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About mikl_pls

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    Alabama, US (not native Alabamian!)

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  1. Sometimes pdocs combine aripiprazole with antipsychotics that are known to increase prolactin. Just a thought. Unfortunately I wasn't able to locate a list of antipsychotics available to you in India.
  2. The appetite and diabetes problems associated with Zyprexa are nothing in comparison to clozapine. Clozapine can really screw you up big time. Don't fix what isn't broken. If you get diabetes, cross that bridge if you come to it. There are plenty of medicines to address it. You're already on metformin which helps protect against it. There are other -pine meds that could possibly benefit you.
  3. Sorry that didn't work for you. You may be like me and be tolerant to anything GABAergic in its mechanism of action, including benzos. Also, like @Iceberg said, you may need 30 mg. It's definitely a major thing to consider. My dad and brother both had lap band surgery, and they had major complications with it (their band slipped) and they constantly had issues keeping food down while eating and I'm an emetophobe. I'm terribly sorry for your loss, @Beth45. Losing a friend is like losing family. Have you had sleep issues before the gastric surgery as well as mood regulation issues to this degree? It definitely sounds complicated to manage afterwards. I definitely will do my homework and weigh my options before jumping to any decisions. I'm not ready to switch yet, I'll just be sure to ask him to check my rT3 levels next time I see him. Very sorry to hear that. Big hugs!
  4. I'm glad you were able to get a prescription for the Restoril. I'm also glad you were prudent with the dosage and opted for a lower dosage. That was very wise of you and demonstrates that you aren't out for a "fix" to your prescriber—you can always go up in dose if the 15 mg isn't effective. They make a 22.5 mg capsule, but most often they just go straight up to 30 mg. I personally started at 15 mg and while it was effective at first, I quickly developed a tolerance for it and needed 30 mg by my next prescription. It was very effective for a very long time though at 30 mg for what it's worth. Many people can take benzos for sleep and not get addicted/dependent on them or develop a tolerance to them. If you end up needing to come off of it, definitely taper off of it as gradually as you can to avoid rebound insomnia. If you still experience insomnia, there are many alternatives that can help that won't affect appetite adversely. I have recently started to consider gastric sleeve surgery. I did very well several years ago on the keto diet and lost almost 40 lb IIRC. I got as close to my goal weight as I ever have. But a med switch threw me off my diet and I gained all the weight back and then a ton more on top of that. I've lost a good bit of it since then, but am still very obese. I've tried getting back on the keto diet, but I can't stick with it ever since I had to have my gallbladder removed. The high fat content of the diet I think is what upsets my stomach and makes me not want to eat which then throws me back into my old bad eating habits. My problem isn't necessarily portion control, but rather I just eat the wrong foods, and while I'm eating small snack-sized to very small meal-sized portions several times a day, which some say is a good thing to do, I'm probably eating too often. That combined with eating the wrong things is probably what is keeping me from losing weight. That and my thyroid is so out of whack. My TSH is extremely suppressed, but T3 and T4 is either low normal or right in the middle of normal. I've never had reverse T3 (rT3) checked before, but I bet it's high, and high rT3 is said to cause problems with losing weight and cause fatigue and whatnot. I have a good endocrinologist, but he isn't being as thorough as I'd like him to be. (Not checking rT3, not checking to see if I have central hypothyroidism, i.e., is my hypothalamus telling my pituitary to secrete TSH, or do I have something wrong with my pituitary like an adenoma?) Anyway, that's my rant for the day too. I'm so happy we have been of help to you. It always makes me happy to see when this community is of help to someone, because god knows it has been of immense help and support for me. I don't know where I'd be without this community, it's such a healthy place to turn for advice or just post in your blog to vent or just post about how your day went or whatever. Always feel free to ask any questions you have—we're here for you! Also, any advice you may be comfortable with sharing about the gastric sleeve surgery/gastric bypass (not sure what the difference is or if there is a difference) I'd be very interested in hearing about, whether it be on here or via a private message, whichever you're more comfortable with.
  5. I really hope you tolerate this change in regimen well without any side effects. Is this second pdoc the hospital's pdoc? (Are you already hospitalized?) Could it be that you may have to get off of clozapine entirely? Risperidone may not be a suitable substitute for clozapine due to hyperprolactinemia at the dose that might be needed to control your symptoms, and for the fact that the risk for extrapyramidal symptoms is equal to that of haloperidol (and is dose-dependent, just like hyperprolactinemia), but there's got to be something out there that can help you. There also has to be something to take for your OCD that doesn't require you to take the higher dose of clobazam. Perhaps just backing off on the clozapine and/or replacing it with another antipsychotic might eliminate your obsessive symptoms? Is the Lexapro replacing the paroxetine CR or augmenting it? If you don't mind my asking, where do you live? I'd like to research the medicines available to you in your country. The fact that you have tried amisulpride tells me you're certainly not in the US. (US FDA is so picky about what they approve, yet they also approve things that are very dangerous or completely ineffective.... ugh...) Either that or you could research on your own and make the list yourself if you like. I just thought I'd offer to do it to take some stress off of you since you have enough going on already.
  6. Wow, I had no idea... lol. Derp. I learned another way to multi-quote tonight. Caplyta hits pharmacies in March! Every time I type or write that, it looks so wrong, and no matter how many times I check the spelling, it still looks wrong... lol
  7. Wow, it sounds like you're really having a good response to Zyprexa! The appetite thing I think is almost unavoidable though. Some have it to lesser or greater degrees than others. 10 mg just taken for one day makes me binge eat uncontrollably for several days afterwards. 10 mg may be sufficient for you, but if you continue to have the "aura"-like hallucinations, perhaps 15 mg would be your sweet spot. Hopefully you wouldn't have to go to 20 mg or go off-label and go higher. From what I've read, Zyprexa really should not be used as a long-term maintenance med unless nothing else works due to its diabetogenic mechanism of action. You can eat as healthily as you can, exercise as much as you can, etc., but it will still mess with glucose metabolism as well as cholesterol and triglycerides if you take it for several years. At least, that's my understanding. I know of someone who took it long term and of course got diabetes but even had to have a toe amputated. I'm not by any means trying to fearmonger about this medicine because it works fantastically for many people and enables them a quality of life they wouldn't be able to have without it otherwise. Just be very careful and have regular testing of fasting glucose and A1c done with your GP. Metformin is a great prophylactic idea as it will help maintain insulin sensitivity, and will do so in a dose-dependent manner. I heavily recommend the extended-release form as the IR form is very hard on your GI system. Metformin has many other benefits too, such as having general anti-aging properties.
  8. Maybe 10 mg or 20 mg after you get off the Effexor would be all you need. Prozac is typically not a "numbing" SSRI for most people.
  9. According to my pdoc, mixing stimulants particularly in high doses and benzos particularly in high doses can be dangerous to the heart. The doses must complement each other: if one is high, the other must be low, and vice versa. I don't know how much truth that holds, but that's how she used to prescribe both agents to me when she used to prescribed stimulants and now when she used to prescribe benzos to me. I pissed her off one day by calling her out on her inconsistent rules on stimulant prescribing concerning dosage, and she jumped down my throat pulling the "I'm the doctor here" card, citing several medical non sequiturs that had nothing to do with stimulants and their dosing, and has not prescribed a stimulant to me since. I haven't asked either. Benzos are off-limits indefinitely because of my recent suicide attempts.
  10. Also I thought I'd mention that there is no shame in taking several psych meds. The only time the quantity becomes a concern is if the combination is either not helping or making one worse, the individual can't afford that many meds with or without insurance, and/or the presence of several drug-drug interactions that could result in toxicity.
  11. Amphetamines have documented (in very old literature) anticonvulsant properties, and used to be prescribed alongside phenobarbital to enhance its efficacy and alleviate the sedation it causes back when it was virtually the only med for epilepsy. This literature has long been forgotten as amphetamines have been lumped into the methylphenidate-based stimulants as being pro-convulsant. Just like how all the MAOIs' and atypical antipsychotics' side effects have been lumped together as well as their clinical effects, despite the individual meds in their classes having their own unique side effect and clinical effect profile... Psychiatry is getting lazier and lazier and not making much progress.
  12. Indeed they are very hit or miss. Neurologists are too. My mother had one who, I'm not going to get into it at all because he was such an ass to her and so mean to her when she had her TBI and concussion that I almost beat the shit out of him and strangled him to death. It still makes me violently angry to think about to this day, and I can't let go of it. The triage nurse who was in full army uniform was also very harsh. He yelled at my mom because her instructions for her Xanax said to take half to a whole tablet as needed, and he kept asking "which is it?" and my mother and I kept saying "it's both, it just depends on how much she needs," and he was visibly getting very angry and finally his whole body's muscles all flexed, his nostrils flared, and his eye brows went down as he practically yelled "WHICH ONE?!" to us, which was very alarming as I thought if we said it again he would've assaulted us. That whole office was full of bad vibes... God almighty... Dr. Mulpur in Huntsville, AL. I will never forget that name. I avoid it like the plague, but if I am ever confronted with him and he pulls that shit with me, he'll never forget why not to do that with his patients.
  13. Lately I've noticed texts, posts, and private messages getting increasingly longer and longer and having a very hard time staying on topic the worse my illnesses get, and they're getting ever worse by the second, declining vastly beyond where I was at my prior worst.
  14. I was originally diagnosed with idiopathic hypersomnia by my first sleep doc, who was really just a GP/FP who could read and interpret sleep studies. He wasn't willing to prescribe Dexedrine above 15 mg/day, but did 30 mg/day what I was on with my pdoc at the time (when she would prescribe me stimulants) and said that would be the only Dex prescription he would write like that. He wrote me a Nuvigil 200 mg prescription, but didn't follow up with the prior authorization necessary for my insurance to let me have it. So I just gave up with him. I saw a second sleep doc who was a total dick because he literally cussed me out and scorned me for being on so many meds at once, telling me I didn't need to be on most of my meds if I have a seizure disorder, which isn't set in stone as my neurologist has me down for PNES (psychogenic non-epileptic seizures) as my diagnosis. Despite me telling him that, he still was very gruff with me about my meds, saying I didn't need to be on most of them if I have seizures. In his defense, during my sleep study (which he did a sort of less complicated EEG montage than most EEGs), he captured what he interpreted as four seizures during my sleep. He couldn't tell me whether they were focal or generalized or anything, and said I needed to get a neurologist. My first neurologist was kind of a quack and finally quit her practice to do research on pediatric epilepsy, so I was without a neurologist for a while. I found my current neurologist, and even when showing him the rather fuzzy and almost unreadable sleep study report with printouts of the EEG montage of all four seizures, he said "those aren't seizures, that looks like myoclonus," which is either another type of epileptic seizure (which the way he described it sounded like he was actually referring to myoclonic epileptic seizures) or it refers to periodic limb movement disorder which I feel strongly I don't have and was not what he was referring to. My second sleep doctor refused to prescribe stimulants at all, saying "I just prefer to stick to my sleep medicines," and prescribed me iron for an iron deficiency I didn't have which eventually I couldn't take anymore because of rather a bitter, metallic taste in my mouth constantly as well as certain personal side effects I was having from it, a tiny dose of ropinirole (a dopamine agonist) for some supposed Parkinsonism that I had which severely exacerbated my already bad impulsiveness, and Belsomra for sleep. I stopped seeing him and stopped trying to see a sleep doc until recently. He also had me down as "hypersomnia unspecified." My third sleep doc whom I saw earlier this month wanted me to get off ALL of my psych meds and have yet another sleep study. I told him that I could do that to an extent, but getting off my psych meds at that point in time (and still now) was not an option as I have been suicidal for the past month and a half. He said there was nothing he could prescribe me. He told me the Dexedrine I was on is worsening my bipolar (it's not), causing my seizures (it's not, I still had seizures, at time more often than now, when I was off stimulants, and amphetamine has documented anticonvulsant effects that have been long lost in the medical literature as amphetamines have been lumped in with methylphenidate as being pro-convulsant), and a third thing I can't remember, and that unless I had a note written from my psychiatrist and neurologist both, he would not prescribe any stimulant to me, and if he did, he would not exceed the max dose. He listed a whole bunch of meds, some of them that I had been on or was on at the time, and one my NP tried to prescribe me, Wakix, but said "oh you can't take this because you don't have narcolepsy." Then he just ended the appointment after like 5 minutes of talking to me. They asked me to schedule a followup appointment a month out, which I did at first, but I called after I left and said "forget the appointment, he didn't do anything for me and that appointment was a waste of money." I don't know why he wanted to follow up with me, I guess he assumed that I would try to get those letters of approval... He didn't ask me to, he just said those were the only circumstances under which he would prescribe anything. I don't know what good this post is to you but that's my experience with sleep docs... 😕
  15. In my experience, NP's in virtually all specialties, are more attentive, take longer, consider requests/suggestions from patients more readily, are more humble, etc. They are generally better than the doctor(s) who preside over them. I almost exclusively see one NP in particularly at my family doctor's practice. He has to go through the main doctor to prescribe my Dexedrine. The GP there for a while prescribed me a max of 20 mg Dexedrine, then stopped, saying "I'm going to default to your pdoc on this and say she needs to be the one to prescribe this." So I started seeing the NP and he was way more open to Dexedrine, hence why I'm now on 60 mg/day. He prescribed me Nuvigil to augment it when 60 mg became not enough, and even tried prescribing Wakix, a brand new med with a novel mechanism of action, but he didn't know you have to fill out a form to request a prescription from their specialty pharmacy rather than writing a prescription and handing it to me. When I told him this at my next visit, he didn't seem as open to trying to fill out the form necessary, probably because he couldn't do it on his own, and probably because getting just the Dexedrine for me is hard enough for him. Wakix isn't scheduled though which was his main justification for prescribing it (as he didn't have to go through my doctor). That's my experience though. I prefer to see NPs for the most part. I have never seen a psych NP before, but I can assume the same goes for them too. My pdoc already listens very well and, well, used to be open to suggestions, but she is becoming very surly and terse with me, and often cuts sessions very short whereas she would give me as much time as I needed before. I guess she is probably getting closer and closer to retirement and probably even burn out is setting in. I don't blame her, she works literally 24/7 into the early morning hours very often. She has such a heavy patient load that I often don't get to see her until anywhere from 12 to 2 AM, when my appointment is usually 6 or 7 PM. She keeps me for last, she said because she wants to spend more time with me if I need it as she regards me as one of her sickest patients, but now that is not the case, so I don't know why she keeps me last if she's only going to give me a max of 30 minutes while she takes other people less sick than me and lets them go on for 2 hours or more. Then when I get out after 30 minutes, one staff of the office in particular chews me out for taking "so long," and that "I'm going to have to do better than this in the future." It really miffs me when she does that. She's very bossy and gruff with me.
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