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About browri

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    Pennsylvania, USA
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    genealogy and all things tech.

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  1. @OCDme have you talked to your pdoc about boosting the Pristiq with something? Until recently, I had been taking a combo of 300mg Wellbutrin XL and 30mg of Remeron for depression, but I was having issues with this constant low-grade anxiety and irritability from the Wellbutrin, so we recently switched it to Pristiq 50mg. I've taken Pristiq as monotherapy for depression before I was rediagnosed as bipolar 2. But taking it now with Depakote as a mood stabilizer and also being able to take Vyvanse for my ADHD, I appreciate it so much more, and the Remeron is a really nice pair in my experience so
  2. I was curious about this too. Apparently the studies that included risperidone did not include it as an active comparator but rather an active control similar to placebo in order to validate assay sensitivity (i.e. they needed to make sure that the PANSS test itself actually worked for both a known proven drug as well as the study drug). As I indicated in a previous post, there was a switch study where patients with an acute exacerbation of schizophrenia who went inpatient were given risperidone to stabilize them. Then after a period of stabilization, the patients were split into groups.
  3. You make a fair point. It might be on the formulary, but it's a non-preferred brand that they'll only pay for after you've tried several other things, and even then you can't use it off-label. And even if you are using it for its FDA-approved indication, some plans make the copay for a non-preferred brand completely unaffordable month-by-month. I guess the hope is that if they get a broad approval like the one they've submitted, that it will be one less hurdle for the patient. By default, the drug reaches more populations by removing one of the insurance company's excuses not to pay. I suppos
  4. Heard that as well. Additionally, in schizophrenia and bipolar disorder, one of the highest comorbidities is cardiovascular disease of some kind. Some of this is due to lifestyle but a lot of it is also due to the treatments for these conditions. They claim that Caplyta should allow clinicians to not compromise efficacy in order to achieve a better safety profile. Clinicians will prescribe it because it leads to similar outcomes to other standard-of-care antipsychotics while having a placebo-like safety profile. Insurance companies should pay for it because it's demonstrated utility in a wide
  5. For what it's worth, it would seem that the meal requirement might be in place for two reasons. The prescribing information definitely says to take it with food. Looking at the pharmacokinetics, its absolute bioavailability is 4.4% which is really low. Combined with a half-life of 18 hours. It takes 5 days of continuous dosing to reach steady-state. Taking Caplyta with food, increases the time to maximum concentration after oral administration from 1 hour to 2 hours, decreases the maximum concentration by 33% and stretches out the average area under the curve by about 9%. Taken together, that
  6. https://ir.intracellulartherapies.com/news-releases/news-release-details/intra-cellular-therapies-announces-fda-acceptance-caplytar https://seekingalpha.com/article/4420996-intra-cellular-substantial-unlocked-value-in-caplyta-franchises I've been watching this one like a hawk. The indication that was filed was for Caplyta (lumateperone) either as monotherapy or as an adjunct to lithium or valproate to treat depressive episodes associated with bipolar I and bipolar II disorder. This is big for the bipolar depression space because: Seroquel (quetiapine) is approved for depressive
  7. @Selkie So I had my pdoc appointment, and we decided to replace the Wellbutrin XL (bupropion) with Pristiq (desvenlafaxine). I brought up the low-grade irritability/anxiety from Wellbutrin again. His instinct was to shave off some of the irritability and anxiety with Risperdal (risperidone), which I was very open to, but I also pointed out to him that despite my improved motivation and drive on 300mg bupropion, that I still didn't feel in a very good mood, and even all the while I would be going about and doing the things I'm not motivated to do, my thoughts are just negative the whole t
  8. Prolongation of the QT interval was an issue with citalopram (Celexa), which is why the maximum dose of that was reduced from 60mg to 40mg per day. However, even at 20mg, escitalopram (Lexapro) doesn't come close to the QT prolongation of 60mg of racemic citalopram. Going to 30mg on escitalopram for treatment-resistant cases like OCD that require significant SERT occupancy actually pretty common because of escitalopram's positive safety profile.
  9. O-desmethylvenlafaxine has been regarded as venlafaxine's chief metabolite because the metabolite has a greater affinity for inhibition of the serotonin transporter than venlafaxine does (~40nM for desvenlafaxine and ~80nM for venlafaxine). Because psychiatry has clung to the serotonin hypothesis, this made sense. Desvenlafaxine also seemed to have a somewhat higher affinity for the norepinephrine transporter than venlafaxine, but less of an ability to inhibit norepinephrine's reuptake. Couple this with the fact that desvenlafaxine is taken in smaller concentrations because of its higher affin
  10. To your first question about aripiprazole and weight, in order to understand whether or not it will make a difference, it's important to understand the why of it. For most people, aripiprazole, unlike other antipsychotics, doesn't have a significant direct impact on metabolic parameters like fasting blood glucose, lipids, prolactin, etc. Most of those side effects from other antipsychotics occur via dopaminergic antagonism, and in the case of olanzapine and clozapine particularly, cholinergic antagonism. However aripiprazole is a dopamine partial agonist with an intrinsic activity at these rec
  11. So two weeks later, I'm not feeling too hopeful. I still feel "keyed up" a good portion of the time with low-grade anxiety and irritability. But no panic or rage/explosiveness. So everything is smoothed over but still above level. I've been at 30mg of mirtazapine for 4 weeks and on 300mg of bupropion for 8 weeks. The low level tension doesn't seem to be getting better and I'm (literally) chewing my lips to hell. So I called into the pdoc, and I'm going to drop back down to 150mg of bupropion for the next two weeks until my appointment. Then decide if 150mg is both effective enough and tol
  12. Thanks, @Iceberg! Appt went well this morning. Talking to him about the low-grade anxiety and irritability that has stuck around, his suggestion was to back the bupropion down to 150mg. But after some discussion, we decided to keep everything as it is for another month before we make any more changes. Here's to patience...
  13. Yeah I usually have to remind myself to be patient. But I'm at least noticing enough of a difference at this point that it feels worth waiting patiently for, which is promising at a minimum.
  14. So it's been 12 weeks now on mirtazapine at escalating doses and 30mg for the past 2 weeks (since 3/23). The first week of 30mg was interesting, but by the middle of last week I was starting to notice some light mood differences that are more noticeable now. Some of the issues I was having with bupropion 300 + mirtazapine 15 were that I didn't feel very nice (like I didn't feel nice to be around, not very social or friendly), my baseline anxiety and irritability are higher (expected from bupropion) even though I am generally less explosive/reactive overall, and I would sometimes get lost
  15. Well last night was my 6th night at 30mg of mirtazapine. So far so good, and each day is a little bit better. A lot of the concerns I had previously have been mostly allayed since the increase. Time will tell though. That's probably a smart idea to not make a change like that amidst the pandemic. Just the same, if using clonazepam as a prn, it should be used as minimally as possible. It might be difficult, though, with the bupropion on-board. Another smart idea. Benzos are good for short term management, or for those with chronic anxiety, for breakthrough anxiety management. Bu
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