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Your Cocktail Deconstructed

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5 hours ago, JustNuts said:

Brexpiprazole is a weaker dopamine receptor partial agonist than aripiprazole is. There are some other less important differences but that's easily the biggest one.

The practical effect of this is that brexpiprazole is basically a somewhat less stimulating (and much more expensive) version of aripiprazole.

Aripiprazole/brexpiprazole act directly on certain dopamine receptors as partial agonists, while methylphenidate acts indirectly on dopamine and norepinephrine receptors via inhibition of the dopamine/norepinephrine reuptake mechanisms. Those antipsychotics have a bunch of misc receptor actions alongside the dopamine stuff, primarily in a large number of 5-HT receptors (but they hit tons of other stuff), while methylphenidate lacks significant secondary receptor activity outside of some extremely weak binding affinities to two 5-HT receptors, SERT, and a vague, poorly explored, and quite weak affinity for the sigma-1 opioid receptor.

There are some minor conflicts with using these together, but there isn't really anything unduly concerning IMO.

Thanks @JustNuts! This is helpful. Abilify is expensive enough - Rexulti I'm sure costs a fortune at the moment.

I'm really not sure why my pdoc said that Abilify could be blocking dopamine action & that is why i don't notice the Ritalin working as well. Bizarre, it makes me wonder if she really knows what she's taking about!

I did read somewhere (perhaps here) that Abilify works differently depending on the dose (like under 10mg it is stimulating and works better as adjunct for depression & antidepressants - while above 10mg, it acts more as an antipsychotic blocking dopamine (not sure if this is entirely true) but it seems complicated!

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5 hours ago, Blahblah said:

Thanks @JustNuts! This is helpful. Abilify is expensive enough - Rexulti I'm sure costs a fortune at the moment.

I'm really not sure why my pdoc said that Abilify could be blocking dopamine action & that is why i don't notice the Ritalin working as well. Bizarre, it makes me wonder if she really knows what she's taking about!

I did read somewhere (perhaps here) that Abilify works differently depending on the dose (like under 10mg it is stimulating and works better as adjunct for depression & antidepressants - while above 10mg, it acts more as an antipsychotic blocking dopamine (not sure if this is entirely true) but it seems complicated!

Yes that can be true about abilify higher dose= more antipsychotic 

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Greetings. Meds got updated recently as I was ultimately hospitalized for mania. Boo. 

Saphris (asenapine) / 5 mg at bedtime  / anti-psychotic, mood stabilizer / mostly for sleep, however, ever since we've decreased the dose I have been having a few auditory, visual, and tactile hallucinations which have not been very fun; pdoc decreased the dose mostly because of an elevated prolactin level (have had a negative MRI in the past) and now I'm not sure what's going to happen 

lithium / 1500 mg as 600 mg AM and 900 mg PM / mood stabilizer / has leveled me out exceptionally; no major signs of toxicity on this ridiculous dose surprisingly and the propranolol is still keeping the shakes at bay

Zonegran (zonisamide) / 400 mg as 200 mg twice daily / anti-convulsant, mood stabilizer / seems to have leveled me out a bit since doubling the dose in the hospital

Neurontin (gabapentin) / 1200 mg PM / anti-convulsant, sleep agent / my morning dose was eliminated and the nighttime dose was kept to help with sleep quality; they may increase the nighttime dose if I'm not sleeping well or add more in the morning if anxiety turns out to be a problem but so far it is working out OK 

Ativan (lorazepam) / 1 mg PRN / I haven't needed it lately since the mania has wound down; was taking up to 3 mg a day to control agitation previously

propranolol / 30 mg as 10 mg AM and 20 mg PM / fights lithium-induced tremor highly effectively - makes high dose lithium tolerable for me

Nuvigil (armodafinil) / 250 mg AM / wakefulness-promoting agent / treats my narcolepsy

Ergocalciferol / 50,000 IU weekly / vitamin D supplement / taking for continued, chronically low vitamin D levels and to ward off depression 

Levoxyl (levothyroxine) / 100 mcg AM / for post-surgical hypothyrodism

liothyronine / 10 mcg AM / for post-surgical hypothyroidism

spironolactone / 200 mg as 100 mg twice daily / for PCOS 

Recently Discontinued:  Rexulti (4 mg) +  Seroquel (50-100 mg)

My pdoc definitely thinks the Rexulti has made me manic on more than one occasion now. Eep. Not sure how that works.  

 

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Ativan 1 mg, TID

Depakote 250 mg, TID

 

so far I just keep having crazy depressing dreams and I wake up wondering if I've died yet. my paranoia is worse. it's only day one, so i know i have to ride it out...but...this sucks. as usual... i hate starting new meds...

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Updates:

1200mg Oxtellar and 25mg of loxapine for mania. 5mg of Trintellix for depression. 30mg of Vyvanse for ADHD. Vascepa prescription fish oil for triglycerides and to help with mood along with MethylGuard-Plus for proper B vitamin metabolism and methylation. Vitamin D too for a deficiency which should theoretically help with mood.

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Well, my sig is up-to-date, but here's a quick rundown on what they do for me:

Rexulti (1mg QHS) - This is the backbone of my cocktail. Eliminates 90% of my depression, lengthens my mood cycles (I'm a rapid cycler normally), lowers my general anxiety level, and makes me slightly sleepy. It hits every problem I have, to some degree, and has done more for my BP depression than any other med ever. I don't care about the cost, or how similar it is to Abilify, or whether it's a pharmaceutical marketing ploy -- it works wonders for me!

Provigil (200mg AM) - Just started this due to excessive daytime sleepiness from obstructive sleep apnea (adjunct to CPAP therapy.) I'm on day 3 and it makes a huge difference. I am 100% awake and alert until about 5-6pm, and then I can feel it start tapering off. Sleep doc thinks that if we push my daytime wakefullness level higher, my brain will naturally start pushing me to fall asleep, and my insomnia will disappear (circadian rhythm problem.) Right now I still need something for insomnia, but hopefully this works out and I can drop another med off my list.

Lunesta (3mg QHS) - Treats my insomnia. Gets a lot of flak for not being good at inducing sleep, but it's primarily useful for maintaining sleep. It makes my brain slow down enough that I can drop off to sleep. It's not very sedating compared to other z-drugs, or most other sleep aids, but I find I need the time to mentally unwind instead of being dropped off a sleep cliff. Pdoc and sleep doc are both happy with the current effect it's having, so I'll keep it around as long as it works. I got used to the heavy sedation of Remeron and Seroquel for years, but as it turns out that kind of lights-out sleepiness is not normal. I'm trying to rewire my sleep patterns, with some success so far.

Xanax (0.5-1mg BID PRN) - Acute anxiety. My anxiety tends to ebb and flow, with stressors causing major spikes, so a fast-acting intermediate benzo is best for me. I feel my anxiety start spiking, I take 0.5mg, and titrate from there. Usually 1mg will pull my symptoms back down to manageable. I've tried Klonopin and Valium, and I still had breakthrough anxiety attacks. Rexulti keeps my general anxiety level managed, so I just need something for the spikes.

Non-psych:

Axert (12.5mg PRN) - Migraines. I get stress-induced migraines, so If I don't manage my anxiety quickly, a migraine forms too. Without a triptan, my migraines can last for weeks at a low to mid-grade. Axert has been the only triptan so far that I can tolerate, and it's pretty effective as an abortive. My Xanax, Axert, and naproxen go everywhere with me.

Recently Discontinued:

Trileptal (300mg AM / 900mg QHS) - Mood stabilizer. Not sure it was doing much besides making me continue to gain weight. I d/c'd during a depressive episode, and started feeling better, so it must not have been doing much. I've been on Lamictal and Depakote as well, and they had no apparent benefit for my depression either. I think mood stabilizers just aren't effective for my depression (primary symptom) and I end up with side-effects that I would rather not put up with.

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Just saw my pdoc last night. Made a dramatic shift from an MAOI to an SSRI + NRI (I had quit the MAOI long ago, Marplan... so I was able to start the SSRI immediately). I'm very pleased with my combo, as I am already feeling the stimulating effects of the Prozac, low-dose Geodon, and high-dose Adderall. Eventually, I'm sure the Strattera will come in to the picture more as I titrate up to the target dose, 80 mg. My pdoc said depending on how I tolerate Strattera, she may even raise me to 100-120 mg.

As of 6/22/17

  • amphetamine salts (Adderall) 30 mg 1 po bid (60 mg) — ADHD, binge eating d/o
  • fluoxetine (Prozac) 40 mg 1 po bid (80 mg) — bipolar depression, binge eating d/o
  • lamotrigine ER (Lamictal XR) 300 mg 1 po q AM — bipolar depression, just so happens to be effective for binge eating d/o too
  • levocarnitine or L-carnitine (Carnitor) 330 mg 1 po tid (990 mg), target dose 330 mg 3 po tid (2970 mg) — idiopathic hypersomnia, weight loss, low energy levels
  • Strattera (atomoxetine) 25 mg x5 days, 40 mg x5 days, 60 mg x5 days, then 80 mg 1 po q AM — an adjunct to Prozac for depression, ADHD, OCD, binge eating d/o
  • ziprasidone (Geodon) 20 mg 1 po bid (40 mg) — bipolar depression, an adjunct to Prozac for depression
  • zonisamide (Zonegran) 100 mg 1 po q AM + 2 po qhs (300 mg) — bipolar depression, just so happens to be effective for binge eating d/o too
  • oxazepam (Serax) 30 mg 1 po qd prn — anxiety, panic
  • ondansetron (Zofran) 4 mg 1 po qd prn — occasional, transient nausea

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No actual med changes since my last update, but I've been observing the effects of the previous set of changes/trials/etc...

  • bicalutamide - Seems to make me rather tired and low on energy, which isn't too surprising, but it's a bit more prolonged/strong than I was hoping it'd be (although it's still definitely in character with the drug's properties for now). My Dr. is running a couple lab panels, I'm waiting on the results from those with interest as the drug's effects on certain things are rather unpredictable, and unfortunately even more so given the ridiculous half-life and the fact that we don't have a good way to measure testosterone suppression with this drug due to the MOA (although she is running total/free T just to see what results we get, and she's also trying SHBG, which may be interesting and useful or a total crapshoot). Other panels cover estradiol (very curious about that one, bicalutamide is likely to affect it oddly in a somewhat unpredictable way, but unlike the testosterone panel it doesn't make it mostly useless), then a few basic/standard safety-related lab panels that I really should have had ran much sooner than this (previous doctor was alarmingly nonchalant about these basic safety-related panels that are technically supposed to be very important).
    • Unfortunately I don't expect the hormone-related panels to be too useful (the estradiol levels are immediately useful to a limited degree but that's it) until things are a bit more settled down and I've been on the bicalutamide for significantly longer (at which point rerunning them and comparing the results should yield more useful information with fewer major uncertainties involved).
  • sumatriptan - One interesting effect of having this is that I learned exactly how many migraines severe enough that I took this occurred over the past month, and the number surprised and somewhat concerned me - I'm starting to wonder if one of my meds has been causing my migraines to occur more often, possibly the bicalutamide or even just a more generalized hormone-related thing... IDK. There have been some odd patterns of them over a sustained period of time, and I've never bothered measuring their exact frequency before, so I can't make any exact comparisons, which is frustrating. Anyways the drug itself is still effective but not quite as much or as fast as I'd like it to be. Haven't seen it work alone so far, every time I've ended up taking ibuprofen at some point before/alongside/after the sumatriptan, and when taken after (only once or twice so far) I saw no effect by the point that I resorted to the ibuprofen. The ondansetron is still marvelously useful for migraine-related-nausea (obviously only worsened by NSAIDs).
  • belsomra - I've been extremely conservative with my very limited supply of samples (maybe too much so), but every time I've taken it (three times now, all at 10mg) it's uniformly performed quite impressively well. The only possible negative is a slight hangover effect, but I feel it's no worse than (and possibly less than?) what I'd see with temazepam+diazepam.
  • Deplin - I keep on forgetting to take this, so there have been a number of gaps since starting this (my intention was to take it continuously even though I don't have enough samples to last me all the way to the next pdoc appointment since I should be able to see a difference (if any) the best if I have a sustained period of continuous use followed by discontinuation). Unfortunately this is screwing up that plan. I have had at least some semi-sustained periods on it that I can compare vs. before it or when I realized I'd missed it, but it's a more flawed comparison that way. I checked my Promethease report prior to initiating Deplin and confirmed that I'm somewhat unlikely to respond based on the primary MTHFR SNPs, but there was enough uncertainty all around (including in if the exact magnitude of the mutations are even really all that well correlated with response) that I still think it has a chance of doing something...but so far the only things I've tentatively noticed are increased stimulant effects, dry mouth, and possibly some association with the observed increased frequency of migraines. There are other possible effects I think I may be noticing but they aren't clearly present enough for me to semi-firmly say anything yet - I'm rather wary of the placebo effect for obvious reasons.

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40 mg celexa - for depression, probably for anxiety too

300 mg gabapentin X twice daily - anxiety(?), nerve pain

200 mg topiramate X twice daily - anxiety, anger, joint pain

1.5 mg (moving to 3 mg tomorrow) vraylar - depression, voices, jumbled thoughts

Considering asking the shrink to move me from celexa to cymbalta. My joints are killing me and that contributes to my depression more so than anything I think.

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Zoloft 50mg depression 

Lamictal 100mg 2x day mood stabilizer 

Valium 5mg max 3 prn anxiety, sleep, panic

Non psych

Topamax 75mg 2x day anti migraine, fibromyalgia, weight loss 

Trileptal 300mg 2x day fibromyalgia, neuropathic pain

Elmiron 300mg per day interstitial cystitis 

Omeprozole 40mg day esophagitis, gastritis, duodenitis 

Tramadol 50mg max 2 PRN pain

Flexeril 10mg max 3 PRN muscle relaxant 

Zyrtec 10mg  allergies

Flonase one spray ea nostril allergies

Flovent inhale 2x day cough/asthma/allergies

Rescue inhaler as needed asthma usually upon exertion 

Supplements 

VitD/K2 deficiency 

VitB-12 & B-complex deficiency 

L-lysine immune system 

Probiotics digestion 

Dairy enzyme lactose intolerant 

Digestive enzymes digestive aid

Iron anemia 

VitC immune helps iron absorb & immune

Magnesium deficiency 

Calcium deficiency 

Chromium picolinate  metabolism 

L-carnitine metabolism 

Selenium nervous system 

Chlorophyll cleans 

Choline brain function 

L-tyrosine brain function 

Omega-3 krill oil heart

Zinc if getting sick/ immune 

 

PRN: zofran (nausea) bentyl (cramping) <IBS> 

 

 

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lamotrigine 400 mg -- depression (and partially for mood stabilization)

venlafaxine ER 225 mg -- depression

bupropion 300 mg -- depression

ziprasidone 160 mg --depression

Armour Thyroid 60 mg -- depression (are we sensing a trend here?)

topiramate 100 mg -- mood stabilization

clonazepam 1 mg TID -- general anxiety

alprazolam 1 mg PRN -- panic attacks

Adderall XR 30 mg -- ADHD (inattentive)

amphetamine salts 30 mg BID -- ADHD (inattentive)

Saphris 10 mg -- insomnia

-----

I know it's a lot, and I do hate it, but my depression is finally in remission after suffering for 25 years, so I'm not going to complain about my meds.

 

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Cymbalta 60 mg

 Gabapentin 300 mg X 2 daily

Topiramate 200 mg X 2 daily

Vraylar 4.5 mg

updated.

Moved from Celexa to Cymbalta 2 days ago since depression and joint pain not good. More anxiety, but hopefully it goes away. Moved up the vraylar and it seems to be helping.

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This is my very first post on CB so, please, bear with me.

Here's my cocktail:

  • sertraline (Zoloft) 100 mg 2 po qhs (200 mg) — Panic disorder
  • buspirone (BuSpar) 10 mg 1 po bid (20 mg)* — Panic disorder 
  • alprazolam (Xanax) 1 mg ½-1 po qd PRN — Panic disorder/panic attacks
  • lorazepam (Ativan) 1 mg 1 po qd PRN — Panic disorder/panic attacks
  • amlodipine (Norvasc) 10 mg 1 po q AM — HTN, angina
  • losartan (Cozaar) 50 mg 1 po qhs — HTN

Supplements: methylcobalmin sublingual drops, PrimalJax, Noopept 10 mg 1 po bid (20 mg), L-theanine 100 mg 2-4 po PRN, Bromelaine

*recently added

Edited by THE_REAL_Bryan
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Updating my cocktail:

  • Amphetamine salts (Adderall) 30 mg 1 po bid — ADHD, depression, hypersomnia, BED
  • Atomoxetine (Strattera) 80 mg 1 po q AM — ADHD, depression, hypersomnia, BED
  • Fluoxetine (Prozac) 40 mg 1 po bid — OCD, Bipolar II depression, BED
  • Lamotrigine ER (Lamictal XR) 300 mg 1 po q AM — Bipolar II depression/mood stabilizer, BED
  • Levocarnitine (Carnitor) 330 mg 3 po tid (2970 mg) — Hypersomnia, supplementation
  • Lithium carbonate (Eskalith) 300 mg 1 po qhs — Bipolar II mood stabilizer
  • Oxazepam (Serax) 15 mg 1 po bid PRN or 2 po qd prn — Anxiety/panic attacks
  • Zaleplon (Sonata) 10 mg 1 po qhs prn — Insomnia
  • Ziprasidone (Geodon) 60 mg 1 po bid + 20 mg 1 po bid PRN — Bipolar II depression/mood stabilizer
  • Zonisamide (Zonegran) 100 mg 1 po q AM + 2 po qhs (300 mg) — Bipolar II depression/mood stabilizer, BED

Non-psych meds (still mostly the same):

  • Acebutolol (Sectral) 400 mg 1 po q AM — Essential  tremor
  • Esomeprazole (Nexium) 40 mg 1 po q PM — GERD
  • Levothyroxine (Synthroid) 50 µg 1 po q AM 1h ac — Hypothyroidism
  • Montelukast (Singulair) 10 mg 1 po qhs — asthma/allergies
  • Victoza (liraglutide) 1.8 mg SC q AM — pre-diabetes
  • Vitamin D2 (Drisdol) 1.25 mg/50,000 IU 1 po q wk — hypovitaminosis D
  • Breo Ellipta (fluticasone furoate/vilanterol) 100 µg/25 µg/act. DPI 1 puff qd — Asthma, maintennce
  • ProAir RespiClick (albuterol) 90 µg/act. 2 puffs qid prn — Asthma, rescue
  • Levalbuterol (Xopenex) inhalation sol 1.25 mg/3 mL (0.042%) neb 1.25 mg NEB q6h prn — Asthma, rescue
  • Minocycline (Dynacicn, Minocin) 100 mg 1 po bid — acne                                        ] alternate between
  • Trimethoprim/Sulfamethoxazole (Bactrim DS) 160 mg/800 mg 1 po bid — acne      ] these two
  • Metaxalone (Skelaxin) 800 mg 1 po qid prn — back pain
  • Diclofenac sodium topical gel (Voltaren gel) 1% apply to affected area — Red ear syndrome
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My lovely cocktail is:

Abilify~ 5mg for mood stabilizing/manic depression

Lexapro~ 30mg for anxiety

Suboxone~ 8.5mg for preventative opiate drug use

Vyvanse~ 80mg for adhd inattentive type

Ambien~ 10mg for knock out drag down zzz's

Iron supplement~ 65mg for serious anemia deficiency

Omega 3~ Mind clarity

***Any and all subject to change as I continue to ride the merry go med coaster weeeeeee!!!!???

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My current cocktail: 

Divalproex sodium ER 1500mg (500mg tid) - mood stabilizator/anti-manic

Venlafaxine 150mg q AM - antidepressant/anti-anxiety

Trihexyphenidyl 2mg (1 mg bid)- anti EPS

Quetiapine 400mg  500mg ( 100mg q PM; 400mg q HS)  - insomnia/mood stabilization/ antidepressant

Flupentixol decanoate - 20mg/q2wk - antianxiety/mood stabilization/augment AD

Clonidine .225-.450mg ( .075-.15mg tid) - opiate withdrawal

Zopiclone 7.5mg q HS - insomnia

Diazepam - 15mg (5mg tid) - opiate withdrawal/anti-anxiety

Esomeprazole 40mg q AM - GERD

Perindopril 4mg q AM - high blood pressure

Nebivalol 5mg  - q AM -high blood pressure/ sinus tachycardia

 

Edited by centaurus

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My updated cocktail:

  • Lithium ER 900 mg as 450 mg bid | mood stabilizer/anti-manic
  • Depakote (divalproex sodium) 750 mg as 250 mg qAM + 500 mg qPM and titrating) | mood stabilizer/anti-manic
  • Vraylar (cariprazine) 3 mg | antipsychotic/mood stabilizer/depression/mixed episodes  
  • Emsam (selegiline) 6 mg / 24 hr | MAOI for severe depression
  • Klonopin (clonazepam) 0.5 mg PRN | anxiety, insomnia, agitation, anti-manic 
  • Nuvigil (armodafinil) 250 mg qAM | narcolepsy
  • ergocalciferol 50,000 IU weekly | low vitamin D levels 
  • levothyroxine 112 mcg qAM | post-surgical hypothyroidism 
  • liothyronine 10 mcg qAM | post-surgical hypothyroidism 
  • spironolactone 200 mg as 100 mg bid | PCOS
  • Arnuity Ellipta (fluticasone furoate) 200 mcg | asthma maintenance inhaler  
  • ProAir HFA (albuterol) 90 mcg PRN | asthma rescue inhaler
  • (tapering to d/c) Zonegran (zonisamide) 400 mg > 200 mg > 100 mg taper q5d | mood stabilizer 
  • (tapering to d/c) Neurontin (gabapentin) 1500 mg > 900 mg > 600 mg > 300 mg taper q5d | anxiety, (weak) mood stabilizer

Cocktail was updated a bit since my hospital stay and ECT treatments in July. 

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Mine changed again:

Lamictal 200 mgs twice a day: Mood disorder

Xanax XR 1 mg twice a day: Panic, anxiety

Prozac 80 mgs: Depression, OCD, anxiety

Seroquel 3 mgs: Add on for OCD and depression

Wellbutrin XL 300 mgs: Depression

 

 

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Updating for fun.

Psych meds

  • Wellbutrin 150 mg/morning, 75 mg/noon - Depression (wish it would bloody work)
  • Buspar 7.5 mg/morning, 15 mg/bedtime - Anxiety
  • Lamictal 200 mg - Mood stabilizer
  • Loxapine 10 mg, PRN - anti-mania (hypo, actually)

Other meds

  • Iron 65 mg - Anemia
  • One-A-Day multi-vitamin - I don't get enough of pretty much anything in my diet most of the time.
  • For now, 6-day prednisone pack - bronchitis
  • For now, Tesselon pearls - bronchitis (cough supressant)

Aside from the Welly, everything works pretty well. Buspar could work better, tbh, but it brings me from anxiety that keeps me up until 2 AM to anxiety that's just there and sometimes gets unmanageable. 

 

 

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There's been very recent med changes.

Wellbutrin XL has been dropped- yes dropped.  Bye bye welly.

My nightly 1mg of Ativan has been cut in half! :D

I am about to change my signature to reflect these changes. 

By the way, my CPAP machine might be delivered next week....!

 

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