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About mikl_pls

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    Alabama, US

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  1. ECT is the only thing I can think of in an instance like this, but I imagine you've already tried it.
  2. Makes sense. Pharmacokinetic interaction... Latuda is faaar less likely to induce hyperprolactinemia than ricsperidone. Brest cancer, according to my pdoc, can be a complication of severely elevated prolactin levels.
  3. Thanks everyone. I tried to get my pdoc to prescribe Metadate CD, but she is apparently done prescribing stimulants for me. I'll have to go through my NP, who has to go through my doc, who is opposed to prescribing those meds when I have a pdoc. But I worry if I tell them my pdoc won't prescribe them that it will come across that I do something weird with them like abuse them or sell them. My pdoc added pindolol 5 mg for depression (in lieu of propranolol) and added Seroquel 25 mg for sleep. She also switched my benzo from Tranxene to regular doses of Xanax.
  4. First and foremost, what are all the meds you are taking, their dosages, and how you take them? How well controlled is your myasthenia gravis? Are you taking Prozac + Trintellix concurrently? Which beta-blocker did you get prescribed? THC in weed is bad for your heart, so be careful if partaking in that. I would recommend pure CBD oil, either in tincture form to take sublingually, or to use with a vape (but you'd have to buy a vape setup if you don't have one). CBD oil can be a bit pricey, just to let you know. Hydroxyzine is an antihistamine with 5-HT2A antagonism, so it is actually going to be very sedating. Do you know if it's Vistaril or Atarax (capsule or tablet)? Just curious. What dose of it did you get prescribed? Lunesta works similarly to benzos, so that might not be a good sleep med for you. I would be willing to say low-dose trazodone, but that can prolong QT interval; however, in low doses that are used for insomnia, I doubt it would cause anything to happen. I would still run this by your cardiologist though before asking about it. Low-dose Seroquel would also be an option, but that, too, can prolong QT interval. I would worry about your heart with those meds. Probably the most benign that has been suggested thus far would be low-dose doxepin (I mean 10 mg and probably no more; it's more effective in lower doses for sleep anyway), Belsomra (as aforementioned is expensive but if your insurance covers it, there's a copay coupon), low-dose trimipramine (like 25 mg, which can be hard to find if not impossible as they're apparently phasing this medicine out), low-dose nortriptyline (10-25 mg, but this may cause heart problems), low-dose amitriptyline (10-25 mg, but this too may cause heart issues), and Vistaril/Atarax (which you've already been prescribed... it could be used for both anxiety and insomnia). It doesn't sound to me like you need an antidepressant (although some of the aforementioned sleep meds are antidepressants, but can be used as hypnotics in low doses), but I'm no expert. I think if your insomnia and anxiety were ameliorated, your depression would remit and you would be back to yourself. However, antidepressants are used for anxiety, hence being prescribed Prozac and Trintellix (I would take only one or the other if it were me). If you want an antidepressant... Of the SSRIs, Celexa and Lexapro are probably no-no's due to your heart conditions. Prozac and Zoloft can cause unwanted stimulation in some people with anxiety, as well as insomnia. I would be willing to bet the safest of the SSRIs and for your side effect profile would be Luvox (fluvoxamine), which is rarely used, but it's taken usually at bedtime or in divided doses. Once you get up to 100 mg (if you get that high), they make a controlled-release capsule (Luvox CR) for once daily dosing at night. The SNRIs might not be a good idea because of your heart conditions. The SMS's, Viibryd and Trintellix would be incompatible with your GI issues. Depakote can actually help a little with anxiety in some people, but it can also zombify you (as it did my dad and me). Another alternative is gabapentin (Neurontin), not sure if you've ever taken that before. Lyrica (pregabalin) is like gabapentin but isn't used as much for anxiety in the US as it is in Europe, for which it's actually approved for that indication. If it were me prescribing, which I'm not because I'm not a doctor (lol), I would give you these meds: Luvox 25 mg at bedtime for a few weeks, then move up to twice a day for 50 mg (start low and go slow with family history of bipolar) Desyrel (trazodone) 50 mg 1/2 to 1 at bedtime (take it while you're in bed, because if you've never taken it before, it will knock you out in about half an hour and you might not be able to make it to bed lol) OR Sinequan (doxepin) 10 mg once at bedtime (not so great at sleep initiation as it is with sleep maintenance) Neurontin (gabapentin) 100 mg or 300 mg 3 times per day (this can literally make you feel drunk, so starting with 100 mg 3x/day and moving up to 300 mg might be prudent.) Zofran (ondansetron) 4-8 mg every 4-6 hours as needed (have to be careful with this because it can also prolong QT interval, this would be for the nausea) OR, since you have breast cancer... you could qualify for a lot more nausea meds... aprepitant 125 mg + Zofran 4-8 mg + dexamethasone combo If you still needed more... Thorazine 10-25 mg as needed Compazine 5 mg as needed Trilafon 4-8 mg as needed Some other anti-emetic not working at the receptors the aforementioned do... And if your myasthenia gravis weren't well controlled... Mestinon 60 mg every 8 hours and increase as needed OR a corticosteroid (which would work well to suppress nausea) and/or some form of immunosuppressant.
  5. Yeah, because it works, and it isn't bad for you! lol... I believe OP is already on Paxil CR, but perhaps increasing the dose might help @clinic? Do you think you could handle a dose greater than 37.5 mg? Like 50 mg? The max is 75 mg/day for panic disorder and 62.5 mg for MDD.
  6. There is a medicine called "etizolam." I don't know where all it's available, but it's definitely not available in the US. It's technically not a benzo, but a thienodiazepine derivative which is a benzodiazepine analog. (It's a thienotriazolodiazepine.) Brand names include Etilaam, Etizest, Pasaden, and Depas. I believe it's actually a research chemical, but it's not controlled in some countries. It has a sort of "reverse tolerance," wherein it becomes more effective the longer it is taken. It tends not to cause cognitive disturbance. Basically it has a reduced liability to induce tolerance and dependence compared to the classical benzodiazepines.
  7. I know a lady who goes to my pdoc's office who has VNS for seizures. It has almost completely ameliorated her seizures (which are very refractory), but when the VNS kicks in, she sometimes gets coughing spasms to the point of emesis, and it makes her voice kinda hoarse. I don't know how well it works for her psychiatric issues (if she has any) though. While it works fantastically for her, it does have complications. That's all I really know about it.
  8. Vraylar and its active metabolite have veeery long half-lives (2-5 days for cariprazine, 2-3 weeks for active metabolite desmethylcariprazine). It takes 5 half-lives for a medicine to be considered either steady state (while taking) or to be eliminated from the body (after ceasing). 2-5 days * 5 half-lives = 10-25 days for the cariprazine (Vraylar), and for its metabolite... well... 2-3 weeks * 5 = 10-15 weeks. So you may still suffer side effects from Vraylar for about a month and a half to two months.
  9. IME, if I vape too much CBD, I get sleepy. That's just my experience, and I'm not saying that's the reason for your fatigue. Klonopin can possibly be the culprit, but I understand you need that. BuSpar can be increased further than the max dose unless your insurance won't allow it (quantity limit). I was on 90 mg when I was on it. It was very stimulating on that dose, but in the wrong way lol (at least for me).
  10. Yes, they are indeed rough drugs to take, but hopefully low doses wouldn't cause too many side effects, especially the cardiovascular valvulopathy associated with cabergoline... My dad has been on Neupro patch for a number of years and has a prolactinoma and it seems to control his prolactin. Perhaps one of the non-ergot derivative dopamine agonists would be a better fit, if and only if a dopamine agonist were to be indicated. I was just concerned about OP being on two AAPs concomitantly. But at the same time, a dopamine agonist may reverse the benefits of the AAP. @clinic, is there any other AAP you could try besides risperidone, or is this what works for you and only what works for you for now?
  11. A combo of aripiprazole, sertraline, desipramine, and dextroamphetamine. Oxcarbazepine may also play a part in it too.
  12. Would a low dose of bromocriptine or cabergoline also be useful, or would that be too much dopamine agonism? I've read articles about using them with antipsychotics, but of course can't produce the sources as my bookmarks are in severe disarray... Also, I should mention that paliperidone (Invega) does the same thing as risperidone to prolactin, so if your pdoc wants to switch you to that to "improve" your prolactin thinking it may cause less elevation in prolactin, it won't. My pdoc has patients who have been put on paliperidone by other pracitioners whose prolactin levels are through the roof, usually emergency room physicians putting them on Invega Sustenna... Elevated prolactin can not only cause galactorrhea and gynecomastia, but increase odds for breast cancer in both men and women.
  13. My first episode like this happened several years ago (before I was on an antipsychotic). It was storming very heavily, and I had an image of an airplane being struck by lightning and crashing into our house and only killing my parents, leaving me behind without them. I was too scared to wake them up, so I started pacing madly around my room in tears. I eventually curled up in the fetal position under my bed with the weather radio on in my arms and eventually fell asleep. When I told my pdoc about this, she was like "yeah, let's try Latuda." (She had already discussed possibly adding Latuda to my cocktail.) This was my first AP, 40 mg Latuda. It took a little adjusting to being on an AP, but eventually I was more myself than I had been in years according to my family (most of my family except one who is vehemently opposed to psychiatric meds, who said it caused negative side effects, but he doesn't see me except for special occasions or deaths in the family...). Anyway, I think there may be something to the "delusion" aspect. I also think there may be something to the "OCD" aspect. According to my pdoc, the two can go hand-in-hand, as for a little while (I won't go into too much detail), I was having what she called "psychotic preoccupations," which she treated with loxapine at my request. (She was going to add an AP to my current one, which I think was Abilify at the time still). I will say that loxapine killed my psychotic preoccupations off like they were nothing. I was happy again, I was happy with who I was, etc. I should've probably taken it regularly as my psychotic depression was OMEGA bad, but I waited until I was in the hole to take the loxapine, and it was the lowest dose at that (5 mg). I probably needed more too. Anyway, I hope this has given you some insight. I hope these intrusive images and ruminations are ameliorated by the increased risperidone. Good luck! Keep us posted!
  14. It's just out of the blue depression that has gradually set in and is getting worse. That's very true. Abilify 20 mg is my current AP. It is my brain glue, and nothing else seems to work. I go bananas if I try to lower it or come off it. Going from 30 mg to 20 mg was scary enough. Well, this started before my BF turbulence. Also, FWIW, he has become a lot more affectionate since I told him "I love you." He also is sure to keep his dog under control when we show affection for each other (i.e., make sure he's in another room, put his foot on his back and scratch it with his foot, etc.)
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