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Need AP/AAP recommendation for me to think about


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So.  I haven't worked in over four weeks due to a bad reaction to rexulti.  Eventually got taken off that and by consensus between me and pdoc I started abilify.  I'd been on it before and no side effects.  I got taken off it before because I was hospitalized for being suicidal.  Knowing now I have OCD/tendencies, it was intrusive thoughts and the doctors at the hospital I went to were just dumbs (my old pdoc was out of the country at the time).  I am now taking zoloft for intrusive thoughts which is like a miracle drug.

Sickness continued on abilify, so I went off that Wednesday (today's Saturday) with pdoc's permission.  Better every day.  I've lost like 24lbs since the start of February either being too nauseous to eat or puking and not wanting to eat.  Fun times.

Pdoc and I both thought it'd be best to have some time to let my body return to normal before introducing someone else.  I take loxapine at a low dose (normally 20mg, raised to 40mg until I get better - I haven't been a therapeutic dose of an antipsychotic since January!  But I've been too physically ill I guess.  I have some sporadic visual hallucinations but they're not debilitating or super distressing, just distracting.  

So, I've been on most AAPs.  APs I take loxapine and had a haldol was a...spectacular...fail.  Yikes.  

I am SZA if that matters.  Have a lot of psychosis issues, to me, more than mood stuff, but what do I know.

I had been thinking saphris to try (again) next.  Other than being convinced Toby was going to die (which was sad) and that I would then have to kill myself (dunno why; was also sad because I didn't want to die) - these may be more intrusive-y than anything.  Don't remember why I went off it.  Do remember it tasted awful.

I still have a lot of weight to lose before I'm in a place I feel I'm healthy, but I am no longer classified as obese by BMI (barely; but barely is good enough for now).  But I would like to be able to lose weight in a less traumatic manner.

Which matters mostly because I know why individual effects vary (this all started because I FINALLY got taken off zyprexa due to scary lipids and weight gain) - I do NOT want a med likely to cause weight gain, and I don't want lipids that will give me a heart attack in the next couple of years.

Any good suggestions?  I think AAPs are pretty washed out in terms of what I've tried/would be willing to try again.  

I am more than open to APs.  I LOVE loxapine, have taken it at a variety of doses, got taken off it as monotherapy because APPARENTLY homicidal ideation is 'bad' and requires a change in meds haha 😳 Haldol was terrible, but I got started low, and that was a mistake in judgement (me and pdoc were very new to each other).

Any AP suggestions?  Weight-neutral if possible, points for not crazy sedation (I do need to work), and known for being effective with psychosis?

Otherwise, I think saphris is up.  Though of course will talk about with pdoc.

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caplyta....idk if thats approved where you are ? You could try prolixin but as a potent AP it comes with its own possible nastiness, so getting up to a therapeutic dose might be problematic. Um... Vraylar? Perphenazine is known for being pretty tolerable with side effects, but i also havent heard (or experienced) many success stories of it actually being effective. there is this med called molindone that hovers between ap and aap which is supposedly great as a weight option. I had one pdoc who really liked is as second line for bipolar, but it can be a massive pain in the ass to get filled 

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14 minutes ago, Iceberg said:

caplyta....idk if thats approved where you are ? You could try prolixin but as a potent AP it comes with its own possible nastiness, so getting up to a therapeutic dose might be problematic. Um... Vraylar? Perphenazine is known for being pretty tolerable with side effects, but i also havent heard (or experienced) many success stories of it actually being effective. there is this med called molindone that hovers between ap and aap which is supposedly great as a weight option. I had one pdoc who really liked is as second line for bipolar, but it can be a massive pain in the ass to get filled 

Thanks!!!!  I am PRETTY sure caplyta is not approved in Canada yet, googling did not turn up anything.  

I am not at all interested in vraylar - I've seen too many people on here talk about it causing crippling anxiety.  I know everyone responds differently but that makes it sooooo unattractive to me.  

Just did a quick look at molindone.  That could be a good one.  I would expect it's available in Canada too if it's generic.  

Thanks for all this!  (And that I'm not annoying)

I really appreciate your help.  I'll include molindone with prolixin as a possible.

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I took Prolixin for 2 years.

It definitely helped psychosis and it helped me sleep. I had to go off of it because I got severe tremors. I could not stop. I also bounced my leg a lot. I was on a very high dose. That particular time in my life  I was very very ill...hospitalized a lot. IP eventually took me off of it if I remember correctly. So much traumatic experiences in my life at that time that I really can't remember much. 

To summarize:

Prolixin did help psychosis, but the side effects were too much.

Best AAP: I have been on Clozapine for 6 years (minus 3 months). Worth the hassle and commitment. 

I hope this helps.

 

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Thanks @Butterflykisses!  I really appreciate hearing about your experience.

Clozapine has been raised before but I am concerned about weight gain (JUST lost everything I'd gained on zyprexa), lipids (on zyprexa I was so scared I was gonna have a heart attack, they were REALLY high) and sedation - I am the primary income earner in our family by a lot.  I don't know.  It's an option.  

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1 hour ago, Butterflykisses said:

Best AAP: I have been on Clozapine

I love clozapine, but it did take me a solid 6+ months to figure out dose, schedule, other meds etc. to manage the sedation. For me totally worth it in the long haul, but I had lots of support during my transition on to it and didnt have to work for the first 5 months 

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That's what concerns me.  I do get some pay while sick, but it's not regular pay and as I make over 3x what Toby does it's a real hit for us.  The sedation and inability to properly work if I started clozapine is a real worry along with the other stuff.  The blood tests would be annoying but not the end of the world.

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21 hours ago, jarn said:

That's what concerns me.  I do get some pay while sick, but it's not regular pay and as I make over 3x what Toby does it's a real hit for us.  The sedation and inability to properly work if I started clozapine is a real worry along with the other stuff.  The blood tests would be annoying but not the end of the world.

Prolixin then could be a good option

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16 minutes ago, Butterflykisses said:

Prolixin then could be a good option

That's what I'm leaning towards.

Molindone does not appear to be available in Canada?  I called my pharmacy, who couldn't find it.  I then asked them about prolixin (well, the generic, they couldn't find anything else) and they said 'there's lots of entries, we need to know what you would take, you need a prescription' I DON'T KNOW, I am trying to see if it's even available for me to get before I go asking pdoc! (who realistically would know, especially as he works at a psychopharmacology clinic so I assume he's a psychopharmacologist, but sometimes I like to plan eveeerything out).  It was a highly frustrating conversation.  I kept saying, I know I need a prescription, I am just trying to see if the drug is even available to take before I ask my doctor about it (oh yeah, I thought it'd be one of those over-the-counter antipsychotics 🙄)

Anyways, I then got the bright idea to check the Health Canada database and I couldn't find molindone at all.  Fluph-whatever (prolixin) is, but only in a few strengths and by one manufacturer.  I read the monograph they had there and it said it was better for 'behavioural' aspects of psychosis rather than like delusions...I'm not sure where I'd fall on that.  Said it worked on delusions, just not as well as the behavioural stuff.  Dunno.  When I'm psychotic I'm generally highly agitated...I have no idea.  Will ask pdoc.

Will also call the pharmacy at the hospital pdoc works at to take to them about molindone and prolixin.  They were very helpful last time clozapine was floated in terms of how it worked, the patient registry, etc etc...the hospital pharmacy is where I'd have to get clozapine though, I can't just get it from my local pharmacy.  And they only carry clozaril which is apparently crazy expensive, we have benefits, but I'm not clear how much would get covered between the two of us...Ontario provides it for free to schizophrenic folk, so am I in a grey area?

I just keep thinking, if I try saphris again.  I honestly can't remember why I stopped it before.  Probably people were watching my thoughts or something.  I have reoccurring delusions of a bunch of varieties (is thought broadcasting a delusion?  Sometimes they go out over the radio and since I was a kid sometimes people can watch my thoughts inside my head).  Mostly lately though I've been having issues with the trackers monitoring me (they act like normal people, but they watch me and report to these supernatural people, and they transfer in and out and communicate to other trackers what I'm doing, but since they're different people they think I don't know what they're doing) although being home all the time with COVID and not commuting to work has been highly helpful in that regard.  The subway is very difficult for me, the trackers are especially bad there though sometimes they're in cars around me or walking by on the sidewalk while I'm out with the dogs.  

Anyways, is there any point in trying saphris again?  I know I tried trying abilify again, but I truly believe I was taken off it for the wrong reason - confusing actual suicidal intent with intrusive thoughts.

So far prolixin is looking like the winner.

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On 3/13/2022 at 7:12 PM, jarn said:

That's what I'm leaning towards.

Molindone does not appear to be available in Canada?  I called my pharmacy, who couldn't find it.  I then asked them about prolixin (well, the generic, they couldn't find anything else) and they said 'there's lots of entries, we need to know what you would take, you need a prescription' I DON'T KNOW, I am trying to see if it's even available for me to get before I go asking pdoc! (who realistically would know, especially as he works at a psychopharmacology clinic so I assume he's a psychopharmacologist, but sometimes I like to plan eveeerything out).  It was a highly frustrating conversation.  I kept saying, I know I need a prescription, I am just trying to see if the drug is even available to take before I ask my doctor about it (oh yeah, I thought it'd be one of those over-the-counter antipsychotics 🙄)

Anyways, I then got the bright idea to check the Health Canada database and I couldn't find molindone at all.  Fluph-whatever (prolixin) is, but only in a few strengths and by one manufacturer.  I read the monograph they had there and it said it was better for 'behavioural' aspects of psychosis rather than like delusions...I'm not sure where I'd fall on that.  Said it worked on delusions, just not as well as the behavioural stuff.  Dunno.  When I'm psychotic I'm generally highly agitated...I have no idea.  Will ask pdoc.

Will also call the pharmacy at the hospital pdoc works at to take to them about molindone and prolixin.  They were very helpful last time clozapine was floated in terms of how it worked, the patient registry, etc etc...the hospital pharmacy is where I'd have to get clozapine though, I can't just get it from my local pharmacy.  And they only carry clozaril which is apparently crazy expensive, we have benefits, but I'm not clear how much would get covered between the two of us...Ontario provides it for free to schizophrenic folk, so am I in a grey area?

I just keep thinking, if I try saphris again.  I honestly can't remember why I stopped it before.  Probably people were watching my thoughts or something.  I have reoccurring delusions of a bunch of varieties (is thought broadcasting a delusion?  Sometimes they go out over the radio and since I was a kid sometimes people can watch my thoughts inside my head).  Mostly lately though I've been having issues with the trackers monitoring me (they act like normal people, but they watch me and report to these supernatural people, and they transfer in and out and communicate to other trackers what I'm doing, but since they're different people they think I don't know what they're doing) although being home all the time with COVID and not commuting to work has been highly helpful in that regard.  The subway is very difficult for me, the trackers are especially bad there though sometimes they're in cars around me or walking by on the sidewalk while I'm out with the dogs.  

Anyways, is there any point in trying saphris again?  I know I tried trying abilify again, but I truly believe I was taken off it for the wrong reason - confusing actual suicidal intent with intrusive thoughts.

So far prolixin is looking like the winner.

I would say that even psychopharmacology experts often stray away from the really old potent typicals so you might want to keep saphris in the running 

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8 hours ago, Iceberg said:

I would say that even psychopharmacology experts often stray away from the really old potent typicals so you might want to keep saphris in the running 

Yeah.  He was fine with Haldol...but maybe not this.  Well, I'll talk to him I guess.

7 hours ago, DogMan said:

My old pdoc said saphris is the best for negative symptoms. Things like inappropriate or blunt affect 

I'm not so bad with that?  I think?  I don't totally remember much from that time though.  Other than crying because Toby would die and then I would have to kill myself (didn't want either of us to die), me losing taste, and once walking to our local wearing my favourite white shirt that Toby later tore by accident.  

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I am still randomly hallucinating Toby's alarm - not all the time, but today, it was sporadic as opposed to constant once it goes off (which is what it normally is).  He has a sort of 'musical' (it's not actually music, more chimes) alarm...the hallucinations are mostly annoying because I keep thinking 'he hasn't turned off his alarm!!!!!  Ugh!' when actually he has.  Thankfully I know I do it enough that I don't tell him to turn off his alarm, but I do check he's up.  This morning while he was out with the dogs I wandered into the bedroom to check his phone though...it wasn't even in there.  Sigh.

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On 3/12/2022 at 1:45 PM, jarn said:

So.  I haven't worked in over four weeks due to a bad reaction to rexulti.  Eventually got taken off that and by consensus between me and pdoc I started abilify.  I'd been on it before and no side effects.  I got taken off it before because I was hospitalized for being suicidal.  Knowing now I have OCD/tendencies, it was intrusive thoughts and the doctors at the hospital I went to were just dumbs (my old pdoc was out of the country at the time).  I am now taking zoloft for intrusive thoughts which is like a miracle drug.

Sickness continued on abilify, so I went off that Wednesday (today's Saturday) with pdoc's permission.  Better every day.  I've lost like 24lbs since the start of February either being too nauseous to eat or puking and not wanting to eat.  Fun times.

Pdoc and I both thought it'd be best to have some time to let my body return to normal before introducing someone else.  I take loxapine at a low dose (normally 20mg, raised to 40mg until I get better - I haven't been a therapeutic dose of an antipsychotic since January!  But I've been too physically ill I guess.  I have some sporadic visual hallucinations but they're not debilitating or super distressing, just distracting.  

So from reading your signature, and assuming the changes, you are taking?:

Loxapine 40mg (temp increased from 20mg)

Lamotrigine 300mg

Sertraline 100mg

Gabapentin 900mg

Lorazepam 0.5mg PRN

On 3/12/2022 at 1:45 PM, jarn said:

Otherwise, I think saphris is up.  Though of course will talk about with pdoc.

If you don't mind the orally disintegrating tablet method, asenapine (Saphris) is definitely an option to retry.

On 3/12/2022 at 4:21 PM, Iceberg said:

caplyta....idk if thats approved where you are ?

Looks like Caplyta isn't approved yet in Canada, unfortunately.

On 3/12/2022 at 4:21 PM, Iceberg said:

Um... Vraylar?

Mmmm....if one doesn't tolerate aripiprazole (Abilify) or brexpiprazole (Rexulti), likelihood of success on cariprazine (Vraylar) is probably pretty low.

On 3/12/2022 at 4:25 PM, Iceberg said:

also, youre not annoying 🙂

Agreed. You're definitely not annoying, @jarn :) 

On 3/12/2022 at 4:40 PM, jarn said:

I am not at all interested in vraylar - I've seen too many people on here talk about it causing crippling anxiety.  I know everyone responds differently but that makes it sooooo unattractive to me.  

Everyone is different and not all meds are the same, but like I said above, if you can't tolerate brexpiprazole or aripiprazole (both dopamine partial agonists), this is at least somewhat predictive of your experience on cariprazine

On 3/12/2022 at 5:40 PM, jarn said:

Thanks @Butterflykisses!  I really appreciate hearing about your experience.

Clozapine has been raised before but I am concerned about weight gain (JUST lost everything I'd gained on zyprexa), lipids (on zyprexa I was so scared I was gonna have a heart attack, they were REALLY high) and sedation - I am the primary income earner in our family by a lot.  I don't know.  It's an option.  

A patient isn't necessarily guaranteed to have weight, lipid, and glucose increases on clozapine or olanzapine, but if they increase on one, they are almost guaranteed to increase on the other. So that probably does rule out clozapine.

On 3/14/2022 at 8:19 PM, Wonderful.Cheese said:

@jarn

There’s Stelazine (Trifluoperazine). It’s supposed to be good for anxiety as well as for schizophrenia symptoms and it’s a typical AP. 

Trifluoperazine is definitely an option to consider. Its chemical structure incorporates piperazine like loxapine, olanzapine, and clozapine. It is less preferential to serotonin receptors than dopamine receptors like most first generation APs, but it does have some affinity for serotonin receptors. Adding trifluoperazine to loxapine would largely just add more dopamine antagonism, and at that rate, I would just say that staying on the higher dose of loxapine makes more sense.

On 3/13/2022 at 7:12 PM, jarn said:

Anyways, is there any point in trying saphris again?  I know I tried trying abilify again, but I truly believe I was taken off it for the wrong reason - confusing actual suicidal intent with intrusive thoughts.

So far prolixin is looking like the winner.

I would still say that asenapine is probably a safer bet. It's a potent and proven AAP. So it will be able to deal with the psychotic side of your condition.....

On 3/14/2022 at 9:35 PM, DogMan said:

My old pdoc said saphris is the best for negative symptoms. Things like inappropriate or blunt affect 

.....but additionally, it will definitely be very effective for these negative/"mood" symptoms, which first-gen APs like fluphenazine and trifluoperazine fail to effectively address. There is something to be said for the fact that you respond so well to olanzapine and loxapine. It adds evidence to the possibility that you would do well on asenapine. It also may have a lower metabolic side effect profile than olanzapine (...maybe).

Another one I might have you consider is risperidone (Risperdal). I'm taking it currently, and I find that addresses both sides of my condition, the ups and the downs. When new medications are being tested for the effectiveness in negative symptoms, risperidone is often used as an active control/comparator because it has some efficacy in controlling negative symptoms. It may still have metabolic disturbance associated with it, but that liability is lower than with olanzapine and quetiapine, statistically speaking. Additionally, it is known for having less sedation than olanzapine and quetiapine.

I might also ask if you've tried lurasidone (Latuda) for the same reason I recommend risperidone. It'll be good for psychosis and good for negative symptoms. However, it may have a relatively greater akathisia/EPS potential at higher doses. Happened for me personally around 80mg, but my threshold for akathisia is pretty low.

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2 hours ago, browri said:

Another one I might have you consider is risperidone (Risperdal).

Have you never tried this @jarn? I just skimmed over because it’s so commonly used 1st line- but if you haven’t I’d agree with browri 

2 hours ago, browri said:

Adding trifluoperazine to loxapine would largely just add more dopamine antagonism, and at that rate, I would just say that staying on the higher dose of loxapine makes more sense.

I agree here too- might also make some side effects more likely from the mutual action on dopamine (among other things) which is why I thought about putting it in my initial post and then changed my mind 

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Thank you so much @browri and @Iceberg - I have not taken risperdal - I took invega (bad prolactin, got put on bromocriptine, ended up paranoid and hallucinating (I guess?  I saw people turning into demons before reassuming their human form so I guess so).  I've always thought maybe cause of that risperdal wasn't worth trying.  I shall ask pdoc about that.

That's good to know what I shall refer to as 'triphufy' and 'fluphy' (heh, I dunno why old school APs have such hard to remember names) and the dopamine antagonism.  Will raise with pdoc but mention that you guys said it may not be a great fit because of that. 

I just like loxapine so much...I wonder if I should mention to him that my homicidal ideation has not ENTIRELY receded, I just don't want him to stick me on god knows what (aka clozapine) and I've been like this for the past two years (why he decided I needed zyprexa and loxapine monotherapy was no longer appropriate) (I started fixating on killing Toby when he's older and senile - my grandma had lewy bodies dementia and I don't want him to go through that, she begged for death...but I wouldn't do it UNTIL such a happenstance...anyways, apparently coming home on Valentine's and asking him to buy a gun so I'd prepared for when I needed to kill him 'wasn't romantic' though he wasn't particularly upset - says I'll never kill him (realistically I wouldn't, I love him so much, I just don't want him to suffer, I'm very anxious about us as we age).  And I like to plan/prepare.  Anyways, pdoc said it had elements of intrusive thoughts and psychosis because I didn't feel any remorse/wasn't upset by the thoughts...occasionally I'll still say to Toby we should have a gun so we can kill ourselves when society collapses and we're too old to fend for ourselves.  But I think about killing him now more in an abstract way.  Dunno.  I don't feel bad about it though.  He says we can't have a gun, not because he worries about me killing him, but he's worried I'll kill myself.)

Perhaps saphris is the way to go then.  Hmm.  Like I said, I really can't remember why I stopped it.

(I have been on Latuda - took 120mg?  160mg?  Not sure what the max dose was.  I'm pretty sure I stopped it because it wasn't helping depression, don't remember how it was on psychosis)

And @browri those are my current meds.  I should update my sig I guess but it's just been in such flux.

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On 3/19/2022 at 1:05 PM, jarn said:

Thank you so much @browri and @Iceberg - I have not taken risperdal - I took invega (bad prolactin, got put on bromocriptine, ended up paranoid and hallucinating (I guess?  I saw people turning into demons before reassuming their human form so I guess so).  I've always thought maybe cause of that risperdal wasn't worth trying.  I shall ask pdoc about that.

It's always worth talking about, but if you experienced elevated prolactin on paliperidone (Invega), then you'll almost certainly experience it on risperidone (Risperdal) as well.

On 3/19/2022 at 1:05 PM, jarn said:

That's good to know what I shall refer to as 'triphufy' and 'fluphy' (heh, I dunno why old school APs have such hard to remember names) and the dopamine antagonism.  Will raise with pdoc but mention that you guys said it may not be a great fit because of that. 

Well it may not be a great idea if you layer 'triphufy' or 'fluphy' on top of 'loxy'. However, they may still be useful when used to top off an AAP like asenapine or something else.

On 3/19/2022 at 1:05 PM, jarn said:

I just like loxapine so much...I wonder if I should mention to him that my homicidal ideation has not ENTIRELY receded, I just don't want him to stick me on god knows what (aka clozapine) and I've been like this for the past two years (why he decided I needed zyprexa and loxapine monotherapy was no longer appropriate) (I started fixating on killing Toby when he's older and senile - my grandma had lewy bodies dementia and I don't want him to go through that, she begged for death...but I wouldn't do it UNTIL such a happenstance...anyways, apparently coming home on Valentine's and asking him to buy a gun so I'd prepared for when I needed to kill him 'wasn't romantic' though he wasn't particularly upset - says I'll never kill him (realistically I wouldn't, I love him so much, I just don't want him to suffer, I'm very anxious about us as we age).  And I like to plan/prepare.  Anyways, pdoc said it had elements of intrusive thoughts and psychosis because I didn't feel any remorse/wasn't upset by the thoughts...occasionally I'll still say to Toby we should have a gun so we can kill ourselves when society collapses and we're too old to fend for ourselves.  But I think about killing him now more in an abstract way.  Dunno.  I don't feel bad about it though.  He says we can't have a gun, not because he worries about me killing him, but he's worried I'll kill myself.)

You kind of highlighted here that your pdoc thought you didn't do well on loxapine monotherapy and added olanzapine for more stability. Maybe this reinforces the need to have loxapine paired with an AAP. Even if it isn't olanzapine, pairing an AAP with a typical AP is pretty common in tougher cases.

On 3/19/2022 at 1:05 PM, jarn said:

Perhaps saphris is the way to go then.  Hmm.  Like I said, I really can't remember why I stopped it.

Might be worth exploring. Asenapine could provide that baseline stability with loxapine getting you the last 10-15% of the way. Additionally, asenapine might be more weight neutral than olanzapine or clozapine while having similar effect. Loxapine is also generally associated with weight loss due to the norepinephrine reuptake inhibition from the metabolites.

On 3/19/2022 at 1:05 PM, jarn said:

(I have been on Latuda - took 120mg?  160mg?  Not sure what the max dose was.  I'm pretty sure I stopped it because it wasn't helping depression, don't remember how it was on psychosis)

Max dosage form available is a 120mg tablet. However, lurasidone can be dosed up to 160mg (120mg+40mg tablets). Although I doubt it would be effective for depression on its own at such a high dose. Antidepressant effects are seen more at lower doses where lurasidone is predominantly a 5HT7 antagonist and has a more intermediate binding profile at dopamine receptors. At higher doses, it blocks dopamine too significantly to still be an effective antidepressant. Even initial trials found that doses above 60mg didn't really add much benefit for depression. However, higher doses can still be quite effective for psychosis and useful when there is a prominent mood component.

I suppose you could consider a combination of lurasidone+loxapine as your AP base.

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3 minutes ago, browri said:

Well it may not be a great idea if you layer 'triphufy' or 'fluphy' on top of 'loxy'. However, they may still be useful when used to top off an AAP like asenapine or something else.

This literally made me laugh out loud.  And I suppose it's not just APs, I cannot for the life of me remember the generic names for rexulti or abilify.  Especially abilify.  All those a's and p's.  Heh.  #senile #badmemory

You are definitely talking me into keeping loxapine with saphris.  I started loxapine when I was very agitated and psychotic, and within I don't know how long of taking the first dose I felt this wonderful sense of calm.  I've loved it ever since.

I would rather take saphris over latuda, despite the whole bad taste thing.  I lost weight on it (possible losing my sense of taste was helpful there), and I remember doing well in other regards where we lived at the time.  Other than being morbid I suppose.  But physically I meant.

However, the latuda info is not wasted!  Toby takes trintellex and is up to...30mg? Been a bit over a week and a half at 30mg, he's still really not great.  I know, AD, can take a while.  Got him to email his pdoc.  I told him (before the dose got raised, and now) that I think he should try latuda.  I shall tell him this interesting info about dosing, I did not know that.

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I thought @browri would laugh - I had the appointment with pdoc (he totally agreed with you and @Iceberg about the other APs I was wondering about layering on top of loxapine - so we'll likely add saphris - of course, I only started to really feel better Friday and I talked to him Thursday so I see him in a few weeks and then we'll likely add something.  Told him about the thoughts about Toby and he said, look, I KNOW you're not homicidal, I'm not at all concerned about that.  But, we don't want it to continue either.  

But this conversation I thought was funny:

Me:  I'd also thought about prolixin, but some friends into pharmacology said with loxapine it'd all be dopamine antagonists and not add a lot

Pdoc:  Prolixin? (It's only generic in Canada and I think he'd forgotten the brand name)

Me:  Me.  Yeah, fluphy something, I can't remember the whole name

Pdoc:  Fluphy?  Oh, you mean fluphwhatever

Me:  That's the one!

Pdoc:  They're right about it and loxapine

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On 3/23/2022 at 3:34 PM, jarn said:

This literally made me laugh out loud. 

Glad I could make you laugh :)

On 3/23/2022 at 3:34 PM, jarn said:

However, the latuda info is not wasted!  Toby takes trintellex and is up to...30mg? Been a bit over a week and a half at 30mg, he's still really not great.  I know, AD, can take a while.  Got him to email his pdoc.  I told him (before the dose got raised, and now) that I think he should try latuda.  I shall tell him this interesting info about dosing, I did not know that.

Yeah, with Latuda the recommended dosing is 20-60mg with a max dose of 120mg. However, additional benefit wasn't seen in most patients when the dose was raised above 60mg. Doesn't mean it won't work. It just means that statistically it isn't likely to.

As for the Trintellix, it works for some people and not for others. It worked really well for me....too well. I have bipolar disorder so the more effective the antidepressant is, the more likely it will trigger treatment-emergent affective switch (TEAS). And considering that Trintellix hasn't been out that long but there are reports ROLLING in of it causing manic switch, I would wager a guess that Trintellix is statistically almost as effective as tricyclics while being more tolerable. However, I'm sure that it won't take too long for someone to read this and say something to the contrary. Just goes to show you that we are all very different.

2 hours ago, jarn said:

I thought @browri would laugh - I had the appointment with pdoc (he totally agreed with you and @Iceberg about the other APs I was wondering about layering on top of loxapine - so we'll likely add saphris - of course, I only started to really feel better Friday and I talked to him Thursday so I see him in a few weeks and then we'll likely add something.  Told him about the thoughts about Toby and he said, look, I KNOW you're not homicidal, I'm not at all concerned about that.  But, we don't want it to continue either.  

But this conversation I thought was funny:

Me:  I'd also thought about prolixin, but some friends into pharmacology said with loxapine it'd all be dopamine antagonists and not add a lot

Pdoc:  Prolixin? (It's only generic in Canada and I think he'd forgotten the brand name)

Me:  Me.  Yeah, fluphy something, I can't remember the whole name

Pdoc:  Fluphy?  Oh, you mean fluphwhatever

Me:  That's the one!

Pdoc:  They're right about it and loxapine

HAHAHAHAH!!!! Well I'm glad I made a good call then. Hope your pdoc enjoyed our "funny" :lol:

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