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Your Cocktail Deconstructed

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Lithium - 600 mg total for mood stabilization and anti-manic (150 mg capsule in am; 450 mg tab in pm)

Lamictal - 200 mg for bipolar-safe anti-depressant effect

Ativan - 1 mg total for anxiety (0.5 mg am and 0.5 mg pm)

Zyprexa - 7.5 mg for psychosis

Prazosin - 2 mg for PTSD-related nightmares

 

non-mental health:

-synthroid - 75 mcg - for hypothyroidism

-xyzal - for allergies

-treximent PRN (migraine); imitrex PRN (migraine); zofran PRN (nausea); bentyl PRN (abdominal cramping and diarrhea)

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I remember updating here not that long ago but some things have changed...

No more Ritalin, I’m not allowed near ADHD drugs right now b/c of psychosis. This does not make me happy.

Added 150mg of Wellbutrin for what is apparently depression.

Still taking...

latuda 120 mg - psychosis

lamotrigine 100mg & lithium 900mg - mood

levothyroxine - for my ailing thyroid 

Olanzapine PRN 

Edited by saintalto

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6 hours ago, saintalto said:

I remember updating here not that long ago but some things have changed...

No more Ritalin, I’m not allowed near ADHD drugs right now b/c of psychosis. This does not make me happy.

 

Once the psychosis is gone you may be able to take an ADHD med. People with psychosis have been known to take stimulants like Ritalin or Adderall once things are well under control.

 

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7 minutes ago, notloki said:

 

Once the psychosis is gone you may be able to take an ADHD med. People with psychosis have been known to take stimulants like Ritalin or Adderall once things are well under control.

 

Yes, I have been on and off it for 16 years for this very reason. The problem with me is things never stay under control for very long. Meds for me are like one long stream of shoddy bandaids.

Edited by saintalto

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Been a while since I updated, and some of my meds have changed so here is my current cocktail:

Lamictal 100mg once daily (working up to 200mg by 2/16)

Memantine 5mg twice daily (working up to 10mg twice daily)

Dexedrine 15mg two capsules twice daily

Zenzedi 30mg once daily

Xanax 1mg two to three times daily

Valium 10mg once daily at bedtime

Halcion 0.25mg at bedtime as needed

Recently had a seizure on 1/30 from benzo (mainly Xanax) withdraw; I was not taking Valium at the time either (stopped on 1/22) so I guess Lamictal wasn't enough to prevent benzo withdraw seizures. Resumed Valium 10mg 2/2 and am really serious this time about trying to get off Xanax so I don't have to deal with dependency/addiction for the rest of my life. My psychiatrist mentioned in-patient detox as an option to get off benzos but I want to actually give myself a chance to take this seriously and wean off without having to admit myself. Why are these depressants so damn attractive and addictive?? You can officially add me to the group of people who can legitimately say I wish I never even began taking Xanax. At least I am fortunate enough to have a doctor who is willing to go as slow as I need to get my body off alprazolam. Lamictal is working pretty well for my mood, I'd say as good as Lithium without as many side effects. Memantine to help reduce/prevent further stimulant tolerance; don't know how effective it is since I've only been on it for 3 weeks. Halcion is amazing, my ideal sleep aid. Finally found something that helps me get to sleep and wake up feeling refreshed, not drugged or over-sedated. I try to only take it 4-5x a week so it maintains its effectiveness. Will keep you guys updated on my progress over the next weeks/months, please wish me as much luck as possible :)

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Well, here we go.

  • Lithium: for mood stabilization, mania/depression
  • Latuda: I'm honestly not sure, I think depression?
  • Seroquel: For psychosis, depression, sleep 
  • Zyprexa: Psychosis and mood stabilization
  • Xanax: for severe anxiety
  • Dexedrine: for my sleep disorder 

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I've had some minor changes (doses are total per day):

Seroquel XR 600mg - Schizophrenia
Lamictal 300mg  - Mood
Prazosin 3mg - Anxiety
Klonopin 1mg - Anxiety
Mirapex 1mg - Negative symptoms
N-acetylcysteine 2000mg - Negative symptoms & OCD
Metformin 1000mg - Metabolic syndrome

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Not major changes, but some adjustments...

Rexulti 2mg (same) - Still the backbone of my cocktail. Kills my depression 90% of the time. I will fight you if you try to take this from me.
Trintellix 5mg (new) - Adjunct for depression, since my last depressive episode was pretty severe. Pdoc thinks it will be enough of a boost to keep me from slipping.
Trokendi XR 100mg (same) - Migraine prophy. Works pretty damn well, went from 8-10 a month to maybe 1 a month. I can live with that.
Xanax 0.5mg (same) - PRN up to 1.5mg/day for anxiety. Works as described, except it makes me sleepy at doses of 1mg and higher. Kills anxiety like nothing else.
Nuvigil 250mg (was 150mg) - For excessive sleepiness due to sleep apnea. Keeps me going for a good 12-14h a day before it rolls off, unless I'm depressed, in which case, I can sleep through it.
Klonopin 1-2mg (new) - QHS insomnia/anxiety. Had a rough week of rebound insomnia and transition off of Lunesta and Restoril, but now that the Klonopin has leveled out, my general anxiety is lower, and my sleep is good.

Non-Psych:

Zomig 5mg (same) - PRN migraine
Zofran 4mg (same) - PRN nausea from migraine + from Zomig (stupid triptan makes the nausea worse)

Sleep doc hopes that with CPAP and Nuvigil my level of wakefulness will be high enough that I will be naturally tired by the end of day and my mind will basically wear itself out. I've only been on the higher doses for less than a week, but prior to now, that didn't happen. Yesterday, though, I was able to get up and function from 6am - 9pm, take 1mg of Klonopin, and sleep well until 6am again. I might not have even needed the Klonopin as tired as I felt, but I wasn't willing to risk waking up in the middle of the night because of insomnia (which has been completely horrible the past few weeks.) I've done Klonopin 1mg BID anxiety before, and it didn't work, but for some reason in this combo it is working. I haven't touched Xanax in over a week, and that's only dosing the Klonopin QHS. The long half-life of Klonopin does mitigate some of the effects of Nuvigil, but not enough that I'm sleepy, I'm just not super-energized, which really isn't an effect of Nuvigil anyway. 

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I've actually been on the same thing for four months.  Fingers crossed that it stays the same next week.

  • lithium (600 mg) - mood stabilization and anti-manic
  • lamictal (200 mg) - anti-depressant/mood stabilization
  • zyprexa (7.5 mg) - antipsychotic [this might have to change because I'm having a weight gain issue]
  • ativan (1 mg) - anxiety
  • prazosin (2 mg) - PTSD nightmares

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Lithium 600mg - mood stabilization

Trileptal 450mg - mood stabilization? I actually have no idea why I'm on this medication.

Zyprexa 20mg - for psychosis, currently not working very well

Clonazepam .5mg PRN - anxiety and sleep

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UPDATE AS OF 4/19/2018

DAW Namenda 20mg once daily AM - ADHD and to reduce stimulant tolerance 

DAW Vraylar 3mg once daily AM - bipolar mania 

Xanax XR 0.5mg once daily AM - currently tapering off, but use for anxiety

Valium 40mg once daily PM - helping me taper off Xanax and avoid withdrawal seizures and symptoms

Halcion 0.25mg to 0.5mg as needed (about 2-3 times a week) - insomnia

DAW Dexedrine Spansules 15mg two capsules three times daily - ADHD

L-methylfolate (generic Deplin) 7.5mg once daily AM - MTHFR genetic mutation

Strattera 80mg once daily AM - ADHD

Edited by mmaryland
update

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Still undergoing some major med changes (no more Seroquel XR, no more wellbutrin XL, lowering invega dose in half, I'm not sure if pdoc will let me lower Abilify to 30 mg instead of 35 mg, etc)

I'm pretty nervous that I will go crazy and end up fat with being on only 2 AAP's. I feel ok now but feel pretty stupid because I initiated these changes. I don't want to end up IP or worse (dead).

 

Abilify 35 mg - mood stabilizer and psychosis......5 mg AM and 30 mg bedtime

Klonopin 3 mg - severe anxiety........1 mg AM, 1 mg afternoon, 1 mg evening

Zyprexa Zydis 20 mg - mood stabilizer and psychosis........20 mg bedtime

Invega 12 mg (about to titrate down to 6 mg then see how I do?!?) - for psychosis....12 mg AM for now, then next week 6 mg

Lamictal 300 mg - mood stabilizer......300 mg bedtime

Yaz - birth control and heavy period control.......one pill AM

Nuvigil 200 mg - sleep disorders/wakefulness.....200 mg AM

Synthroid 25 mcg - hypothyroidism.....25 mcg AM

Metformin 2000 mg - weight gain prevention from psych meds.......1000 mg AM and 1000 mg evening

Topamax 200 mg - weight management/loss, controlling overeating.....100 mg AM and 100 mg evening

Lunesta 3 mg PRN - insomnia.....3 mg PRN bedtime

Vistaril 150 mg PRN - panic attacks or severe anxiety attacks.....50 mg up to three times daily

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(First post... Hi etc.)

Effexor 225 - Depression & anxiety

Abilify 5 - OCD & tics

Ritalin 30 - ADHD

I have an “almost there” feeling, maybe a minor adjustment (or time?) will do.

Various degrees of failure: Cymbalta (worked but killed sex drive), Prozac, Zoloft, Wellbutrin, Milnacipran (WAY too activating), Trintellix (placebo, as far as I can tell), Risperdal (worked but was too sedating).

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Maybe... a little bit scared of increasing this one, being an AAP, but I'll ask the doc :) 

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  • levomilnacipram (Fetzima) 120mg — depression
  • Adderall IR 60mg (20mg TID) — ADHD
    • finally changing back to Adderall IR 80mg (20mg QID) in the next half-week or so
  • temazepam (Restoril) 30mg QHS — sleep issues
  • diazepam (Valium) 10mg (5mg PRN BID) — anxiety
  • bicalutamide (Casodex) 50mg — gender dysphoria/gender identity disorder
  • estradiol transdermal system (Vivelle-Dot) 0.2mg/24h BIW — gender dysphoria/gender identity disorder
  • pantoprazole (Protonix) 40mg — antral gastritis (idiopathic/chronic)
  • sumatriptan (Imitrex) 50mg PRN — migraines

So after three very miserable months on Adderall IR 20mg (10mg BID) thanks to a stupid incompetent fucktard of a psychiatrist who really needs to have his board certification revoked, I finally managed to flee to the only other psychiatric practice in the area, which luckily has a so far seemingly decent psychiatrist, although he's remote (it's via telepsychiatry, which is weird), he's less accessible, and it took me almost two full months to get in to see him. Still, he agreed to take me on as a patient, and he restored the ADHD meds to something more or less functional (Adderall IR 60mg (20mg TID)), although I still unsurprisingly couldn't seem to manage to get the intended 12 hours out of TID dosing without some nasty crash-like effects towards the tail end of doses, which is a bit of a major issue. Still, it was enough for me to return to my part-time software development job at a startup, which I'm glad about.

Today after close to a month on Adderall IR 60mg (20mg TID), I had my first follow-up appointment with this new psychiatrist, and we discussed the remaining issues I was having with TID dosing and what to do about them. Switching to Vyvanse was discussed, but it just wasn't that good of an option in a number of ways, so we're keeping it as a reserve option instead for if I ever need to switch ADHD meds in the future. The psychiatrist agreed that going back to my full old dose of QID IR Adderall (I had previously been on QID 20mg from August 2016 to December 2017 before the stupid incompetent fucktard of a psychiatrist who really needs to have his board certification revoked decided to screw with the dose) was probably the best option available to resolve the remaining issues, but due to it technically being an "off-label" dose, he wants me to go get an EKG done once I'm back on the full "off-label" dose in order to rule out any arrhythmias despite having at least two negative past EKGs (although this is apparently because I wasn't on as high a dose of IR Adderall specifically for any of said past EKGs).

So I've got to go get that EKG done next week — hopefully my insurer will cover that, their site says it should be between $26–$95 if the EKG is covered and in-network, but they could be a dick and reject it for being technically somewhat medically unnecessary if they wanted to. And hopefully nobody decides that my relatively high resting HR on meds (it's high off meds too, just less so) counts as an arrhythmia... I'm probably worrying too much over nothing again though.

On the bright side, I've been hearing interesting rumors through the grapevine about my previous stupid incompetent fucktard of a psychiatrist who really needs to have his board certification revoked. Apparently his practice has been virtually unreachable for patients and providers recently (heard this from both my therapist and secondhand from someone else), and according to someone else (secondhand) he and his practice are apparently under investigation for Medicare & Medicaid fraud and overprescribing/misprescribing (although I'm not sure if these particular accusations are fully true because while they do fit the picture I saw almost perfectly, I can't find any independent proof yet beyond this single person's second-hand claims to corroborate these claims — however if he is currently actively under investigation there won't necessarily be any open public records of it until after the fact).

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@JustNuts Wondering how long have you been on Fetzima, and how do you like it (say compared to other SNRIs?) Not too many folks here are on it.

I'm on Effexor and it's not doing much TBH,  as far as brightening my depression, increasing motivation or cutting out negative ruminations. I'm not super depressed really, just still apathetic and ruminating. I'm also not digging the short half-life. I got nasty withdrawal syndrome from Cymbalta even..Anyway, curious to hear your feedback as far as comparing these 3 with benefits, side effects, etc. I think it is not generic yet, correct?

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2 hours ago, Blahblah said:

@JustNuts Wondering how long have you been on Fetzima, and how do you like it (say compared to other SNRIs?) Not too many folks here are on it.

I'm on Effexor and it's not doing much TBH,  as far as brightening my depression, increasing motivation or cutting out negative ruminations. I'm not super depressed really, just still apathetic and ruminating. I'm also not digging the short half-life. I got nasty withdrawal syndrome from Cymbalta even..Anyway, curious to hear your feedback as far as comparing these 3 with benefits, side effects, etc. I think it is not generic yet, correct?

I've been on it since late December 2016. Titrated from 20 mg -> 40 mg -> 80 mg -> 120 mg. Its unique 1:2 serotonin:norepinephrine ratio (compared to 30:1 for venlafaxine, 14:1 for desvenlafaxine, and 10:1 for duloxetine) makes it a rather interesting SNRI, but that ridiculously NE-heavy ratio leads to poor tolerability and significant side effects, especially when first starting the med. IIRC back when my old psychiatrist first proposed prescribing levomilnacipran she had said that most of her patients couldn't tolerate it, but the ones who did tolerate it generally did well on it. Anxiety and nausea were definitely the most significant side effects during initial titration, but as I had a generous supply of PRN meds for both of those issues at the time, the titration process wasn't too bad, and the side effects dampened down significantly once I was done titrating and had stabilized at a consistent dose for a little while.

Compared to other ADs, the only thing that's topped this was vortioxetine, which I had a superb initial response to (but that didn't last very long). It's definitely my favorite SNRI (duloxetine wasn't too great, while both venlafaxine and desvenlafaxine were utter crap). I'd say my long term response to Fetzima is significantly better than all other ADs, but it's not ideal. Then again, nothing is ideal, and this is the best single-entity antidepressant I've found so far. It lessens the depression and suicidal thoughts, increases my energy levels, increases my motivation a bit, and probably a couple other minor things that I can't think of.

Side effects are somewhat similar to what you'd see with something like bupropion (anxiety, appetite suppression, increased heart rate, sometimes some mild jitteriness, dry mouth, nausea, insomnia, etc).

In terms of half-life, it's relatively short at just 12 hours, but there are no major withdrawal issues assuming you take it "daily" (doesn't have to be exactly every 24 hours — I've found it to be much more forgiving than the other SNRIs in that regard). I've inconsistently noticed some limited changes in effects late in the day, but that's minor. If you actually outright skip/miss a day, withdrawal effects are initially reasonably minor (mostly just tiredness and difficulty thinking — sometimes the depression worsens a bit), but if I skip/miss more than a single day (it's happened a few times) I notice the depression rapidly getting much worse and I also start to get antidepressant discontinuation symptoms (it's not as bad as the other SNRIs with these but it's still not pleasant at all). Going back on the med quickly resolves both of those issues.

Yep, it's brand-name only right now. Their 5-year FDA exclusivity expires in late July this year, but they have several patents covering the drug, the earliest of which expires in early June 2023, and the latest of which expires in late May 2032. So generics are nowhere near being available. It's relatively pricy for an antidepressant (cash price of >$400, my insurer/PBM pays ~$325), and my insurer considers it to be a non-preferred brand-name drug ($100 copay), but Allergan has a pretty good savings card available that cuts my copay down to $30 (if your copay is above $30 they'll pay up to $105 towards reducing it to $30). Last year's savings card had reduced my copay ($80 at the time) down to just $20, but they changed it this year (they also increased the maximum they'll pay towards reducing copays from $80 to $105, so I guess increasing the patient's share of the costs from ≥$20 to ≥$30 isn't too bad of a tradeoff to make on a broader scale...but of course on a more personal scale I'm pretty fucking fed up with these damn copay increases (my generic drug copay went from $10 to $15 this year)). It's not the most expensive drug I've been on (that dubious honor goes to the atypical antipsychotics I've been on, the worst of which was Vraylar (which had my insurer/PBM paying a whopping ~$1085)), but it's still relatively pricy for an antidepressant.

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@JustNuts Thanks for the info. I'm trying to decide what to do. I do have room to go up on Effexor, but part of me wonders if I should switch to Cymbalta (which has more NE and longer half-life). I was on that like 10 years ago, so don't really remember if it was much better. I guess Effexor is helping, I feel pretty stable and haven't had long dips in depression (I used to get triggered and then get stuck for days). Now depressive episodes are incredibly short, however, I'm stuck in the blahs (I wonder if Lamictal could be contributing to this???) Effexor Side effects are tolerable (typical dry mouth/throat clearing, constipation, a bit of "spaciness")

My main thing is that meds have helped prevent/stave off the worst depressive episodes, but I guess I always feel blah. Like it's good that my negative emotions aren't intense, but I can't remember the last time I felt pleasure or excitement in anything!! Every single one effects my sex drive (no orgasms either). But if I go off, I know I will be de-stabilized and experience alot of emotional lability (which includes more downswings). So it is a constant trade-off :-(

I tried Trintillex also, and I felt no effect whatsoever. I would be eager to try Fetzima, but the cost is a barrier/annoyance. So with less Serotonin (and more NE) does this mean it has less of a calming/blunting effect and more of increased heartrate, energizing, "fight or flight" restless legs, sort of effects? My physical energy level is fine. Since I'm on Ritalin, I don't want to get on something that has significant cardiovascular effects.

Edited by Blahblah

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