Multiple AAPs

[jarn]

Is there any reason why people shouldn't be on 2/multiple AAPs?

When I was trying Ziprasidone one of the reasons my psychopharmacologist took me off Seroquel cold turkey was that I was going onto another AAP. Now that I'm back on Seroquel he's suggesting Pregabalin as a mood stabilizer (I posted in the cocktail forum re: this as I'm not impressed with what I've read about it).

Why couldn't I be on 2 AAPs at once? I like how they work with my brain, though I don't love all of their side effects. Is he concerned b/c I wasn't totally compliant with the Seroquel (lowered my dose without talking to him) that multiple AAPs aren't for me? Probably not if he was willing to have me on Ziprasidone only.

I noticed that other people on here seem to be on multiple AAPs and I think for stabilization this would optimal for me - I haven't in the past found mood stabilizers (lamotrigine, lithium) to work all that well for me, i.e., they haven't stabilized me. Maybe in conjuction with Seroquel this one will but if I don't find it helps I wanted to explore the option of 2 AAPs but I wasn't sure if there was some valid medical reason not to go that route.

Thanks!

[gizmo]

You CAN be on two AAPs (I am) but you double the risk of the big side effects... diabetes, weight gain, EPS & TD, pancreatitis, and so on. So for most people, it is best to stick to only one AAP.

If you are a med crash test dummy like myself for whom no other med works anywhere near as well as zyprexa and you have to take funky geodon because SSRI's trigger your episodes quicker and you need freaking AD coverage, then you get an oddball like me who has to take two AAPs.

Trust me, I am in the small minority here.

So if you feel you need to be on two, you discuss it carefully with your doctor, and if you get on two, blood tests every six months to make sure your body is kosher is an excellent idea. I know all about my BUN, TSH, WBC, and all those interesting numbers that always stay in the normal range.

[jarn]

Thanks....I can't take SSRIs....that didn't go well.

I love Seroquel aside from the sedation, and I just tried Geodon (well, Ziprasidone, whatever it's called in Canada). After 2 weeks of puking and not being sure if it was withdrawal from being taken of Seroquel cold turkey or the Ziprasidone, I just wanted it to stop so I stopped the Z and went back to S, though I'm holding at 400mg b/c I see my gp this week to add the mood stabilizer.

I guess I should look into the other mood stabilizer options if this one doesnt' work - I just don't feel a lot of confidence based on what I've read - I've already tried lamotrigine and lithium, and I don't think they'll put me back on lithium b/c I went off it by myself (after....10 months? 11 months? on it) and I got a rash with lamotrigine so of course that was discontinued even though no way it was the fatal rash.

[carmex]

I was on two AAPs once, and the side effects really sucked. The only option I had was to be on a very VERY high dose of Zyprexa (27.5), which my body couldn't take any more, i was gaining too much weight. I'm now on Seroquel, and its treating me well, im less sedated, more focused, (let me reiterate, WAY more focused) on the Z i felt like I had ADHD or something cause I would start something and it would take me forever to finish it. Sorry for the rambling, but yeah, if you think you need to be on two AAPs, let the pdoc know, but be aware of the SEs.

[jarn]

Thanks. I'm just worried b/c of the mood stabilizers I've tried (admittedly, only 2), they didn't work. Only AAPs have worked. But I don't love the side effects....being on a higher dose of Seroquel with Provigil is maybe another option, which I've resisted b/c I don't want to take meds for my med (Provigil to counter the sedation), but....I may not have 20,000 options here, and I know Seroquel at 800mg will keep me stable, not that I could never have breakthrough symptoms, but still.

I seem to be sensitive to meds so increased side effects are definitely a concern. Boo.

At this point I can't see being off of Seroquel. Within 45 minutes of taking a small dose (200mg) last Wednesday night I felt the nausea start to abate....after 2 weeks. I'm just not sure I could handle being off of it.

[papertrees]

Like they said, being on two AAPs at once will double your risk for side effects. I just am on two AAPs at once because my doctor found a study that abilify can be used to augment another antipsychotic (in my case, invega) and offset its negative side effects (i.e. weight gain). So far, it's working out. I actually lost weight on my current combo (see my sig). And my thinking is crystal clear now, not cloudy. I'm not zombified either. I've never felt this stable in the two years since I was diagnosed. I think I've found the perfect cocktail for myself. So, 2 AAPs at once can either make or break you.

Just my two cent's.

ETA: I get head tremors on this cocktail that don't stop with biperiden. That's, I guess, the only complaint I have.

[blackbird]

I am on two APs because of treatment resistant psychosis. I want to be prescribed Zyprexa and Risperdal Consta (injections) because I want to be more sedated but my p-doc is having none of that. He won't prescribe two atypicals simultaneously. I take 20mgs Zyprexa (my mother has recently given me the full dose back when I said the psychosis was so bad I was going to kill myself) and 3mg Haloperidol. I have a jaw tremor and stiffness for which I got procyclidine thrown at me. I am also on multiple mood stabilisers - topamax and tegretol.

blackbird x

[jarn]

Thanks both of you!

I am concerned about the side effects but if the Pregabalin doesn't work to stabilize me (and I'm not hopeful), than I will ask about it and way out the options. Maybe an AAP and AP is a good route too.

....I always worry that I seem to respond well to AAPs and not to mood stabilizers - does that mean I am Schizoaffective, not BP? - but that's probably silly since the 2 I've tried are for BP as well.

[AnneMarie]

Thanks both of you!

I am concerned about the side effects but if the Pregabalin doesn't work to stabilize me (and I'm not hopeful), than I will ask about it and way out the options. Maybe an AAP and AP is a good route too.

....I always worry that I seem to respond well to AAPs and not to mood stabilizers - does that mean I am Schizoaffective, not BP? - but that's probably silly since the 2 I've tried are for BP as well.

Med response does not make for a diagnosis. If you have psychosis and/or other schiz symptoms while you are euthymic, then schizoaffective might be your issue. If you do not, then probably that is not your problem.

As for seeing that other people are on two AAPs, I think there are a number of reasons. I take a low dose of Seroquel as a sleeping med. While on other antipsychotics for treatment, I was given the option to remain on Seroquel at a very low dose. This is a little different than using to AAPs for illness management. I assume there are others in the same boat. There are others with SZA like two who have responded here. That's a different illness than BP. And, there are a few w/BP for whom other options were tried that didn't work so well. Until you have tried the rest of the ACs one at a time or in combo or in combo w/an AAP, it's premature to go for two AAPs, IMO. The risks are not worth it until you know your other options don't work.

Lithium is a med that sometimes only works well the first time it's taken. This is not true for everyone, but if there is reasonable probability that you will discontinue again, it might not be such a good option.

Pregabalin is not first line treatment. However, it does work for some. You also have meds like Depakote, Tegretol, and Trileptal which it sounds like you have yet to try. I like Tegretol. It stopped my rapid cycling. Depakote did, too, but it came with more side effects for me. Everyone does not have a side effect problem with Depakote, though. Lamictal makes people rash prone in general. Some pdocs will stop it for any rash. Others will confirm it's an SJS rash. If d/c'd for non-SJS rash, some pdocs will retrial. I would try each of these before considering the two AAP or one AAP + one AP alternative. Anticonvulsants are thought to treat the illness whereas AAPs are thought to be more about treating symptoms. I find that one of the most compelling reason to give each of the ACs a serious trial.

[jarn]

Thanks Stacia!

I know responding well to AAPs doesn't mean I'm Schizoaffective....I do know that I have problems with paranoia or delusions when I'm not affective, at least I don't think I am, but I wouldn't say they're serious. Some I've had since I was a kid - 7 or 8 years old - and I definitely didn't have mood issues then, not that I can think of - but I'm never sure if I'm sub-stable, so not fully affective, but still having psychotic symptoms within mood issues.

The pdoc said they need to rule out Schizoaffective, but nobody is really doing that right now. Both that pdoc and my psychopharmacologist think I'm probably too high-functioning to be Schizoaffective, but are concerned that I have psychotic symptoms outside of mood symptoms. I'd just like to sort of know, rather than have it hanging around, if that makes sense.

My old therapist said the paranoia/delusions could also be from PTSD, but he wasn't a diagnosing kind of guy. None of my pdocs have really explored that. There is no doubt according to my old therapist that I was sexualized at a young age (around 3 is when I can remember, not that I have a lot of childhood memories, of hard-core and inappropriate sexual knowledge and fantasies....) but I can't remember abuse per se, so I'm never sure if I was sexually abused or just an imaginative, perverted child.

Which is off-topic!

Lithium made my hypothyroid really quickly, which I hated, though I stayed on it for months. I went off of it b/c my gp wouldn't prescribe me more than 2 months of birth control b/c I hadn't had a physical for awhile, and I was pissed b/c I was in there every couple of months for follow-up and blood tests and I already was taking enough time off work for doctor's appointments and who did she think she was to deny me birth control anyways....did she want the crazy person getting pregnant? So I decided I'd show her and I went off of everything; lithium, my hypothyroid med, and birth control. It wasn't until I was put on Seroquel that I realized how not stable I had been on lithium....it was like I had no concept of what it was like to be stable until I was on Seroquel.

Thanks for the med suggestions! If Pregabalin doesn't work (I just haven't found much about it and bipolar) then I will talk to the psychopharmacologist about some of the other anti-convulsants/mood stabilizers.