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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. There are a few difficult things to unravel here. The first part is that Zyprexa is a dopamine antagonist. With reduced dopamine activity comes increases in prolactin which can cause dyslipidemia, increase blood sugar, general metabolic dysfunction, etc. Second part is that Zyprexa is a strong muscarinic acetylcholine receptor antagonist, particularly M3 which is found on pancreatic cells. Its antagonism correlates positively with type 2 diabetes. Even plain anticholinergics like Cogentin (benztropine) carry a high risk of type 2 diabetes when used on a regular basis. Zyprexa is also a strong
  2. So far, so good. First two days, I mainly just felt a tad overstimulated like I had too much coffee, but today I've actually started to notice some mood changes that feel like progress. Brightening...idk. So far at least it doesn't feel like the increase was a BAD idea. That much I can say at this point. It does feel subtly different than the last time I was on bupropion and increased to 300mg. Less anxious. Mirtazapine and bupropion seem to make a nice pair.
  3. Almost invariably and without fail, anything that slows the reuptake of serotonin by inhibiting the serotonin transporter is going to cause a certain level of agitation and anxiety on the come-up for the first week or so. This is the reason pdocs often prescribe a short course of a benzo like lorazepam, alprazolam, or clonazepam if a patient isn't experienced with antidepressants. Most patients that have difficulty with antidepressant start-up often are able to power through with a benzo. Clonazepam is preferable because its long half-life allows it to be dosed once to twice daily. Alprazolam
  4. Got a call from my pdoc this morning and we spoke about it. He said he was more inclined to increase the bupropion before increasing the mirtazapine. So starting today I'm doing 300mg bupropion XL with 15mg mirtazapine along with my usual valproate mood stabilizer and Vyvanse for ADHD. Will keep you posted on how it goes.
  5. @Starman Jim indeed the pandemic has made things exceptionally hard for everyone. And I can certainly attest to what you're saying. I was on a pretty standard combo of divalproex and brexpiprazole as mood stabilizers and vortioxetine as an antidepressant since 2017, but it just wasn't compatible with this new environment. Situations changed. I have a call in with my pdoc to up either the bupropion or mirtazapine. So far I've liked the combo, but I don't think I've experienced the full potential yet because I haven't reached appropriate doses.
  6. Yeah a direct consult is probably good to re-assess, if it's been a while. The pandemic has really been making a lot of work for mental healthcare workers like psychiatrists. It's introduced whole new variables to which people aren't normally subjected. That's complicated things for them. But at least they aren't out of a job like so money, on the other hand. Yeah starting from Remeron only and then adding Wellbutrin, there's definitely a settling period. Each day has been a little bit better than the last. But I do think I need increases. I am only on 15mg of Remeron and 150mg of Well
  7. Glad I could provide some info and hopefully your eyes don't hurt too much after reading that. When is your next pdoc appointment to discuss next move?
  8. Followed up on that and confirmed from the NIH's website:
  9. I'm not sure whether anxiety was an endpoint at all in the trial, but if it was, I'm inclined to think it wasn't a primary endpoint. Statistically significant changes may have been noted, but the study wouldn't have been dependent on those measures because the focus was depression.
  10. Hey @Selkie! The past few weeks have been interesting for me, and for whatever reason I felt the need to write a thesis for a response. By the time I realized it was insanely long, I was like screw it I can't let this go to waste. So I posted it anyway. Sorry in advance Actually, until recently I was taking a combination of Vyvanse 50 in the morning with Trintellix 20 / Rexulti 2 / Depakote 1250 at night. Due to recent events, a change was required. So now I'm on a combo of Wellbutrin XL 150 / Vyvanse 50 in the morning and Depakote 1500 / Remeron 15 in the evening. We'll go through your p
  11. So I have considered it. The only reason increasing the Remeron further makes me slightly nervous is just because of the impact it has already had on my appetite. I knew about the sedation and increased appetite and subsequent weight gain from the two before starting Remeron, but I guess I was surprised by the intensity of those symptoms. Starting at 7.5mg and the first few days after the increase to 15mg, the increased appetite was more noticeable. I seemed to adjust to the side effect a few days after the initiation at 7.5mg and increase to 15mg, but my baseline appetite is certainly higher.
  12. Thanks, @Wonderful.Cheese! Seeing as he passed away Sunday night, this week has been tough still kind of going through Trintellix withdrawal but also coming up on Remeron on top of that. However, here I am at the end of the week feeling better about it. I've been able to process it normally, I think. His quality of life had deteriorated already even before contracting coronavirus. In a way, he isn't in pain anymore not just from coronavirus but from everything else he dealt with in life. My grandmother also seems to be at peace with it. It helps me to feel better knowing that she may be sad bu
  13. So far so good. Did 7.5mg Remeron last Tuesday evening through Saturday evening. Then last night was my first dose of 15mg. My appointment with my pdoc isn't until next Tuesday, but I'm going to call in over my lunch break to see if they have any appointments at the end of this week instead. Not sure I feel like waiting until next Tuesday. My impressions so far: I like this med. Definitely helps my sleep. I normally have no interest in eating during the day. Now I do. I actually will eat just about anything that isn't nailed down. That's gotten a tad better as days have gone on but DAMN.
  14. Well @Iceberg we're doing it. The mirtazapine part at least. Started 7.5mg this past Tuesday evening. Increase to 15mg this coming Wednesday the 20th. Then appt with pdoc on the 26th to likely increase further to 30mg. Fingers crossed.
  15. No I certainly do think that combining two antidepressants in bipolar disorder carries an even higher risk of cycling than one does alone. My hope is that mirtazapine as a baseline antidepressant will carry a lower risk than an SSRI or an SNRI, but the beauty of mirtazapine is that if it is dosed appropriately, you should theoretically be able to add 20mg or 40mg of duloxetine to it in times like seasonal depression when the mirtazapine alone isn't enough I also keep in mind that I've technically been taking two antidepressants for years now. I think anyone who has taken Rexulti can vouch
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