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  1. Interestingly enough, when they came out with Epidiolex (prescription CBD), the parents whose kids participated in the clinical trials for Lennox-Gestaut and other treatment-resistant epilepsy noted that the over the counter CBD extracts they had been getting previously until CBD was released as Epidiolex were actually more effective than Epidiolex at controlling their children's seizures. They're thinking this is because the over-the-counter CBD oils that the parents were getting originally had more THC in them than the purified, pharmaceutical grade CBD (Epidiolex) which is heavily filtered of all other cannabinoids including THC. The extracts they were getting before didn't have enough THC to intoxicate their child, but scientists are now seeing that CBD probably works better for epilepsy with just a LITTLE THC on-board as well. In essence, THC has its own anti-epileptic effects in conjunction with CBD. In your context, @Ethansmom, what is a "little" THC exactly? Like do you know how much CBD and THC were in each gummy or in the package as a whole? The CBD can be sedating but pair it with just a little bit of THC and it can make for a "couch-lock"
  2. you definitely can't discount the effect that good ole fish oil has on the mood. There's lots of evidence that starting high-potency fish oil can actually precipitate hypomania similarly to antidepressants and that Prozac combined with a good fish oil did better than Prozac or fish oil alone for major depressive disorder. I take Vascepa which is an EPA-only, prescription fish oil product providing 960mg of EPA (eicosapentaenoic acid) in a 1 gram (1000mg) capsule. That's the highest potency EPA-only fish oil around as far as I know. I take 2 grams twice a day during Fall and Winter and reduce to 1 gram twice a day in Spring and Summer because it actually stimulates me a bit in combination with the rest of my cocktail. Spring and Summer are usually my time to reduce the Vascepa and Trintellix and increase the Vyvanse and Depakote while reversing that in the Fall and Winter.
  3. A couple things though. It's possible that coming off Seroquel may have brought up some anxiety. It's a potent norepinephrine reuptake inhibitor which has anxiolytic effects. So it would only make sense to feel anxious coming off of it. Even more so, Rexulti is known itself for having really potent anti-anxiety effects. It just can be hard to adjust to in the beginning. However, Seroquel also is known for anti-cholinergic effects that can make withdrawal difficult. Based on my experience with Rexulti, I would say the titration up was too fast. I started on 0.5mg for 2 weeks and actually went DOWN to 0.25mg for 6 weeks before increasing back up to 0.5mg. I'll tell you what, those first two weeks on 0.5mg were ROUGH, but after a week or two on 0.25mg I started to feel A LOT better. And it improved even more when I went back up to 0.5mg, which felt completely different the second time around. It was only several months into Rexulti that I went to 1mg. I've been on it now since September 2017 I believe, and I haven't taken more than 1.5mg. Rexulti takes a LONG time to build up in your system because it has such a long half-life, but pair that with Seroquel which has a really short half-life and therefore leaves your system more quickly than Rexulti can accumulate in your system, you could have a roller coaster of a ride. Dr. Stahl says that the -pines (e.g. Seroquel [quetiapine], Zyprexa [olanzapine] Clozaril [clozapine]) should have at least 2 weeks of overlap with the new antipsychotic as titration occurs. If you were to try it again, it would probably make sense to talk with your pdoc about starting the Rexulti at 0.25mg WITH the Seroquel at your normal dose and slowly decrease the Seroquel over the course of 2-4 weeks like 50mg at a time while you increase the Rexulti to a target of 1mg. After that, I think it starts to become stimulating. How much Seroquel were you on before your pdoc decided to switch you to Rexulti? Knowing that would more accurately guide how to titrate up on Rexulti.
  4. Curious. When did you start Rexulti, and how did you titrate? And are you taking it morning or night?
  5. yes, of course! mCPP being the infamous ecstasy substitute. It's a serotonin agonist in almost all areas which would be stimulating similarly to ecstasy but reports say it isn't a pleasant experience relative to ecstasy.
  6. Viibryd by far. Lexapro can be stimulating for some in the beginning but tends to be a more calming AD. Viibryd tends to be activating.
  7. Honestly I'm thinking you would really only need to be on escitalopram for a week before withdrawing the paroxetine. It takes 7 days for escitalopram to reach steady state. And I'm thinking the allosteric modulatory effect that escitalopram has on the serotonin transporter should further ease withdrawal symptoms by slowing dissociation of paroxetine from the transporter. I think escitalopram has this effect on itself binding to both the orthosteric and allosteric sites on the transporter and delaying dissociation of the compounds from the transporter thus leading to a stronger inhibition. Paroxetine has a similar effect, but I don't know if escitalopram's allosteric activity would slow paroxetine's dissociation from the transporter as well. At any rate, it should work fine. I would say that once your pdoc starts decreasing, I would want to do it in 2-week intervals for each dose drop. Paroxetine discontinuation can be tricky if it isn't done very slowly.
  8. Wait. Trazodone actually becomes STIMULATING? This. Viibryd definitely caused insomnia for me. You are on a low dose. I assume you take it in the morning early? I remember if I took it past like 11AM, there was no way I was sleeping that night. Love valerian. And I love Depakote. Lemon balm is the cherry on top of a perfect valerian sundae!
  9. All things considered though, they know that from heating the coils, heavy metals are released into the vape stream like nickel and cadmium. Some of the same heavy metals that tobacco pulls up out of the ground and releases into tobacco smoke. And SOME of the flavors on their own (e.g. cinnamon) have been shown to reduce cell genesis in the lungs. So when it comes to the healthiest way to consume it while maintaining good bioavailability, sublingual is the way to go. I used a vape in my trials because I was already a smoker but if I wasn't smoking I would definitely go back to CBD the sublingual route. It seems to make more sense. And actually, the lungs don't absorb the contents of vape clouds to the same degree that they absorb the contents of incinerated plant matter. So I would actually wonder if sublingual has higher bioavailability than inhaled (unless of course there was a more appropriate base salt or substrate for the CBD in an inhaler).
  10. Oh that's right I totally forgot they bothered making an IR of Focalin. Guess it was an opportunity to make more money. Come out with IR first even though you know it should have been XR from the get-go lol. OP said that because they don't technically have an ADHD diagnosis and that the Ritalin is technically being used as an augment for fatigue it would be hard for them to get anything amphetamine based. Definitely. Might give you the kick you once had with Ritalin. And like I said, the XR actually does last pretty long unlike Adderall XR.
  11. Hard to say. You're taking Cymbalta which is why I asked earlier if your signature is correct. Theoretically taking Cymbalta Will make Abilify more weight positive than weight neutral but it varies so much from person to person. And they SAY an AAP is less likely to cause weight gain but there's usually not enough evidence to back that up. For some there is evidence but there will always be a fringe group of people who still gain weight no matter what. I resisted weight gaining medications for so long because I was afraid of it and then I basically ended up moving to mostly gainers and I haven't gained THAT much AND I feel a lot better. So your mileage will definitely vary. Not surprising. LTG always makes things worse before it makes them better. But if you can get through the titration to 200mg, most end up feeling a lot better about it. Well any weight gain through 5HT2C is based almost entirely on appetite. It controls whether you feel full or not. Not necessarily whether you gain or lose weight. Histamine antagonism on the other hand can definitely cause weight gain. The only TRUE mood stabilizer is lithium technically. Depakote, Lamictal, Tegretol, and Trileptal we're all anticonvulsants before they were used for mania. And even the typical antipsychotics were supposed to just be anti-histamines before they realized what they ACTUALLY did. So really, Rexulti is an atypical antipsychotic. It doesn't have an indication to treat mania in bipolar disorder but it is approved for schizophrenia and as an add-on for MDD much like Abilify. But it's very different from Abilify in many ways. But if you look at it another way, it's really hard if not near impossible to maintain good physical health if you don't maintain your mental health. So it might be good to look at generally weight neutral options. I'm thinking specifically of ziprasidone (Geodon) and lurasidone (Latuda). The former is already generic, and the latter will have generics out shortly from what I've been reading. Both have been shown to have minimal impact on weight (meaning you MIGHT gain a few pounds in the beginning but you wouldn't notice if you weren't weighing yourself) and a good appetite and physical exercise will help ensure you're part of the positive end of that statistic regarding weight.
  12. I would imagine wait a few weeks for the escitalopram to reach steady state, then slowly start reducing the paroxetine. They also make a 25mg and 12.5mg CR tablet. Paroxetine is one of the (if not THE) hardest ADs to come off of. I'm sure he wants to do a full cross-titration. Dropping the escitalopram in right at 10mg makes sense because that will likely be your go-forward dose. Then you VERY SLOWLY decrease the paroxetine over the course of several weeks to avoid discontinuation syndrome. Having the 10mg escitalopram there should handle most of the discontinuation symptoms from the paroxetine.
  13. Only thing to watch out for is nightmares which can happen to some people with Thorazine. Yeah loxapine won't put you on your ass quite like Seroquel or Zyprexa but it definitely can help promote sleep. You can take 5mg during the day PRN for anxiety or to calm agitation or you can take 10-25mg regularly at night before bed to help with sleep in combo with Lunesta. As for loxapine's impact on weight, it's actually an interesting one. Because one of loxapine's major metabolites is amoxapine, it actually has a strong inhibitory effect on norepinephrine reuptake. Generally speaking, loxapine is either weight neutral or might cause you to actually lose a little weight according to Dr. Stahl. Always raving about Stelazine. Makes me want to try it badly. I think I read earlier that sedation via histamine antagonism is not an option for the OP. So it would be better to target 5HT2A antagonism and ɑ-1 adrenergic antagonism. Both effects should help with sleep significantly in combo with Lunesta or a benzo. However, finding a typical AP without anti-histaminergic effects that will also cause enough sedation can be tricky. When it comes to the phenothiazine class, I would personally stick to the piperazines. They typically have common piperazine metabolites that act as potent adrenergic blockers, which should help with sleep. My recommendations there would be: 1. Perphenazine because of its binding potential at the benzodiazepine site combined with high 5HT2 antagonism and modest alpha-adrenergic antagonism from the parent drug (although the metabolites, like I said, may do this to a stronger degree) 2. Trifluoperazine because @mikl_pls thinks it's the greatest thing since sliced bread, it's a piperazine and still carries some appreciable 5HT2 antagonism For the remaining typical chemical classes, I would pick loxapine because it's more of an atypical antipsychotic in doses of 25mg or less, meaning it's more of a serotonin antagonist than a dopamine antagonist at those doses, therefore lower risk of movement-related side effects. ugh trazodone XR was such a slimey move on pharma's part. Sure, its effects are good for sleep and its a good augment to antidepressants but I feel like coming out with Oleptro was just a way for them to make more money considering he trazodone metabolites are all depressogenic. Yeah gotta make sure you take enough trazodone. That could make all the difference. Well nortriptyline is a metabolite of amitriptyline which is technically the sedating one whereas nortriptyline may be more stimulating depending on the dose. And like your doctor can't send them the information and prove the max acceptable quantity is insufficient? Probably not in their database because nobody prescribes Oleptro. They just prescribe generic IR trazodone.
  14. Why thank you! Glad to be of service Yeah it can be difficult to get stimulants if you can't get an ADHD diagnosis, which is why I went and got one. My pdoc had been treating me for bipolar disorder, and over the months and years he had been treating me, I would have an ongoing conversation with him about focus/concentration issues (NOT energy and motivation). By the time we stabilized my mood, I hadn't had a depressive or a hypomanic blip in a while yet I was still having issues staying focused. Very well may be med fog caused by the mood stabilizers, but the fact remains that when my mood is stable, I'm still left with ADHD-related symptoms, which you really shouldn't attempt to address until the mood is stable. So I got to a point where i brought it up again and he gave me an ADHD assessment questionnaire for adults. I simply filled it out, he looked at it, and then he wrote for Adderall IR. We used the IR form to determine my best daily dose that was enough to stimulate me and improve my executive function but not make me jittery or trigger hypomania, then we converted to the Adderall XR at about 20mg. But then after a while I was complaining of afternoon poop-out, which is quite common for Adderall, so I asked to be switched to Vyvanse. Depending on the time of year and my dose of Trintellix, my Vyvanse dose floats somewhere between 30mg and 40mg. I've been on it ever since. And yes, your assessment is correct. Ritalin is methylphenidate. Focalin is just the dextro (right) half off the methylphenidate molecule (dexmethylphenidate), which has most of the pharmacological effect. I found that Focalin lasted a good portion of the day more like Vyvanse than like Adderall which pooped out around 1PM or 2PM. Well keep in mind that even in bouts of dysphoria, there can be an adrenergic response that creates somatic symptoms of anxiety like a tight stomach or an ache in your chest. A norepinephrine reuptake inhibitor can desensitize these kinds of reactions. Effexor generally is stimulating, but more so at >150mg. 37.5mg and even 75mg are too low to get an appreciable amount of stimulation.
  15. Ugh, I'm so sorry to hear that. HMOs are the worst. An HSA can be terrible too but at least it's a PPO network. If I went on an HMO, I'm not sure how I would function. It's a total change to how you actually have to do healthcare. I take it that's the neck pain? Well in some cases anxiety is due to a glutamate problem. You can suppress glutamate with the help of benzos, which increase GABA activity (GABA being the OPPOSITE of glutamate). Lamotrigine calms and modulates glutamate activity. For many, this can have a profound effect on anxiety. My mother-in-law takes LTG at 125mg I believe and it calms down her anxiety and neurotic behaviors quite a bit. Abilify is supposedly more weight neutral than most. Although in the presence of an antidepressant, this can kind of be invalidated. For example, patients in the schizophrenia and bipolar disorder clinical trials that were taking Abilify as monotherapy (no other medications) didn't have much weight gain, but the patients in the MDD adjunct trial (taking Abilify with an antidepressant) had weight gain. This is probable due to 5HT2C partial agonism on Abilify's part. In the absence of an antidepressant, serotonin levels would be lower, and thus Abilify would act as more of an agonist at 5HT2C. This activity is what makes you feel full (i.e. satiety). However, when one is taking a serotonergic antidepressant, Abilify acts as more of an antagonist. This can make you feel more hungry, but it has the added positive effect of increasing norepinephrine and dopamine release in the PFC among other brain regions which can have positive antidepressant effect. If you found Abilify stimulating at the lower doses, I would recommend Rexulti. It's very chemically similar to Abilify but it's calming in lower doses and gets stimulating as you increase (kind of Abilify's opposite). Less of a chance of akathisia or agitation with Rexulti as well. They found that those who couldn't tolerate Abilify often tolerated Rexulti without issue. Rexulti can potentially cause more weight gain than Abilify, but if you keep to lower doses like 1mg and below, I've found the weight gain to be there but it's minimal. I'm taking Rexulti with Depakote which are both KNOWN weight gainers, but Trintellix is now being shown to increase weight for some as well. So I should be gaining weight like crazy but I've only gained maybe 10-20 pounds. Additionally, in long-term trials, the weight gain from Rexulti plateaued after ~6 months.
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