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psychwardjesus

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  1. 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).
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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
  10. Depending upon the person, dosages of each, and what they're treating, nothing says that you can't take both at the same time, but that doesn't make it a good idea. Unless your illness is that severe and you've tried all other commonly prescribed antipsychotics, there may be a better option. As the other person pointed out, you'll have a lot of challenges with things like sedation, weight gain, diabetes, hyperlipidemia, etc.
  11. Professionally, I don't see a lot of Latuda usage in general. Not sure if that's more due to it being newer and perhaps less reliable in the psychiatrists' eyes or that it just hasn't seemed to work well for bipolar mania or psychosis. I've seen it used a handful of times as a primary or adjunct med for bipolar depression and major depression, but I don't remember it doing anything amazing. Plus, I imagine the calorie requirement plays a factor in people wanting to take it in that, whenever you take it, you really need to be at home to make yourself something to eat (or plan ahead for the day with a big enough meal or snack, but that can be a hassle) and since a lot of people take most meds at night, there's probably a lot of concern about weight gain when you're eating 350+ calories a night right before sleep. I couldn't say with Rexulti or Vraylar. They're too new and too expensive for most patients to afford before they go generic. If I had to guess though, I'd say Rexulti won't do great with mania as it's very similar to Abilify and in my experience hasn't worked for most people in that regard. I could possibly see it used as an adjunct, but not a primary antipsychotic. I've seen it used a lot more on units where I work that specialize more in straight depression, bipolar depression. Whether they actually work for those indications or it's just clever marketing though is another matter. I've seen a good amount of usage of Invega with some success, but it's primarily used for people that don't remember or stop taking their meds and it potentially has less undesirable side effects (at least of the parkinsonian/movement variety) as compared with the Haldol Dec shot. I also wouldn't expect it to be significantly more effective than Risperdal simply because paliperidone is the active metabolite of Risperdal, kinda like Pristiq and Effexor. Yes. I'm not as familiar with outpatient psychiatry, but I would imagine it's similar or the same — you're typically offered 1-2 test doses if you've never taken Invega before to test how you react to it (tolerability) before the one month or more IM injection. Because it would be a nightmare if they didn't do the test doses and then find out the hard way it gives you akathisia or something like that. Then you're stuck (as far as I know) until it wears off. And, yes, because it's an active metabolite of Risperdal, it can have a very similar side effect profile. I've only personally seen 4-5 people in 10 years develop any kind hyperprolactinemia on Risperdal or Invega and if your doctor worries that you might be at risk for it can easily order a blood test for your prolactin level.
  12. I use a task app on Android and set up reminders for every dose. There are medication apps for that kind of thing too, but none of them took. Was kind of a pain to have two different apps.
  13. I was on it two different times. Both times I stopped at 600mg TID. It was very hard to tell, but I felt like the first time it migh'tve had a very subtle effect; the second time I didn't feel anything at all though.
  14. As others have pointed out, especially with Lamictal, unless you have a tapering plan already set up with your psychiatrist, I wouldn't mess with it. Aside from an increased seizure risk, you also increase your risk for getting Steven-Johnson Syndrome (SJS), which can potentially be lethal. That being said, the likelihood of getting SJS is pretty low.
  15. I tried it for social anxiety. I got up to the max dose (forget what that is - maybe 400mg?), but didn't feel anything. Ultimately stopped using it both because it didn't work and it wasn't cheap due to not being generic yet.
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