Adding an antipyschotic

[jarn]

So I've been having some issues lately - doing pretty good this week but since mid-June - eeeeh.

My bf would like me to consider adding in another antipsychotic.

I am hopefully of one that is more weight-neutral? Perhaps I could try that at a higher dose and stay on a low dose of Seroquel (I've discontinued Seroquel twice and because of discontinuation symptoms I'd prefer not to go off of it).

He just thinks I might need something more.

Ziprasidone and Invega are out. But extension, so is Risperidal.

Saphris and Fanapt are not available in Canada as far as I know.

I do NOT want to take Zyprexa because of weight issues. I know the Zydis is supposed to have less problems but I'm still not sure I'm comfortable with it.

Abilify I don't find particularly appealing.

My bf was wondering about the typical antipyschotics or Clozapine. All I know is that the typicals will = drooling + EPS that might not go away. And Clozapine will = drooling, possible effing up of white blood cells, and some serious weight gain.

My other concern is staying stable enough to train (triathlons) and be able to hike and do backcountry trips (I lead groups for an outdoor club I volunteer for). Basically, I need to be able to be quite active on the med.

I don't even know if my doctor will be receptive to 2 AP's. I suspect it is not his favourite thing. I don't even know if I want to CHANGE, again.

[CrazyCatLady]

My pdoc gave me Zydis because I told her that I really don't want to take anything that will make me fat. I only take it prn, so it may be different if you're taking it everyday, but it didn't make me want to eat more. You seem to be pretty active, so maybe that will help so that you don't gain anything from it. The only thing that I don't like about it is that it makes me super tired so I can only take it at night or when I have nothing to do/nowhere to be. I guess you just have to see what your doctor thinks, but I would try Zydis before a typical antipsychotic.

[jarn]

Have you noticed any changes in your metabolism either?

....maybe I should try it. I'm just scared it will cause weight issues.

[confused]

What don't you find appealing about abilify?

[CrazyCatLady]

Nope. I've gotten fatter over the past 5 years, but that has nothing to do with meds, I just stopped being so active and started eating more (most of that time I wasn't even on meds). I'm pretty much against taking regular Zyprexa, but Zydis isn't supposed to mess with your weight nearly as much.

[AnneMarie]

FYI, two AAPs tend to be more fattening than one. Two also increase your odds of EPS. I have found both of these generalities to be true.

If Seroquel isn't cutting it, then you are better off giving Abilify and Zydis real trials before doing the two AAP path or the typical AP trail.

[jarn]

....I don't like the name of Abilify. Brand name or generic, they both bother me. I know that's not logical....sometimes little things REALLY bother me, and it's one of them. I develop these illogical prejudices. Again, I know, not a good reason.

I don't so much want to be on 2 AAPs as I don't want to go off of Seroquel. I REALLY hate going off Seroquel. And I go back to it because it's familiar and for the most part it works pretty well, ignoring certain events. But it is seriously 6-7 weeks of me puking and on anti-nauseants. On the other hand, I want to lose weight.

I don't know if I should just see having breakthroughs as something that happens and not worry about them. I would've been inclined to look at my recent psychotic symptomst hat way but the strong suicidal compulsions (I was NOT suicidal, but had planned out what to do and was....very....tempted? to do so) is of concern to me.

I've always thought of APs and Clozapine as meds of last resort, but my bf was asking about them. I'm not sure if it's fair I look at them that way though I know the thought of being on Clozapine freaks me out.

Gizmo, I am of the opinion that I put the food in my mouth - but I do know after I dropped the Seroquel + Invega combo last winter to just Invega....successful diet! Whoo!!!!!

[CrazyCatLady]

If the Seroquel works well for you most of the time, maybe you can talk to your pdoc about having something you can take just when you need it? I don't know, that's just what mind did when I was on the Risperdal, she gave me Zydis prn. Maybe that way you won't be on two AAP's on a daily basis. I get you on not liking something for basically no reason, the illogical prejudices, especially when it comes to small, trivial things. It wouldn't do any good to even get the Abilify if you're not going to take it. I just feel like you should have something to help you through the really tough spots.

[jarn]

Well, I've always been very good about taking my anti-psychotic, if you don't count me lowering the dose of Seroquel from 800mg to 500mg over several months and not telling my doctors even though I was still getting prescriptions for 800mg. But I still did TAKE it, even if it wasn't at the right dose.

And when I had my episode in March and the emergency room doctor said she couldn't give me a prescription because there was no follow-up (p-doc was out of country) I asked about adding Seroquel back to my Invega and she said she couldn't tell me to that, and I said 'but you're not telling me not to'. I don't know if that counts as uncompliant or not. I've also when I've had issues raised my dose by 100mg as I knew I was still in the allowable range my p-doc set out but my social worker said that was non-compliant as well b/c it wasn't my prescription.

....I may not be considered to have a perfect history of med compliance. I always think I'm pretty good, but my bf says I'm not. (Went off Lithium to spite my doctor when she wouldn't give me more than 2 months of birth control because I hadn't had an annual physical; the aforementioned Seroquel dose change, though technically, I still took it; and me going off of Lyrica (which I've done a couple of times, if I'm honest) because I feel like my anxiety's fine, it's my least-important med (IMO), I don't like taking it 3X/day, and it's capsules, which I don't like swallowing (I know these are not good reasons and I'm being good now).

So I don't know if I have to take into account possible side effects and me not being perfectly med compliant as a possibility despite my good intentions.

I would like to be med compliant; I want kids and if for whatever reason I don't do the biological thing I'd like to adopt, but I have to have a proven period of stability and med compliance to do so (which is why I didn't tell my GP I wasn't taking Lyrica anymore, so it would look like I was being med complaint. Again, genius thinking on my part).

A med as PRN might be good. And for that even something like Invega....it worked GREAT (ignoring some depression, which Lamotrigine took care of) until the lactation started. And the med for the lactation was less than successful. But taking Invega PRN probably would be okay. Hmmm.

[CrazyCatLady]

I feel like a lot of people probably do the same kinds of things with their meds. Reducing, increasing, stopping, restarting. Why does your doctor want to you take the Lyrica so much if your anxiety isn't giving you issues? (maybe it has to be spaced that way, I don't know anything about that one) If you were increasing your dose within the limits your pdoc sets, I don't see how that could be counted as non-compliant. Obviously I can't say much about non-compliance since I just went off my meds without talking to my pdoc like 2 months ago. It's a struggle to stay on them (whether it be due to side effects, forgetfulness, feeling better, spite, etc). Just know what your limits are-if you have things you absolutely will not take, tell that to your pdoc upfront so that you can both go from there. I hope you can find someway to get rid of some of the things that are going on. I know where in a similar boat right now and it sucks.

[jarn]

We have had some stuff in common....hopefully improving for the both of us though! I will be really interested to see how you find the Zydis for symptoms.

Initially I was given the Lyrica to see if it could help with mood stabilization and I could stay at a low 500mg Seroquel dose. Didn't work for mood stabilization, but it helped a bit with some anxiety I was experiencing (I seem to get anxious during episodes). Titered up to 100mg 3X/day and I've been there - well, I was going to say 'ever since' but that's perhaps not entirely accurate. But that's how I ended up taking it as I do.

I have to admit, I do feel - when I first went on Seroquel (after unsuccesful Lamotrigine (rash) and Lithium) it was monotherapy - I got seen by a couple of different p-docs 4-6 weeks after going off Lithium - it was just a coincidence - and they stuck me on Seroquel as I was a bit triggered thanks to removing Lithium with no taper several weeks before. I stabilized symptoms at 700mg except for my DREAD which was helped at 800mg, where they stopped me.

So I USED to take this dose of Seroquel and I didn't need either Lamotrigine or Lyrica. Frankly I don't think I need Lamotrigine now - Invega made me depressed which is why they added it in - but since it's a pain to go on I didn't see the wisdom in asking for it to be removed from my meds.

Anyways, I kind of feel like Seroquel USED to take care of everything so I don't see why it shouldn't now. Not 100% logical, but it does affect how I think about meds like Lyrica.

....I emailed my bf some stuff about Zyprexa Zydis and he got off reading some stuff about Zyprexa and now thinks I should RUN, RUN AWAY where it is concerned. I tried to make him feel better by pointing out the Seroquel lawsuits (diabetes and that recent whistleblower one) but I'm not sure that helped.

[CrazyCatLady]

Do you want to stay on the Seroquel because it's helping except for some breakthrough symptoms, or because it used to help and is so hard to come off of? I'm wondering because maybe something PRN would be an easy way to combat the breakthrough symptoms, but if it isn't then maybe you need somethiing different altogether.

Do you have an appointment set up with your pdoc soon? Can you talk to them about your other meds? Maybe that way they can remove the Lyrica (if you aren't taking it anyway-which you don't have to say) and you won't have to worry about that screwing with your med compliance. Maybe you can have your bf go with you to see your pdoc so he can hear the pros and cons of the different med options? The best thing about Zydis is that it brings me down a few levels (so I'm not flipping out) very quickly. I can't really tell you to try it, because it might work differently for you, but I would try everything before I started in on the typicals, just because of the higher side effects profile.

[jarn]

Do you want to stay on the Seroquel because it's helping except for some breakthrough symptoms, or because it used to help and is so hard to come off of?

Sort of both....?

Seroquel does work well. I think antipsychotics have worked BETTER for me, but then I supposed I've had issues on them all. Nothing's perfect though.

My weight is a real concern. I know it is my own fault but the Seroquel doesn't help. I'm about 40lbs above race weight and it's a real issue for me in terms of doing the things I love to do, and which I think are really healthy for me and important for me to do (and so do my doctors).

But going off of Seroquel is unattractive because of the discontinuation. It doesn't help that a new med is an unknown but I find going of Seroquel so horrible.

Do you have an appointment set up with your pdoc soon? Can you talk to them about your other meds? Maybe that way they can remove the Lyrica (if you aren't taking it anyway-which you don't have to say) and you won't have to worry about that screwing with your med compliance. Maybe you can have your bf go with you to see your pdoc so he can hear the pros and cons of the different med options? The best thing about Zydis is that it brings me down a few levels (so I'm not flipping out) very quickly. I can't really tell you to try it, because it might work differently for you, but I would try everything before I started in on the typicals, just because of the higher side effects profile.

I see my p-doc August 23, which is his first day back in office. I can talk to him about my meds in general - he will already know I'm not compliant as we initially thought when I got worse in July or whenever that it was from that - my gp knows and my p-doc has an email from me - well, 2 - one, outlining that my social worker and gp thought I should see him but I wanted to try to see how being back on the Lyrica went, and then the email when I asked for an appointment.

Zydis might be good as a PRN then.

My bf has come with me before. I'll talk to him and see if he wants to come. He has said he'll help me with any med changes and monitoring me.

[CrazyCatLady]

It's important to address the weight issue, especially if it's making the things you like to do difficult, or making you feel down on yourself. I'd just bring it up with the pdoc and maybe he'll have some good options for you. It's hard because so many things seem to make you gain weight (or at least have a high potential to do so).Just see if your bf wants to go with you, that way he can voice any concerns as well as be aware of things that he should be looking for.

[jarn]

Well and some stuff I wonder....

I used to shower every day. Sometimes twice in a day if workouts and life dictated such. Now I shower every 5-7 days. More commonly the 7 day average unless I work out. You guys can tell how much I'm working out these days though, maybe once, twice a week if I'm lucky. I showered this morning (5 days) and washed my hair (I don't even know....12 days?) because Toby made me get up and shower. He'd mentioned something about my hair I think, anyways, for whatever reason he said he would get me up this morning to shower (normally I get up about 10 minutes before I leave the house). Anyways, he remembered, any made me get up this morning so that I showered. AND so that I washed my hair. Sigh. I thought another hairband day would've been fine.

I DO shave my armpits more often though.

My workout clothes, assuming I actually get some workouts in, ha, get washed by Toby a lot, but otherwise I wash my clothes on average once a month....I just wear the same outfits. Maybe roll the dog/cat/rabbit hair off. I rotate through the same outfits for work.

I'm not depressed. It's not like a black cloud that I can't clean myself or my clothes. I just don't think that I smell - maybe my hair is optimal, but then I can put it back in a hairband - and I don't think my clothes smell or look dirty. I usually wash them if I'm going away (backpacking or whatever, but I'll do a load of laundry then).

Is that bad? It's DIFFERENT than what I used to do. Been that way since....March.

Which is when I went back on the Seroquel actually. Don't know that I'd necessarily draw any correlation there.

Are these negative symptoms? Should Toby and I be concerned about this? Should an antipsychotic do something for this if they are negative symptoms?

[CrazyCatLady]

I don't know if the Seroquel is part of the problem or not. I know for me I have gotten worse as the illness has progressed. I used to shower daily, wear my clothing only once (maybe twice for jeans) before washing. Now I shower every 2-3 days and will wear my clothes several times. I still put on makeup every day that I go somewhere though. My husband does the laundry because I will let it pile up.

I wonder if it isn't an issue of motivation?

[jarn]

I don't know.

I wonder if I've just become lazy.

The house is pretty messy because both Toby and I are slobs. I used to vacuum more (before he moved in, though actually even when he first was living hear).

Toby is also ACTUALLY depressed, so he may be a little lax on the vacuuming due to that. When he wasn't working he would do that stuff and I think I let it get to about 7 weeks before I asked him to do it. Which might not sound that bad but we have a German Shepherd, a Husky mix, 2 cats, and 2 rabbits. So lots of fur.

[CrazyCatLady]

I don't know.

I wonder if I've just become lazy.

The house is pretty messy because both Toby and I are slobs. I used to vacuum more (before he moved in, though actually even when he first was living hear).

Toby is also ACTUALLY depressed, so he may be a little lax on the vacuuming due to that. When he wasn't working he would do that stuff and I think I let it get to about 7 weeks before I asked him to do it. Which might not sound that bad but we have a German Shepherd, a Husky mix, 2 cats, and 2 rabbits. So lots of fur.

Okay, well that makes a lot of sense. This might be dumb or totally out of the question for you guys, but we acually had to make a chore list. It's broken out into each day and we have all the basics on there under which days each thing needs to be done. Dishes, vacuum, bathroom, living room, laundry, etc. It seems simple, but it actually has helped us because it's not so overwhelming when you only have like 3 things per day to do. We're both pretty lazy.

[jarn]

We should have that. We usually do the dishes at the last possible moment. I actually don't MIND vacuuming (don't love picking stuff off the floor) I just don't feel like bothering to do it. We should try a schedule. Maybe after Ironman Canada so that training-related excuses are gone. Unless Toby does try to Boston qualify this fall, but I doubt he will.

[CrazyCatLady]

Maybe you could try it out. I know it's easier to put things off, but then it becomes this huge, overwhelming task.it just seems easier to keep thing clean if you can keep up on it and only have to do a few things each day. I do my dishes every day since it's just the 2 of us so it's easy, but pretty much everything else is spaced apart.