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About browri

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    Bethlehem, PA

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  1. Fatigue is typically another one that passes with time. It may linger in a sub-level kind of way but it won't be noticeable in the way that it is now.
  2. Heat stroke not so much. However, body temperature dysregulation is not uncommon among atypical antipsychotics. Latuda I believe has a similar side effect. As does Vraylar.
  3. In regards to efficacy or tolerability and risk? For efficacy, clozapine is regarded as being able to treat cases of bipolar disorder and schizophrenia that don't respond to anything else or only partially respond. In that regard, it works where many other medications can fail. So pdocs do view it as quite efficacious relative to it's other atypical cohorts. However, in regards to risk and tolerability, clozapine is known for quite a bit of sedation. Agranulocytosis and leukopenia. Type 2 diabetes. You name it. So you would think that because of how effective clozapine is in most cases that it would be prescribed more, but because of the risks, it's only prescribed when 1-2 other atypicals have failed.
  4. Mood brightening may be more at 1.5mg with 3mg being the more calming dose of the two. And of course once you get to 4.5mg and 6mg, those are both mania-only doses. Won't help with depression.
  5. Antagonism of 5HT2C naturally causes you to crave carbs and sugars. A way to counteract this is to eat foods low in calories, but high in fiber, because fiber makes you feel full. I'm thinking ants on a log (celery, low-fat cream cheese or peanut butter, and raisins) Or even just munch on celery with nothing else. Metamucil is also probably you're friend.
  6. Yes it is quite possible. For a long time, lamotrigine got relegated to a "maintenance-only" status meaning, it was generally regarded as not effective in acute treatment because of the long titration to the doses necessary for full symptom control. However, more recent literature seems to indicate that lamotrigine can and many times does show improvement in symptoms as early as 50mg. It wouldn't be far-fetched for the same to be said for 25mg. Lamotrigine has a widely varying half-life and it's possible the half-life is longer in you than average leading to higher concentrations of lamotrigine with lower dosing. Said another way, the fact that you think you may actually already be seeing a response at just 25mg could be placebo OR it could mean that lower doses of lamotrigine will work well for you. For most, positive effect doesn't really settle in until between 50mg and 100mg. This could be a good sign. I think you said you go to 50mg this Wednesday? Per usual, expect a few days of side effect weirdness and then it will slowly go away like it did for 25mg. If you haven't given up on lamotrigine at this point, then I'd say you can reasonably expect to be able to handle the rest of titration without issue. Each dose increase shouldn't be any WORSE than the last one. In fact, each dose increase should get easier as you go higher.
  7. I'm currently starting on Vraylar now too. If you find you have any tolerability issues, my pdoc told me it may be good to do 1.5mg every other day for the first two weeks, then increase to 1.5mg every day for another 2-4 weeks, then increase to 3mg if necessary. Vraylar is definitely activating, but in a different way from Rexulti and Abilify (having personally tried taken all three at this point). Point is that Vraylar has a really high rate of akathisia for an atypical antipsychotic, and going to 3mg quickly can sometimes cause really bad akathisia. However, I see you're also prescribed diazepam, which will certainly help to keep that under control. The long half-life means that it's really easy for a pdoc to increase the dose too fast and ultimately have to decrease it later because of tolerability issues like akathisia or EPS. And the diazepam may be covering that up. I'm taking clonazepam with Vraylar right now and I'm going into Week 4. Did the first 10 days 1.5mg every other day and now on my 12th day of 1.5mg every day. It's really really nice actually. Not quite like Rexulti. Not as sedating. I like the activation during the day, but it does keep me very UN-agitated, lol
  8. So I was reading up on the titration for lamotrigine. Originally, it was 25mg for 2 weeks, 50mg for 2 weeks, then 100mg for 2 weeks, and then you could increase by 50mg every week, but apparently after 2 weeks on 100mg, it looks like you can jump right to 200mg if you haven't shown any signs of the rash titrating up. The author of this modified titration suggestion doesn't give much indication if this is for more acute treatment or if it should be titrated ++50mg/week for tolerability in the case of maintenance.
  9. And what dose are you on at this point? Once you get to 100mg, it gets a lot easier.
  10. They do mention this in literature that lamotrigine has a VERY modest affinity for the serotonin transporter and the 5HT3 receptor acting as an inhibitor and an antagonist respectively. It isn't generally believed to be clinically siginificant, but lamotrigine is dosed so high and has a relatively longish half-life that you gotta wonder....
  11. In today's day and age, clonazepam is generally regarded as having the longest lag time until anxiolytic tolerance sets in. Tolerance to the sedative effect is rapid like other benzos, but with clonazepam, the anti-anxiety effects can persist for much longer, contrasting to lorazepam or alprazolam which develop anxiolytic tolerance quite quickly, relatively speaking.
  12. I'm thinking one of the reasons he wanted to try you on Rexulti is because it has such a long half-life. That means even if you are an ultra-rapid metabolizer, he can titrate you up to higher doses without issue because you'll be able to tolerate them. The alternative is generic aripiprazole, but if quetiapine of all things made you rage out, then I would say starting on Rexulti before aripiprazole (Abilify) makes more sense. That being said you can always fall back to aripiprazole as an option because it too has a long half-life which should help combat the ultra-rapid metabolism issue. Although it depends on what KIND of ultra-rapid metabolizer you are. I'm assuming CYP2D6, but it could be CYP3A4 which is different altogether.
  13. @Blahblah I would say Viibryd is definitely worth a shot if your insurance will cover it without a fuss. It was very activating for me. Granted I wasn't being treated with a mood stabilizer, but even my pdoc has said to me that his perception of it is that it's activating for most people. Known for having VERY little sexual dysfunction and somewhat less anhedonia. However, some people don't tolerate Viibryd. You should give it 4-6 weeks before you throw in the towel, but some people don't mix well with the GI side effects, and it can cause insomnia because of how activating it is. Just things to keep in mind going into it.
  14. Your combo in your signature looks great honestly. The calming effects should be felt within 3-5 days of starting but most likely within 2-3 days of beginning the 500mg dose. That's what I currently take now. I assume you're taking it all at night, and I think you'll find it's pretty tolerable. Average dose is about 1000mg but it goes much higher than that. Most people in an outpatient setting don't require doses that high. Blood levels are apparently important with valproate to a certain extent. 80-100mcg/mL is necessary when you're treating acute mania in an inpatient setting. 50-100mcg/mL is generally accepted to be the broader therapeutic range. However, milder forms of bipolar disorder that don't require hospitalization do function on lower levels. I take 500mg and it only gets me like 35mcg/mL. It does still help though and allows me to take lower doses of antipsychotics to avoid akathisia (I've got a low threshold).
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