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I am bipolar (I think actually SZA, I've been diagnosed with that before, current pdoc says 'on the schizophrenic spectrum' and that psychosis is a bigger part of my disease than most bipolar people).  In case that gives context.

I take:

Zyprexa 15mg (20mg was causing me to sleep when I should be working)

Lamotrigine 300mg

Gabapentin 900mg

CBD for akathisia caused by Zyprexa, sometimes I need .5mg Ativan for that too, or to help sleep.  

Generic Alesse for birth control

I have had bad depression this week, sufficient that my husband stayed home with me Wednesday and made sure I got a pdoc appointment sooner (next Tuesday).  

It's a bit better today - I'm still depressed, but I was able to work all day.

I don't know if I need a med change or adjustment or what.  Zyprexa is new (since spring) and it's working pretty well from a psychosis perspective.  Should I ask about going up on lamotrigine?  Think of adding something new?  Or is this just a brief cycling?  I do realize I've been minorly depressed for a bit, but little enough that I didn't recognize it.

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Hi jarn, do antidepressants make you manic?

I'm not sure what the max dose of lamotrigine is for bipolar, but if you haven't reached it maybe ask about increasing it?

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Oh yes I should've said - I think my first psych med was...celexa (though I may be completely wrong) and it made me manic.  Since then I've taken an AD (don't remember which one) while on other meds and I was fine.  It didn't work well, but I didn't go manic.  

I think there's room to go up on lamotrigine, but I'm not sure.  That's a decent idea.

Thanks!

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for the question of whether to tweak something, I'd say that it makes sense....both because of the low underlying depression and the more acute symptoms. 

for what to tweak, I'm unfortunately not a good source of ideas on that front.  wish I could help more. 

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Thanks @dancesintherain.  I could go back up to 20mg of Zyprexa I suppose, but I had so much daytime sedation I don't think that's workable.  I don't know.  I have been having a lot of trouble falling asleep with Zyprexa and am having to take Ativan.  Waking up sucks, but it's not putting me to sleep.  It's a bit frustrating.  I don't want to be taking the Ativan! 

I'm thinking if I increase vs. add something new, Lamotrigine makes sense to increase.  I THINK I can go up to 400mg.

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33 minutes ago, jarn said:

Thanks @dancesintherain.  I could go back up to 20mg of Zyprexa I suppose, but I had so much daytime sedation I don't think that's workable.  I don't know.  I have been having a lot of trouble falling asleep with Zyprexa and am having to take Ativan.  Waking up sucks, but it's not putting me to sleep.  It's a bit frustrating.  I don't want to be taking the Ativan! 

I'm thinking if I increase vs. add something new, Lamotrigine makes sense to increase.  I THINK I can go up to 400mg.

you can, im at 400. but lots of docs feel like the benefit might be negligible at that point since 200 is "therapeutic dose" As far as a new med, I would be really careful about adding something after only one week. If it is just normal cycling, now you have this new med on board which may not even be helpful. Waiting it out sucks, I know, but i think you might have to give it enough time to "cycle out" Also, ive had the same issue with zyprexa and didnt get any antidepressant effect at high dose. also, celexa was my first med and threw me into mania too, would you look at that!

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I am improving but still down.  Mildly functional now, so there's that.  I am not sure if this is cycling, or - I've actually been mildly depressed for a few months I think.  It just got that much worse last week.  I'll see what pdoc thinks I guess?

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Posted (edited)

@jarn There is a pill called symbyax that is Prozac and zyprexa combined. I take Prozac and zyprexa separate. But it’s made a huge impact in my depression issues. Or the rexulti. Not sure.

That said, I think Iceberg has a lot of wisdom in the above post too.

Good luck with your pdoc appointment. Keep us posted. ❤️ 

Edited by Wonderful.Cheese

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Thanks Cheese, I'll for sure keep everyone updated.  Good to know about symbyax.

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Okay weirdly, my husband was just complaining I'm very distractable and hyper (I can get like that a lot, but then, I can cycle over a few hours at times).  Last couple of nights I've needed ativan to fall asleep after trying for an hour or so.  

He thinks I might be mixed.  Whee!

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So had online session with pdoc today.  Said that I've probably been mildly depressed for the last month and a half, but it got bad last week, it's not bad now.  Said that Toby thought I was having mini manias/was mixed.  He was happy to hear no psychosis!  

Pdoc pointed out that 6-8 weeks ago we dropped the Zyprexa dose to 15mg from 20mg to help with daytime sedation (I slept a lot).  I'm supposed to go back up on Zyprexa and if we need to, we'll add modafinal which I think I was on when I was on Seroquel - is that the same thing as Provigil?

He also wants to revisit metformin as I'm just taking 1000mg (I think he thinks 1500mg would be better, but when I was on that dose I pooped the bed in my sleep (and didn't wake up...1000mg is better).  He says to keep track of weight and we'll talk about it some more.  

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Make sure to ask your pdoc (if s/he is the prescriber of metformin) to have you on the ER metformin (Glucophage XR). It's way easier on your tummy. I speak from experience of being on both at extremely high doses. Lol 2000 mg IR metformin was like fecal incontinence and was always searching for a bathroom everywhere I went.

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Posted (edited)

Also, I've been up to 400 mg lamotrigine in hopes that it would help my depression, and all it did was flatten me out. I was gray, everything was gray. Nothing was even black or white, there were no shapes or figures, just haze. It was like someone turned the contrast all the way down on a TV or something. It was abysmal. Not to mention I suffered tremendous cognitive side effects on that dose (Topamax has nothing on Lamictal for me), my hair was falling out like crazy (it was visibly thinner, but my hair was long at the time and I pulled it back all the time so it could've also been traction alopecia), the zits and cysts all over my back, shoulders, and chest just got even more flared up and nothing I did (benzoyl peroxide 10%, tretinoin 0.05% topical, adapalene 0.3% topical, clindamycin topical 1%, oral monocycline and doxycycline, all of it did nothing to help... I never reached isotretinoin territory though).

Just be very careful and very watchful if you decide to go up to 400 mg in lamotrigine for depression. Don't expect much. IME, past 100 mg, it starts acting more like a true "mood stabilizer" in that it "narrows down your emotional color gamut" until there's just nothing but gray with very little variance in the huelessness so as to be able to make shapes out. I'm of course being figurative about that, it didn't literally make me color blind, but that's just what it felt like was a constant struggle to make sense of what was what emotionally and had no insight emotionally.

And the rashes, oh the rashes... If you are not prone to these with this medicine, you're soooo lucky! I had all kinds of rashses plus the aforementioned acne.

Edited by mikl_pls

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That's a great idea about the Metformin.  I think I'm on IR - I still have urgency quite a bit (but I've always had a dodgy stomach - everyone in my family does).  But I will ask, it is pdoc who prescribes it.  

We went with increasing the Zyprexa back to where it was before - 20mg - I feel out of it this morning but am awake.  

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43 minutes ago, jarn said:

That's a great idea about the Metformin.  I think I'm on IR - I still have urgency quite a bit (but I've always had a dodgy stomach - everyone in my family does).  But I will ask, it is pdoc who prescribes it.  

We went with increasing the Zyprexa back to where it was before - 20mg - I feel out of it this morning but am awake.  

Metformin while on Zyprexa is definitely a good idea, however high a dose you can handle. The XR formulation is, as I said, much easier to tolerate with your tummy and gut-workings. If you have insufficient blood sugar coverage at 2000 mg XR, you can add a small dose of IR to it I believe.

There are also other meds. Aren't you the one who takes/took liraglutide (Victoza)? If so, that would be actually a fantastic medicine to take while on Zyprexa. If you don't like the daily injections, Ozempic IMO/IME is a lot better. Made by the same people (Novo Nordisk), it's kinda like "Victoza 2.0" in that it's weekly injections and lowers A1c, blood sugar, weight, cardiovascular risk, etc. by a lot more. I didn't experience too much of a drop in anything (weight especially) I guess since I took Victoza for several years beforehand and then Trulicity for a short while. But it helps keep me in check (lately I've been having some very high readings and I wonder if I need an adjunct med to it).

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Oh I forgot... Metformin depletes your body of vitamin B12, so you might go out and grab yourself a good vitamin B12 supplement. Preferably methylcobalamin (methyl B12) over cyanocobalamin (what most OTC B12 supplements are). I don't know about dosage, I take 1000 mcg per day (for MTRR and MTR genetic mutations) along with 25 mg P-5-P (activated form of vitamin B6 I have to take due to genetic mutations, I think CBS upregulation it was...) and 15-30 mg L-methylfolate (for MTHFR genetic mutations).

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Yes, I did take Victoza - good memory!  I haven't taken it in...two years?  It helped my mood, but I found the daily injections painful (would've helped if varied the injection location I suppose).  That's good to know.  Perhaps I'll ask pdoc about other meds.  

Because I want them not only for appetite/weight control, but I am worried I'll get diabetes thanks to Zyprexa.  I need to do bloodwork but lowered Metformin to 500mg last week as I ran out, thought pdoc had already sent a script to pharmacy, but he hadn't, so then I had to request that, wait a few days, they filled it but didn't tell me, so by Sunday night I had none.  Got delivered Monday.  But I thought I should try to be back on Metformin like normal before I do the bloodwork.  I've been putting it off because, labs + COVID (though I don't think they test for COVID at the one I go to, but just being around people, yech).  

Just now, mikl_pls said:

Oh I forgot... Metformin depletes your body of vitamin B12, so you might go out and grab yourself a good vitamin B12 supplement. Preferably methylcobalamin (methyl B12) over cyanocobalamin (what most OTC B12 supplements are). I don't know about dosage, I take 1000 mcg per day (for MTRR and MTR genetic mutations) along with 25 mg P-5-P (activated form of vitamin B6 I have to take due to genetic mutations, I think CBS upregulation it was...) and 15-30 mg L-methylfolate (for MTHFR genetic mutations).

Yup, I eat mostly vegan, so try to supplement already, but I got a higher dose B12 supplement.   Thanks though, it's a great reminder (I should go take some!)

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2 minutes ago, jarn said:

Yes, I did take Victoza - good memory!  I haven't taken it in...two years?  It helped my mood, but I found the daily injections painful (would've helped if varied the injection location I suppose).  That's good to know.  Perhaps I'll ask pdoc about other meds.  

Because I want them not only for appetite/weight control, but I am worried I'll get diabetes thanks to Zyprexa.  I need to do bloodwork but lowered Metformin to 500mg last week as I ran out, thought pdoc had already sent a script to pharmacy, but he hadn't, so then I had to request that, wait a few days, they filled it but didn't tell me, so by Sunday night I had none.  Got delivered Monday.  But I thought I should try to be back on Metformin like normal before I do the bloodwork.  I've been putting it off because, labs + COVID (though I don't think they test for COVID at the one I go to, but just being around people, yech).

I get you on wanting to put it off for the current reasons at hand...

Wow, I can't believe my memory served me right for once! Lol usually my memory is terrible lol. I think I have associated your profile picture + your avatar with some of your meds somehow... (I don't know why or how those things have made a connection in my mind...)

I got off Victoza for the same reason. I was getting knots in my tummy where I would inject. My tremor is too severe to inject in my thigh or upper arm, and it hurts worse since I have a WHOLE lot more fat in my belly lol.

If you go for any other GLP-1 agonist like Victoza, I would highly recommend Ozempic. It has been wonderful for me. No GI side effects (particularly nausea) starting up like with Victoza, the injections aren't as painful (somoething to so with the Ozempic itself maybe?). I just love it all around. Trulicity was okay but I didn't feel like it was really doing anything for me. Never taken any of the other GLP-1 agonists, but haven't heard too many good things about Bydureon/Bydureon BCse, Byetta, or Adlyxin. Tanzeum got discontinued I think. They make an oral form of Ozempic, called "Rybelsus," if you don't even want to bother with weekly injections, I almost forgot. GLP-1 agonists are kinda the future of weight loss, weight management, and diabetes management I feel, as does my gdoc.

There are DPP-4 inhibitors that sort of act similarly to GLP-1 agonists. They stimulate insulin release and I believe inhibit glucagon release (a hormone that causes your liver to generate glucose from glycogen stores). They are weight neutral I believe, perhaps can lose a couple of pounds on them, but nothing serious.

Stay away from the SGLT2 inhibitors (Invokana, Jardiance, Farxiga, Steglatro) or any product containing one... A fellow user on this site got the infamous genital mycotic infection and had to have skin grafts on his genitals from it. They also have black box warnings for increased chances of limb amputation. They're nothing to mess around with. They basically make you pee out extra sugar in your body. They can cause weight loss. But none of it I don't think is worth the potential risks.

But you can't go wrong with good old metformin (if it works for you that is, I don't think it really does anything for me).

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