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About mikl_pls

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    Alabama, US

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  1. The first time I took it, it only went away after I quit taking it. This time, however, I'm not having any issues/only occasional mild symptoms that go away. This time, however, I am having issues with stiffness/rigidity of my legs, especially at night. My pdoc prescribed me benztropine (Cogentin) for that. I only had to take a few and I haven't really had any problems with that ever since then. I hope you find some relief from this, I know how annoying it can be.
  2. Meds like Vraylar can also cause restless-legs syndrome-like symptoms. That can be helped by low doses of dopamine agonists, like ropinirole, pramipexole, and Neupro (rotigotine transdermal). The first time I took Vraylar I had these symptoms really bad at night.
  3. Wow, really?? I was given this I think last year for my Tourette's syndrome (2 mg 2x/day I think?), my pdoc didn't seem to bat an eye when I asked her about it. I got off of it when I read apparently the same things that @Simba Cub read... I tried fluphenazine next, which helped my Tourette's with almost no side effects (except marked blunted affect and depression at 1 mg 3x/day, not as bad as with haloperidol though...)
  4. Bromazepam (Lexotan, Lexomil), if available where you live, is said to have similar side effects to diazepam (Valium). Have you tried chlordiazepoxide (Librium)? It wasn't very sedating for me, but then again, it wasn't very effective for anxiety either. It's a pretty long-acting benzo. Flunitrazepam (Rohypnol) is typically used for insomnia... so it must be pretty sedating. (It may or may not be available where you live though.) Halazepam (Paxipam) I'm not sure is available anymore. If it is where you live, then it could be a possibility. It does say drowsiness is an adverse effect though. Ketazolam (Anxon) is said to produce a reduced level of side effects such as sedation compared with diazepam (Valium) and the side effects when they occur tend to be milder. Loprazolam (Dormonoct) appears to be (or was) marketed for insomnia, so probably don't want to try that one (if it's even available where you live). Lormetazepam (Noctamid) also appears to be marketed for insomnia. Medazepam (Nobrium) acts as a prodrug to diazepam (Valium), as well as nordazepam (Nordaz, Calmday), temazepam (Restoril), and oxazepam (Serax). Nitraxepam (Mogadon) has sedating properties... Nordazepam (Nordaz, Calmday) is primarily used for anxiety, so may be a good option. It is an active metabolite of diazepam (Valium), chlordiazepoxide (Librium), clorazepate (Tranxene), prazepam (Centrax, Lysanxia), pinazepam, and medazepam (Nobrium). Oxazepam (Serax) is said to be a good benzo for those who have concurrent anxiety and depression. It is an active metabolite of diazepam (Valium) and temazepam (Restoril). I personally really like oxazepam. It might be a good option if it's available where you live. Prazepam (Centrax, Lysanxia) is a prodrug for desmethyldiazepam which is responsible for the therapeutic effects of prazepam. It's indicated for anxiety, and is a long-acting benzo (at least its metabolite is). If available where you live, this might be a good option. Quazepam (Doral) is mainly used as a hypnotic, so that might not be a good one for anxiety. Temazepam (Restoril, Normison, Euhypnos) is also used mainly as a hypnotic... Triazolam (Halcion) is also used mainly as a hypnotic... Yes, oxazepam would be a good one to try. It's pretty short-acting and takes a while to start acting, but it's one of the only benzos that work for me anymore. I'm a big fan of oxazepam.
  5. Primidone is another potential option, but propranolol is the mainstay of lithium-induced tremor, unfortunately. Primidone for me caused severe cognitive issues, probably worse than with Topamax! If you try primidone, start low and go slow to the target dose. (I would talk to whomever would prescribe it about starting at like 12.5 mg instead of 25 mg and go up by 12.5 mg increments weekly or biweekly instead of 25 mg increments per week). Another treatment option is vitamin B6 (900-1200 mg/day) (this can be a toxic dosage if taken for a long time, so talk to your doctor/pdoc about taking it if you wish to try this). It apparently has good results for lithium-induced tremor. Lastly, severe tremor may be a sign of lithium toxicity.
  6. Yeah, I had that problem with Lamictal when I was on 400 mg too. It also gave me horrible acne. The last time I tried it though, it didn't do that (only got to 150 mg). I think I might be allergic to either lamotrigine itself or some of the fillers in some generic brands. That's very odd. I wonder if you're sensitive to noradrenergic meds, because while noradrenergic meds can be stimulating, if one is either sensitive or the dose of the med is too high, it can sedate you and zombify you. Stahl calls this "overtuning" of the adrenergic system. I forget exactly what is going on though when this happens. Have you tried any other SNRIs? Desvenlafaxine (Pristiq/Khedezla), duloxetine (Cymbalta), Fetzima (levomilnacipran)? Effexor really is a very strongly serotonergic medicine for an SNRI. At 75 mg is where the dose response curve levels out for SERT occupancy, which goes pretty high actually (can't remember the exact percentage... It's above 80% though.) That could also be the reason that higher doses tend to numb you. You could probably get away with just 37.5 mg, or switching to an SNRI that is a more balanced SRI-to-NRI ratio (Pristiq is still slightly more serotonergic but more noradrenergic than Effexor, Cymbalta is closer to being somewhat balanced but still is more serotonergic than noradrenergic, and Fetzima is the only one that is more noradrenergic than serotonergic). Ah ok. I read this in your thread that you posted. All APs as a class have the side effects "weight gain" and "increased appetite," and have warnings for the development of type 2 diabetes mellitus, simply because they fall within that class of meds, and generally speaking, as a class, atypical antipsychotics cause those side effects. However, there are a few that are relatively "metabolically friendly," such as aripiprazole (Abilify), ziprasidone (Geodon), Vraylar (cariprazine), and Latuda (lurasidone), with Rexulti (brexpiprazole) following closely below. I'm not trying to convince you to ask your pdoc for an AAP, I'm just mentioning this in case it comes up as an option later on down the road, and perhaps you might have a little more open mind in trying another one. But I totally get you on that, I am very overweight and prediabetic, but not from antipsychotics; rather, from the MAOI Parnate and the TCA Anafranil. It sounds like you've possibly achieved what's called a "partial remission" or "incomplete remission." Therapy does a lot, and while meds can only do so much, therapy too can only do so much.
  7. This could also be a result of either the medication stopping working too soon or stimulant "rebound," which is when the medicine clears the system too quickly and is no longer occupying receptors/inhibiting transporters. If it's the former, perhaps a different formulation of methylphenidate could work better. Ritalin SR (or Metadate ER) works for only 2-8 hours at a time. Dosing 2-3x/day is what would normally be the solution to this, but if for some reason it's working less than 2 hours per dose, changing the formulation might give better results. Ritalin LA (which are 50% IR/50% DR) works for 6-9 hours, but it often falls short of this duration of action, and often needs to be dosed twice daily. Metadate CD is 30% iR/70% ER and works 6-9 hours as well, and tends to work the full 6-9 hours (as opposed to Ritalin LA). Concerta, the extended release mechanism of which is called "osmotic-release oral system" (or OROS for short), can work up to 12 hours. The think to be wary of is that the Concerta dosage doesn't equally correspond to the amount of methylphenidate that is in it milligram per milligram (IOW, 72 mg Concerta, the official max dose, which most pdocs and physicians think is 12 mg above the max methylphenidate dose, is actually only 48 mg of methylphenidate (divide the Concerta dose by 4.5 and multiply by 3 to get the amount of methylphenidate). The "unofficial" max dose is 108 mg, which has 72 mg methylphenidate. There are many more formulations in the US, most of which may or may not be available where you live. If it's the latter reason, then raising or lowering the dose may help. Or it could be that the methylphenidate isn't the stimulant for you, in which case switching to either dexmethylphenidate (Focalin/Focalin XR) (if it's available where you live) or an amphetamine-based stimulant (not sure which ones are available where you live, but I bet dextroamphetamine and Vyvanse are probably among them...).
  8. Yeah I empathize with you on all of this... Most of the time, meds will quit working and won't work anymore despite maxing out the dose (or attempting to but not being able to due to side effects). Have you tried raising your Lamictal to 200 mg? Increasing Effexor? (I believe you have before but I can't remember for sure... sorry!) Increasing the Ritalin to max dose? (60 mg) (or switching to an amphetamine-type stimulant?) Trying other adjunct AAPs? (Rexulti, Vraylar, and Latuda come to mind...)
  9. I believe this is the main mechanism of action behind ECT, triggering release of more neurotransmitters via inducing generalized seizures. They give you a muscle blocking agent so you don't convulse during the seizures, and put you under general anesthesia so you don't remember the experience (although the ECT itself is going to screw with your memory too...).
  10. Belsomra is heretofore the only sleep med that has worked for me. I think it might cause depression for me thoughβ€”just something to watch out for. (I was started on the max dose right off, 20 mg... You might be titrated up gradually.) My pdoc just added Doral which I've never tried before. My pharmacy had to order it though so it won't be here until tomorrow (dropped off the prescription on Saturday). Good luck with your med changes and with getting the Belsomra prior authorization (those are such a pain!!).
  11. Not quite every month, and usually the meds that are taken away/added are either temporarily needed or as needed medicines. Also, there are core meds that I haven't changed in over a year or so. Usually it's either because I don't need a med anymore (trying to trim down my regimen), side effects become too burdensome, or I need a little extra something for my mood (such as Wellbutrin this past appointment). My pdoc said it's okay to periodically add and remove Wellbutrin, for instance, but she doesn't want me on it all the time because of my seizures. Also, Wellbutrin is approved for seasonal affective disorder, which doesn't require it to be taken all the time. I usually ask her if something can be changed, and she will either say yes or no. Usually it's tweaking the dose, but this past time she added two meds. As for going back to meds I've taken in the past, I revisit meds I've taken before that worked but pooped out because I've tried so many meds over the years, and there's almost nothing left to try. No, I don't think you're unusual at all. That's how most people are. We usually try maxing the dose of a med out before switching unless side effects become too much for me; e.g., with clomipramine, despite side effects, I tried it for about 3 months and got to 225 mg (just 25 mg under max dose). The side effects became too much (profound urinary retention, extreme sexual dysfunction, excessive daytime sedation). Oh no, I didn't take your post like that at all. I've been asked these same questions before, though. If you look at my med list, about half of them are PRN or "as needed." My core meds are Vraylar, Viibryd, Visken, Dexedrine, and Trileptal. I've been on Trileptal for about two years, and before that I was on Zonegran, which I was on for about three years. Dexedrine I've been on for about two years as well. Usually she doesn't do more than one or two changes at a time unless I'm really bad off (e.g., depression or severe side effects). I keep what I guess you could call a "journal" of my med changes and and I try to keep up with how I feel on a daily basis in multiple aspects (side effects and benefits both). I have heard of the "kindling effect" before. I'm not sure if I believe it or not. I do suppose I should try and stick with my meds for longer periods of time though. It would be less confusion for my pdoc... lol. I hope I adequately answered your questions.
  12. I thought about splitting the dose too. The tablets are actually scored so I could split them evenly. I don't think my insurance would ever cover brand-name Nuvigil now that there's a generic. I don't know why they still have a copay card since they have a generic now and you and I both know that no one's insurance would pay for it... lol. Maybe I'll try splitting the dose in the AM and noon. Thanks for your response!
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