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mikl_pls

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  1. In the short-term, increasing Ativan could help with the hypomania, according to my pdoc (I once had a mixed episode that was one of the worst in my life last September and that was one of the recommendations she gave me). She wound up prescribing me Zyprexa 10 mg to take for a week or two until I was back to baseline. It worked quite well, but I did gain some weight (not much though). She kept me on it as needed for several months before dropping it off the prescription. Now I have a stockpile of Zyprexa lol. Polypharmacy with antipsychotics isn't a first-line option by any means, but it can be done under close supervision. Choice of antipsychotics is key too; e.g., combining a dopamine partial agonist with a dopamine antagonist is usually the most beneficial combination according to Stahl. But polypharmacy therapy with antipsychotics doesn't need to be protracted for very long, just as long as is needed. As for maintenance treatment, I also suggest a combination, perhaps of Lamictal and Depakote? I know Lamictal made you hypomanic, but you don't need as much of either med if you are on that specific combo. You may actually be able to do without an antidepressant (if that's possible, I know it's not for some bipolar folks), which would probably also lower your chances of becoming manic.
  2. My case is rather unusual because I developed an impulse control disorder from Abilify once I hit 20-30 mg, but I felt extremely stimulated at the high end of the dose range, especially at 30 mg. When I started it the very first time back in summer of 2015, 2 mg made me literally hypomanic/manic and borderline psychotic—I had an abundance of positive symptoms for the first time in my life at that point, and to be honest, it felt pretty damn nice! Then as I got used to it, 2 mg was worse for me than before I started it, so we went to 5 mg, which helped a little but I developed akathisia, so back to 2 mg. Eventually I climbed to 15 mg that summer, and akathisia hit me like a sledgehammer and I had to stop taking it. The most recent time I tried it, I was actually on it for about two years and escalated the dose much slower than the first time. I tolerated it okay, but like I said, when I got to 30 mg, the impulse control disorder started rearing its ugly face. I'm not even on Abilify anymore and I have problems with impulsive spending sprees from time to time (regardless of whether I'm hypo/manic or depressed). It's better than it was while I was on Abilify, but still not where I was before I started high-dose Abilify. I will say 10-15 mg was rather innocuous as far as side effects vs benefits went the most recent time I took Abilify. I wasn't necessarily sedated or calmed per se, but rather I just felt like everything had receded into the background for the most part, both side effects and depression (until the depression came back on 15 mg). It was a damn good medicine for me, but I just can't sustain spending the amount of money I was with little to no income at the moment. In retrospect, I would probably say that 10-15 mg was probably actually when my spending got out of hand, just that it was a lot more subtle for me than the flagrant excessive spending I had in the higher doses. I mention all this as a caution about this medicine as well as any other dopamine partial agonist (Rexulti, Vraylar, etc...), as well as the dopamine agonists (Mirapex, Requip, Neupro, etc.). Everyone is different. Not everyone will experience this side effect. But it is a possibility to be considered I believe and something to keep a watch out for. Sorry for the long-winded post! I hope you get the relief you need from your depression and anxiety!
  3. It might be best to ask your pdoc about when to take it before switching over. Yes, almost all antidepressants can decrease REM sleep, but this occurs regardless of whether you take it in the AM or PM. If you have issues with sleeping, there's an antidepressant that they can add to your regimen called trazodone (Desyrel) which can help improve quality of sleep.
  4. Glad to hear that you successfully transitioned to sertraline! Sorry for the late response, I thought I'd go ahead and respond anyway since no one else had. That was a good idea to split the 25 mg tablet in half at first, that's very often what needs to be done at first if it can be done (i.e., sometimes you can't what with the medicine being in capsules, like with Cymbalta or Effexor, so you have to be prescribed twice as much of a smaller dose in case there's tolerance issues at the intended starting dose). I loved Zoloft, it worked very well for me for a few years, but as with all antidepressants for me, it kinda pooped out. I know that I can go back to it though if I need to try something I know will work, but I suppose I need to give it a good break before I go back to it. Yes, that does sound like imipramine withdrawal to me, very similar to side effects I've experienced withdrawing from similar antidepressants. I think your pdoc may be trying to establish the lowest effective dose for you. You may not need to go up in dosage right away, but if those withdrawal effects last for a while, you may wish to increase your sertraline (which of course you should always discuss with your pdoc first before doing). If you get to a high dosage acutely, and then start feeling better, sometimes they will cut the dosage down towards a lower maintenance dose. For example, if you made it to 150 mg acutely, you may be able to get by with 75-100 mg for maintenance, or even lower. Everyone is different. Typically sertraline is dosed in the morning; however, for some, it is sedating and thus should be dosed at bedtime. When I took sertraline, it felt very stimulating, so I took it in the AM.
  5. I've gone to and from TCAs and SSRIs/SNRIs before. It seems like you may need a cross-taper schedule for the imipramine and sertraline. For example, start low on sertraline while at the same time taking a slightly lower dose of imipramine. An example would be something like this (please note that I am not a doctor and this is just an example of what could be done): Weeks 1-2: imipramine 75 mg + sertraline 25 mg Weeks 3-4: imipramine 50 mg + sertraline 50 mg Weeks 5-6: imipramine 25 mg + sertraline 75 mg Week 7 and on: discontinue imipramine + sertraline 100 mg That would be something along the lines of what my pdoc would do for me.
  6. When I took clomipramine, I took 225 mg all at bedtime. I couldn't stand that medicine. 300 mg is a mighty high dose though, beyond 250 mg increases risk of seizures I believe. Just please be careful with that dose. Clomipramine is a heavy hitter of a medicine, both therapeutic effects-wise and side effects-wise.
  7. Do you think it could be the amantadine? That's the most recent medicine added to your regimen that I remember. I don't know if there is a website or app to do what you're asking about, but I will let you know if I find something.
  8. That's always a possibility. She did go up rather quickly, but someone posted from the PI that said it was okay to go up as quickly as you did. Clozapine sounded like it really wasn't a match for you, especially with the sialorrhea.
  9. I don't think it's any more prone to causing TD than something like risperidone (Risperdal), but I could be very wrong. My pdoc is under the impression that it causes EPS very badly and is a bad medicine, even in low doses, but everything I've read about it says it is good at doses < 25 mg. Maybe something like 5-10 mg to augment either daily or as needed might be something to ask your pdoc about. I've read case studies of loxapine and psychotic depression where the patient remits within weeks of starting the low-dose loxapine. If I find the link I'll post it. Please don't apologize, you have nothing to apologize for. We understand you're going through a hard time, and I totally understand your reservations of trying certain meds. Sometimes after you've tried everything "in the box," you have to start reaching "outside the box."
  10. It sounds like you might have psychotic depression as you seem to be having a lot of nihilistic delusions. I'm not an expert though, so don't hold me to that, that's just what I noticed from your OP and from what I identified in my experience, if that makes any sense. There has to be a way to control your symptoms more efficiently than with three concurrent AAPs. Clozapine didn't do well for you. Sometimes first gen antipsychotics are good for people who don't respond to clozapine, I believe. I think loxapine might be worth a try for you. It produces amoxapine as a metabolite, which is a tetracyclic antidepressant. Low doses actually behave like an atypical antipsychotic (< 25 mg).
  11. Saphris is actually not known for causing weight gain. It has a higher possibility than some AAPs due to its affinity for the 5-HT2C and H1 receptors, but in clinical trials, it wasn't a very prominent side effect. Saphris just tastes like ass is the only thing I remember about it. They're sublingual tablets you have to dissolve under your tongue, and you can't eat or drink anything for a certain amount of time before and after taking it. Geoodon is similar to Latuda in that you are required to take it with food in order for it to be optimally absorbed. Where Latuda only requires to be taken with 350 calories, Geodon (which is taken twice daily usually) requires at least 500 calories per dose, and if you take it twice a day, that's 1000 calories just to absorb the medicine properly. If you don't take it with food, you run the risk of increasing chances of mania and/or psychosis. Don't get me wrong, Geodon is a good medicine in my opinion and from my experience, it's just a bit of a hassle to keep track of taking it with food. But it is very weight neutral, but probably not as weight neutral as Latuda. Latuda can be taken up to a maximum of 160 mg/day (2x80 mg tablets). Perhaps you could talk to your pdoc about going up to 120 mg, and if that doesn't work, then going up to 160 mg? You may experience some akathisia, so be sure to ask for a prescription for Cogentin just in case it happens. If you've never experienced akathisia, it's absolute hell; if you have, then you know exactly what I'm talking about. I'm taking Vraylar 4.5 mg right now and it's doing quite well to control my mood stability and psychosis. Abilify was working very well for me, but I was having severe impulsive buying problems with it and had to get off of it. I don't seem to have nearly as much of a problem with impulse buying with Vraylar, and while it seemed to disappear at 3 mg, since going up to 4.5 mg, it seems like it may be returning. So if you have a propensity for that sort of thing, watch out with Rexulti and Vraylar (especially Rexulti). You also may consider discussing with your pdoc temporarily going down in dosage on your Effexor XR, like 75-112.5 mg, since you are experiencing possible mania and/or psychosis.
  12. There's a prescription medication in the US (not sure where else it's available) that is used to treat Sjögren's syndrome (I believe) called cevileline (Evoxac). While I don't have Sjögren's, I did ask my GP to try it because my dentist commented on how dry my mouth was and mentioned that I needed to try something like Biotene (which didn't work at all for me) as dry mouth like I had could cause problems with my teeth. So my GP prescribed it for me and I went from having an arid, dry mouth to practically drooling while awake... lol. I kinda backed off on the dosage (instead of 3x/day I took it 1-2x/day as needed), but wow did it ever help! The only downside is that it also causes increased sweating, and I already have severe hyperhidrosis all over my body. I tolerated it as long as I could, but I just couldn't handle all the sweating (my clothes would be drenched at the slightest exertion—more so than usual!). Just figured I'd mention that.
  13. Derp... thanks for pointing that out! I didn't mean to provide misinformation. I've taken both and get them mixed up often. This intrigues me, as I have a chronically runny nose and post nasal drip, as do both my parents. I imagine this is prescription, right? Also, when I looked it up in Epocrates, it says to take it up to 4 times per day (depending on the indication). Is this how you take it, @notloki? I used to take cromolyn sodium nasal spray, which also requires to be taken qid, but I couldn't keep up with having to take a nasal spray that often per day. It really helped and I could actually smell things around me again (both a blessing and a curse lol)!
  14. Glad to hear that the culprit has possibly been figured out, @notloki! I hope this is a simple fix for you! Please continue to keep us updated.
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