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Everything posted by psychwardjesus

  1. I've definitely seen a few patients buy it on the street or have a history of abusing it, typically when unable to get their hands on the good stuff, calling it a poor man's speed essentially, but I don't think it's very common because I don't think it's even remotely comparable in efficacy to amphetamines or methamphetamines.
  2. I don't think it's all that common, but I do remember a psychiatrist I worked with talking about SSRI's potentially interfering with platelet formation or functioning (honestly don't remember which it was), which would put you at an increased risk of bleeding. But, again, like I said, I don't think it's terribly common and I also don't know how dependent it is on the person, the SSRI, the dosage, etc.
  3. I don't have personal experience with Vyvanse, but I've definitely seen it cause problems with people in general, whether sleep, irritability, etc., even at appropriately prescribed doses and especially people with diagnosed, suspected or familial bipolar disorder. And obviously when you get into the realm of dosages of abuse with stimulants and crush/snorting them, things can get even worse. I remember working with one person who was doing that, felt bugs moving under his skin and tried to get them out with a hammer.
  4. I personally wouldn't recommend it and I'd be surprised if most prescribers were comfortable with it either. It considerably increases the risk of certain side effects like sedation and more importantly, respiratory depression, metabolic side effects like weight gain, elevated blood glucose levels/Type II DM, dyslipidemia, etc.
  5. As others have said already, the term overmedicated is a relative term — relative to both the prescriber prescribing the medication and the person taking it — so it's difficult to decide where to draw a line in the sand and then develop an action plan to combat that. You're much more likely to hear or read a term like polypharmacy, especially in the context of a person being prescribed more than one antipsychotic at one time. What was the logic behind putting you on loxapine? Was that to help manage any overflow psychotic symptoms that weren't managed by the olanzapine? Do you feel like it actually does something for you or are you like me and a lot of other people — taking medications that may have done something in the beginning, but you've been taking for so long you don't notice anymore or can't remember anyway. I don't know how crucial it is for you to take the loxapine or if you've tried other antipsychotics in place of it, but have you and/or your prescriber considered other medications for the residual depression/intrusive thoughts, like aripiprazole, quetiapine, lurasidone or even another typical like haloperidol or perphenazine if you wanted to stay in the same family, etc.? I would understand if you were reluctant to try, or had already tried, the first two, as, even though Otsuka has claimed that it's weight neutral, I've found that with few exceptions that's pretty much across the board bullshit. Sure, some people may have less metabolic side effects or less weight gain overall as compared to notorious weight gainers like olanzapine, but that's not exactly a comforting thought in my opinion. And quetiapine ... again, typically a weight gainer (although frequently not as bad as olanzapine) and at higher doses its first pass metabolite has antidepressant properties. You'd also have to talk to your prescriber about any interactions between the quetiapine metabolite and sertraline or any of the other drugs to make sure it doesn't put you at an increased risk of serotonin syndrome or anything like that. I also noticed in your signature that you were previously in some form of therapy. Did you find that helpful and/or would you ever consider trying it again? Psychotherapy is obviously generally a good non-pharmacologic tool to add to the toolbox and may be worth re-considering.
  6. I obviously don't have quite the same anxieties as you around medication and side effects, but if I did ... I feel like just hearing what you have to do and deal with to get half a dose every day, I'd end up saying fuck it because I'm just that lazy and it'd be much easier to take a whole pill. Haha.
  7. I've never done it personally, but sounds very risky and potentially unethical when weighed against what you could possibly gain if done outside of the IP setting.
  8. I don't know very much at all about the pharmacology of loxapine. In my professional work experience, I honestly can't remember when I've seen loxapine used clinically, even when I worked on a chronic psychotic disorders unit with psychiatrists who were more likely to prescribe old-school first gen AP's. With just a cursory google search, Wikipedia says that loxapine is listed as a typical AP, but structurally similar to clozapine, and some researchers argue that it works more like an AAP than AP. So not sure what to think about that. I've also not seen a lot of use of perphenazine (Trilafon). The few times I have as an AP, it was either because they were on it prior to admission, had been working but stopped taking it, and the doc planned on restarting it or was used off-label as a PRN for anxiety (4mg at a time) on an anxiety/depression disorders unit with mixed results. I was also personally prescribed it OP to try off-label as a PRN for anxiety; PRN doses in the 4-8mg range did nothing and when I impulsively decided to try 16mg one weekend, I didn't experience anything positive, only negative (low-grade taedive dyskinesia and akathisia). Have you and your prescriber tried or ever considered adding metformin to the Zyprexa? Where I work the psychiatrists try that sometimes with Zyprexa or Clozaril to help manage weight gain and other metabolic side effects. Not sure if the decision making process is based more on scientifically controlled studies or anecdotal evidence from other prescribers or case studies. If your prescriber is open to clozapine, it might be an okay alternative to Zyprexa, obviously keeping in mind you'd have to be okay with (initially) weekly blood draws to monitor clozapine level and more important WBC count.
  9. The way you wrote this post, it's hard for me to tell whether you're not happy with having to take clonazepam every day and would like to take less or something different or that you're taking clonazepam every day and it's not effectively managing your anxiety. In general, from personal experience and what I know working in mental health, you might be able to convince your prescriber to try a longer acting benzo like diazepam (Valium) or chlordiazepoxide (Librium), but it's lower potency as compared to clonazepam and I honestly can't think of other benzos of equal or longer duration and potency as clonazepam. Not to say that they aren't out there, but I question if they'd be FDA-approved for human use (research chemicals) or ones your provider would be comfortable prescribing and you using. Alprazolam XR has a longer half life than regular Alprazolam, but still not as long as Clonazepam. So, on the one hand, that might make things a little better as far as potential for abuse and physical dependence, but I don't know if it will last long enough for you to be effective. Yes, you could take it twice a day, but that would likely increase the risk of abuse/dependency, not to mention having no idea how your prescriber would feel about Alprazolam XR in general, let alone BID dosing. Plus, not that it's the be-all end-all authority on medicine and dose scheduling, but most websites I looked at recommended the dosing range be between 3-6mg QD on average, which seems awfully high; it definitely would be if it was instant release Alprazolam or Clonazepam.
  10. I can't tell if you live in the US or somewhere else, but in re: the hurdle of refilling and picking up scripts, have you considered looking into whether your insurance would cover a mail-order pharmacy? The only one I know off the top of my head is PillPack, but I'm sure there are others. Obviously there would be more variables than just insurance. Some would depend on your prescriber — like if they only do paper scripts or can e-prescribe — while others would also depend on what meds your on or could be on in the future. I say that because PillPack doesn't dispense Schedule II meds at all, so no Adderall, and more recently they don't accept scripts for controls like benzos through anything other than e-prescribing.
  11. So I've been researching and looking at possible new medications to try for my social anxiety and wanted to know if people had experience with any of these and also, if so, how was it? - gabapentin (Neurontin) doses > 600mg TID - pregabalin (Lyrica) doses > 200mg TID - tiagabine (Gabitril) - topiramate (Topamax) - lamotrigine (Lamictal) - quetiapine xr (Seroquel XR) - propranolol er (Inderal ER) - any anti-epileptic/mood stabilizer other than lithium and depakote
  12. I've never taken mirtazapine personally, but through work both anecdotally and observationally, I've heard and seen doses > 15mg to be less sedating and more activating, likely due to greater noradrenergic simulation and so possibly triggering more agitation, anxiety, hypomania/mania, etc. That being said, if you feel like the Bupropion is actually helping, I'd be more likely to reduce the mirtazapine than cross-taper to desvenlafaxine, as they're just different meds and not likely to generate the same results. I don't know how your psychiatrist feels about it, but specifically with the XL formulation of bupropion, you can go up to a max dose of 450mg (which I'm personally on and find helpful).
  13. Just my two cents, but ... please don't be afraid of ECT. If your psychiatrist or another medical professional recommends you for it, please consider it seriously. For the last eleven years I've worked full time at a very well known, free-standing psych facility in the United States which easily performs at least 10,000 treatments a year and I've seen numerous treatments from start to finish with my own eyes and helped countless others both before and after the treatments. Yes, it doesn't help everyone, or doesn't help them as robustly as we'd like, but I've also seen it work miracles for some and can confidently say they wouldn't be alive without it. And personally, if my psychiatrist (a doctor who performs ECT at the same hospital I work at) recommended it, I'd do ECT. I'd be anxious about going under general anesthesia because I've never been put under before, you know, but the treatment itself wouldn't worry me.
  14. I know it feels like choosing the lesser of two evils — would I rather be shot or stabbed — but realistically neither is good and I don't think you should set your expectations at that level. Plus, that's not to say it all boils down to medications that influence you to end up on one side or the other. There's also therapy — whether you're in it or not, is the therapist and you a good fit, is the style of therapy appropriate, etc. — and general life stuff, like sometimes you're just depressed because life sucks or certain aspects of life are hard.
  15. Most of the time I see my therapist once a week and my psychiatrist once a month even though I'm pretty sure I could go less frequently, especially my psychiatrist, since, other than some tweaking/playing with new meds here and there, I think my meds are what they are. You know what I mean? And sometimes I do, but that's typically more due to scheduling issues since I work 40+ hours a week and my therapist carries a pretty full load of clients and only sees people four days a week. I think if my therapist suggested it, I'd go along with it. But I don't know that I would ever suggest it myself, both because I think there's some transference on and I would worry I'd start decompensating right after. I don't know why and I don't think it's very likely to happen, but still. Plus, honestly, I think there's therapeutic value to having someone to vent to when you don't really have that outside of treatment, whether because of social anxiety or whatever. Like, we obviously talk a lot of therapy, but I also talk to my therapist a lot about work (full time inpatient mental health), both because it can be quite stressful some weeks (whether due to patients or staff [almost always staff]) and it's just a big part of my everyday life both literally and metaphorically.
  16. Sometimes I honestly wonder and don't know. But typically, I would say some combination of stubbornness, hope and not wanting to hurt family and a few close friends. I also think there's a logical part of me in somewhere in my head that says, Yeah, things definitely aren't great / suck right now, but they'd suck even more if you just threw in the towel. Everything would probably go downhill rather rapidly and you'd either end up dead or sectioned and in the hospital.
  17. If you're referring to tardive dyskinesia when you say TD, I wouldn't worry about it too, too much. Zyprexa is much less likely to cause TD as compared to pretty much any first gen. antipsychotic. Plus, even if you were to develop it, as long as you notice it pretty soon after it starts and you discountinue the Zyprexa,you should be perfectly fine and it'll go away once the olazapine works its way out of your system. Personally, if I were in your shoes and found it helpful, I'd stay on it. I'd be more worried about the increased appetite/weight gain/hyperlipidemia/diabetes mellitus and sedation than TD.
  18. Also, apologies if this was already brought up / addressed, but ... minus the side effects, do you think the Wellbutrin could be worthwhile to try again, but this time either titrating up more slowly and/temporarily managing the start up agitation/anxiety/whatever with a benzo like clonazepam (Klonopin)? Because I personally found it to be a worthwhile medicine in spite of the week or so of increased agitation and anxiety. I'm still on it now and the agitation/anxiety never came back.
  19. Also, somewhat complicating and anxiety provoking, both medications can cause rashes/allergic responses. The Wellbutrin one, while not the most comfortable to deal with, you can take a daily non-drowsy antihistamine like Zyrtec to manage it. It happened to me and I still take Wellbutrin XL. The other, unless the psychiatrist is well, well versed in rashes and has balls of steel, will likely immediately tell you to stop taking it, regardless of how far along in the titration you are or how helpful it is, because the cons far outweigh the pros of they were wrong if you ended up in the ER and/or ICU.
  20. I understand the strong urge to discontinue a medication when the side effects are really unpleasant, but as others have already said and I agree with: it would behoove you to try your best to tolerate side effects to see if a) they'll go away and more importantly b) if the medication actually helps. If not, aside from the obvious fact that you're simply not going to get relief from your symptoms, you're potentially significantly limiting your medication choices in the future, as there is some evidence that starting and stopping meds can possibly retard or completely remove their efficacy in the future. Plus, honestly, none of those side effects will kill you, physically harm you in any way or cause anything to be permanent (like tardive dyskinesia with antipsychotic). It's not Lamictal or Clozapine. And for whatever it's worth, trust me ... I get it. Side effects suck. Plain and simple. I put up with two different antidepressants, fluoxetine (Prozac) and sertraline (Zoloft) — the Prozac destroyed my sex drive, made me feel completely numb inside and best of all broke me out in full-body hives when I went up to 40mg and the Zoloft literally turned my GI tract inside out, making me have bowl movements six, seven, eight times a day (and I tried it on two different occasions!).
  21. Do you have any history of overdosing on your meds? If not, maybe one of the other tricyclics or MAOI's?
  22. If you're open to doing another run of trial and error, a tricyclic might be an option; but I will say though that, if you're really concerned about side effects, tricyclic may not be the road you want to go down. Historically, they tend to have more and greater likelihood of side effects compared to other antidepressants. As for why some prescribers don't prescribe tricyclic (or MAOI's for that matter), it may have to do with their significant cardiotoxicity in accidental or intentional overdose. Plus, the relatively newer SSRI, SNRI, NDRI, etc. medicines have better results and more mild side effect profiles for the average person.
  23. As the other person said, you might want to try to work through the side effects before stopping medications. Otherwise, you're wasting your time, not helping yourself feel better at all, and potentially reducing efficacy of antidepressants if re-trialed in the future and/or complete treatment resistance.
  24. Nicotine interferes with clozapine, so with heavy smokers they sometimes have to go higher than normal to achieve the same therapeutic blood level.
  25. They likely haven't done research on it because it would be highly unethical and no IRB would approve it.
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