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psychwardjesus

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  1. That's terrible. Was that the first one you've missed or have you had a tough time making appointments?
  2. If you fall and break your wrist, but still say your mood seems better it must be doing something
  3. I know it's easy to get discouraged, but don't lose hope. Kind of like most things in life, sometimes you have to do things a few times before you experience a positive and long-lasting change. It also depends on the type of treatment you're currently doing (unilateral vs. bilateral) and the settings they put the machine at. The place where I work, unless it's an acute course i.e. already inpatient, have catatonia, not eating or drinking organs shutting down, etc., they try to start with the most conservative treatment and settings to see if you benefit but don't run into issues like problems with short-term memory.
  4. On the other end, some chemicals interfere with the metabolism of clozapine, like nicotine, so you have to essentially double the dose to get the correct blood level and efficacy.
  5. There's no way for any of us to know because it depends on a lot of factors — your doctor specifically, your history of using benzos, the current state of opiates where you live (because a lot of people like to mix opiates and benzos, which makes people much more likely to stop breathing and die, so the DEA is likely tracking not just opiate prescribing practices but also benzos, etc.), and the specific benzos you take or are asking to be prescribed. My psychiatrist prescribes me clonazepam as a PRN for anxiety and it doesn't seem to be an issue. I've also worked with him for 4-5 years he I think me trusts me. If anything, I think he thinks I underuse them. Where I work too, the impression I get is that they're not against prescribing them as long as it's appropriate and ultimately therapeutic for the patient in the long run. But they're also much less likely to prescribe certain ones like Xanax, especially the 2mg bars, both in general and for high maintenance doses and/or large quantities per prescription, as well as some of the more potent opiates that typically aren't used long-term or for things like anxiety e.g. triazolam, midazolam, temazepam, etc.
  6. Whatever meds you ultimately decide to take, you really, really need to do your best to cut down on drinking, if not abstain completely. Alcohol and most meds — and especially psych meds — do not play well together. It could cause anything from interfering with the effectiveness of the meds you're prescribed, it can increase the likelihood of side effects with the medications you take, and most dangerous of all, it can decrease your alcohol tolerance, causing you to become impaired/blackout drunk much sooner than normal, and increase respiratory depression (along with potentially sedating meds like mirtazipine), which could eventually lead to you stopping breathing and death. Don't get me wrong. For most people, a glass of wine or a dram of single malt scotch during the course of an evening isn't going to kill most people. But if you feel like you won't be able to control your impulses, you're better off leaving it alone entirely. I used to drink more than I do now (I'm not in recovery nor would I say I've chosen to abstain from alcohol completely), but I only have a glass or two of alcohol (craft beer, bourbon and scotch mostly) a couple of times a year. At some point, I went from being an okay drunk to a hot mess. The way I explain it to people is this: when I drink too much, one of two things happen for me — SI or HI — and neither are fun or safe for myself, anyone who has to take care of me, or put up with me. That's it.
  7. Yes, it's typically not the second or third line either. It's much more frequently used off label for anxiety, fibromyalgia, or essentially anything because it seems like a very benign medication (as far as medications go).
  8. You still have quite a way to go with the Lamictal. Even with no issues going up, it'll likely take you at least a couple of weeks, if not longer, to hit 150-200mg. Nothing says you couldn't go higher, but that's typically when the med is used for seizure control and not psych. Honestly, anything is possible, but I'd be pretty surprised if the Neurontin had any effect positively or negatively. Obviously a very small percentage of people have a robust response when trying it for the first time, but it's debatable whether that's the medication actually working or placebo. For the large majority, though, myself included, it has no effect positively or negatively — not even side effects. I was on it two different times myself as an off-label for (social) anxiety. For a couple of weeks it made me feel a little tired and I could definitely feel the sort of brain fog typically associated with anti-epilepticals or anti-convulsants. I believe that eventually went away, but I couldn't say for sure, and as far as any therapeutic benefit ... it was ultra subtle bordering on can't actually feel anything. The second time I felt absolutely nothing, good or bad, got tired of taking the large 600mg horse pills three times a day, and stopped.
  9. The way you describe not staying on topic sounds more like difficulty with concentration, which could be virtually any flavor of mental health issue. There's also "loose associations," "flight of ideas," "tangential," and "circumstantiality," which be in the context of schizophrenia, schizoaffective, bipolar, etc.
  10. Definitely a possibility and I've definitely heard that it can exacerbate current anxiety with no guarantees of abating with enough time on the medicine. Anecdotally, when I started on Wellbutrin XL, I didn't experience any anxiety, but I did notice some increased irritability for a few days to a week, then it passed. Have been on 450mg for some time now — I want to say more than a year, but can't remember exact time frame — and have found it beneficial.
  11. Well, ultimately, I defer your psych as I am a) not a psychiatrist and b) don't know you as well as that person. Even if the Cymbalta isn't destabilizing you by triggering hypomania, there's nothing to say that it's not a primary or secondary cause of your anxiety. How long have you been experiencing this anxiety? For a long time? Long enough to pre-date Cymbalta or at least going up to the dose you're at now? As I said before, you don't want to change too many things at once because you may not be able to tease apart what is doing what. Furthermore, by attempting to improve one thing, you could be worsening another, i.e. titrating down on the Cymbalta helps to alleviate the anxiety, but you become more depressed in the process. And because of that, perhaps your psych is hoping you'll get improvement in mood with the Lamictal — enough so that you may eventually be able to go down on the Cymbalta. But as someone else said, titrating up on Lamictal to doses typical of treating bipolar depression is a long slog. Remind me again why your psych is focused on getting you at a lower dose or off of Neurontin and Klonopin? It very well might be. I'm not very well versed in BPII psychopharm. To me, giving Lamictal to a full-blown manic and/or psychotic person would be akin to applying a Sesame Street bandaid to a gunshot wound to the chest.
  12. First of all, I feel the need to make the caveat that I don't have ADD/ADHD or bipolar, but have worked for the last decade on a locked inpatient unit for the more extreme end of BPI with florid psychosis, full blown mania, catatonia, agitated delirium, etc. and a not-insignificant percent brought on by both prescribed, "normal" use of psychostimulants and abuse/misuse. Honestly, I would say things are too much in flux right now to make a judgment about whether stimulants are your friend or enemy. You're going up and down on two meds which are in different drug classes and do different things, so that's likely going to mess with you a lot, both in terms of whatever they're doing or not doing for you and side effects, especially if you're pretty naïve to antipsychotics. Even though you probably don't want to hear it (but it's what is typically done where I work), I'm surprised they didn't stop the stimulants as a first course of action, let the dust clear and see what's still standing. While it might make certain aspects of your life more difficult, it would only be changing one thing and that one thing would be much less likely to destabilize your mood than the push-pull tug of war you have going on now. Aside from that, if you're on the max dose of Cymbalta, have been for some time, and still struggling along with using benzos to counteract anxiety you seem to think could be directly related to it, something likely has to change with that. Either the Cymbalta isn't doing anything, it's too high of a dose for most people and is directly contributing to your struggles, or, if the BPII diagnosis is likely accurate, could be completely destabilizing you at any dose since serotonergic drugs don't tend to play nice with any flavor of bipolar. I saw somewhere that you felt like the Risperdal might not be cutting it, but not what dose you're on or how long you've been taking it for. Most people start at 0.5mg (or 0.25mg if you're super sensitive or want to go slow) and can typically go up to 8mg, although unusual because the higher range tends to be more for full blown psychosis and mania as well as certain side effects can become more pronounced and unpleasant, like akathisia (which there is medication to help with if the risperdal ultimately works), tachycardia and orthostatic hypotension (less able to treat and more risky if you black out standing up and fall). Also, it's used at times as an augment for both monopolar and bipolar depression as well as believed to have some form of anti-manic properties while not in a true mood stabilizer sense. Speaking of which, have you been on any before? I know less about treatment of BPII hypomania and mood cycling from that angle. Our typical go-to's are Lithium, Depakote, and sometimes both in tandem or a more robust antipsychotic like Zyprexa if warranted. I'm vaguely aware of the units below us using Seroquel more often, frequently in the 2-400 or 600mg range for both mood stabilizing properties, depression (as one of its active metabolites has antidepressant properties), anxiety, sleep, etc. They also use a fair amount of Lamictal, but I believe that's primarily for bipolar depression and has very little to no anti-manic properties. There are also other not as commonly used anticonvulsants that may have some benefit, like Tegretol, Topamax, Trileptal, possibly even Keppra or Zonegram as well as other antipsychotics like Abilify and Latuda. Unfortunately, it boils down to trial and error, your body's individual response, your ability to tolerate potential side effects before any potential gain to fully rule out medications, psychotherapy, and a little hope.
  13. Truthfully, up until this point, I didn't have a clue how much I spent on my meds. I imagined it wasn't terribly high as, when I would glance at the charges, they never seemed to amount to much individually. I think the most expensive one migh'tve been pregabalin (Lyrica) because it was brand name and hadn't gone generic yet, but I didn't stay on it very long anyway since it didn't seem to do anything. And I know it sounds utterly stupid and clueless, but I knew there had to be some kind of annual deductible because usually later on in the year when I would go to pay for a prescription and they wouldn't charge me anything. I did a little looking — nothing crazy 'cause I didn't want to go digging through my prescription insurance paperwork — but I found through the billing and itemization of PillPack that my deductible must be $250 a year, as that's the amount the charges to my card stops at since 2013 or '14. Then that amount gets taken out of and paid for by the healthcare fsa (flexible spending account) my employer allows us to set up if we want to. The money is all pre-tax and automatically deducted from our pay checks; and it's only up to a certain amount (but you can always select to set aside less) set by the IRS every year. I think this year it was increased to $2,750. It can be used for quite a few things other than prescriptions too, like medical, mental health, and dental co-pays, a whole bunch of healthcare-related equipment (but there are specific rules for some things like having to treat a specific disorder or illness and not just for general health as well as possibly a prescription [like for a CPAP machine for example because it's a regulated medical device] and sometimes a LMN, a letter of medical necessity, which is kind of like a doctor's note/unofficial prescription, and obviously receipts and whatnot, whether you're using the debit card they provide or your card and then filing for reimbursement from them). I'm still learning more and more about it as the resources the 3rd-party company provides are pretty vague — not so much for the specific, clear cut things they allow or not allow, as those aren't even set by them but the IRS — but more the gray area stuff that they say you might be able to get approved with an LMN, but they don't say definitively, even when I've talked to people there. It still could be potentially worth it for you though, if you have access to a healthcare fsa through your employer or maybe your significant other or parent if you're a dependent, and you don't mind a little risk with that won't get automatically approved. Like, for example, I'm in the process of buying a water flosser because my gums and teeth suck and my dentist brings it up every time I see her. So, she wrote me a letter for it and I had a chat with people at the 3rd party fsa administration where they gave me a pretty vague okay. Now, I'm just waiting for enough money in my account to buy it because it doesn't immediately count as fsa eligible and I'll have to file for reimbursement with them later on.
  14. Is it technically possible? Yes. Will your doctor or any local doctor prescribe two at the same time? Hard to say, but I'd imagine you'll need a pretty good reason, as the abuse/addiction potential, risk of respiratory depression (especially if you take other sedating meds), etc. counts against you. The other hurdle is if you use insurance and are in the US, you might get push back from. They'll likely say either use a longer acting benzo, increase the dose of the original or try other non-benzo meds for anxiety first.
  15. I'd say Thorazine is a very sedating antipsychotic, but not a good or potent one when compared to others, both typical and atypical. Generally speaking, an antipsychotic's potency — not to be confused with efficacy — is at least in part determined by its D2 and D3 receptor-binding affinity. So, for typicals, ones like Haldol, Stelazine, and Prolixin would qualify. In conjuction with dopamine receptor binding affinity, it's all relative to Thorazine. In other words, scientists measured how much of a particular drug vs how much thorazine would it take to occupy x% of receptors. So potency really only correlates with a higher risk of extrapyramidal side effects, not how good it is at alleviating whatever you have going on. Atypical antipsychotics are even harder to measure as some don't bind very tightly to D2/D3 or hit many other receptors than just dopamine. And if you look at the "best" antipsychotic we have, clozapine, it has a pretty weak affinity for D2 as compared to other meds, but it can do a lot for people where all others have failed
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