Iceberg

Ever Tried melatonin?

Yeah, this is a big Rite Aid, and they’ve been helpful to me in the past so I’m keeping my fingers crossed. When I did a price check through my insurance a couple places popped up, so someone somewhere must be able to get it I guess. Thats exactly what he said about small doses often being better..and your right he did mention trying as low as possible (I can do .25 with the unmeasured bottle). I have tried a range of bedtime doses with no effect, but since this is a tiny afternoon dose, maybe I’ll try again under can’t hurt. He did make it clear that we don’t have a ton of good options left (assuming I want to avoid the possible side effects nightmare of cloz + typical which may not even work) which is why he said I should start them both together

Went with the Niravam. He gave me .5s To try first cuz the goal is just to chill a bit for sleep. He said go to 1 mg if needed. Only gave me 30, but that was partially due to him trying to lower my out-of-pocket cost, and partially because he feels if I start going heavy on the benzos he wants me to check in, cuz it could be transitioning from “sub syndromal” to “needs attention now” especially cuz he knows benzos don’t hold off my mania very well. Of course pharmacy out of stock. He also suggested taking a daily tiny dose of melatonin ( <.5) in the afternoon which has helped some patients to reestablish their circadian rhythm (as opposed to higher doses intended to knock you out). Apparently it is evidence supported, but I’ve never heard of anyone on here doing it Went with the Niravam. He gave me .5s To try first cuz the goal is just to chill a bit for sleep. He said go to 1 mg if needed. Only gave me 30, but that was partially due to him trying to lower my out-of-pocket cost, and partially because he feels if I start going heavy on the benzos he wants me to check in, cuz it could be transitioning from “sub syndromal” to “needs attention now” especially cuz he knows benzos don’t hold off my mania very well. Of course pharmacy out of stock. He also suggested taking a daily tiny dose of melatonin ( <.5) in the afternoon which has helped some patients to reestablish their circadian rhythm (as opposed to higher doses intended to knock you out). Apparently it is evidence supported, but I’ve never heard of anyone on here doing it

As always, @mikl_pls offers some good advice. Strongly agree that you try the oral version first. If it doesn’t agree with you, you’re screwed when you get the long acting shot. i would also pick Vraylar from those options and I also agree that Rexulti seems subpar in the antimania department

As far as duration of action? Yeah. Funny though there seems to be a lower level of dependance concern. With Ativan (anecdotally)

I think part of the issue is that it really obvious when it kicks in and reallyyyy obvious when it wears off (unlike something like klonipin which may be more gradual) and that creates the feeling of really needing that next dose, making it have a higher abuse potential. Just my theory

Although, long acting benzos taken PRN are often considered to be at lower risk for dependance than short acting ones like Xanax

@mikl_pls do you think switching to the ODT could make a difference ?

Yeah... any Thorazine with the cloz requires me to skip any type of activity that involves thinking or social interaction. I’ve actually been on both Atarax and vistaril (long story.) we’ve decided no MAOI’s, my doctor and I agree that BuSpar probably isn’t worth it since I often need help with nasty dysphoric anxiety stuff and not more typical GAD like symptoms. Never tried Gabatril, but same thing, I’m not sure it would do a lot, and I’m already on a high dose of lamictal... I’m sorry to keep shooting it all down, I know my med history is a total mess, party do to resistant symptoms, some bad doctoring, and the fact that most people seem to not know how to handle an acutely manic 14 year old. Thanks for the suggestion on the med charting. I do do that, but it’s still tough with all the contradictions. Ex. I went from klonipin to Ativan back to klonipin - it’s hard to really come away with a. Good conclusion there. I am very good at charting my doses/frequencies, I had to be because I got seriously med blitzed when I was first Dx’d and it was the med go round from hell until after I graduated high school (such as 56 mgs of trilafon - which was with zyprexa and seroquel at the same time too) the problem with the Xanax XR was it couldn’t be a PRN for me. I had to take it as a standing for it to do much, and while I am not one to object to daily benzos when necessary, I’d rather not go there unless I really need it Again, I don’t mean to shoot it all down, thanks for the input!!

I use thorazine for that purpose, but it can get ugly. Trilafon was a total fail, and we are weary of the others because I am super prone to akathisia. So, since the goal is for me to almost never take it, we stick with the thorazine which we know works. I did try it daily but it was too sedating (with Ativan at one point.) Trilafon was up to 56 mg a day. I think the goal is to have a rung on the ladder between nothing and a typical, because once I get in the pattern of needing a typical a lot its not gonna end well. Tried Restoril, nothing. I was on valium 10 qid for awhile for a certain panic-y spell, and we switched back to clonazepam but idk why. Also have tried low dose Seroquel and low dose Zyprexa for prn agitation (and established that risp/Invega are off the table.) The problem is ive basically switched off all of them onto another one of them, so its hard to even remember whats what

maybe I should have said "smooth acting" instead of quick acting. I am trying, I don't think this always happened, in fact I used to take 2 mg for sleep. Maybe its just because my overall mood symptoms are less intense. Unfortunately, I do need to have a benzo in place for sleep or emergency agitation, so maybe a change in overall symptom structure requires a change in benzo? I don't know about the serax with my pdoc. He is not at all uncreative, but he has never mentioned using it to me, and we've been deep in the bag of tricks several times. Also, if the serax is really slow onset, does that make it less useful as a PRN?

So I am having an interesting experience. I have Xanax 1 mg, which I sometimes use for sleep, but I seem to be metabolizing it weirdly or something. The other day I took .5 at about 9 pm to get to bed on time. Several hours later, nothing. So I take another 1 mg, and I end up sleeping for like 12 hours. It almost like a delayed effect. Its not just sleep either. its also happened on long car rides and airplane flights, where I wake up for the end of the trip just to find myself in the full throes of benzo sedation. Ive tried the main benzos before, but should I talk to pdoc about maybe switching to something that comes on smoother? I thought the whole point of Xanax was quick-acting, short duration of action. We switched to it from klonipin because we thought the "punchiness" would be Beneficial to my symptoms. Is this delayed reaction a thing that ive never heard of? Should I retry a more gradual med (valium/clonazepam?)

Yes, after looking at @mikl_pls s list, I want to amend my statement. I meant that focalin would be a good option if you figured out the lower dose was still problematic... I would always try sticking with a med you can tolerate first

I’d look at focalin. It is still a stim but is known for being pretty mild

Really low dose typical AP? If you and your pdoc feel you’ve gone through all the mainstream options