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Trigger-happy for AAP BP prophylaxis


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hey y'all ---

I've had multiple issues with PDocs trying to push AAPs on me for mood instability issues. For prophylaxis. Despite knowing full well that I have never, ever had destructive mania. Despite the fact that there exists no FDA-approved indication, and little other clinical trial data, that AAPs are useful for PROPHYLAXIS of BP, needless to say, BPII!!!

August 2004, California: PDoc puts me on Zyprexa as a mood stabilizer. 5mg gave me akathisia, which both of us misinterpreted as anxiety. PDoc ramps up the dose to 10mg. More anxiety. (You'd think she, or even I, woulda figured out what was going on right then.) Up to 20mg. Akathisia so horrendous that one minute seemed like a century. I had no idea what was wrong with me, and thought I was going SERIOUSLY insane despite being on an antipsychotic. This caused me to quit my job in January '05 and then move home to my parents for the time being.

June 2005, Indiana: Stuck at home longer than expected due to alleged adrenal tumor. Near the peak of a mostly euphoric hypomania that started in late March after synergizing Cymbalta with Trazodone (and quitting Z, needless to say). Would occasionally get intrusive mixed states for 3-5 days at a time, 1-2 times a month. PDoc misinterprets this as psychosis, or at least something that had a damn good possibility of turning into it.

Offers me Abilify, I agree to take it until my mixed state ends, he tries to convince me that I need it for BPII prophylaxis. I told him that no way in Sam Hill was I going to take another dopamine antagonist for longer than necessary. We had quite an animated discussion (though he had no positive points other than "what if, what if, what if...", and I was bludgeoning him with FDA indication data and my personal experiences). I'm surprised he became so irrational, as I respected him as a psychopharmacological genius (which he is), and he's also considered likely the best PDoc in the state, if not the whole Midwest!

I take Abilify when I noticed mixed state coming, then had to stop 4 days later. And you thought Zyprexa's akathisia was bad. =P Kept a bottle handy just in case I had a "crisis" (it's still in my bathroom linen closet, somewhere).

October 2005, Maryland: Fired. (But that's irrelevant.) PDoc informs me that the horrendous anxiety symptoms I was having on Z and Abilify are known as akathisia, and are underdiagnosed and the gravity of the general syndrome underestimated. Recommends that I avoid dopamine antagonists (just as I was thinking before). Under her guidance, I began Lamictal. Note that she's the only PDoc who never pushed an AAP on me.

June 2006, Georgia: I tell PDoc I'm getting a lot of sand, so to speak, and mention that I'd rather not take benzos. Bad Idea.

PDoc keeps asking me if I'm hearing voices or having weird delusions that I cannot explain rationally. An obvious no there. He keeps asking me again. I keep saying no. Then he offers me the option of taking an AAP for my sand. I told him I'm incompatible with AAPs, since one of the least-akasthisiogenic AAPs (Z) gave me horrendous akathisia (and EPS, I know, I'm weird). Then he says we might have to resort to one, anyways. I told him Seroquel would be the only one I'd even THINK of trying.

Then I backed up and said I'd be willing to try low-dose Klonopin (that's what I did in Maryland for a while, and it worked reasonably well, and I quit it cold turkey without any problem). He still insists on considering an AAP. I start thinking to consider another PDoc. ;)

(Epilogue: Because neither of us wanted introduction of a benzo now, and I adamantly refused AAPs, we attempted reducing my serotonin action by cutting Cymbalta in half. Within 2 days, that proved to be a disaster, so I went back up to 60mg. Oh well. K-time soon.)

So anyways yeah. What's up with doctors being trigger-happy with AAPs? Is it liability crap, that if you're sedated out of your mind you won't go manic or psychotic?

Or is it a conspiracy by the drug companies pushing their pricey AAPs over cheap generic benzos?

You know, if I said that stuff to my current PDoc, he'd put me on the express train to AAP-land, posthaste. :)

get out y'all's tinfoil hats,

--herrfous

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Honestly, it was Geodon that finally stabalized my dd's mood swings. It's working so well that we are reducing the Trileptal. Now, you say, why not just do away with the Geodon? Because it was the "final" component to make all of this work. God knows these phamacuetical companies (and I'm speaking specifically to the makers of Abilify) are inundating the print media with ads that their drug is used for mood stabalization.

I'm sorry they didn't work for you.

I've never heard the term "sand". What does that mean?

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DMF--

Don't even get me started on Abilify (literally and metaphorically, hehe)... I believe that when I was prescribed it, the going rate for a 30 day supply of 10mg pills was $660. Even though my insurance copay was only 20%, still, yeah, ouch.

And as far as sand, well, just imagine having a lot of sand in you. Trust me, you'd be rather jumpy and irritable.

native of the state with the America's largest sand dunes,

--herrfous

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Yeah, you don't want to get me started on the cost of these meds, either. I'm not sure what percentage our co-pay is but it's about 100.00 a month for each - Tripleptal, Geodon, and Abilify and I'm not sure what the Effextor or Cogentin is (dh has been getting it because the stres of the cost is just more than I can handle right now). Seriously, I could really get myself committed if I started to think "what" are we going to do when dd is not able to be on our insurance any longer. These meds are killing us already - there is no way we or she could every pay full price.

WHEN IS THE U.S. GOING TO GET A NATIONALIZED HEALTH INSURANCE PROGRAM??????

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WHEN IS THE U.S. GOING TO GET A NATIONALIZED HEALTH INSURANCE PROGRAM??????

Ugh. Don't even get me started on it. My father and I agreed that the only way to get good healthcare for all was to upset the monetocracy this world has become.

(But can we pleeeeease keep that discussion to another thread and only discuss AAPs and BP here... pretty pleeeeeease? *does cute pouty look*)

is very good at doing cute pouty looks,

--herrfous

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