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Everything posted by Iceberg

  1. did anything work at all? Also, if you are mainly treating psychosis you could try a typical, but the long term side effects can be just as problematic. You could also try a polypharm approach. A common one is to back off the clozaril dose a bit and add in low dose abilify to see if that can reduce metabolic issues, but unfortunately that often doesnt happen
  2. Unfortunately there isn’t an easy switch candidate from clozapine, I’d say it would depend on if anything has worked for you in the past and maybe looking at something similar to that. Have you tried most of the atypical antipsychotics?
  3. Maybe she just froze and panicked. I agree with Cerberus, I highly doubt that this was in any way malicious
  4. Clozapine is often regarded as on its own in treating difficult symptoms. What are you trying to treat?
  5. Ever tried loxapine? Some People have good success with that here...I’ve tried perphenazine, twice, but I really don’t think it does much. I liked Vraylar over rexulti but it seems like I’m the only one that dose. Both approved for schizo, so yes they supposedly treat psychosis, but I haven’t read anything stating they’re any better than other aps
  6. Makes sense. Theoretically it’s approved for up to 15 for depression, but I’m not sure if higher doses make the mechanism of action more effective in ocd
  7. It can at 10-15 but I think the dose is usually kept low for OCD, although o may be wrong and there are always exceptions
  8. I wasn’t meaning you should retry and SSRI specifically just that the AD+Abilify combo is probably a solid option
  9. I have a close family member doing well on high-ish dose of SSRI with low dose abilify
  10. I think obsessive rumination is probably found in some form in most anxiety disorders, just with different presentations/triggers. Panic can involve worry over a common theme, social anxiety causes repetitive concern with going out etc. I don’t think the term “obsessive” means it is totally limited to ocd or ocpd
  11. I’d think gradual taper unless there is a severe issue. Also might partially depend on how you’ll dose quetiapine
  12. Personally no - but I have a close family member who had good results. I know it’s scary- but if you have a good therapeutic relationship with your therapist I think it’s really worth a shot. With MI, we put ourselves in doctors hands all the time, dealing with meds and trauma and all that other stuff, this way is just more.... direct. I think all you can do is go into that next meeting with an open mind
  13. For what it’s worth the memory loss was annoying but bearable for me from ECT. If start with “low dose” unilateral treatments and they work without going to bilateral (big if), some people have minimal cognitive issues. Rexulti is an AP- it’s is theoretically very similar to abilify, but some people find the effects very different. Some people with bipolar find it helpful for depression, not so much for maina There is also a very new AP called caplyta which has shown some promise with BP depression. Being new many docs still don’t use and many insurers still don’t cover it
  14. hey- i think you posted somewhere else, but i forget what does your med history look like? what are the major symptoms of this current episode? some off the top of my head ideas- remeron is supposed to be more bipolar friendly than other antidepressants. what about the other usual suspects for BP depression? latuda, abilify, rexulti or the second line options (for depression, not overall, i know lithium isnt always a second line option) like lithium or maybe zyprexa ? I guess theoretically you could switch to mirapex another dopamine agonist- but that is pretty far out in the realm of unknown. Also- have you tried cytomel? its a T3 booster but also lesser known BP depression treatment. Unfortunately, bipolar can evolve across the lifespan, and i think the ratio of depressive episodes gets higher as people age (but id have to check the stats on that)
  15. when i got put on high dose valproate and later lithium, they had me try selenium and zinc
  16. Wellbutrin is thought to inhibit reuptake of dopamine and norepinephrine, meaning prolonged exposure of receptors to those neurotransmitters, causing the mood enhancing effect. Vraylar is a dopamine partial agonist (at D3 receptor and also D2) which means it modulates the level of dopamine action in the brain leading to antipsychotic and some antidepressant possibilities. Vraylar may also affect some serotonin receptors which can help depressive symptoms, which is a mechanism. Shared by other atypical antipsychotics
  17. That’s not uncommon, lots of pdocs don’t prescribe stims for depression, and if the serotonin + ropinirol made you hyper it’s possible stimulants could make you even more hyper
  18. I am usually pretty good with med stuff, but I’m not sure I could comment with much accuracy. I have seen dopamine agonists in treatment resistant depression (usually mirapex) with mixed results in studies punished. However, most of the preliminary stuff done was not paired with a med that could be very stimulating like Wellbutrin so that combo would certainly be creative. Would it be just the two or other meds? I’m assuming you’ve tried all the regular suspects already
  19. Just an Interesting aside- some very recent psychological studies/texts have started using the acronym NSSI (non suicidal self injurious behavior) to avoid the “SI” confusion. I first saw it in some of the articles I cited for a final paper on psychopathology a couple years ago, where the intervention was DBT- which is supposed to target self injury and suicidal ideation so there is high potential for confusion
  20. with me, when i am in bad shape my pdoc is fully aware that i may be having suicidal thoughts. So usually I will tell him about it at appointment (or call if i need to address things quickly) with the assumption that it is an ongoing symptom ... so i never call about it on a day to day basis. When I am more stable, it happens time to time, but if i am feeling ok otherwise my main approach is distraction, since functioning me can usually switch gears to a productive activity and kind of let the thoughts fizzle out. So i would say yes, for me, it can happen even when in remission Regarding meds- thats a tough one because of the huge individual variation. I would think that if you are in a state where the symptoms are consistent a prn may not do much except get you through until a main-med change can take effect. having to take a prn all the time for the ideation is a big flag to me that its probably time for a a change in my mood booster/stabilizer/etc.
  21. I also for some unknown biological reason am not a good responder to meds. Meaning not that they don’t help, but that I often don’t feel them at all even when a normal person would be hit hard (best examples ambien, trilafon, trileptal, restoril, Vraylar and rexulti but there are others)
  22. What specific symptoms are you targeting with the increase- like what do you need it to do better? And do you know your valproate level? I never have and probably never will take risperdal, but I’d think that if your valproate levels are topping out it would make sense to gradually transfer more of the burden to an ap
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