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Your Cocktail Deconstructed

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Current meds for ADHD, Anxiety, Bipolar 1 severe mania, and a touch of OCD.

Last p.doc visit I was taken off a lot of meds and only prescribed Xanax 6mg a day, Zyprexa 10mg, Lithium 600mg, Zenzedi (dextroamphetamine) 90mg a day, and Lyrica 600mg as a mood stabilizer and also does really well to prevent my seizures.

I was very very manic when I last saw her, and I was acting erratic, excessive spending with dad's Amex, hypersexuality, not sleeping more than 3-4 nights a week, feeling amazing, and felt I could do anything, get any girl I wanted, and so much more reckless and dangerous behaviors. I have never felt more normal after being on Zyprexa. Now that I am not on an SSRI anymore, I am going to ask about Symbyax, the Zyprexa/Prozac combination pill, and she what she has to say about it. The reviews on Symbyax are outstanding but I sorta wish it was Zyprexa/Paxil combination pill because Paxil works like magic for my anxiety, social phobia, and self-confidence.

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21 minutes ago, mmaryland said:

I am going to ask about Symbyax, the Zyprexa/Prozac combination pill, and she what she has to say about it. The reviews on Symbyax are outstanding but I sorta wish it was Zyprexa/Paxil combination pill because Paxil works like magic for my anxiety, social phobia, and self-confidence.

Why not just ask about taking Zyprexa and Paxil instead?

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Posted (edited)

ETA: changes were to decrease Abilify down to 30 mg (finally, yay!) and increase or double my zyprexa zydis dose to 20 mg (so far so good, no side effects that I’m aware of)

 

 

The AAP’s:

Zyprexa Zydis 20mg - treatment resistant psychosis.......20 mg bedtime

Abilify 30 mg - mood stabilizer and treatment resistant psychosis......30 mg Bedtime

 

The anti anxiety:

 Klonopin 3 mg - severe GAD........1 mg AM, 1 mg afternoon, 1 mg evening/bedtime

 

The mood stabilizer:

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

    

Birth control:

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

 

 Sleep disorders:

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

 

Hashimoto’s disease:

Synthroid 50 mcg - hashimoto’s disease.....50 mcg AM

  

 Weight control:

Metformin 2,000 mg - weight gain prevention from psych meds.......1,000 mg AM and 1,000 mg evening

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

 

Allergies:

Flonase - Allergies.....Sprays in the AM

Edited by Wonderful.Cheese

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Posted (edited)

Saw my pdoc two days ago. She changed a few things for me.

  • alprazolam (Xanax) 1 mg 1/2-1 PO tid as directed
  • MethylPro L-Methylfolate 15 mg 1 PO q AM
  • pindolol (Visken) 5 mg 1 PO q AM
  • vitamin D3 50,000 IU 1 PO q wk
  • Viibryd (vilazodone) 40 mg 1 PO q AM cc (switched from Prozac 80 mg)
  • Vraylar (cariprazine) 3 mg 1 PO q AM
  • Vyvanse (lisdexamfetamine) 50 mg 1 PO q AM
  • dextroamphetamine (Dexedrine) 10 mg 2 PO tid prn
  • oxcarbazepine (Trileptal) 600 mg 1 PO bid (1,200 mg)
  • benztropine (Cogentin) 1 mg 1 PO bid prn (raised dose from 0.5 mg)
  • perphenazine (Trilafon) 4 mg 1 PO tid prn
  • quetiapine (Seroquel) 100 mg 1 PO qhs prn (raised dose from 50 mg)
  • thiothixene (Navane) 2 mg 1 PO tid prn
  • trazodone (Desyrel) 100 mg 2 PO qhs prn (200 mg)
  • trifluoperazine (Stelazine) 2 mg 1 PO tid prn

Other meds:

  • butalbital/APAP/caffeine (Fioricet) 50 mg/325 mg/40 mg 1-2 PO q4h prn max 6 per day (migarines)
  • zolmitriptan ODT (Zomig-ZMT) 2.5 mg 1-2 PO x1 prn (migraines)
  • baclofen (Lioresal) 20 mg 1 PO tid prn (muscle spasm)
  • levothyroxine (Synthroid) 150 mcg 1 PO q AM 1h ac (hypothyroidism)
  • losartan (Cozaar) 25 mg 1 PO q AM (HTN)
  • montelukast (Singulair) 10 mg 1 PO qhs
  • Ozempic (semaglutide) 0.25 mg sq q wk

Also, discontinued desipramine (Norpramin).

Edited by mikl_pls

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15 hours ago, mikl_pls said:

Saw my pdoc two days ago. She changed a few things for me.

  • alprazolam (Xanax) 1 mg 1/2-1 PO tid as directed
  • MethylPro L-Methylfolate 15 mg 1 PO q AM
  • pindolol (Visken) 5 mg 1 PO q AM
  • vitamin D3 50,000 IU 1 PO q wk
  • Viibryd (vilazodone) 40 mg 1 PO q AM cc (switched from Prozac 80 mg)
  • Vraylar (cariprazine) 3 mg 1 PO q AM
  • Vyvanse (lisdexamfetamine) 50 mg 1 PO q AM
  • dextroamphetamine (Dexedrine) 10 mg 2 PO tid prn
  • oxcarbazepine (Trileptal) 600 mg 1 PO bid (1,200 mg)
  • benztropine (Cogentin) 1 mg 1 PO bid prn (raised dose from 0.5 mg)
  • perphenazine (Trilafon) 4 mg 1 PO tid prn
  • quetiapine (Seroquel) 100 mg 1 PO qhs prn (raised dose from 50 mg)
  • thiothixene (Navane) 2 mg 1 PO tid prn
  • trazodone (Desyrel) 100 mg 2 PO qhs prn (200 mg)
  • trifluoperazine (Stelazine) 2 mg 1 PO tid prn

Other meds:

  • butalbital/APAP/caffeine (Fioricet) 50 mg/325 mg/40 mg 1-2 PO q4h prn max 6 per day (migarines)
  • zolmitriptan ODT (Zomig-ZMT) 2.5 mg 1-2 PO x1 prn (migraines)
  • baclofen (Lioresal) 20 mg 1 PO tid prn (muscle spasm)
  • levothyroxine (Synthroid) 150 mcg 1 PO q AM 1h ac (hypothyroidism)
  • losartan (Cozaar) 25 mg 1 PO q AM (HTN)
  • montelukast (Singulair) 10 mg 1 PO qhs
  • Ozempic (semaglutide) 0.25 mg sq q wk

Also, discontinued desipramine (Norpramin).

I hope the increases and the viibryd helps! Have you ever tried trintellix? I don’t think my pdoc would ever let me touch an AD ever again, but that is what I would like to try if depression got bad again. But I’ve been running high for quite some time since seroquel was swapped. If I crash it’s going to be hard. Yikes. I know Prozac pairs well with zyprexa though. Maybe she’d go for that? Hmmmm .

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1 hour ago, Wonderful.Cheese said:

I hope the increases and the viibryd helps! Have you ever tried trintellix? I don’t think my pdoc would ever let me touch an AD ever again, but that is what I would like to try if depression got bad again. But I’ve been running high for quite some time since seroquel was swapped. If I crash it’s going to be hard. Yikes. I know Prozac pairs well with zyprexa though. Maybe she’d go for that? Hmmmm .

I have tried Trintellix. Three times I think, actually. lol.

If it works, I hope your pdoc would consider it. :) 

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Posted (edited)
3 hours ago, Wonderful.Cheese said:

I hope the increases and the viibryd helps! Have you ever tried trintellix? I don’t think my pdoc would ever let me touch an AD ever again, but that is what I would like to try if depression got bad again. But I’ve been running high for quite some time since seroquel was swapped. If I crash it’s going to be hard. Yikes. I know Prozac pairs well with zyprexa though. Maybe she’d go for that? Hmmmm .

That would be fair to ask for prozac.

The med is called Symbyax, which is FDA approved for bipolar depression. It's basically prozac+zyprexa in one pill. That's basically the same as asking for both at once.

https://www.rxlist.com/symbyax-drug.htm#description

Edited by argh
clarification
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Now with more BID goodness

Anti-depressant: Bupropion IR (Wellbutrin IR) 100mg BID

Anxiety/adjunct mood stabilizer: Gabapentin (Neurontin) 400mg TID

Mood stabilizer: Lamotrigine (Lamictal) 100mg BID

Sleep: Trazodone (Desyrel) 25-50mg qpm

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Aripiprazole 15mg qAM; - anti-manic; mood stabilizer

Venlafaxine XR 225mg qAM; - antidepressant

Carbamazepine CR 800mg; (400 BID) - mood stabilizer

 Gabapentin 900mg; (300 TID) - anti-anxiety

Mirtazapine 30mg qhs; - antidepressant

 Quetiapine 1200mg qhs. - for insomnia;mood-stabilizer;antidepressant;anti-anxiety

PRN: Diazepam 5-10mg; Haloperidol 5-10mg;

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900mg/day pregabalin - panic disorder, generalized anxiety disorder

120mg/day duloxetine - panic disorder, generalized anxiety disorder

4mg/day clonazepam - panic disorder, generalized anxiety disorder

 

All three of my medications are being used to treat the same two disorder from which I suffer and they do a really good job in combination. If one were to remove any medication comprising the trio, I would fall unstable very, very quickly. The combination, however, isn't ideal due to the goddamn sexual side effects associated, but I am grateful that the medications exist and allow me to go about my life as though I were neurotypical. 

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Now that I’m well my psychiatrist reduced what I’m taking and I’m still going down on dosages. I haven’t taken so few pills since I was 19. She’s not a fan of complex cocktails if it can be helped. 

Bupropion 450 mg (unfortunately I need a high dose of this, I did try to reduce with bad results)

Latuda 120 mg (down from 160mg and I’ll continue to lower dosage as time goes on)

Lamictal 100 mg

Levothyroxine 12.5 MCG (been going down on this steadily since I went off lithium)

 

 

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Zoloft - 150 mgs - I honestly don't know why the fuck why, all it does is shoot my mood up, but hey I'm having a good time so

Abilify - 20 mgs - anti-psychotic, anti-manic, mood stabilizer. my favorite psych med ever. god blessssssss

Depakote - 100- mg -- mood stabilization. I hate these horse tranquilizers but what are ya gonna do?

Ativan - 1 mg - anxiety, very helpful

Ambien - 10 mg - the only sleeping pill that works for me!

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Venlafaxine (Effexor) - 150 mg morning, for depression, ocd and social anxiety.

Modafinil (Modiodal) - 100 mg morning, for wakefulness, mood lift, lethargy.

Quetiapine (Seroquel) - 50 mg at noon, 150 mg bedtime; anxiety, insomnia, mood stabilizer.

Methylphenidate XR (Concerta) - 54 mg at noon; adhd, mood lift, depression.

Atomoxetine (Strattera) - 40 mg at noon; for adhd.

Clonazepam (Rivotril) - 0.5 mg at noon, 1 mg at bedtime; anxiety, insomnia, ocd.

Lamotrigine (Lamictal) - 200 mg at evening; mood stabilizer.

 

 

This cocktail is working great, i hope it keeps working, though i would like to try Zolpidem for insomnia, i'm gonna ask my psychiatrist for it, hopefully agree with me, does anyone try it and has positive experience with Ambien? Greetings from México!

Edited by Equilibrium022x
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On 9/17/2019 at 6:48 PM, Equilibrium022x said:

i would like to try Zolpidem for insomnia, i'm gonna ask my psychiatrist for it, hopefully agree with me, does anyone try it and has positive experience with Ambien? Greetings from México!

 It is effective in getting people to sleep but not so good at early morning waking. I did not find it was strong enough to keep me asleep all night, but it did get me to sleep.

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On 9/17/2019 at 7:48 PM, Equilibrium022x said:

This cocktail is working great, i hope it keeps working, though i would like to try Zolpidem for insomnia, i'm gonna ask my psychiatrist for it, hopefully agree with me, does anyone try it and has positive experience with Ambien? Greetings from México!

¡Saludos! Solo sé un poco de español, ¡pero estoy aprendiendo! ¡Me alegra que sus medicamentos funcionen bien para usted!

Como @notloki dijo, el zolpidem me ayudó a dormir, pero no me ayudó a dormir toda la noche. Siempre me despertaba demasiado temprano. Tomé 10 mg.

Si lo intentas, ¡espero que funcione para usted!

 

Greetings! I only know a little Spanish, but I'm learning! I'm glad your medications are working well for you!

As @notloki said, zolpidem helped me sleep, but didn't help me sleep all night. I would always wake up too early. I took 10 mg.

If you try it, I hope it works for you!

(I don't know if I'm allowed to post in other languages here, sorry mods if I neglected to take note of that!)

Edited by mikl_pls
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1 hour ago, mikl_pls said:

¡Saludos! Solo sé un poco de español, ¡pero estoy aprendiendo! ¡Me alegra que sus medicamentos funcionen bien para usted!

Como @notloki dijo, el zolpidem me ayudó a dormir, pero no me ayudó a dormir toda la noche. Siempre me despertaba demasiado temprano. Tomé 10 mg.

Si lo intentas, ¡espero que funcione para usted!

 

Greetings! I only know a little Spanish, but I'm learning! I'm glad your medications are working well for you!

As @notloki said, zolpidem helped me sleep, but didn't help me sleep all night. I would always wake up too early. I took 10 mg.

If you try it, I hope it works for you!

(I don't know if I'm allowed to post in other languages here, sorry mods if I neglected to take note of that!)

I'm glad you know Spanish and you do it so well, 😊 thanks!

So back to my cocktail i've done some changes by myself 😁 i hope my pdoc agree because i could't wait until october 02.

Venlafaxine (Effexor) - 150 mg morning, for depression, ocd and social anxiety.

Modafinil (Modiodal) - 100 mg morning, for wakefulness, mood lift, lethargy and 100 mg at noon.

Quetiapine (Seroquel) - only 150 mg bedtime, i switch to aripiprazole at noon well it works better for ocd, anxiety, insomnia (seroquel) mood stabilizer.

Aripiprazole (Abilify) - 15 mg at noon; it does improve my OCD tendencias, you know..ruminating thoughts, fear of contamination or a desease, perfeccionist and so on, i can manage it much better. Also good at stabilizating, depression and autism, so is a plus.

Methylphenidate XR (Concerta) - 54 mg at noon; adhd, mood lift, depression.

Atomoxetine (Strattera) - 40 mg at noon; for adhd.

Clonazepam (Rivotril) - 0.5 mg at noon, 1 mg at bedtime; anxiety, insomnia, ocd.

Lamotrigine (Lamictal) - 200 mg at evening; mood stabilizer.

Valproate (Depakene) - 400 mg i'm the morning for mood stabilazer, manía..i'm not bipolar i think but sometimes my mood can be so down or struggle with anger so maybe an stabilizer could help.

 

Well that's it, maybe i'll try later the Zolpidem, but it's very expensive and maybe it doesn't worth it we'll see later cause i have some payments to do, but thanks for your reply notloki and mikl!

Edited by Equilibrium022x
Some changes.

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@Equilibrium022x It’s never a good idea to introduce new meds or adjust dosages without a doctor’s supervision. If you need to make changes sooner, at least touch base over the phone or try and get in for an appointment sooner than October 2. If things are bad enough you are making changes on your own, I’m sure the doctor would want to see you asap. Playing doctor is dangerous. As much as we think we know about meds ourselves and as much experience as we may have with them personally, we are not qualified to act as psychiatrists. 

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2 hours ago, saintalto said:

@Equilibrium022x It’s never a good idea to introduce new meds or adjust dosages without a doctor’s supervision. If you need to make changes sooner, at least touch base over the phone or try and get in for an appointment sooner than October 2. If things are bad enough you are making changes on your own, I’m sure the doctor would want to see you asap. Playing doctor is dangerous. As much as we think we know about meds ourselves and as much experience as we may have with them personally, we are not qualified to act as psychiatrists. 

I know, you're right! At least i'm gonna send him a whatsapp and see if i can return to those previously prescribed them. Hopefully he agree with me cause i'm more stable now.

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11 hours ago, Equilibrium022x said:

I'm glad you know Spanish and you do it so well, 😊 thanks!

So back to my cocktail i've done some changes by myself 😁 i hope my pdoc agree because i could't wait until october 02.

Venlafaxine (Effexor) - 150 mg morning, for depression, ocd and social anxiety.

Modafinil (Modiodal) - 100 mg morning, for wakefulness, mood lift, lethargy and 100 mg at noon.

Quetiapine (Seroquel) - only 150 mg bedtime, i switch to aripiprazole at noon well it works better for ocd, anxiety, insomnia (seroquel) mood stabilizer.

Aripiprazole (Abilify) - 15 mg at noon; it does improve my OCD tendencias, you know..ruminating thoughts, fear of contamination or a desease, perfeccionist and so on, i can manage it much better. Also good at stabilizating, depression and autism, so is a plus.

Methylphenidate XR (Concerta) - 54 mg at noon; adhd, mood lift, depression.

Atomoxetine (Strattera) - 40 mg at noon; for adhd.

Clonazepam (Rivotril) - 0.5 mg at noon, 1 mg at bedtime; anxiety, insomnia, ocd.

Lamotrigine (Lamictal) - 200 mg at evening; mood stabilizer.

Valproate (Depakene) - 400 mg i'm the morning for mood stabilazer, manía..i'm not bipolar i think but sometimes my mood can be so down or struggle with anger so maybe an stabilizer could help.

 

Well that's it, maybe i'll try later the Zolpidem, but it's very expensive and maybe it doesn't worth it we'll see later cause i have some payments to do, but thanks for your reply notloki and mikl!

Thank you! :D

As for the addition of valproate, make sure you adjust your lamotrigine dosage if you're going to take valproate. Valproate slows the clearance of lamotrigine from your body, so you need to take half the normal dose of lamotrigine if you take it with valproate. In other words, you'd need to go down to 100 mg lamotrigine with the valproate. It's a small valproate dose, but still, the interaction can happen. I would actually say to wait to add that to your regimen until after you've discussed it with your pdoc—that's a very risky change to make on your own.

If zolpidem is too expensive, perhaps you could try something else? Have you tried trazodone? I take that with Seroquel and it works very well for my insomnia. Also, is zopiclone available in Mexico? Is temazepam?

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