I'm pretty sure I've determined that with CBZ you hear yourself in the correct pitch but hear everything ELSE a semitone lower. I'm fairly certain at this point.

It's been treating me well so far. I like it. Haven't felt this way in a while. I just don't know if the hearing thing is going to be a deal-breaker or not.

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4 hours ago, browri said:

So I'm pretty sure I've determined that with CBZ you hear yourself in the correct pitch but hear everything ELSE a semitone lower. I'm fairly certain at this point.

 

That's very interesting. I never had/do not have that side effect.

I do have a side effect that if my blood level get low, I begin to hallucinate a smell that smells like something between onions and mold.

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I think it's going to be a deal breaker for me. I have a call into my pdoc to see what we should do. Waiting to hear back from him.

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Music gives me joy. And I love to sing. This means no more karaoke. No more singing for people's weddings. No more holiday carols. Unless I do all of it a cappella... :(

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Yeah just got off the phone with him. We're switching back to the Depakote for the weekend and I see him on Monday. We'll decide what to do then.

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Sure enough, skipped CBZ last night and this morning and my hearing is almost back to normal. Music still sounds a hair off key but barely. Start back on the 500mg Depakote this evening.

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2 hours ago, centaurus said:

Will you stay on Depakote?

Not sure. I'm still only taking 500mg of it at this point just so I'm on it and adjusted to it in case he does want me to increase back up, but I'm going to talk to him about either:

1. Slowly increasing the Rexulti by 0.25mg every 2-3 days until I reach 2mg and withdraw the Depakote to see what happens.

2. Titrating off the Rexulti while initiating Vraylar and eventually withdraw the Depakote.

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On 2/10/2019 at 9:09 AM, centaurus said:

Will you stay on Depakote?

So I had the appointment this morning. He felt that making any more changes would be overtuning since I'm in a good mood. I'm not depressed but I'm not sub-hypo now that I've reintroduced the Depakote at a low dose. I asked about option #1 where we would slowly increase the Rexulti dose and eventually withdraw the Depakote, but he said he wanted to avoid TD or other EPS like akathisia and that we could justify the very low dose of Depakote because I'm also on Rexulti. He would rather use lower doses of two medications than slim down to just one of them.

I also asked about option #2  (Vraylar), and he confirmed his experience with it that it is agitating for some patients. But I also relayed some of the experiences that others have had where it is activating/agitating but stabilizing at the same time. He didn't bite. Wanted me to stay the course:

Trintellix 15mg

Vyvanse 30mg

Rexulti 1mg

Depakote 500mg

And he said that if I my thoughts ever feel like they're picking up speed that I can bump the Depakote to 750mg on my own without calling him. I can tell that he's seriously thinking about my past experiences with AAPs and that my akathisia threshold is low. He really doesn't want to push the Rexulti unless I need a really quick fix.

So much for CBZ and I guess I won't be trying Vraylar, but it's probably for the best. I'm doing good right now and there isn't a really GOOD reason to switch other than my complaints about weight gain, but it hasn't been too serious and we did reduce the Depakote so maybe I'll shed a few pounds.

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3 hours ago, browri said:

So I had the appointment this morning. He felt that making any more changes would be overtuning since I'm in a good mood. I'm not depressed but I'm not sub-hypo now that I've reintroduced the Depakote at a low dose. I asked about option #1 where we would slowly increase the Rexulti dose and eventually withdraw the Depakote, but he said he wanted to avoid TD or other EPS like akathisia and that we could justify the very low dose of Depakote because I'm also on Rexulti. He would rather use lower doses of two medications than slim down to just one of them.

I also asked about option #2  (Vraylar), and he confirmed his experience with it that it is agitating for some patients. But I also relayed some of the experiences that others have had where it is activating/agitating but stabilizing at the same time. He didn't bite. Wanted me to stay the course:

Trintellix 15mg

Vyvanse 30mg

Rexulti 1mg

Depakote 500mg

And he said that if I my thoughts ever feel like they're picking up speed that I can bump the Depakote to 750mg on my own without calling him. I can tell that he's seriously thinking about my past experiences with AAPs and that my akathisia threshold is low. He really doesn't want to push the Rexulti unless I need a really quick fix.

So much for CBZ and I guess I won't be trying Vraylar, but it's probably for the best. I'm doing good right now and there isn't a really GOOD reason to switch other than my complaints about weight gain, but it hasn't been too serious and we did reduce the Depakote so maybe I'll shed a few pounds.

Glad to hear you're doing great. Valproate doses are often changed in either directions according to symptoms, often blood levels are not so improtant than clinical symptoms.

For Bipolar 2 serum levels of VPA doesn't need to be very high.

Edited by centaurus

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1 hour ago, centaurus said:

Glad to hear you're doing great. Valproate doses are often changed in either directions according to symptoms, often blood levels are not so improtant than clinical symptoms.

For Bipolar 2 serum levels of VPA doesn't need to be very high.

Yeah and my pdoc is very much of that mindset. He always checks VPA, CMP, and WBC just to make sure I'm not toxic and don't have agranulocytosis, but he doesn't really pay too much mind to what the level actually is if my symptoms are controlled. I spent a good portion of my time on Depakote <50mcg/mL and that was even at a dose of 1000mg. So yeah, my pdoc does dose based on clinical response and tolerability and doesn't hold to the guidelines unless I'm acute in some way. Then we push to 1250mg which actually got me a 69mcg/mL at one point in time. I think they say 80-100mcg/mL is required for acute mania control like if you're inpatient.

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