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12 hours ago, Will said:

I don't know that I need your post to help.  And I don't mean that snidely... too terribly much. The focus of the board on meds has remained unchanged since I joined it.  I have always understood that.  And I largely agree w/ that as it applies to me, insofar as I am "free" to make my own judgments on that.  

 

I think this is just a little off. The focus of CB is treatment. This is not the place to come if you want to revel in the supposed glories of the tortured bipolar genius, e.g. We welcome people who are serious about recovering as best they can, and on living their MI lives as safely and productively as they can.

For a lot of people, that means medications. For some people (like me) that means multiple medications, every day, for the rest of their lives. Our goal is to support people in their efforts to be med-compliant, and to help them take meds safely and as comfortably as possible.

There’s a lot of stigma around taking psych meds, a lot of pressure not to do it, and it’s our goal too help our members stand up for themselves and tell their detractors that they need meds and that’s ok. 

Too many of us here know what it feels like to be over medicated or on the wrong meds for any of us, the members or the staff, to think that blindly throwing med after med at a problem without considering the whole person is a viable solution. We are pro-med in the sense that we are pro-treatment, pro-health, anti-stigma, centered on the needs of our members, and to hell with what the rest of the world thinks. 

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My cocktail is slimming down a bit as I become more and more stable! Was able to get rid of the PRN antipsychotic. Now I have a stockpile of Zyprexa and Geodon!! lol aripiprazole (Abilify) 20 mg

So, no more anti-drooling pill, no more clozapine, no more vraylar, and hoping to make zyprexa zydis 10 mg part of my regular cocktail (I have been taking it daily anyway), also I take Flonase for all

Cerberus, Curious if you've read Mind Fixers, by Anne Harrington?y That's not a trick or rhetorical question, and I'm not suggesting anything if you haven't OK, let me narrow this.  The

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I hear you Gearhead.  I agree.  It's not like I'm trying to plot my own course here.  So, I'd say to you pretty much what I said to Cerberus.

As for being just a little off, that makes me laugh.  Out loud.  I mean sure, as a manic depressive I might be a little off.  So, I can agree w/ both Cerberus and Gearhead, and somehow hope that I don't wind up being a supplicant of either of you.

Edit:  Not laughing at you, but with the phrase.  I am more prone to agree with you that than Cerberus, whose user name I could not even spell for about for about 2 years.  But that's just my not paying attention all the time. 

 

Edited by Will
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Cerberus - I do not doubt your position at pdoc, but from own experience I've seen good and bad doctors, the ones that really helps and knows how to empathy with you, others just for the money and very little help with unsuccesful results, and so on. That's why in my case jumped from many psychiatrists since 2004 and agree with you the mind is still very complex and I'm not intend to damage it by self medicated, I don't do illegal drugs anymore, not even drink a single glass of alcohol anymore, my mental health is first and thank God currently I found a good doctor right now since January this year. Sadly my appointment has changed to the 9th October, because he is not in the city, had a not planned travel but still in contact vía whatsapp, and let you know if something in my regimen changes next week, i will update all of you ;) cheers! Goodbye.

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My cocktail hasn’t changed that much, just a few tweaks here and there and dosage modification to find my sweet spot. Here goes it

Paxil 30mg for anxiety. This is working wonderfully

Vraylar 3mg for bipolar 1. I love Vraylar it personally works so great

Zenzedi 15mg twice daily for adhd

Rexulti 1mg for mood boost 

Zyprexa 10-20mg for acute mania and insomnia

Clonidine 0.6-0.8mg PRN for insomnia

Lyrica 300mg twice daily for mood stabilization

Remeron 15-30mg PRN for insomnia

Solodyn 105mg for acne

 

Actually right now I am out of Vraylar and Zenzedi because I lost the bottle of Vraylar I had and it had a bit more than 39 zenzedi mixed in. So I haven’t had these two medications in about a week. I see the psychiatrist today after work and Medicaid doesn’t cover either of these meds, so I have no idea how I’m going to get more Vraylar and I’m going to have to see if my doctor if he can prescribe adderall since the generic would be like 10 bucks. I no longer have commercial insurance so I’m stuck with Medicaid only. Does anyone have a suggestion on what to do? I printed some prior authorization forms for both and filled them out and gave the rest to my dr but I don’t see these getting approved that easily. How about any information re the dosage comparison between dextroamphetamine and adderall. I’m thinking if I take 15mg zenzedi then 20mg of adderall would probably be sufficient but I haven’t tried adderall in so long

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  • 3 weeks later...

Pdoc added prozac and said it would be a VERY long time before we could remove any AAP’s. I have no idea what the time frame is or if it will ever happen. Also Abilify in the AM to see if that helps the evenings any (my worst time of day). Also stopped the Flonase for now as said ok by my GP. I will need in the spring again though. And my nuvigil was split into a morning and afternoon dose as per sleep doc’s orders. 
 

The AAP’s:

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

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

Rexulti 2mg - treatment resistant psychosis.......2 mg bedtime

 

The antidepressant:

Prozac 10 mg - BP depression.......10 mg AM

 

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.....150 mg AM, 50 mg noon

 

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

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I saw my pdoc last night and she made a few changes. She didn't want to increase the Vraylar up to 6 mg like I kinda wanted, but that's good I suppose since if I really need to increase it later, I'll have some room to go up.

She added Wellbutrin XL 300 mg for depression and Doral 15 mg for sleep (a "new" benzo on the US market, quazepam, which has actually been around for decades...).

  1. alprazolam (Xanax) 1 mg 1 PO tid prn
  2. Vraylar (cariprazine) 4.5 mg 1 PO q AM
  3. Viibryd (vilazodone) 40 mg 1 PO q AM
  4. trazodone (Desyrel) 100 mg 1-2 PO qhs prn
  5. quetiapine (Seroquel) 100 mg 1 PO qhs prn
  6. benztropine (Cogentin) 1 mg 1 PO bid prn
  7. ondansetron (Zofran) 4 mg 1 PO qd prn
  8. pindolol (Visken) 5 mg 1 PO q AM
  9. dextroamphetamine (Dexedrine) 10 mg 2 PO tid (60 mg)
  10. oxcarbazepine (Trileptal) 600 mg 1 PO bid (1,200 mg)
  11. bupropion XL (Wellbutrin XL) 300 mg 1 PO q AM
  12. Doral (quazepam) 15 mg 1 PO qhs

She said she would replace the Seroquel with Saphris, but I think she forgot to.

Edited by mikl_pls
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3 hours ago, mikl_pls said:

I saw my pdoc last night and she made a few changes. She didn't want to increase the Vraylar up to 6 mg like I kinda wanted, but that's good I suppose since if I really need to increase it later, I'll have some room to go up.

She added Wellbutrin XL 300 mg for depression and Doral 15 mg for sleep (a "new" benzo on the US market, quazepam, which has actually been around for decades...).

  1. alprazolam (Xanax) 1 mg 1 PO tid prn
  2. Vraylar (cariprazine) 4.5 mg 1 PO q AM
  3. Viibryd (vilazodone) 40 mg 1 PO q AM
  4. trazodone (Desyrel) 100 mg 1-2 PO qhs prn
  5. quetiapine (Seroquel) 100 mg 1 PO qhs prn
  6. benztropine (Cogentin) 1 mg 1 PO bid prn
  7. ondansetron (Zofran) 4 mg 1 PO qd prn
  8. pindolol (Visken) 5 mg 1 PO q AM
  9. bupropion XL (Wellbutrin XL) 300 mg 1 PO q AM
  10. Doral (quazepam) 15 mg 1 PO q AM

She said she would replace the Seroquel with Saphris, but I think she forgot to.

I see you take doral qAM. What do you take it for? It is marketed as a hypnotic sleeping aid but I assume you're taking it for other reasons

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5 hours ago, mmaryland said:

I see you take doral qAM. What do you take it for? It is marketed as a hypnotic sleeping aid but I assume you're taking it for other reasons

Oops! That was a mistake! lol Glad you caught that!

It's supposed to be qhs prn.

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Trintellix and Ativan have been upped. I also found out I have exercise induced asthma! So I got an inhaler and can try exercising without dying now! :D Given what life has been like lately I'll take anything good. 

Vyvanse 50mg QAM -  ADHD 

Trintellix 20mg QAM - Depression 

Lamictal 150mg BID - Complex Partial Seizures 

Ativan 1mg BID (QD + HS) PRN - Anxiety/Insomnia

Proair HFA PRN - Exercise induced bronchiospasms/asthma

Sleep Doctor is working on a Belsomra prior auth. I'm hoping it goes through!

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16 hours ago, mikl_pls said:

I saw my pdoc last night and she made a few changes. She didn't want to increase the Vraylar up to 6 mg like I kinda wanted, but that's good I suppose since if I really need to increase it later, I'll have some room to go up.

She added Wellbutrin XL 300 mg for depression and Doral 15 mg for sleep (a "new" benzo on the US market, quazepam, which has actually been around for decades...).

  1. alprazolam (Xanax) 1 mg 1 PO tid prn
  2. Vraylar (cariprazine) 4.5 mg 1 PO q AM
  3. Viibryd (vilazodone) 40 mg 1 PO q AM
  4. trazodone (Desyrel) 100 mg 1-2 PO qhs prn
  5. quetiapine (Seroquel) 100 mg 1 PO qhs prn
  6. benztropine (Cogentin) 1 mg 1 PO bid prn
  7. ondansetron (Zofran) 4 mg 1 PO qd prn
  8. pindolol (Visken) 5 mg 1 PO q AM
  9. dextroamphetamine (Dexedrine) 10 mg 2 PO tid (60 mg)
  10. oxcarbazepine (Trileptal) 600 mg 1 PO bid (1,200 mg)
  11. bupropion XL (Wellbutrin XL) 300 mg 1 PO q AM
  12. Doral (quazepam) 15 mg 1 PO qhs

She said she would replace the Seroquel with Saphris, but I think she forgot to.

Hey @mikl_pls Just curious, as you seem to change/add meds every month.... I was just wondering how you & your pdoc decide to remove a med, or add a new one??  Especially one you've already taken in past. I'm assuming she has a criteria and it's not just random.

Maybe I'm unusual, but (unless I have intolerable side effects, or find after minimum 6 weeks a med does nothing),  I stay on the same combo for years (that is, unless I have severe/acute symptoms that last 2+ weeks). I guess I'm for the very cautious approach and do incremental increases. If I don't notice anything, we increase until the max before switching.

But I've only been on 3-4 meds max. I still have intermittent, bad "blips" but IME, they aren't helped by throwing more meds at it. 😞 When someone is on 12 meds and switching every 6 weeks, how can you tell what med is doing what? My pdoc also told me about the "Kindling effect" where stopping and then starting the same med later, reduces it's effectiveness. (BTW, I hope this doesn't sound like a reproach or criticism - just a curious question!)

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8 hours ago, Blahblah said:

Hey @mikl_pls Just curious, as you seem to change/add meds every month.... I was just wondering how you & your pdoc decide to remove a med, or add a new one??  Especially one you've already taken in past. I'm assuming she has a criteria and it's not just random.

Not quite every month, and usually the meds that are taken away/added are either temporarily needed or as needed medicines. Also, there are core meds that I haven't changed in over a year or so. Usually it's either because I don't need a med anymore (trying to trim down my regimen), side effects become too burdensome, or I need a little extra something for my mood (such as Wellbutrin this past appointment). My pdoc said it's okay to periodically add and remove Wellbutrin, for instance, but she doesn't want me on it all the time because of my seizures. Also, Wellbutrin is approved for seasonal affective disorder, which doesn't require it to be taken all the time. 

I usually ask her if something can be changed, and she will either say yes or no. Usually it's tweaking the dose, but this past time she added two meds.

As for going back to meds I've taken in the past, I revisit meds I've taken before that worked but pooped out because I've tried so many meds over the years, and there's almost nothing left to try.

9 hours ago, Blahblah said:

Maybe I'm unusual, but (unless I have intolerable side effects, or find after minimum 6 weeks a med does nothing),  I stay on the same combo for years (that is, unless I have severe/acute symptoms that last 2+ weeks). I guess I'm for the very cautious approach and do incremental increases. If I don't notice anything, we increase until the max before switching.

No, I don't think you're unusual at all. That's how most people are. We usually try maxing the dose of a med out before switching unless side effects become too much for me; e.g., with clomipramine, despite side effects, I tried it for about 3 months and got to 225 mg (just 25 mg under max dose). The side effects became too much (profound urinary retention, extreme sexual dysfunction, excessive daytime sedation).

9 hours ago, Blahblah said:

But I've only been on 3-4 meds max. I still have intermittent, bad "blips" but IME, they aren't helped by throwing more meds at it. 😞 When someone is on 12 meds and switching every 6 weeks, how can you tell what med is doing what? My pdoc also told me about the "Kindling effect" where stopping and then starting the same med later, reduces it's effectiveness. (BTW, I hope this doesn't sound like a reproach or criticism - just a curious question!)

Oh no, I didn't take your post like that at all. I've been asked these same questions before, though. If you look at my med list, about half of them are PRN or "as needed." My core meds are Vraylar, Viibryd, Visken, Dexedrine, and Trileptal. I've been on Trileptal for about two years, and before that I was on Zonegran, which I was on for about three years. Dexedrine I've been on for about two years as well.

Usually she doesn't do more than one or two changes at a time unless I'm really bad off (e.g., depression or severe side effects).

I keep what I guess you could call a "journal" of my med changes and and I try to keep up with how I feel on a daily basis in multiple aspects (side effects and benefits both).

I have heard of the "kindling effect" before. I'm not sure if I believe it or not. I do suppose I should try and stick with my meds for longer periods of time though. It would be less confusion for my pdoc... lol.

I hope I adequately answered your questions. :) 

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12 hours ago, Persona_Is_Life said:

Sleep Doctor is working on a Belsomra prior auth. I'm hoping it goes through!

Belsomra is heretofore the only sleep med that has worked for me. I think it might cause depression for me though—just something to watch out for. (I was started on the max dose right off, 20 mg... You might be titrated up gradually.)

My pdoc just added Doral which I've never tried before. My pharmacy had to order it though so it won't be here until tomorrow (dropped off the prescription on Saturday).

Good luck with your med changes and with getting the Belsomra prior authorization (those are such a pain!!).

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@mikl_pls Super helpful, thanks! That totally makes sense, especially with the Wellbutrin thing.

I def feel like my combo isn't helping enough..playing with the doses a bit, but I guess I'm just so tired of trying things over again, adding new things that totally de-stabilise me, etc. Plus at high doses I often just get no more benefit, and more side effects (sigh) So as long as I'm functioning I endure it. Yet, honestly, my combo should probably be tweaked/changed more often...So sick of this ride, its like a full time job.

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2 hours ago, Blahblah said:

@mikl_pls Super helpful, thanks! That totally makes sense, especially with the Wellbutrin thing.

I def feel like my combo isn't helping enough..playing with the doses a bit, but I guess I'm just so tired of trying things over again, adding new things that totally de-stabilise me, etc. Plus at high doses I often just get no more benefit, and more side effects (sigh) So as long as I'm functioning I endure it. Yet, honestly, my combo should probably be tweaked/changed more often...So sick of this ride, its like a full time job.

Yeah I empathize with you on all of this... Most of the time, meds will quit working and won't work anymore despite maxing out the dose (or attempting to but not being able to due to side effects). 

Have you tried raising your Lamictal to 200 mg? Increasing Effexor? (I believe you have before but I can't remember for sure... sorry!) Increasing the Ritalin to max dose? (60 mg) (or switching to an amphetamine-type stimulant?) Trying other adjunct AAPs? (Rexulti, Vraylar, and Latuda come to mind...)

Edited by mikl_pls
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5 hours ago, mikl_pls said:

Have you tried raising your Lamictal to 200 mg? Increasing Effexor? (I believe you have before but I can't remember for sure... sorry!) Increasing the Ritalin to max dose? (60 mg) (or switching to an amphetamine-type stimulant?) Trying other adjunct AAPs? (Rexulti, Vraylar, and Latuda come to mind...)

I recently raised it to 150mg Lamictal, so I don't know. It's so subtle..on previous trial I went up to 300-400mg and it really affected me cognitively, forgetting words, feeling off balance, ditzy... Effexor at higher doses makes me more tired & apathetic numb. And Ritalin I just increased. My pdoc won't switch me to any other stimulants until I've been on this dose awhile. APs I've had really bad side effects from (at least the typicals & also Abilify) Either super sedated, or I started binge eating at night. I'm afraid of them because they often cause metabolic stuff or weight gain with longterm use. Yuck.

I really feel like this is as good as it gets...I keep my pdoc posted every month, but when I'm apathetic like this, she just suggests therapy. Meds can prevent severe episodes, but they don't make you feel "good" per se if you are already fairly stable (at least IME).

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3 hours ago, Blahblah said:

I recently raised it to 150mg Lamictal, so I don't know. It's so subtle..on previous trial I went up to 300-400mg and it really affected me cognitively, forgetting words, feeling off balance, ditzy...

Yeah, I had that problem with Lamictal when I was on 400 mg too. It also gave me horrible acne. The last time I tried it though, it didn't do that (only got to 150 mg). I think I might be allergic to either lamotrigine itself or some of the fillers in some generic brands.

3 hours ago, Blahblah said:

Effexor at higher doses makes me more tired & apathetic numb.

That's very odd. I wonder if you're sensitive to noradrenergic meds, because while noradrenergic meds can be stimulating, if one is either sensitive or the dose of the med is too high, it can sedate you and zombify you. Stahl calls this "overtuning" of the adrenergic system. I forget exactly what is going on though when this happens.

Have you tried any other SNRIs? Desvenlafaxine (Pristiq/Khedezla), duloxetine (Cymbalta), Fetzima (levomilnacipran)?

Effexor really is a very strongly serotonergic medicine for an SNRI. At 75 mg is where the dose response curve levels out for SERT occupancy, which goes pretty high actually (can't remember the exact percentage... It's above 80% though.) That could also be the reason that higher doses tend to numb you. You could probably get away with just 37.5 mg, or switching to an SNRI that is a more balanced SRI-to-NRI ratio (Pristiq is still slightly more serotonergic but more noradrenergic than Effexor, Cymbalta is closer to being somewhat balanced but still is more serotonergic than noradrenergic, and Fetzima is the only one that is more noradrenergic than serotonergic).

3 hours ago, Blahblah said:

And Ritalin I just increased. My pdoc won't switch me to any other stimulants until I've been on this dose awhile.

Ah ok. I read this in your thread that you posted.

3 hours ago, Blahblah said:

APs I've had really bad side effects from (at least the typicals & also Abilify) Either super sedated, or I started binge eating at night. I'm afraid of them because they often cause metabolic stuff or weight gain with longterm use. Yuck.

All APs as a class have the side effects "weight gain" and "increased appetite," and have warnings for the development of type 2 diabetes mellitus, simply because they fall within that class of meds, and generally speaking, as a class, atypical antipsychotics cause those side effects. However, there are a few that are relatively "metabolically friendly," such as aripiprazole (Abilify), ziprasidone (Geodon), Vraylar (cariprazine), and Latuda (lurasidone), with Rexulti (brexpiprazole) following closely below. I'm not trying to convince you to ask your pdoc for an AAP, I'm just mentioning this in case it comes up as an option later on down the road, and perhaps you might have a little more open mind in trying another one.

But I totally get you on that, I am very overweight and prediabetic, but not from antipsychotics; rather, from the MAOI Parnate and the TCA Anafranil.

3 hours ago, Blahblah said:

I really feel like this is as good as it gets...I keep my pdoc posted every month, but when I'm apathetic like this, she just suggests therapy. Meds can prevent severe episodes, but they don't make you feel "good" per se if you are already fairly stable (at least IME).

It sounds like you've possibly achieved what's called a "partial remission" or "incomplete remission." Therapy does a lot, and while meds can only do so much, therapy too can only do so much.

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Hi, I just saw my pdoc yesterday, so these are my current meds:

1. Venlafaxine (Effexor) - 150 mg AM

2. Modafinil (Provigil) - 200 mg AM

3. Aripiprazole (Abilify) - 15 mg AM

4. Pregabalin (Lyrica) - 150 mg AM and 150 mg PM

5. Atomoxetine (Strattera) - 40 mg at Noon.

6. Methylphenidate XR (Concerta) - 36 mg at Noon.

7. Escitalopram (Lexapro) - 20 mg at Noon.

8. Olanzapine (Zyprexa) - 10 mg PM

9. Quetiapine (Seroquel) - 100 mg PM

10. Clonazepam (Klonopin) - 1 mg PM

 

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  • 3 weeks later...

My pdoc just increased Zoloft to 150 mg and swapped Xanax for Klonopin 1 mg to take twice daily and one more as needed.

Also, while not a psychiatric med, my dermatologist prescribed me Robinul Forte 2 mg to take twice daily for hyperhidrosis which should help my anxiety about being out and about and not having to worry about being drenched in sweat from head to toe.

Edited by mikl_pls
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