How often do you make major med changes?

[Wonderful.Cheese]

Do I switch meds too often? I’m worried about this now. Maybe that is why my pdoc won’t return my calls for help. No matter what I say. I’m worried she will not listen to me and then I really will be out of options. 

Is 4 (or maybe 5 to be safe) major med changes in 7 years or so too many changes (by major, I mean switch to a new med or revisit a med you’ve tried before, etc.)? Anyone have any advice or experiences with how many changes they do over a stretch of time? 

I mean I’ve been on abilify for 10-11 years. Klonopin too. Lamictal as well. Seroquel about 10 years. (Except for a brief off period while trying latuda) (And the addition of Invega to abilify and seroquel because my psychosis was out of control, but I’m off of that now due to starting clozapine). 

Any insight would be much appreciated!

Edited February 10 by Wonderful.Cheese

[HydroCat]

I am now on 4 meds, tried about 8 more in the past 7 years, repeating 2 of them more than once. Is this too many changes? I guess it is for some.

I wouldn't worry about it though.

[mmaryland]

My doc has said to me in the past "I have to say I think you're depending on meds too much for your feeling of well being and the cocktail you have come up with is difficult to evaluate for its effectiveness.  I think that once you're not in school you need to be off the stimulants for a while to reduce your tolerance"

like are you serious doc...... the cocktail YOU, meaning myself, "came up with" as if there is some algorithm and that my meds have become out of control because of my own fault? I forgot, who again prescribed all of these meds in my damn chart? That kinda pissed me off. then she wants to chop down meds without my input and it sucks. Lots of the meds were old and hadnt been deleted so sounds like a problem ya created yourself doctor by not listening to me when we change meds or discontinue an other med to remove the med from my chart. So I saw her once since that message which was december 19, don't feel comfortable continuning with her because she made me feel like I was no longer able to be treated because my meds were too complicated for her to figure out what the hell was the next step/action to take w/r/t my cocktail of meds that isn't working

Edited February 10 by mmaryland
answr.

[Iceberg]

2 hours ago, mmaryland said:

My doc has said to me in the past "I have to say I think you're depending on meds too much for your feeling of well being and the cocktail you have come up with is difficult to evaluate for its effectiveness.  I think that once you're not in school you need to be off the stimulants for a while to reduce your tolerance"

like are you serious doc...... the cocktail YOU, meaning myself, "came up with" as if there is some algorithm and that my meds have become out of control because of my own fault? I forgot, who again prescribed all of these meds in my damn chart? That kinda pissed me off. then she wants to chop down meds without my input and it sucks. Lots of the meds were old and hadnt been deleted so sounds like a problem ya created yourself doctor by not listening to me when we change meds or discontinue an other med to remove the med from my chart. So I saw her once since that message which was december 19, don't feel comfortable continuning with her because she made me feel like I was no longer able to be treated because my meds were too complicated for her to figure out what the hell was the next step/action to take w/r/t my cocktail of meds that isn't working

I share your pain on that one, I had a doc who told me I need to rely less on meds while being on 3 aps 

[Iceberg]

3 hours ago, Wonderful.Cheese said:

Do I switch meds too often? I’m worried about this now. Maybe that is why my pdoc won’t return my calls for help. No matter what I say. I’m worried she will not listen to me and then I really will be out of options. 

Is 4 (or maybe 5 to be safe) major med changes in 7 years or so too many changes (by major, I mean switch to a new med or revisit a med you’ve tried before, etc.)? Anyone have any advice or experiences with how many changes they do over a stretch of time? 

I mean I’ve been on abilify for 10-11 years. Klonopin too. Lamictal as well. Seroquel about 10 years. (Except for a brief off period while trying latuda) (And the addition of Invega to abilify and seroquel because my psychosis was out of control, but I’m off of that now due to starting clozapine). 

Any insight would be much appreciated!

I think that's really hard to nail down especially when you have treatment resistance not responding to the normal stuff....as long as your meds get a fair chance which can be unique to the med 

[looking for answers]

if your pdoc wont return calls or attempt to help, can u find a new pdoc

[jt07]

Except for removing Remeron 2 years ago, my cocktail has not changed for the past 7 years. Dosages have gone up and down, but the meds have remained the same.

[notloki]

I have made dosage changes but have been on the same meds for over 15 years.

[aquarian]

Effexor/Remeron/Valium has been my mainstay since 2002. (Well, it started as Effexor/Remeron/Xanax but after a year or two pdoc made me taper off the xanax and onto valium.) I remained totally stable med-wise and was mostly functional. But then around 2011-2012, shit hit the fan and my combo was no longer cutting it, so we added abilify and tried various dosages. I also tried swapping out effexor for pristiq but went back to effexor eventually. Also tried out latuda (maybe before or after abilify?). Not sure in what order all that happened and whether it was over the course of months or a year. Tried adding in some stimulant stuff eventually. Nuvigil was no help. Ritalin ok at best. Finally settled on adderall. Stayed on adderall for at least a couple years I think.

One day a year or two ago, my pdoc says, why not add buspar to the mix? She said it probably won't do anything but can't hurt and might help with anxiety, right? So turns out buspar gave me some energy although did zero for anxiety (not sure how that works) so I told my pdoc it was time to stop the adderall since the buspar was superior and I was tired of the afternoon crashing from adderall among other things. So now I'm on effexor/remeron/valium/abilify/buspar. Pdoc has me try going up to 30mg remeron from 15mg at one point. No difference but I'm still on the 30mg btw. 

So more time passes. I'm frustrated that I'm not making any big "progress" and am still on SSDI and not working or volunteering. Pdoc says lets cross-taper from effexor to cymbalta. During the cross-taper, a bunch of minor life stressors occur and my panic disorder comes back after being mostly in remission for a decade. I stayed on cymbalta for a few months at least, maybe longer. Finally said, let me go back on effexor since cymbalta doesn't seem to be any better.

So back to effexor yet again. And now more valium to help with the panic disorder. 2mg 3-4x/day so still a tiny dose but I was only taking about 1mg at night for years prior to this. And I still can't drive on my own due to panic. Can barely make it through a meal at a restaurant without panicking. Am exhausted after having to leave the house to do something in public. But still have to keep leaving the house and trying to drive with someone else in the car so that maybe, someday, I can get back to the old status quo, which I used to be dissatisfied with but would do anything now to get back to.

So basically my cocktail can be stable for a decade. But then it can also be tinkered with and meds swapped in and out many times over the course of a few years. Hard to say since my concept of time is poor. And the more med changes and crazy, the more hazy things become in the rearview mirror.

[argh]

Changes as we work to figure out what is actually wrong with me. Went in a year and a half 100% sure of MDD. Not as sure currently.

[Hume's doona]

risperdal: 2003 -present

epilim/valproate: 2005-present

cymbalta: 2008-present

[Wonderful.Cheese]

Ok. So I don’t feel so bad now. I think it varies from person to person. I should have mentioned that my pdoc has said I have treatment resistant psychosis, so that could be why I’ve had a moderate ish amount of med changes over the past 7 years. So treatment resistance could be a factor maybe?  I’m no Dr though. So it’s best to talk to your own doc to discuss this issue further. Only they know your history best. I’m just speculating here. 

[Wonderful.Cheese]

14 hours ago, looking for answers said:

if your pdoc wont return calls or attempt to help, can u find a new pdoc

I should have explained. At the county clinic she is the best doc they have. She is the medical director even!  We can’t go elsewhere because we owe them $90,000 and change and counting. But we have a deal with them monthly payments and that way we are in good standing with payments. I get all my services there and they charge us one mass bill. We can’t afford the county clinic montlhy bill plus a copay of a pdoc at another practice, unfortunately.  We just can’t afford double the cost (one for the county clinic and one for a private practice). It is what it is I guess. It has been worse for me. So I am not complaining. Or trying not to anyway. 

[looking for answers]

11 hours ago, Wonderful.Cheese said:

I should have explained. At the county clinic she is the best doc they have. She is the medical director even!  We can’t go elsewhere because we owe them $90,000 and change and counting. But we have a deal with them monthly payments and that way we are in good standing with payments. I get all my services there and they charge us one mass bill. We can’t afford the county clinic montlhy bill plus a copay of a pdoc at another practice, unfortunately.  We just can’t afford double the cost (one for the county clinic and one for a private practice). It is what it is I guess. It has been worse for me. So I am not complaining. Or trying not to anyway. 

ahh i understand. well is there anyone u can talk to

[Geek]

Major med changes... every 12-16-ish weeks lately. Sometimes closer to 24 weeks. Minor changes (dosages) more frequently than that. 

Treatment resistant MDD and GAD... we can't seem to find a cocktail that keeps me stable for any extended length of time or increase in stress levels.

[Wonderful.Cheese]

3 minutes ago, Geek said:

Major med changes... every 12-16-ish weeks lately. Sometimes closer to 24 weeks. Minor changes (dosages) more frequently than that. 

Treatment resistant MDD and GAD... we can't seem to find a cocktail that keeps me stable for any extended length of time or increase in stress levels.

Damn that treatment resistance! It can pack its bags and leave my friend alone already! 

But seriously, having treatment resistance sucks. Big time. And it seems to happen to the best people. Ugh. 

[Wonderful.Cheese]

Oops. I forgot one. 6 changes in 6 - 7 years.

[Ethansmom]

I have had so many meds changes, add on's etc. I can't keep anything long enough. They either just give me side effects, work for awhile, or don't work at all. It's not fair!

[Wonderful.Cheese]

7 hours ago, Ethansmom said:

I have had so many meds changes, add on's etc. I can't keep anything long enough. They either just give me side effects, work for awhile, or don't work at all. It's not fair!

At least you have drs who listen to you and make changes when you report things not working or what not. Mine have not been so kind. 

Are you giving each med at least 8 or so weeks at a high enough dose so that you can truly see whether or not the med is a keeper? Switching meds every other week or two is just as bad as a pdoc who never changes anything or never listens. That’s just something I’ve seen happen to people. Ymmv. 

[mikl_pls]

I used to ask my pdoc to make massive changes to my med regimen almost every time I saw her when I first started seeing her because I felt like nothing I was taking was working. Usually something would stay the same though (for example, I was on Wellbutrin for 3 years until it started causing seizures, but meds to augment it would come and go, go up and down, etc.). But lately, we make only minor changes (1-2 changes) every 3-6 months, and really, I've been on the same combo of "core" psych meds for almost a year and a half, which is really an achievement for me... lol. Usually meds poop out and quit working after just a few months and I have to go switch back to something else. I've noticed that I've been more stable with less med changes too, which is always a plus. I did have a hypomanic episode back in September last year after which I started spiraling back into major depression for the first time in almost a year, which, after all I've been through, is really miraculous for me. I've had to make dose changes though almost every month to every other month.

All the meds you see in my signature that I've tried in the past I have tried in only the last 5 years... It's pretty sad. It's really my fault because I would get too discouraged about a med and jump ship too soon I think. Had I any insight before, I would've given meds more of a chance earlier rather than cycle through pretty much everything there is as fast as I could. So don't think you've made too many med changes in the past few years.

Edited February 13 by mikl_pls