Does this combination seem a little redundant?

[balletomane]

So I started out on Lexapro a long long time ago, probably about 13 years ago. I was on Celexa and then switched to Lexapro, but that wasn't a big deal. I went on Lamictal about 3 years ago, and am at 350mg. Wellbutrin was added to combat sexual side effects of Lexapro, and Klonopin was added as a prn for anxiety. Finally, this combination still wasn't doing much for me, I went on Risperdal (went into a manic state) and then Abilify (anxiety so bad I self-harmed for the first time in my long-term MI). I then got put on Pristiq, which I have been having constant headaches and fuzzy thoughts on.

So right now, we have the following:

20mg Lexapro

350mg Lamictal

0.5-1.5mg Klonopin prn

150mg Wellbutrin

50mg Pristiq

I feel that the more we add, the fuzzier I feel and the 3-4 days/week of migraines or intense headaches are getting to be too much. I can't take away the Lexapro, that lead to my first hard relapse 1.5 years after my diagnosis. I wonder if the Lamictal is doing its job, if the Pristiq is actually not high enough and that's why I feel this way, or what. I'm just starting to feel hopeless. I was given the option to go off all my meds and start fresh in the hospital, but the more I think about it (and the more I talk with other people about it), I don't think I will. I also have constant side effects... fuzzy thoughts, difficulty concentrating, that awful empty feeling of never being truly satisfied by anything in my life, and sexual side effects so awful that thinking about sex is repulsive.

Basically, I feel like none of this is working and is all for not. Any suggestions on what options to talk to my doc about on Wednesday? Am I just not even being treated by my treatment? Abilify was amazing until the anxiety got bad, but I want to try it again with a really high dose of an anti-anxiety. Does this sound redundant? My mind is swimming and I am so tired of feeling tired and depressed and taking handfuls of pills that don't even seem to work.

Thanks all.

Ashley

[blueandgray]

Wow. I wish I could be of help.

I have stopped taking all medication. While I don't necessarily recommend this, I felt like nothing I took did any good. While I am not better off without medication, I certainly don't think I am worse off. I want to try meds again, but I don't have a lot of hope.

I think that doctors have a tendency to add meds without subtracting. I suggest that you talk to your doc about weaning off the meds you don't think you had a measurable change with. Baselining is a good way to reevaluate what works and what doesn't, but don't do this if it is unsafe for you.

[otherwise the curved]

Well, you're on some stuff I've never been on, and I'm not a doctor, but I can give you a few suggestions about possible directions for discussion:

1. I got debilitating headaches like that on a similar drug. You can't live like that. My doc took me off the drug instantly. I'd tell the doctor you need the headaches to stop, period. Personally, I can't imagine them stopping at a higher dose, but that's based on my body chemistry (I'm migraine-prone), but you can check that out with him. That sounds like a priority.

2. Sexual side effects are awful; I experience those, too. But for now, you might want to ask yourself if they're your top priority. They might be, especially if you're in a relationship. For me, they're definitely important, but I try to address the mood disorder/self-harming thoughts first and the sexual side effects after that.

3. Feeling empty sounds like depression, not a side effect. I'm not saying this in a critical way at all, just trying to separate them out a bit.

4. You can take a blood test to see how much Lamictal is in your blood. You might want to ask your doc if you should do that. That'll tell him instantly if he can up it or not.

Offhand, I'd say get a blood test for the Lamictal and see about coming off the Pristiq now. If you react as I did, the headaches should stop almost instantly. Then see what you're left with (especially whether the fuzzy thinking clears up or not), and talk to your doctor about a next step. He might not want to give you Abilify again, but maybe there might be something similar.

That's my two cents, anyway.

otc

[lysergia]

starting fresh in the hospital isn't always such a bad idea. it's not always practical for people to take the time off work, i understand. but going inpatient to do this is what has saved me this year. i struggled with antidepressants for 14 years and they would either "poop out" or not work at all or have intolerable side effects.

i see you're also BPII. for me, that means no more antidepressants since my hospital stay in May. i was there for a month, while pdoc weaned me off my last try at an AD (nortryptaline), and started me on seroquel. it took another 5 months outpatient to tweak things, such as re-trying wellbutrin (nope, too activating), and now trying abilify (which is the most wonderful drug on earth to me right now). but that initial hospital stay made it much easier to try something brand new to me (AAPs as mood stabilizers) in a safe environment. being there meant we could make any changes immediately.

i'm sorry abilify wasn't kind to you. to me, it does sound redundant to take it with a high dose of anti-anxiety meds (i'm no doctor, but i did recently have this conversation with my pdoc.... i wanted to keep wellbutrin and add more seroquel to balance out the superanxious mixed state i was headed towards... pdoc said no, that's kind of missing the point). are other AAPs an option for you? maybe discussing them with your pdoc would be worthwhile. it might not be the answer, but i guess it's worth asking!

i don't get migraines, but i do agree that living with that much pain isn't okay. i've never taken pristiq, but i was on it's predecessor effexor for a long time. i never noticed how many headaches i had until i was off the drug and suddenly i wasn't eating ibuprofen all the time. lamictal gives me headaches when my dose changes, but it doesn't last.

i don't blame you for being tired of all that. it does suck. keep at it - if you keep trying, eventually you'll find something that makes you feel better in both mind AND brain. let us know how things go with the doc

[Cuttlefish]

20mg Lexapro

350mg Lamictal

0.5-1.5mg Klonopin prn

150mg Wellbutrin

50mg Pristiq

Nothing is really redundant per se here. Lexapro, Wellbutrin, and Pristiq all treat depression, although through differing ways, and Wellbutrin is often an add-on AD when not used alone (it's great for SSRI sexual side effects too). Wellbutrin can make a good AD on its own when it works, but it usually requires 300-450mg for that use. You have an SSRI, NDRI, and an SNRI here.

Lamictal is a mood stabilizer that's popular for Bipolar depression, and Klonopin for anxiety is pretty self explanatory. It might not be a coincidence you added Klonopin for anxiety after you added Wellbutrin though, since one of the only regularly reported negative side effects of WB is an increase in anxiety.

Sometimes starting fresh is a great idea, so don't necessarily discredit that option. An immediate option you could try with pdoc's permission is to drop the Pristiq and go up on the Wellbutrin to see if Wellbutrin does more than just reduce sexual side effects for you. If it doesn't, you can try more SSRI's or SNRI's in place of lexapro and Pristiq, or just one or the other. There's also a lot of other AP's you could try aside from Risperdal and Abilify.

[Guest Vapourware]

It seems like your current combo is slanted towards treating depression? Since there's lamictal [which I believe has the reputation of having antidepressant qualities], plus Wellbutrin, Pristiq and Lexapro.

The suggestion for you to go into the hospital and start afresh seems like a sound one to me, if your current combination is not quite working. It's easier and quicker for doctors to change your med regime when in-patient, as they can monitor you through the med changes. Personally, if I were in your position, I would seriously consider the hospital option.

If not - another option you might want to pursue are other APs. Personally, I found ziprasidone [asinine brand name: Geodon] fantastic for my mood issues and psychosis [which were paranoid in nature]. It also seems that some people find Seroquel to be helpful for their mood issues.

[balletomane]

Vape, I mostly suffer from mixed episodes. My hypomania doesn't show up too much anymore, and I asked my doctor if I really am bipolar and he said that the way my depression presents (severe agitation, paranoia, violent outbursts) leads him to think that I am indeed bipolar and just not suffering from hypomania as much anymore but that doesn't make him want to re-diagnose.

[jt07]

What about losing the Pristiq and trying another/adding another mood stabilizer? I take carbamazepine in addition to lamotrigine and it has been a godsend to me. It will also help with migraines. I used to get them all the time, but I haven't had one since I've been on the carbamazepine.

[Anna]

That seems like a crazy amount of AD action for someone who tends towards mixed, to me. As far as redundancy, I consider 3 ADs a bit.... redundant.

There are other AAPs to try than abilify, you know, which does have a reputation for anxiety in some people....what about nixing one of the ADs for an AAP that isn't so activating? Seroquel is approved for BP depression, and you'd have the added benefit of it probably not being so activating, for example.

Anna

[balletomane]

My doctor said today that although I was originally diagnosed as bipolar, he believes that in the MI world, "nothing runs alone". I haven't had a hypomanic episode in 4 years so he said that what I have wouldn't qualify as bipolar disorder if I were to be diagnosed by a brand new psychiatrist. He would say either atypical major depression or psychotic major depression. Anyways, today he pulled the Pristiq, added 20mg of each Zeldox (Geodon) and Cymbalta. I have another appointment on Dec 23.

Thank you so much for all of your opinions and input!! I don't know what I ever did without you folks!

[Velvet Elvis]

FWIW both prestiq and lexapro and serotonic medications and too much of them in combination could put you at risk for serotonin syndrome.

[balletomane]

I don't know how I didn't realize this until today, but only once or twice in my life have I ever been started on one med at a time. I almost always get two (for example, on Wednesday I was started on duloxetine and ziprasidone). Both of my pdocs have done this (past and present). As a result, I'm on 6 meds and have no idea what I need and what I don't need. This is starting to frustrate me, but how do I know if they're all working together harmoniously (with an addition or two) or if I don't even need half the shit I take? Am I just being bitchy about being on so many meds and feeling overmedicated?

[Anna]

If you feel overmedicated, you should talk to your pdoc about this. Also, I agree that if you take two things together, you won't know what is doing what. To be honest, with the geodon, that could well be all you need. If it were me, with the risk of serotonin syndrome from taking both an SSRI and SNRI, I'd be more inclined to lay off the cymbalta and see what the geodon did. But you need to call your pdoc and ask him to explain his rationale and also why he has you on both an SSRI and an SNRI when that's kind of unsafe.

Anna

[Thomas]

I have not yet felt overmedicated. I take 7 MI meds, 9 meds for blood pressure, stomach problems, and diabetes, and a couple shots for diabetes. It took years to get to this cocktail, but finally I have one that almost always works, almost. Anyway, I would not give up my meds unless the pharmogiants came out with something that worked better.

[balletomane]

Had an allergic reaction to the Geodon, so I was clearly in the hospital. I was also getting insanely flagrant involuntary muscle movement so for interest's sake the ER doc told me to discontinue Geodon AND Cymbalta and call my pdoc on Monday. Insert heavy sigh. This is the second bad reaction I've had to an AAP (Zyprexa threw me into a bad psychosis), although my first allergic reaction to any medication.

On another note-- Thomas, I think the reason I feel over medicated is different from the feeling people in your situation may get. I'm on 4 drugs that don't work, was on 6 that didn't work, and I'm just tired of adding onto a med profile that isn't helping in the first place. I'm also very sensitive to side effects and feel a lot of them long term, plus the changes in my body everytime we add and subtract. I feel like a victim of "polypharmacy" as the ER doc put it.

And as an aside, for people who I've talked to in chat, I'm going to go for some serious changes and possibly a clean slate if things aren't working out. I will probably be off work for 2-4 months.

[Anna]

Sometimes a clean slate and starting over can be really beneficial, especially if you feel like your medication cocktail isn't working out.

Have you tried lithium yet?

Anna

[balletomane]

My doc said he uses Lamictal in cases that he used to put lithium. So it's hard to say

[muriel]

Lamictal and Lithium are nothing alike, though, in terms of how they work or the symptoms they control.

[Anna]

Agreed. Also, some people respond well to one, and not the other, though they both can be considered helpful in depression, or agitated depression, or BP dx.

I don't think lamictal can just "replace" lithium for everyone, it doesn't work like that..... You did say in your original post that you were wondering if the lamictal was doing it's job.....

Anna

[balletomane]

I'm pretty much treading water right now.. my GP (who watches over me because my psychatrist was 3 hours away) is looking worse and worse to me. But he always gets me into immediate visits when I'm having an episode, and I would never leave him. I will however, be able to access a psychiatry clinic at a hospital in a neighboring town. I know he's young and they don't necessarily dig lithium... and Anna, I don't really know why he would have said "I'd try all other options first before lithium", but that's what he said.

I'm cut back to my "core four" now. Wellbutrin, Cipralex/Lexapro, Lamictal and clonazepam. c-pam was upped to get rid of my disgustingly awful twitches/tics that I only developed after 2 days of taking Cymbalta and Geodon. I know that my current 4 part cocktail doesn't really work for me. I'm so tired of my ex-pdoc and GP saying "we've tried everything. you're treatment resistant". WELL UNRESIST ME FOR FUCKS SAKE..if you see my "what doesn't work" on my sig, it's obvious that I have faaaar from tried everything. I feel like they are giving up. So i guess for now I'll stay on the superfluous and ridiculous, and go cuddle with my SSRIs.

ETA: I went to the ER again today because my twitches and tics were getting extremely painful and I've slept 90 minutes in the 36 hours. I had bloodwork done to check for hypocalcaemia specifically, but my entire CBC and chemistry panels were normal. So now I've got some (apparently decent) muscle relaxants so I can stop doing the flaily dance all night and day.

[Velvet Elvis]

Try taking some benadryl. That should help with both the EPS and sleep.

[Anna]

Yeah, I would say you are far from treatment resistant as of yet..... I despise docs who have to cycle through EVERY SSRI known to mankind before trying something else..... Honestly, you try 3 or so, they don't work, get a clue and move on to something else.

Do you have any other options for medical care? Maybe a stay at the psych unit wouldn't be a BAD thing if you get a pair of fresh eyes..... and often it's a way to get linked up to another psychiatrist if the one you have isn't working out...... quite often, hospitals can refer to another psychiatrist quickly.

Benadryl should help the twitching, any w/d from cymbalta, and the sleep.

Anna

[balletomane]

Well now the big discussion is in-patient treatment, for me...my family seems to think I should check in for a month and get my meds straightened out, and then take another 2-3 months off work after that. I am petrified. The internet and my phone really are my connections to people and I feel like being alone, without my family and e-socialization, I'll get worse.

[Velvet Elvis]

There are plenty of inpatient facilities that let you keep your phone and have wireless.

[Anna]

You'll be IP, surrounded by people, and in groups all day. Maybe IP, you will socialize more. And VE is right, plenty of IP facilities will let you keep phone/computer access, and your family will be able to attend visiting hours.

Anna

[Thomas]

Call the psych ward and ask them what you can bring and when they have visiting hours. It can vary greatly. The hospital that I spend my psych ward time in doesn't allow cell phone or computers, but they do have two patient phones available (except during group). They also have very limited visiting hours; Saturday and Sunday only, from 2-4. They do however have smoke breaks 4 times a day.