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Lacking in energy, motivation, concentration, much fatigue


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I'm on:

200 mg Topamax (AM)

200 mg Lamictal (PM)

10 mg Zyprexa Zydis (PRN)

25 mg Nozinan (PRN for sleep)

500 mg Glucophage (PM)

20 mg Prozac (AM)

This combo has lifted my depression somewhat, and has prevented moodswings in both directions. It has definitely put an end to my hallucinations and delusions. HOWEVER, I find that I have trouble concentrating. I feel like I live in a fog, and can't keep track of conversation, especially in a group of people. I waiver in and out of focus. I have little to no motivation at work, and it takes a tremendous amount of energy to do anything. In short, I'd rather stay home, sleep and not move. Am I wrong? Am I still subclinically depressed? if so, what can I do about it, med-wise?

Also, I noticed that in the morning, when I wake up, things seem crystal clear to me, but the moment I take my dose of Topamax, everything becomes foggy again, My pdoc says it's not supposed to be this way, but it has. When I was on 150 mg of Topamax, I cycled rapidly, so lowering the dosage is out of the question. Lithium didn't help much either. Would taking topamax at night along with my lamictal help?

Also, I realize that what I am taking would be LIKE symbyax, only different because I take the Zyprexa Zydis PRN. What results can I expect from this, in terms of efficacy and side effects? And will the metformin help? I have a strong history of diabetes in my family, hence the addition of metformin at bedtime. It's a precaution we took.

I hope someone here can help me.

Thanks.

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How long have you been on 200 mg Topamax? Topamax is known to cause cognitive difficulties and "brain fog," but as I understand it, this side effect tends to lessen overtime.

And you may be right, the low energy, motivation, and fatigue could be the result of unresolved depression. What does your doctor say about it?

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Prozac is one of the give it six to eight weeks drugs, I believe, so giving it more time would definitely make sense.

As for whether the symptoms are meds or an underlying depression, I would say its really a time where a psychiatrists expertise is needed...because they are so closely related/look the same at times. That said, I read your title line and immediately thought" crap, papertrees is dealing with depression" because those are some of the first symptoms that show for me. So

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It couldn't hurt to try taking the topa at night. I found that helped with the cognitive effects somewhat when I took it.

Or, the issue might be that you're still somewhat depressed, in which case the prozac should help.

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I would try adding or replacing the prozac for an atypical and activating anti-depressant, like wellbutrin. And maybe the lamictal for abilify and take them both in the AM.

On a side note, if that's your real pic, you look very pretty loved.gif

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I was on abilify on and off since 2007, and I hated the feeling of being numbed down by antipsychotics, which is why my pdoc agreed that I take AAPs on an as-needed basis.

Today, I felt so foggy. I couldn't concentrate at all. Conversations slipped in and out like slippery fish and I got so frustrated that I almost got angry. I'd like to describe my particular state as 'confusion behind my eyes' because, really, the confusion is in my brain and not outside it. Fuck. I feel like I live inside a pearl.

It's so hard to be at work. Takes a tremendous amount of effort not to look spaced out and "busy" when my head is really just blank. Even if I can browse the net freely, I have nothing, absolutely nothing , in mind to browse. I just stare at my screen. So I just resort to reading posts here, which isn't too bad. The confusion, blank look, inability to contribute to conversation and bad memory all make me a wallflower, thus impairing my work, lessening my credibility at work.

Ugh. What do I do now?

The only thing I'm good at is taking smoking breaks.

Sorry for the rant. I'm just so scared, confused, frustrated.

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My hunch is that you are experiencing a round of negative symptoms. Your med cocktail is slanted strongly in an antidepressant direction. The AAP's are touted as helping to counteract negative/residual symptoms, but this is one of those areas where mileage varies considerably.

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I agree with Vanderk, although mileage may vary you seem to be experiencing a bout of negative symptoms. Although, as you mention, AAP side effects can be rough, they (the side effects) tend to wear down over time. How long were you on abilify for the last time? Have you taken any other AAP's?

Also, I find that AAP's are not very effective if not used continually, unless you are on daily AAP's and you have an emergency increased dosage plan.

For the empty head thing, have you tried just doodling, or writing random quotes or poetry? This tends to get my head rolling.

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My hunch is that you are experiencing a round of negative symptoms. Your med cocktail is slanted strongly in an antidepressant direction. The AAP's are touted as helping to counteract negative/residual symptoms, but this is one of those areas where mileage varies considerably.

So, maybe it makes sense for papertrees to take zyprexa regularly for a while, to see if it helps?

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I agree with Vanderk, although mileage may vary you seem to be experiencing a bout of negative symptoms. Although, as you mention, AAP side effects can be rough, they (the side effects) tend to wear down over time. How long were you on abilify for the last time? Have you taken any other AAP's?

Also, I find that AAP's are not very effective if not used continually, unless you are on daily AAP's and you have an emergency increased dosage plan.

For the empty head thing, have you tried just doodling, or writing random quotes or poetry? This tends to get my head rolling.

I've been on risperdal, invega, haldol, abilify (since 2007), seroquel, amisulpride, serdolect,

The newer ones are not available where I live.

These are negative symptoms? Not depression? Now, I'm scared... :(

I'm afraid of deteriorating over time...

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I agree with Vanderk, although mileage may vary you seem to be experiencing a bout of negative symptoms. Although, as you mention, AAP side effects can be rough, they (the side effects) tend to wear down over time. How long were you on abilify for the last time? Have you taken any other AAP's?

Also, I find that AAP's are not very effective if not used continually, unless you are on daily AAP's and you have an emergency increased dosage plan.

For the empty head thing, have you tried just doodling, or writing random quotes or poetry? This tends to get my head rolling.

I've been on risperdal, invega, haldol, abilify (since 2007), seroquel, amisulpride, serdolect,

The newer ones are not available where I live.

These are negative symptoms? Not depression? Now, I'm scared... :(

I'm afraid of deteriorating over time...

I'm still not sure if you have used these AAP's constantly over a period of time (say once a day, every day for several months) or always as needed, that's relevant to the discussion; AAP's are not very effective on an as needed basis, why aren't you an a daily AAP? Given the fact you say you have hallucinations and delusions you really should be on something daily.

On the other issue, you know non of us are doctors and really the internet should be taken with a grain of salt...having said that, I think you show pretty standard negative symptoms.

Have you talked to you pdoc about any of this?

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I agree with Vanderk, although mileage may vary you seem to be experiencing a bout of negative symptoms. Although, as you mention, AAP side effects can be rough, they (the side effects) tend to wear down over time. How long were you on abilify for the last time? Have you taken any other AAP's?

Also, I find that AAP's are not very effective if not used continually, unless you are on daily AAP's and you have an emergency increased dosage plan.

For the empty head thing, have you tried just doodling, or writing random quotes or poetry? This tends to get my head rolling.

I've been on risperdal, invega, haldol, abilify (since 2007), seroquel, amisulpride, serdolect,

The newer ones are not available where I live.

These are negative symptoms? Not depression? Now, I'm scared... :(

I'm afraid of deteriorating over time...

I don't really think negative symptoms are a sign of deterioration. Really, they seem to be something people don't necessarily notice until they're relatively stable. So, if that's what this is, it's probably not the first time you've had them. Just the first time you've been aware of them.

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I agree with Vanderk, although mileage may vary you seem to be experiencing a bout of negative symptoms. Although, as you mention, AAP side effects can be rough, they (the side effects) tend to wear down over time. How long were you on abilify for the last time? Have you taken any other AAP's?

Also, I find that AAP's are not very effective if not used continually, unless you are on daily AAP's and you have an emergency increased dosage plan.

For the empty head thing, have you tried just doodling, or writing random quotes or poetry? This tends to get my head rolling.

I've been on risperdal, invega, haldol, abilify (since 2007), seroquel, amisulpride, serdolect,

The newer ones are not available where I live.

These are negative symptoms? Not depression? Now, I'm scared... :(

I'm afraid of deteriorating over time...

I'm still not sure if you have used these AAP's constantly over a period of time (say once a day, every day for several months) or always as needed, that's relevant to the discussion; AAP's are not very effective on an as needed basis, why aren't you an a daily AAP? Given the fact you say you have hallucinations and delusions you really should be on something daily.

On the other issue, you know non of us are doctors and really the internet should be taken with a grain of salt...having said that, I think you show pretty standard negative symptoms.

Have you talked to you pdoc about any of this?

Yes, Papertrees has previously taken AAP's daily. It's really not so unusual for people to take AAP's PRN. Personally, I've found them to be quite effective that way.

It would be much easier for all of us to evaluate your suggestions if we knew anything at all about your dx and meds.

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Okay, here goes:

I was first diagnosed with borderline personality disorder in 2007. My first med was abilify at 10mg. When that didn't help all my problems (self-injury, mood swing, depression), my pdoc added lamictal at 150 mg.

Then I cycled rapidly, so we got the topamax on board...

After that, things didn't go so well. I continued to self-injure and the hallucinations worsened, and so my pdoc added invega..

I got confined for 6 months for self-injury and depression.

Changed pdocs, changed diagnosis to schizoaffective, put me on risperdal consta and seroquel, and on which I gained 30 pounds. And I stopped that, switched to abilify 15mg, but had (what the church exorcist said) "demonic oppression". Basically, had hallucinations (olfactory, visual, auditory and tactile). So pdoc added serdolect- no effect. We added amisulpride and everything went well.

Except that I felt so damn numb and medicated.

SO... here we are, on PRN zyprexa.

I hope I got everything. My memory is shot. Sorry.

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I agree with Vanderk, although mileage may vary you seem to be experiencing a bout of negative symptoms. Although, as you mention, AAP side effects can be rough, they (the side effects) tend to wear down over time. How long were you on abilify for the last time? Have you taken any other AAP's?

Also, I find that AAP's are not very effective if not used continually, unless you are on daily AAP's and you have an emergency increased dosage plan.

For the empty head thing, have you tried just doodling, or writing random quotes or poetry? This tends to get my head rolling.

I've been on risperdal, invega, haldol, abilify (since 2007), seroquel, amisulpride, serdolect,

The newer ones are not available where I live.

These are negative symptoms? Not depression? Now, I'm scared... :(

I'm afraid of deteriorating over time...

I'm still not sure if you have used these AAP's constantly over a period of time (say once a day, every day for several months) or always as needed, that's relevant to the discussion; AAP's are not very effective on an as needed basis, why aren't you an a daily AAP? Given the fact you say you have hallucinations and delusions you really should be on something daily.

On the other issue, you know non of us are doctors and really the internet should be taken with a grain of salt...having said that, I think you show pretty standard negative symptoms.

Have you talked to you pdoc about any of this?

Yes, Papertrees has previously taken AAP's daily. It's really not so unusual for people to take AAP's PRN. Personally, I've found them to be quite effective that way.

It would be much easier for all of us to evaluate your suggestions if we knew anything at all about your dx and meds.

Sorry about that, it really is time I update my signature. I'm currently taking Wellbutrin 300, Seroquel 100 and Risperdal 2; though I have taken up to 800 Seroquel a day and been through a good 25 AAP and AD drugs in different combos. My dx is "multiple" or as my pdoc says "complicated".

My main point in saying that antipsychotics are not effective PRN is probably not accurate, PRN antipsychotics are shown effective in "Acute" cases. PRN antipsychotics are generally not effective for long term treatment of psychosis because AAP's and AD's need to build stable levels in the bloodstream for their full effects to be shown, though of course they have an effect PRN, their effect is always better if taken daily for other than acute situations like Papertrees describes experiencing.

There are a number of scholarly articles that deal with PRN meds in psych wards but I couldn't find one exactly about what we are talking about, this was the closest

http://journals.lww...._P_R_N_.5.aspx. Of note is the following from the abstract:

"Among the studies involving adult inpatients, estimates of effectiveness, primarily in the management of agitation, were consistently moderately high, averaging approximately 75%...

Administration of p.r.n. medication was also associated with a greater risk of adverse events."

Most of the studies I could find on the subject find very good results for psychiatric medication on agitation, but not on psychotic side effects, particularly where psychosis is prevalent or long term. In other words, these drugs have a great calming effect PRN, but not necessarily a great antipsychotic effect. I could not find an article relating to the manifestation of negative symptoms and PRN antipsychotics but I think it's fair to say negative symptoms have more in common with psychosis than agitation.

I think I could have done a better job of finding relevant articles but it is what it is :).

Like I said, it' just my opinion, and I'm not from the U.S. but I had never before heard of using AAP's on a PRN basis, except when raising dosages of daily AAP's in an emergency. Maybe it's just different ways of doing things. Just my opinion.

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Okay, I think my pdoc was right: I am getting depressed.

I want to die now. I'm just so hopeless, useless, such a failure.

But the quality of the depression is geared more towards apathy than agitation- which is new to me. I'm usually in mixed states. I find it so hard to talk to people. My mind is blank, nothing to say, and articulation is so damn hard....

My pdoc says that bipolar depression is different from unipolar depression, in that they will respond differently to ADs. True?

My memory is shot, I can't think.

I'm so tired of taking medications, the motivation to get better is slowly waning away. I'm becoming enamored to live life as a vegetable. Sleep all day, sleep all night, Nothing in between, I'm so so tired.

I'm seeing my pdoc next week, what can we tweek to get me perhaps out of this living wasteland? Which AD?

Please help.. I'm just so tired and worn out.

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I don't really know if that's always true. Some people with bipolar get hypo/manic on ad's. Then for some (like me) a lot of them tend not to do much. But then for other people they're great. It's just really hard to tell,

The obvious thing would be to try taking zyprexa consistently for a while.

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AD's make me rapid cycle, but it's kind of a necessary evil for me due to OCD. Yeah, yeah, I could probably do Risperdal or something, but I'm really prone to sedation from sedating meds, so I opted for an activating AAP + Effexor. I should probably be manic and out of my mind with the cocktail I'm on, but for whatever reason my mileage totally varied and I do well with activating meds. Effexor seems less bad than some of the other AD's I tried, so I roll with it.

That said, there is no telling what you'll find if you do an AD. It could make the depression worse. It could make the depression better. It could make you manic. It could be like a sugar pill. No telling at all until you try it. But like Sasha said, the next step would probably be to take Zyprexa daily. It helps with depression, so that might be the easiest option.

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