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Which antipsychotic pairs best with zyprexa? Does Invega or caplyta work well with zyprexa, chemically speaking? You know, dopamine and such? (See how “much” I know about meds?!) @browri @Iceberg @Anyone in the entire CB universe!

I do want off Abilify. I hope my NP will still let me come off of it. I also would prefer not to take rexulti because of the same Abilify-like compulsive behavior issues and still feeling miserable and symptomatic. (Hence the need to replace it with a good match with zyprexa). Or would getting off Abilify while leaving rexulti with zyprexa make the compulsive behavior issues go away? Because it’s less “-piprazole?”

Or do I just stay on all my meds? But why am I still symptomatic? I know I’m treatment resistant but this is awful. I hate these positive and negative symptoms and then mood symptoms and then stress and anxiety! I can’t deal. And everyone expects so much of me.

Or do I retry clozapine but have my NP go slower with the dose increases? I don’t think she’s registered to prescribe it though?

I’m at my wits end right now. I’ll try anything. ECT even. Just make me right. I don’t care anymore about anything. 

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13 hours ago, Wonderful.Cheese said:

I’m at my wits end right now. I’ll try anything. ECT even. Just make me right. I don’t care anymore about anything. 

What symptoms are you having now that bother you the most?........Have you let NP know about them?

Unfortunately, I can't offer much help on the subject of APs, I don't have much experience with them, except low doses for anxiety.....

Hopefully someone else will reply with more knowledge, but I do think it would be beneficial to let NP know about the symptoms that are bothering you.

Edited by CrazyRedhead
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18 hours ago, Wonderful.Cheese said:

Which antipsychotic pairs best with zyprexa? Does Invega or caplyta work well with zyprexa, chemically speaking? You know, dopamine and such? (See how “much” I know about meds?!) @browri @Iceberg @Anyone in the entire CB universe!

I do want off Abilify. I hope my NP will still let me come off of it. I also would prefer not to take rexulti because of the same Abilify-like compulsive behavior issues and still feeling miserable and symptomatic. (Hence the need to replace it with a good match with zyprexa). Or would getting off Abilify while leaving rexulti with zyprexa make the compulsive behavior issues go away? Because it’s less “-piprazole?”

Or do I just stay on all my meds? But why am I still symptomatic? I know I’m treatment resistant but this is awful. I hate these positive and negative symptoms and then mood symptoms and then stress and anxiety! I can’t deal. And everyone expects so much of me.

Or do I retry clozapine but have my NP go slower with the dose increases? I don’t think she’s registered to prescribe it though?

I’m at my wits end right now. I’ll try anything. ECT even. Just make me right. I don’t care anymore about anything. 

Am I right in thinking that maybe you and np aren’t totally on the same page? You seem to often express being very uncomfortable but it sounds like your np isn’t really willing to change much (from your perspective) I think the first step is making sure she is 100% clear on your position so you can better work together.

unfortunately I’m not sure one single med will be the answer here. Evidence for antipsychotic polypharm is pretty limited. The only reoccurring suggestion I’ve found is abilify + clozaril or maybe with amisulpride but that isn’t in the us. 
 

One approach might be to target your most distressing symptom and go from there. Because it might be impossible to chase everything at once- ex. Some meds for positive symptoms may worsen apathy etc. i would say that since caplyta is a new (kind of) action it might be worth a shot- but it’s expensive as hell 

I’m sorry I don’t have something more optimistic to say 

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10 hours ago, CrazyRedhead said:

What symptoms are you having now that bother you the most?........Have you let NP know about them?

Unfortunately, I can't offer much help on the subject of APs, I don't have much experience with them, except low doses for anxiety.....

Hopefully someone else will reply with more knowledge, but I do think it would be beneficial to let NP know about the symptoms that are bothering you.

Thanks CRH. I appreciate your wisdom.

My symptoms? I am not conveying them to my NP at all I believe. I get so scared of being forced IP and I clam up. So I say something like “oh I’m doing ok” to NP and I say maybe 2 more sentences and I fill out a depression and an anxiety questionnaire which do not relate to my primary diagnosis. I don’t understand why she forces that depression questionnaire on me each time. I guess she doesn’t know, to be fair. Also, I guess I used to have a case manager always go with me to pdoc appts to help me.

What do I do? I have an appointment with my NP coming up soon. 

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4 hours ago, Iceberg said:

Am I right in thinking that maybe you and np aren’t totally on the same page? You seem to often express being very uncomfortable but it sounds like your np isn’t really willing to change much (from your perspective) I think the first step is making sure she is 100% clear on your position so you can better work together.

unfortunately I’m not sure one single med will be the answer here. Evidence for antipsychotic polypharm is pretty limited. The only reoccurring suggestion I’ve found is abilify + clozaril or maybe with amisulpride but that isn’t in the us. 
 

One approach might be to target your most distressing symptom and go from there. Because it might be impossible to chase everything at once- ex. Some meds for positive symptoms may worsen apathy etc. i would say that since caplyta is a new (kind of) action it might be worth a shot- but it’s expensive as hell 

I’m sorry I don’t have something more optimistic to say 

Thank you iceberg. I appreciate your wisdom as always!

I don’t know what to do. I don’t think I am conveying much of anything that is wrong to my NP. I’m terrified of her sending me IP. And I just can’t make myself open up to her and be honest about what I go through. Do I email her? Write her a note? She doesn’t pay attention to the stuff I have written. Which really is unfortunate. She doesn’t listen that way.

I have good insurance so caplyta’s price shouldn’t be an issue. I’m just wondering if it’s even worth my time though, that’s all. I’m not able to do much but sit in my chair all day doing nothing. I have bad negative symptoms and anxiety. With some upsetting messages from the universe thrown in.

Thank you again. 

Edited by Wonderful.Cheese
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2 hours ago, Wonderful.Cheese said:

Thank you iceberg. I appreciate your wisdom as always!

I don’t know what to do. I don’t think I am conveying much of anything that is wrong to my NP. I’m terrified of her sending me IP. And I just can’t make myself open up to her and be honest about what I go through. Do I email her? Write her a note? She doesn’t pay attention to the stuff I have written. Which really is unfortunate. She doesn’t listen that way.

I have good insurance so caplyta’s price shouldn’t be an issue. I’m just wondering if it’s even worth my time though, that’s all. I’m not able to do much but sit in my chair all day doing nothing. I have bad negative symptoms and anxiety. With some upsetting messages from the universe thrown in.

Thank you again. 

Np might shoot the caplyta down but I’d put it in the “doesn’t hurt to ask” category 

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23 hours ago, Wonderful.Cheese said:

What do I do? I have an appointment with my NP coming up soon. 

If you feel comfortable, maybe you could write down your most troublesome symptoms on a list, and read them to NP.....Just a suggestion.....I've done this before, and it seemed to help me organize my thoughts a bit by writing them down.

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@Wonderful.Cheese your NP seems to be a fan of AP polypharm. However, I don't understand the methodology behind combining dopamine partial agonists (Abilify and Rexulti) with silent antagonists (Zyprexa). The antagonist always wins. So it wouldn't be totally out of the realm of normal to eliminate Abilify and Rexulti.

If we're talking about something that might pair well with olanzapine, the trend with AP polypharm is to combine a full dose atypical antipsychotic with a modestly dosed 1st gen "typical" antipsychotic. So if you take 30mg olanzapine at bedtime, instead of using another 10mg olanzapine PRN during the day you could use something older like loxapine 10mg capsules PRN. Loxapine is structurally very similar to olanzapine, clozapine, and quetiapine. It does have fairly significant activity at serotonin receptors for a 1st gen AP, and it comes in 10mg capsules that can make dosing flexible.

Loxapine is also broken down in the body into metabolites which have antidepressant activity (amoxapine), notably norepinephrine reuptake inhibition, which may pair well with the fluoxetine 40mg that you're taking (according to your sig). Fluoxetine and olanzapine are both 5HT2C antagonists, which increases norepinephrine and dopamine output. This is why they were paired together to make Symbyax for treatment resistant unipolar depression and bipolar depression. So if you take that activity and tack on loxapine, it stands to really increase that effect.

So, like so:

olanzapine 30mg
loxapine 10mg-20mg PRN
gabapentin 1200mg
topiramate 200mg
fluoxetine 40mg
Vyvanse 60mg

Do you know what the gabapentin and topiramate are for?

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On 3/30/2022 at 8:43 AM, browri said:

@Wonderful.Cheese your NP seems to be a fan of AP polypharm. However, I don't understand the methodology behind combining dopamine partial agonists (Abilify and Rexulti) with silent antagonists (Zyprexa). The antagonist always wins. So it wouldn't be totally out of the realm of normal to eliminate Abilify and Rexulti.

If we're talking about something that might pair well with olanzapine, the trend with AP polypharm is to combine a full dose atypical antipsychotic with a modestly dosed 1st gen "typical" antipsychotic. So if you take 30mg olanzapine at bedtime, instead of using another 10mg olanzapine PRN during the day you could use something older like loxapine 10mg capsules PRN. Loxapine is structurally very similar to olanzapine, clozapine, and quetiapine. It does have fairly significant activity at serotonin receptors for a 1st gen AP, and it comes in 10mg capsules that can make dosing flexible.

Loxapine is also broken down in the body into metabolites which have antidepressant activity (amoxapine), notably norepinephrine reuptake inhibition, which may pair well with the fluoxetine 40mg that you're taking (according to your sig). Fluoxetine and olanzapine are both 5HT2C antagonists, which increases norepinephrine and dopamine output. This is why they were paired together to make Symbyax for treatment resistant unipolar depression and bipolar depression. So if you take that activity and tack on loxapine, it stands to really increase that effect.

So, like so:

olanzapine 30mg
loxapine 10mg-20mg PRN
gabapentin 1200mg
topiramate 200mg
fluoxetine 40mg
Vyvanse 60mg

Do you know what the gabapentin and topiramate are for?

Thank you so much! I truly appreciate your words as always! I admire your knowledge so much!

As far as the gabapentin I take it for my generalized anxiety disorder in lieu of the 3 mg clonazepam I had been taking when I first started seeing my NP (she helped me make the switch). For the topiramate I take it for appetite control. I have lost 75+ lbs now by getting off seroquel and back on Zyprexa zydis (which is my miracle medication).

 

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20 hours ago, Wonderful.Cheese said:

Thank you so much! I truly appreciate your words as always! I admire your knowledge so much!

Any way I can help! :) 

20 hours ago, Wonderful.Cheese said:

As far as the gabapentin I take it for my generalized anxiety disorder in lieu of the 3 mg clonazepam I had been taking when I first started seeing my NP (she helped me make the switch).

Well then yeah if you are able to keep anxiety under control with gabapentin instead of clonazepam, that seems like a win to me.

20 hours ago, Wonderful.Cheese said:

For the topiramate I take it for appetite control. I have lost 75+ lbs now by getting off seroquel and back on Zyprexa zydis (which is my miracle medication).

Makes sense too. Topiramate is really effective for appetite control for some people.

Carry on. Let us know how things continue to progress. :) 

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