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Everything posted by mikl_pls

  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.
  16. I had no idea! Such is likely not the case in Alabama where I live though. A bunch of tight-ass bible thumpers... I can't stand living here but it's where all my family is and it's all I've known. Anyway...
  17. Cabergoline, when dosed for hyperprolactinemia, which I assume is close to the same if not higher than doses used for sexual dysfunction, is relatively safe. It is only taken a few times a week rather than being a daily med. I think I read that 30% of patients on cabergoline will experience some sort of cardiovascular symptom, most commonly hypotension (I think). Bromocriptine supposedly has more side effects and requires a slower taper, and is less potent at dopamine receptors, but is probably safer in some regards than cabergoline. Cabergoline is newer and isn't as well-researched as bromocriptine. I guess what I'm trying to say is it's a crap shoot, and you could try either one first. My guess is that cabergoline is probably more effective for sexual dysfunction as it is used in male pornography stars to reduce or eliminate the refractory period, enabling them to have several orgasms one after the other in short periods of time.
  18. Less is good I guess for you. I'm sure 1.61 A1c was a typo, otherwise your average glucose wouldn't be 130 mg/dL. Unless there are other units for A1c I don't know about other than percentage. As long as your insulin resistance is minimized (which metformin is great for) to your body's natural insulin, and that your pancreas is still able to produce sufficient insulin (my dad, who's ravenously diabetic, has been on insulin therapy so long now, and is now using an insulin pump and has been for I don't know how long, that his pancreas no longer produces insulin, and is thusly completely insulin-dependent. His endo refers to him now as type-1 diabetes, but it's "acquired," and not congenital type-1 DM). Hopefully you'll never have to go on insulin therapy because from what I have seen, it is largely unpredictable as to what it does to your glucose levels if you don't eat with it as my dad is very bad about taking huge, heroically dosed boluses and not eating (his judgement is dissipating as his dementia worsens and may eventually need to be taken off the pump and put back on the sliding scale with my mom or me checking his glucose for him and dosing the boluses for him, and, eventually, if it gets bad enough, feed him). It can also wreak havoc on your body in many ways, one of which is that it causes extreme weight gain, especially the short-acting insulins. I'm really hoping that the increased dose of Keppra remains side effect free and continues to work for you. I do wonder though what happened to make you need this increased dose... I guess our bodies/brains/CNS can develop a "tolerance" to anticonvulsants, just as it can to most any medicine type. I've never heard of dose exceeding 3,000 mg/day, but I'm not surprised as I've read of someone taking 1,200 mg Lamictal before for epilepsy and going through one hell of a withdrawal syndrome when it stopped working and their neurologist recommended switching to another anticonvulsant. You're in my thoughts, @notloki. Keep in touch with us on your condition. Keep in touch with me too in PM's.
  19. So you have narcolepsy or a similar condition like idiopathic hypersomnia too?
  20. The only thing you'll likely notice different by taking Effexor at night (besides the withdrawals that start immediately after when you used to take your dose) is increased insomnia. For some people, it's paradoxically sedating. If you're sedated by it, you can gradually transfer to night dosing, but I don't think it will make a difference in your affective blunting. I second what you and @CrazyRedhead mentioned about using Prozac as a bridge to gradually cease the Effexor. After that, if the Prozac benefits you, you can stay on it so long as it doesn't stimulate you too much (Prozac is very stimulating for most people who take it), otherwise depending on the dose you can either taper or just stop taking it cold-turkey (the latter is for lower doses like 10-20 mg).
  21. The danger lies mostly in the supposed serotonin releasing properties of lithium and the agonism (stimulation) of 5-HT2A receptors of these two dopamine agonists, but the ratio of agonism of 5-HT2A receptors to any of the dopamine receptors bromocriptine in particular stimulates should not really be of any concern... Cabergoline is a little different. Its stimulation of 5-HT2A is pretty close in binding potency to the stimulation of dopamine receptors, and in high doses, 5-HT2B stimulation becomes a huge concern which can cause very serious cardiovascular side effects.
  22. It comes in 5 mg tablets that you could take once or twice a day depending, or halve them and take half twice daily. Alternatively, you may respond differently to long-acting versions... The lowest almost any of them come in is 10 mg, except Concerta which comes in 18 mg which is equivalent to 12 mg Ritalin (not all of the methylphenidate in Concerta tablets is absorbed...). There is also a transdermal patch, Daytrana, that is mostly used in pediatric patients, but can be used in adult patients too. Whether your insurance pays for it is the question. Even though it has been out for a while, my insurance chose to stop covering it years ago. Adhansia XR (25 mg, works for 16 hours, either biphasic or triphasic release mechanism) Aptensio XR (10 mg, works for 12 hours, biphasic release mechanism) Concerta (18 mg, works for 12 hours, continuous release mechanism) Cotempla XR-ODT (8.6 mg, biphasic release mechanism, indicated only for pediatric patients) Jornay PM (20 mg, taken in the evening, delayed release mechanism where it is supposed to start acting right when you wake up and then work all day) Metadate CD (10 mg, works 6-9 hours, biphasic release mechanism) Metadate ER (?) Quillichew ER (20 mg, biphasic release mechanism) Quillivant XR (extended release liquid form, the dosage of which I suppose depends on how small it can be measured, they recommend starting at 20 mg, works for 12 hours) Ritalin LA (10 mg, duration 6-9 hours but often falls short of this and needs to be dosed twice daily or accompanied by an IR dose in the afternoon, biphasic release mechanism) Daytrana (10 mg per 9 hours, indicated to be applied for 9 hours per day and off for 15 hours but I suppose duration can be tailored individually, it can be removed at any time during the day if needed, needs to be applied 2 hours prior to desired effect, and duration remains active 3-5 hours after removal, so it actually acts anywhere from 12-14 hours, must be titrated from 10 mg/9 hours regardless of oral methylphenidate dose, max dose is 30 mg/9 hours, I'm not sure how these dosages translate to oral dosages... there are websites that claim to offer equivalencies, but they're all different...) There's also dexmethylphenidate (Focalin, Focalin XR) which is twice as potent milligram per milligram than methylphenidate is. Max dose of IR version is 20 mg, whereas max dose of XR version is 40 mg for some reason; minimum dose of both are 5 mg/day. Alternatively, there are a host of other amphetamine products in the US that may work better for you if any dose/form of methylphenidate has this flattening effect on you: Adzenys ER (mixed amphetamine salts ER liquid, duration 9-14 hours) Adzenys XR-ODT (mixed amphetamine salts ER-ODT, duration 9-14 hours) amphetamine/dextroamphetamine (Adderall) amphetamine/dextroamphetamine ER (Adderall XR, 12 hours biphasic release) dextroamphetamine (Dexedrine tablets, Zenzedi brand-name only tablets with a wider assortment of dosages, ProCentra instant-release liquid) dextroamphetamine ER (Dexedrine Spansule, acts for 6-8 hours, may be dosed once or twice daily, IIRC is biphasic release mechanism with beads that digest with different pH's associated with different parts of the digestive tract unlike having instant- and extended release beads like Adderall XR) Dyanavel XR (mixed amphetamine salts ER liquid, duration 10-15 hours) Evekeo (amphetamine) Evekeo ODT (amphetamine ODT, pediatric indication only) methamphetamine (Desoxyn, while instant release, may be dosed once daily as duration of effects is generally longer than other amphetamines) Mydayis (amphetamine/dextroamphetamine ER, duration up to 16 hours, essentially a triphasic release system with IR, ER lasting 12 hours, and another IR dose that acts 12 hours after ingestion for an extra 4-6 hours of duration) Vyvanse (lisdexamfetamine, prodrug to dextroamphetamine activated by digestion, acts up to 12 hours but for some falls short or may act longer than this, comes in capsules and chewable tablets, capsules most common form) I'd start with IR Adderall or IR Dexedrine and move to an equivalent extended-release version if you wish for once-daily dosing though twice daily dosing is possible with some forms of ER amphetamine-based stimulants (Dexedrine is limited to pretty much Dex Spansules and to some extent Vyvanse, the highest dose, 70 mg, of which metabolizes to approximately 20 mg dextroamphetamine per day, whereas the max dose of Dexedrine, Dexedrine Spansules, Zenzedi, and ProCentra is 60 mg/day; Adderall can be switched to just Adderall XR or any of the other extended release mixed amphetamine salts products, but dosage will be different and re-titration from lowest dose is recommended, however there are equivalencies for most; methamphetamine is sort of a drug of last resort for ADHD, narcolepsy, and obesity because even at therapeutic doses it is mildly to moderately neurotoxic to serotonin neurons and I believe at higher doses quite neurotoxic to dopamine neurons, especially in the nucleus accumbens). Dextroamphetamine is more potent of an appetite suppressant, more potent of a CNS stimulant, and less potent of a peripheral nervous system stimulant than racemic amphetamine is. Dextroamphetamine is relatively more dopaminergic and less noradrenergic than amphetamine, which is roughly balanced in its stimulation of dopamine and norepinephrine release, possibly more noradrenergic if anything else. Methamphetamine is actually no more dopaminergic than dextroamphetamine, less noradrenergic (stimulates the peripheral nervous system less), and way more serotonergic than any of the amphetamines on the market (which may explain its neurotoxicity to serotonin neurons). All amphetamines, like methylphenidates, are Schedule II.
  23. Lower doses of Remeron make you sleepier and hungrier than higher doses do. You may try taking the full 30 mg again and see how your sleep vs appetite is on that dosage. If I recall, you weren't sleeping well on that dose though. Restoril (temazepam) is a benzo, but in the US comes in a capsule. I suppose you could empty the contents of the capsule and take it like that? That would be something your NP would have to address, possibly the bariatric doctor who performed your surgery or who is following up with you. Unfortunately, being a benzo, your NP wouldn't be able to prescribe it and would have to go to the pdoc who presides over them. It's only schedule IV and isn't renowned for abuse or anything like Xanax is (I believe mistakenly) so often. The "sedative/hypnotic" benzos are as follows: Short acting: triazolam (Halcion), oxazepam (Serax) Intermediate acting: esatazolam (ProSom), lorazepam (Ativan) Long-acting: quazepam (Doral), flurazepam (Dalmane) As has been mentioned already, alprazolam ODT (Niravam), basically orally disintegrating Xanax, is extremely effective (to me far more effective than the original tablet form), and helps immensely with insomnia for me (at 2 mg, but I'm extremely benzo-resistant). You definitely need something to help you sleep that won't increase your appetite though. Most meds that act on the H1 histamine receptor will increase appetite. Rozerem (ramelteon) is a brand-name only med that works on melatonin receptors, but it has been debated as to whether this is any more effective than taking melatonin supplements. Doxepin (Sinequan), in capsule form as low as 10 mg, or Silenor, in micro-dose tablet form as low as 3 mg, is a TCA that really is predominantly a very potent antihistamine. If taken in low doses (10 mg and below), it is actually more effective than higher doses, especially the micro-dose form Silenor. It is said not to increase appetite or cause weight gain at these low doses. I've taken a range of doses of the Sinequan form from 10 mg to 75 mg for insomnia, and there is definitely a dose-dependent hangover effect... Keeping the dose as low as possible while keeping effectiveness is I think crucial for this medicine to work well. Hydroxyzine hydrochloride (Atarax) or pamoate (Vistaril) is an antihistamine with a few more mechanisms of action like 5-HT2A antagonism which is said to help with anxiety. It can be used as a sedative or anxiolytic. It may put weight on you, but if you keep the dose low (like 10 mg Atarax or 25 mg Vistaril/Atarax), it might not do that. For some people, even low doses will knock them out silly. Doxylamine succinate (Unisom?), an OTC sleep aid which can be a little pricey, is said to be as or more sedating than some barbiturates. I've personally never had luck with it, but that's just me. It has much less side effects than diphenhydramine (Benadryl, Zzzquil, some forms of Unisom so be sure to look at the label on the back). There appears to be a brand new medicine as of December 2019, Dayvigo (lemborexant) which my guess is a similarly acting medicine on orexin receptors as Belsomra (suvorexant) is just by its "generic" name. It will of course be brand-name only when it comes out, and likely Schedule IV just as its apparent cousin medicine Belsomra is. Certain antipsychotics are used for insomnia, but they can have effects not only on appetite and subsequently weight, but metabolism too, inducing type 2 diabetes over time. Low-dose, instant release quetiapine (Seroquel) (25-100 mg) is said to be more sedating and cause less weight gain than higher doses of both instant- and extended-release quetiapine (Seroquel and Seroquel XR). Low-dose olanzapine (Zyprexa) (2.5-5 mg) will knock you out, but it is one of the most infamous for weight gain and diabetes (just below clozapine (Clozaril)). In my experience, my pdoc has prescribed Saphris (asenapine), and despite being heavy on blockade of H1 and 5-HT2C receptors, it never really caused any or minimal weight gain at 5 mg sublingually at night (it tastes horrible though). It worked fast and kept me asleep (sometimes for too long especially at first), but for me the sedative effect wears off very quickly if I take it every night for too long, like a week or two is for as long as I can use it at once. Otherwise it does benefit anxiety and depression; however, with me, if I take it for too long at a time (several weeks to at least a month), it starts making me feel extremely dysphoric and "weepy." It's brand-name but not for much longer as its patent is expiring, so generic asenapine will soon be available. Latuda (lurasidone), while not typically used as a sedative, has sedating properties especially in high doses (low doses can be even stimulating and cause insomnia). 60-120 mg doses ranged from moderately to extremely sedating depending on how high the dose was. It must be taken with food in the evening (350 calories is the minimum requirement). I take my Latuda at 4 PM, so I take it with a small snack before eating a smaller portioned supper. It's not a "knock you out" kind of sedation (at least below 120 mg), but rather a pleasant, relaxing, "let you sleep" type sedation. It may be worth a try if the above aren't options or don't work. It's very weight friendly and metabolically friendly, probably one of the most friendly of all atypicals. It has no affinity at all for the H1 receptor, so its sedation may be primarily through its antagonism of 5-HT2A receptors, similar to trazodone (except without the stimulating metabolite mCPP with trazodone...). If all else fails (literally everything): Short-acting barbiturates that were used once for insomnia have either been taken off the market, made prohibitively expensive, or pharmacies have decided to quit carrying and ordering them. The only barbiturate on the market that you can get I think is phenobarbital (Luminal) which is a long-acting barb, and isn't necessarily indicated for insomnia, but has an indication for "sedation." I think this is likely for presurgery sedation or something. But I don't see why it wouldn't be able to be used for insomnia in severe, intractable cases where nothing else has worked. It would very likely cause next-day hangover and cognitive/brain fog. There used to be a medicine called chloral hydrate but I don't think it's manufactured anymore. There is a migraine medicine that is a combination of meds, one of which metabolizes into chloral hydrate. Whether it's enough for insomnia I don't know, but it may actually be stimulating due to the noradrenergic effects of one of the other meds in it. Meprobamate (Miltown) is another med that used to be used for anxiety and sometimes insomnia, but it is very, very rarely prescribed. Carisoprodol (Soma), a scheduled muscle relaxant that is being prohibited from being prescribed to new patients left and right due to its addictive nature and narrow therapeutic window, much like barbiturates and barbiturate-like substances, metabolizes into meprobamate, which itself acts very similarly to barbiturates.
  24. If anything, it would inhibit appetite, but I never experienced that. One side effect of Belsomra to be aware of especially is that it can cause sleep paralysis with hallucinations which can be pretty terrifying. I never had that (have experienced it many times before though!), but that's just me. Edluar and Intermezzo (Intermezzo is for middle of the night waking and comes in much smaller doses than Ambien/Edluar). Also, Ambien has an oral mist version, Zolpimist. It tastes horrible, but I'm sure that's an abuse deterrent. Yes, I will say that Niravam is the best benzo in the world. My pharmacy can't get it unfortunately for some reason. When I was still going to CVS they would have to order it every time. That and sometimes they'd just put it in a ziplock baggie as they come in blister packs. That looks totally legit... lol
  25. I second getting a service dog if you can. I hope your recovery is thorough and quick, @notloki. Keep us posted on how you're doing when you can. Has your neurologist figured out why you're having the seizures? I know you said at one point he thought it was hypoglycemia from your diabetes meds and that you were going to switch one of the meds to a different one. Any news on what your neurologist thinks is going on?
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