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About mikl_pls

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    Alabama, US (not native Alabamian!)

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  1. Many people go through this, it's not objectively all that "crazy." It may sound subjectively "crazy" to you personally, but it is something that many people do, so it's not that unusual, really. It may just be that it's peculiar to you personally because (I'm taking guesses in the dark here) maybe these thoughts are new to you?
  2. You're right about that. Having never taken it before, I don't know how insurmountable it can be at any dose, even 12.5 mg.
  3. I'm pre-diabetic, and it's well under control, so I shouldn't have anything to worry about (yet). When I become diabetic, it will be type 2, and it's definitely a matter of when, not if. You're like my brother... You got lucky... lol
  4. True... I have been spoiled by my "classically-trained" pdoc I guess... I think it would be worth it if they were at least allowed a small amount of their stimulant while on Parnate and thus allowed to continue a small amount of the stimulant during the washout. Parnate is pretty magical stuff IME. In case you don't know what this is, @climber47, that is an SNRI + Remeron. The Remeron I would worry might be too sedating for you though is the only thing, even in high doses which are... less sedating than low doses (for most people I should say). But Remeron, especally in combo with an SNRI, is known for bringing people out of the deepest, blackest of depressions. (Just not meβ€”it worsened me by a lot...) Another possible combination that Dr. Ken Gillman really, really likes to use is Zoloft + nortriptyline. It's like a triple reuptake inhibitor-like effect. I did this with Zoloft + desipramine for a good while and enjoyed good benefits from both. Strattera can even be used as the NRI, but beware of the kappa-opioid partial agonist effects of the metabolite, 4-hydroxyatomoxetine, which can not only cause depression but psychosis as well. I see you tried Mirapex, how did that work? What dose did your pdoc take it up to? There're other dopamine agonists: Requip and Neupro more commonly being used in psychiatry, with Parlodel and Dostinex being less used (Dostinex is used more often in psychiatry though to alleviate SSRI-induced sexual dysfunction). I've also heard of low-dose clozapine being used in treatment-resistant depression patients. It's a drug of last resort due to possible serious side effects, but it's worth a shot IMO.
  5. I started with I believe 50 mcg Synthroid based on my levels and increased gradually up to 150 mcg with blood work and consistent checkup visits. That's where I settled. I'm actually technically in hyperthyroid by my TSH levels, which are extremely suppressed, but for some reason my T3 and T4 levels aren't keeping up for whatever reason, so I need the extra Synthroid to supplement. I think it was because I was on Trileptal which lowers T3 and T4 levels. I'm not on that anymore, and I haven't been on Synthroid in months, nor have I had any blood work in that long. I just called my endocrinologist and asked for an appointment because they never called me for my last supposed appointment (I guess 'cause I didn't get the blood work done), and I'm out of both Synthroid and Ozempic (diabetes medicine). We'll see what my thyroid levels are doing now that I'm off of Trileptal. I may not even need Synthroid anymore, though it's nice to have for depression (it classically is used as an augmenting agent for depression, especially bipolar depression, as apparently many bipolar people are also subclinically hypothyroid).
  6. I don't think this has been mentioned yet, but also, very low sodium levels can cause seizures. It was ironically a side effect of Trileptal when I was on it, and was something I was supposed to monitor. I never experienced it to my knowledge, while I was on it anyway. Although lately I am having extremely bad orthostatic hypotension lately. I think it's a side effect of Caplyta, but I could be wrong. It's indeed a documented side effect of Caplyta, but not a prominent side effect or anything according to any literature on the medicine. Just watch out for seizures too while you're watching out for all these other things! lol
  7. You're on a rather stimulating cocktail (or what should be stimulating). My suggestions would be: Regarding your Adderall XR... If your pdoc/doc approves, increasing the Adderall XR in 15-30 mg increments past the 60 mg maximum until you get more benefit. This can be done by adding more Adderall XR or by adding Adderall IR tablets to supplement the Adderall XR. IME, Adderall IR tablets are more stimulating anyway. Try switching to Adderall IR tablets with your total dose divided into 3 doses daily (20 mg every 3x/day ~3-4 hours) Try the new amphetamine salts product, Mydayis, perhaps? It's brand-name, so the quality of amphetamine may be higher. Max dose is 50 mg/day and it lasts 16 hours. Could add Adderall IR/XR to supplement the dose as needed. Try switching to Dexedrine tablets or Dexedrine Spansules (extended release capsules). More potent stimulant mg-per-mg than Adderall More wakefulness promotion, IME... Dexedrine 60 mg = Adderall ~80 mg, or if you do the conversion by accounting for molecular weights of the two stimulants, more like ~92.715 mg Regarding the Wellbutrin... You could try going to 400 mg/day by doing either Wellbutrin IR 100 mg x2 2x/day (2 bid) or SR 200 mg 2x/day (bid), or doing 450 mg/day by doing 300 mg XL + 150 mg XL or 300 mg XL + 150 mg SR or 300 mg XL + 75 mg IR 2x/day (bid). Instant release may act more like a stimulant and confer more stimulation, but also increases risk of seizures. They make a 450 mg tablet called Forfivo XL and a bupropion hydrobromide version called Aplenzin at 522 mg (equivalent to 450 mg hydrochloride). They're both brand-name only so you may run into insurance problems with coverage. When I tried Forfivo XL with just 40 mg Adderall, it made me violently nauseated... Never got sick though, just extremely nauseous. I didn't experience this with the generic XL 300 mg + SR 150 mg or even when I was on 500 mg/day of Wellbutrin by doing 300 mg XL + 100 mg IR 2x/day (bid) Definitely keep the Deplin at 15 mg. Galantamine I believe is a stimulating medicine. The acetylcholinesterase inhibitors, especially Aricept (donepezil), tend to actually cause sleep problems like insomnia in dementia patients and is dose dependent.
  8. I'm sorry it took me like half a month to get back to you! Wow, so that's actually a pretty long remission period for my standards... (I too have a hard time recalling specific time of past events.) A year of remission is almost unheard of for me... lol. So you tend to do better without AAPs? Wow. That's really bizarre! I've heard of Latuda, for example, dong that to many people, but never Risperdal. (My best friend is taking Latuda 20 mg and we believe it is making him anxious, possibly.) Hmm, so you've mostly tried the -pine AAPs? Zyprexa and Seroquel I'm sure, possibly Saphris? Proabbly not Clozaril... WOW... Ok so as we know it, Seroquel XR is your only go-to AAP. Perphenazine caused anxiety and racing/bizarre thoughts? That's literally a paradoxical reaction if I'm not mistaken. Perphenazine is used in combination with amitriptyline for anxious depression (Etrafon/Triavil) and is said to be an intermediate potency FGA, but it looks pretty high-potency to me based on the numbers. Could be wrong though. I was fixing to say maybe it was akathisia, but I know what you're talking about as my best friend has this type of reaction seemingly to all antipsychotics (atypical so far). If Haldol works, have you ever tried Prolixin? I'm just curious since it's sort of regarded as the phenothiazine version of Haldol and has less risk for heart problems, movement disorders, etc. Personally, my favorite is Stelazine, you may have known for a while though. It's not especially a quick-acting antipsychotic, but it's super nice for anxiety of all types, mood-brightening effects, and tics (which I deal with Tourette's syndrome). The new AAP, Caplyta, is literally a butyrophenone, in the same class as Haldol and droperidol. Its pharmacology is nothing alike, of course, but just figured I'd throw that out there. Potent 5-HT2A antagonism, SERT inhibition, D2 bimodal modulation (presynaptic partial agonism + postsynaptic partial antagonism), glutamate increase through D1 receptor stimulation, and aside from the PI sheet, I found out there's some D4 affinity and some pretty potent Ξ±1A/1B/1D antagonism (causes pretty nasty orthostasis with me all the time). This antipsychotic has been a game changer/life changer. The difference in me has been night and day. I still am not where I need to be, and still take Stelazine 5 mg bid prn to patch things up here and there, but it's great. My insurance somehow covers it, all they wanted was a PA, and I got that through my gdoc since my pdoc doesn't give PAs too reliably (plus it was my gdoc who prescribed the Caplyta anyway). It's an option that is out there should you wish to literally go out on a limb and try it. The SERT inhibition could be problematic for you since I seem to remember you don't do too particularly well with SSRIs, and it's just about as potent as its D2 modulation. Right now there's only one dose, 42 mg, and it's the dose for schizophrenia at the moment. I just can't imagine why these antipsychotics are giving you these reactions though. Could be the 5-HT2C antagonism/inverse agonism? Seroquel and its metabolite aren't too potent on 5-HT2C antagonism as Zyprexa is, but it's more potent than Risperdal is (or at least tighter affinity... not necessarily "more potent...") What about Seroquel and its metabolite do you personally think pharmacologically make it the only one right now that you know of that you can depend on? I'm curious what your take on all this is, because this doesn't seem to make sense to me at all, yet it isn't uncommon. Sorry you're going through this, I hope you're doing better, @mjs190. Sorry again it took me so long to respond.
  9. Thank you so much for clarifying this! I have just always thought it meant short-term, but I knew there was another meaning for this.
  10. @Steve223 this is reminiscent of some of my psychotic delusions that I have. They seem to be tied to either psychotic depression when I'm having a super bad bout of depression, and/or my OCD, which evidently my insight is so poor I can be virtually psychotic/delusional at times about my obsessions. Have you ever been diagnosed with OCD? Tic disorders like Tourette's disorder, as well as attention-deficit disorders like ADHD, also go hand-in-hand with OCD and each other, especially in males when they're young, but some never outgrow that "trinity."
  11. I agree with @Iceberg on the Adderall thing. 60 mg divided in 3 doses of IR tablets is more stimulating than 2x 30 mg XR capsules. It's way more flexible and allows you to take a nap if you feel like it simply by just holding a dose. Or if you need to take a dose slightly sooner than expected (whether you're more tired than usual or if you're expecting to go to bed earlier that night), you have that freedom, and vice versa. I take my Dexedrine as 10 mg x2 in 3 doses (it only comes in 5 mg and 10 mg tablets, unless you get the brand-name product Zenzedi). Dexedrine may be something else to look intoβ€”it's far more potent of a CNS stimulant than Adderall is and has more wakefulness-promoting at the expense perhaps of sacrificing that "kick in the butt" that Adderall gives you. The top #1 zombifying medicine for me was Lexapro, 10 mg, while it wreaked havoc on my emotional stability at the same time (I was undiagnosed bipolar at the time, taking it in high school for "anxiety..."). I didn't give a single flying damn about anything while I was on that medicine. The downside was that my motivation nosedived at the same time too. My room went to hell in a hand basket, and so too did my grades. SSRIs in general are pretty zombifying, with the exception of perhaps Prozac and Zoloft (although many do report that Zoloft really numbs them out too). Luvox was also extremely numbing, probably even more so than Lexapro, but I was in college at the time and my academics suffered vastly, and even with mood stabilizers and an antipsychotic, Luvox was pretty trippy for me (induced lots of visual and auditory hallucinations) which is weird because it's a sigma-1 receptor agonist too which is supposed to help with psychosis. On the side of trying to find something that works, I know you've tried Emsam, the patch MAOI... but have you tried Parnate? It's another MAOI that has literally been known to work absolute miracles within days for treatment-resistant depression sometimes even in low, low doses. Emsam is safer, yeah, sure, but like what do you want to possibly be your cause of death (besides natural cause)? Your meds, or your illness you're taking meds for? If you have a treatment-resistant illness, it's time for the big guns, IMO, especially if you've been dealing with it for 15 years. My pdoc tries to really "play it safe" more and more side effects wise as I've known her. I won't get into that. I would suggest asking about giving Parnate a try if you're up for the necessary washout (there are bridging agents you can use, like secondary amine tricyclic antidepressants, such as nortriptyline, desipramine, and protriptyline, and the atypical antipsychotics, Abilify being the one probably most often used in patients taking MAOIs). It's super, super stimulating, so you may not even need your Adderall, but in case you do, your pdoc would likely want to start low and go slow on it if they were comfortable with prescribing the two together. The TCA can be taken alongside the MAOI as well. So long as it isn't imipramine or clomipramine, you should be fine. Protriptyline is probably the most stimulating TCA I've ever taken. Taking the MAOI + TCA, MAOI + Stimulant, or MAOI + TCA + Stimulant combination route enables you to take lower doses of each agent and improves outcome better than monotherapy of the MAOI. They use these combos in people who are treatment-resistant to ECT.
  12. As of the DSM-5, major depressive disorder can be diagnosed as "single episode" or "recurrent," both "with psychotic features" (it's the worst/most severe form of MDD). So "psychotic depression" is a possibility, both in unipolar and bipolar depression. Happens to me rather often, actually (as a bipolar type 2, which is odd because you're not supposed to be psychotic at any point in bipolar type 2, but my pdoc still leans towards type 2). "Acute" psychotic features just means that they're either short-lived, i believe. Someone else with more knowledge on this might chime in.
  13. It really is a fantastic medicine. It holds my brain together when things are getting a bit too weird for me. Only do so if you think it could benefit you. No need to fix what isn't broken, you know? Best of luck to you!
  14. I started getting Zoloft withdrawal symptoms and increased anxiety when I tried to go down on the Zoloft (as instructed), so I went all the way back up to 100 mg Zoloft and I felt fine today for the most part. I finally got my Doral (sleeping med), and I think it's basically generic quazepam but a preferred generic brand of it since the tablets still say "DORAL" on them. It's... not as cracked up to be what I thought it would be... I'm sitting here almost 3:00 AM on here. Taking it with Belsomra 20 mg doesn't seem to touch anything. If I overdo the sleep combo thing, I sleep all day next day though, which is why I don't touch doxepin anymore... lol. Even though the Rozerem is generic now, my insurance still wants a prior authorization. T_T So screw that. My ADHD got pretty bad lately so I had protriptyline (Vivactil) added. It's an NRI TCA (secondary amine). I've taken it before with success, but the anticholinergic effects can get to me if I'm not careful. Psych meds: Caplyta (lumateperone) 42 mg 1 PO qam cc (still taking and doing well on) sertraline (Zoloft) 100 mg 1 PO qam Belsomra (suvorexant) 20 mg 1 PO qhs prn doxepin (Sinequan) 50 mg 1 PO qhs prn quazepam (Doral) 15 mg 1 PO qhs prn dextroamphetamine (Dexedrine) 10 mg 2 PO tid (60 mg) trifluoperazine (Stelazine) 5 mg 1 PO bid prn protriptyline (Vivactil) 10 mg 1 PO tid (30 mg) Neuro meds: Trokendi XR (topiramate ER) 50 mg 1 PO qam propranolol (Inderal) 20 mg 1 PO bid (40 mg) zolmitriptan ODT (Zomig-ZMIT) 2.5 mg 1 PO x1 prn, may repeat x1 in 2h prn, max: 2x/24h
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