If you stopped Abilify and restarted, were your side effects the same or different?

[LilacOutsideMyWindow]

So I tried going on Lamotrigine as monotherapy, but I've been hypomanic for almost a week and the past few days I've been agitated and ragey, going to bed later, getting up earlier, posting all over the 'net...all signs of a lovely dysphoric mania on the rise. Called pdoc and she told me to take half of my 10mg Abilify nightly until I can see her next week. Of course call if things continue or get more out of hand.

When I was on Abilify before, I had a near constant twitch in my left eyelid, plus random other twitches on my face (sometimes it would like I was sneering, or my cheek would twitch, etc). Cogentin never helped the twitches. I also realized, once I was OFF of it, just how bad I'd been having akithisia while on it. I knew I was pacing a lot, and restless, but until I went off and was suddenly able to sit and relax I hadn't realized just how bad it had been. My MIL (who is a former psych nurse) actually asked over Thanksgiving when I had gone off the antipsychotic, as she noticed the akithisia was gone - she mentioned that when she saw me in Sept, I was wringing my hands, tapping my feet, along with popping up out of my chair to pace every few minutes.

I am really hoping that this time, my side effects will be less. I have gone from 5mg all the way up to 20 before coming back down and going off. The twitchiness and akithisia did not seem to be dose dependent - or at least my noting of them wasn't. The few weeks I was on both Abilify and Lamotrigine were the most stable I've ever been, and I'd really like to have that back!

[notfred]

I started at 1 mg and it took me 2-3 months to get to 10 mgs (1,2,5,10). Given its long half life dose changes at no less than 2 week intervals (per the PI) is a pace that makes sense. I think this is key to avoiding akathisia.

nf

[LilacOutsideMyWindow]

huh, I never thought titrating slowly would effect akathisia.

When I started last year, I started at 5mg.

Actually, here is my dosing history (just pulled it up, might as well post it)

11/17/09 - started 5mg

2/2/10 - 10mg

3/30/10 - 15mg

4/27/10 - 20mg (started Lamotrigine)

5/12/10 - 15mg

6/8/10 - 7.5 mg

7/6/10 - 5mg

9/22/10 - 2.5mg

9/28/10 - stopped

And from my notes, the akathisia started the first week I started it, and the facial twitchiness started in Feb. I forgot that in the beginning of April I thought it was causing blurry vision (later got a new Rx for my glasses). So I never did change doses faster than 2 weeks (except going from 2.5 to stopping 6 days later). I guess I can always cut the 10s into quarters and get 2.5 tonight that way, but I'm just not sure I buy that going slower would make a difference once I've already been on it - I guess I'm thinking like people who have taken lamotrigine, stop, and then can titrate much faster, but maybe that's not the same for an antipsychotic? Now I'm just confusing myself.

[notfred]

huh, I never thought titrating slowly would effect akathisia.

When I started last year, I started at 5mg.

Actually, here is my dosing history (just pulled it up, might as well post it)

11/17/09 - started 5mg

2/2/10 - 10mg

3/30/10 - 15mg

4/27/10 - 20mg (started Lamotrigine)

5/12/10 - 15mg

6/8/10 - 7.5 mg

7/6/10 - 5mg

9/22/10 - 2.5mg

9/28/10 - stopped

And from my notes, the akathisia started the first week I started it, and the facial twitchiness started in Feb. I forgot that in the beginning of April I thought it was causing blurry vision (later got a new Rx for my glasses). So I never did change doses faster than 2 weeks (except going from 2.5 to stopping 6 days later). I guess I can always cut the 10s into quarters and get 2.5 tonight that way, but I'm just not sure I buy that going slower would make a difference once I've already been on it - I guess I'm thinking like people who have taken lamotrigine, stop, and then can titrate much faster, but maybe that's not the same for an antipsychotic? Now I'm just confusing myself.

You do not reach steady state until 2 weeks with Abilify so you really cannot tell if it is works until at least the point of steady state.

All I can tell you is my pdoc said slow and low would help avoid side effects like akathisia. It did take a while for the tremor to show itself, it is very

fine so it can be missed until I do something like use a screwdriver. Exertion makes it worse.

Lamictal is different, you a avoiding rashes with the slow titration. The manufacture never recommends faster titration than the standard regardless of if you have taken it before.

nf

[LilacOutsideMyWindow]

I wonder why my pdoc (who is really a PsyD, CNS) started me out at 5mg, then - maybe because it was what she had samples of at the time (although I could have cut them in half in the beginning, but she never suggested it, and at the time, I didn't know about crazy boards - found it quickly enough afterwards, but didn't really look into med titration right away).

Ugh, who knows if I'll even stay on it - this was just her suggestion to a freaked out me calling her yesterday telling her I was flipping my shit - she knew I had some abilify in 10mg leftover, so she's having me take halves of them until I can see her.

I still hope I don't get restless and twitchy, but I'll take what comes if it means I'm not a raging bitch who is trying to get xmas planned for her kids before she totally loses it.

[notfred]

I wonder why my pdoc (who is really a PsyD, CNS) started me out at 5mg, then

Target doses are higher in bipolar than depression so that may be why you were started higher. Still if you have had problems in the past, if it were me I would retry at a lower dose.

nf

[LilacOutsideMyWindow]

thanks