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4 hours ago, Blahblah said:

Yeah, I def feel my brain has downregulated from  the Ritalin 😞 Do you know how long it takes for that to change? Its not permanent is it??? My pdoc doesn't prescribe Adderall, so it's difficult to get any of this as I'm in EU.

I don't think it's permanent. I believe dextroamphetamine and Vyvanse are available in EU if I'm not mistaken. Dexedrine (dextroamphetamine) is superior to Adderall IMO anyway. Vyvanse just metabolizes into Dexedrine.

4 hours ago, Blahblah said:

I know Effexor lower is basically an SSRI, I thought it would be less dulling that Citalopram or Prozac. Higher doses just gave me more side effects. I have basically tried all of them. Apparently, my brain does benefit from a bit of Serotonin, because I no longer have the horrific crying spells or the hellish PMDD. Maybe the dose needs to be lowered or tweaked? I read that more Serotonin leads to decreased Dopamine (I'm sure it's more complicated than my explanation)?

Certainly less dulling than citalopram, but maybe not Prozac. Prozac is also a 5-HT2C antagonist which releases norepinephrine and dopamine. Zoloft is also a dopamine reuptake inhibitor in addition to being a serotonin reuptake inhibitor (about the same potency as Ritalin I believe, but the selectivity for the SERT over the DAT is such that this would probably only felt at high doses), and IIRC is one of the best meds for PMDD. There are two ways to take it for this indication: daily dosing (50 mg/day, may increase by 50 mg/day with each menstrual cycle) and luteal phase dosing (50-100 mg daily on cycle days 15-28). Viibryd is an SSRI + 5-HT1A partial agonist, and Trintellix is an SSRI + 5-HT1A full agonist, 5-HT3 antagonist, 5-HT7 antagonist, 5-HT1B partial agonist, and 5-HT1D antagonist. Both modulate release of dopamine, Trintellix also modulates release of additional serotonin, norepinephrine and acetylcholine among other neurotransmitters.

Perhaps a trial of an MAOI might be what you need? Emsam, the patch, is probably the safest MAOI to take. Parnate is my favorite, but makes me gain weight like crazy paradoxically. You wouldn't have to give up your Ritalin if your pdoc is experienced in administering stims + MAOIs. Otherwise, MAOIs have stimulant-like properties in and of themselves, especially Parnate and Emsam (Parnate is a derived amphetamine, and Emsam metabolizes into L-amphetamine and L-methamphetamine).

4 hours ago, Blahblah said:

It's just this soul-sucking lack of motivation,  interest and apathy. Ugh, this is why I am always tempted to taper off everything and just f&cking start from scratch. Zero. Washout. I find it ridiculous that none of these meds are not without side effects...and many that DON'T seem to have side effects eventually do over the long term!! (or they just stop working, OR like Ritalin, you just have to keep increasing). Then the doc starts adding a bunch of sh&t to counteract the crap from other meds.....Just band-aids all of them.

I totally hear you on that... I too suffer from this side effect, and I wouldn't wish it upon my worst enemy. I totally feel your frustration. I've recently asked my pdoc if I can just go off all my meds because none of them are doing anything... She seemed surprised that I would say that, but took me seriously and said "eventually, but not now."

MAOIs work quite well for this side effect IME. Parnate especially combined with a stimulant was my favorite. I felt the most "alive" I had ever remember feeling on just 20 mg Parnate + 30 mg Adderall (I'm sure Ritalin or Dexedrine/Vyvanse would work too).

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Still having trouble with sleep so pdoc added trazadone for that. It doesn’t work completely on its own so I still have to take a little olanzapine to do the job. Bumped the bupropion up because I was starting to get a little low on the 150mg.

latuda 120 mg

lamictal 100mg

Bupropion 300mg

Olanzapine 5-10mg (currently for sleep but trying to find a replacement for it)

Trazadone 50mg (for sleep)

I’m eating like a bird and exercising a ton to avoid weight gain with the olanzapine. Thus far I’ve managed to lose weight not gain as a result. 

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Adderall for focus, energy, depression, sadness, anxiety, phobias, ruminations, cognition, motivation, even increases my "intelligence"... MIRACLE med for me, though I really don't like to have to take it every morning and will eventually make it into an as-needed habit of use rather than every day

Gabapentin for anxiety, agitation/jitteriness, very mild antidepressant effect for me... I really like this one

clonazepam for times of more severe anxiety and/or panic... sure does work every single time, zero side effects for me

Vistaril calms my body down, helps me unwind and let things go so I can relax... I really like this one too, I think it's a very underrated med

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4 hours ago, Sephiroth999 said:

Adderall for focus, energy, depression, sadness, anxiety, phobias, ruminations, cognition, motivation, even increases my "intelligence"... MIRACLE med for me, though I really don't like to have to take it every morning and will eventually make it into an as-needed habit of use rather than every day

Gabapentin for anxiety, agitation/jitteriness, very mild antidepressant effect for me... I really like this one

clonazepam for times of more severe anxiety and/or panic... sure does work every single time, zero side effects for me

Vistaril calms my body down, helps me unwind and let things go so I can relax... I really like this one too, I think it's a very underrated med

Stimulant has been a godsend....great for cognition also, right? I'm worried the effectiveness is waning. Should try to avoid everyday, but then I lay in bed and can't function.

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On 1/31/2020 at 4:36 AM, Blahblah said:

Stimulant has been a godsend....great for cognition also, right? I'm worried the effectiveness is waning. Should try to avoid everyday, but then I lay in bed and can't function.

Cognition, Hell Yes. You might want to try Adderall rather than your Ritalin. Less frequent dosing is usually needed. It does a few things that Ritalin can't. Somebody online (I'll see if I can find the article) claimed that taking vitamin B6, C and L- tyrosine in between the Adderall dose completely eradicated his "comedown".

Edited by Sephiroth999

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19 hours ago, Sephiroth999 said:

Cognition, Hell Yes. You might want to try Adderall rather than your Ritalin. Less frequent dosing is usually needed. It does a few things that Ritalin can't. Somebody online (I'll see if I can find the article) claimed that taking vitamin B6, C and L- tyrosine in between the Adderall dose completely eradicated his "comedown".

@Blahblah isn't able to get Adderall where she lives, unfortunately. I suggested dextroamphetamine or Vyvanse, but I don't think her pdoc is a fan of amphetamines, or stimulants in general for that matter. It took an act of congress to get her Ritalin dose where it is now, before she was on a subtherapeutic dose of it. But Ritalin can also do things that Adderall can't do. They're just different fruits/flavors/animals/what have you.

I would imagine vitamin B6 and L-tyrosine between Ritalin doses would help too. Vitamin C I'm not so sure about because I'm not familiar with its mechanism of action psychopharmacodynamically speaking.

I know that with B6, it enhances the conversion of L-DOPA to dopamine.

Quote

The enzyme that converts L-DOPA to active dopamine, L-dopa decarboxylase, is a pyridoxine-5'-phosphate (P-5-P, the active form of B6) dependent enzyme and due to the actions of pyridoxine infusion paralleling that of dopamine (in regards to prolactin and growth hormone), it is thought that additional pyridoxine increases the activity of this enzyme particularly in the hypothalamus. It is known that a deficiency of P-5-P hinders the activity of this enzyme in the brain.

Source: examine.com

L-tyrosine converts to L-phenylalanine, which converts to dopamine and norepinephrine.

Edited by mikl_pls

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Currently (decently stable with some minor dosage fluctuations):

  • 750 mg lithium - mood stabilizer and anti-manic
  • 200 mg lamictal - mood episode preventative and anti-depressant
  • 16 mg fanapt - antipsychotic
  • 20 mg zanapt - brain glue and antipsychotic
  • 1 mg klonopin - anti-anxiety related to sleep
  • 0.5mg xanaxXR - anti-anxiety
  • 2 mg prazosin - PTSD nightmare

I know it looks redundant, but we've reduced various things out of the thought that it might be covered by something else (like getting rid of zyprexa and going on fanapt alone) and it hasn't worked.  So I'll stick with the redundancies.

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I've been taking Zoloft 150 mg instead of Cymbalta 60 mg, desipramine 50 mg instead of Wellbutrin XL 300 mg, and Abilify 10 mg instead of Vraylar 4.5 mg. I have been so much happier in just the past few days I've switched back to them on my own (I know... bad patient... *slap on the wrist*) But I was desperate as I was suicidal.

I have also been taking magnesium glycinate 200 mg with every meal and at bedtime and in just the past few days, my depression as alleviated so much it's almost unbelievable. @Sephiroth999 told me that low magnesium can lead to depression and suicidality, so I had my levels checked. They were normal, of course, but I decided to take the magnesium anyway.

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13 hours ago, mikl_pls said:

I've been taking Zoloft 150 mg instead of Cymbalta 60 mg, desipramine 50 mg instead of Wellbutrin XL 300 mg, and Abilify 10 mg instead of Vraylar 4.5 mg. I have been so much happier in just the past few days I've switched back to them on my own (I know... bad patient... *slap on the wrist*) But I was desperate as I was suicidal.

I have also been taking magnesium glycinate 200 mg with every meal and at bedtime and in just the past few days, my depression as alleviated so much it's almost unbelievable. @Sephiroth999 told me that low magnesium can lead to depression and suicidality, so I had my levels checked. They were normal, of course, but I decided to take the magnesium anyway.

If I had to go to an island and take ONE huge bottle of pills I think they would be magnesium 200mg. Great mineral. I just started escitalopram and lamotrigine (low conservative doses for logical titration/check signature). They seem to already have eliminated the lows. I feel as we are in the same boat mood wise (you remind me of me).

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Haven't posted officially my change in meds. My pdoc took away everything extraneous like my insomnia meds, my nausea med, and my benzo. This is all I'm on.

  • desipramine (Norpramin) 50 mg 1 PO qam
  • Latuda (lurasidone) 20 mg 1 PO qpm cc 350 kcal (instead of Abilify)
  • sertraline (Zoloft) 100 mg 1 1/2 PO qam (150 mg)
  • hydroxyzine hydrochloride (Atarax) 50 mg 1 PO x1 prn (hope to get this filled as Vistaril next time, the pamoate formulation)

Plus my oxcarbazepine (Trileptal) 600 mg 1 PO bid (1,200 mg) that my neurologist prescribes that also serves as my mood stabilizer, and the dextroamphetamine (Dexedrine) 60 mg/day and armodafinil (Nuvigil) 200 mg my NP/GP prescribe.

I still have access to oxazepam (Serax) 30 mg, diazepam (Valium) 5 mg, chlordiazepoxide (Librium) 25 mg, and alprazolam (Xanax) 1 mg, but they are in a locked safe with a PIN to unlock it. I don't know the PIN and don't intend on finding it out. If I happen to see the PIN which was written down so my mother could remember it, I will let her know so we can change it again. These benzos are to be used only in cases of dire need.

Still have quite a lot of trazodone (Desyrel), quetiapine (Seroquel), and ondansetron (Zofran), but they're all locked up too.

I also have trifluoperazine (Stelazine) 5 mg bid prn which my NP prescribed me, which is just as good if not better than a benzo anyway, and I don't feel compelled to OD with it.

Edited by mikl_pls

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4 hours ago, mikl_pls said:

Haven't posted officially my change in meds. My pdoc took away everything extraneous like my insomnia meds, my nausea med, and my benzo. This is all I'm on.

  • desipramine (Norpramin) 50 mg 1 PO qam
  • Latuda (lurasidone) 20 mg 1 PO qpm cc 350 kcal (instead of Abilify)
  • sertraline (Zoloft) 100 mg 1 1/2 PO qam (150 mg)
  • hydroxyzine hydrochloride (Atarax) 50 mg 1 PO x1 prn (hope to get this filled as Vistaril next time, the pamoate formulation)

Plus my oxcarbazepine (Trileptal) 600 mg 1 PO bid (1,200 mg) that my neurologist prescribes that also serves as my mood stabilizer, and the dextroamphetamine (Dexedrine) 60 mg/day and armodafinil (Nuvigil) 200 mg my NP/GP prescribe.

I still have access to oxazepam (Serax) 30 mg, diazepam (Valium) 5 mg, chlordiazepoxide (Librium) 25 mg, and alprazolam (Xanax) 1 mg, but they are in a locked safe with a PIN to unlock it. I don't know the PIN and don't intend on finding it out. If I happen to see the PIN which was written down so my mother could remember it, I will let her know so we can change it again. These benzos are to be used only in cases of dire need.

Still have quite a lot of trazodone (Desyrel), quetiapine (Seroquel), and ondansetron (Zofran), but they're all locked up too.

I also have trifluoperazine (Stelazine) 5 mg bid prn which my NP prescribed me, which is just as good if not better than a benzo anyway, and I don't feel compelled to OD with it.

Are you ok with all these reductions? 

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3 hours ago, Iceberg said:

Are you ok with all these reductions? 

I'm doing fine with them. I was barely taking my trazodone and Seroquel anymore, I only use Zofran when nauseated, which now only occurs every once in a while, and I told her before I didn't need the Cogentin but she left it on my prescription anyway. The only thing I miss is the PRN propranolol for anxiety attacks with chest pain and when the propranolol LA 60 mg isn't enough for me for whatever reason that day. But like I said, I have access to all these still from a stockpile I collected, but it's all locked up. I have no access to it unless my mother lets me in the safe, and I'm supervised while getting meds then.

I thought about taking someone's suggestion of having a bottle of like 7 pills in it for myself, but I think I should have everything locked up now, and then "graduate" to that later on when my pdoc approves of it...

I did ask her about writing my prescription for weekly fills, but she said she does that primarily for people who don't have family to support them. I feel bad that my mom has to worry about keeping track of two PINs and safe keys already. I wish she had done the weekly prescription thing, as annoying as it would've been. That way I could've probably kept my PRNs. My pharmacy filled the "hydroxyzine" that she wrote on the prescription as Atarax, the hydrochloride formulation, which does nothing for me. I need the pamoate formulation, Vistaril. Oh well, I'll do that next time.

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8 minutes ago, mikl_pls said:

I'm doing fine with them. I was barely taking my trazodone and Seroquel anymore, I only use Zofran when nauseated, which now only occurs every once in a while, and I told her before I didn't need the Cogentin but she left it on my prescription anyway. The only thing I miss is the PRN propranolol for anxiety attacks with chest pain and when the propranolol LA 60 mg isn't enough for me for whatever reason that day. But like I said, I have access to all these still from a stockpile I collected, but it's all locked up. I have no access to it unless my mother lets me in the safe, and I'm supervised while getting meds then.

I thought about taking someone's suggestion of having a bottle of like 7 pills in it for myself, but I think I should have everything locked up now, and then "graduate" to that later on when my pdoc approves of it...

I did ask her about writing my prescription for weekly fills, but she said she does that primarily for people who don't have family to support them. I feel bad that my mom has to worry about keeping track of two PINs and safe keys already. I wish she had done the weekly prescription thing, as annoying as it would've been. That way I could've probably kept my PRNs. My pharmacy filled the "hydroxyzine" that she wrote on the prescription as Atarax, the hydrochloride formulation, which does nothing for me. I need the pamoate formulation, Vistaril. Oh well, I'll do that next time.

Sometimes an overhaul level reduction is really the best move. Otherwise things get cloudier and cloudier until they just bottom out. I did a similar thing during my second hospitalization. They started tapering me off like 6 meds that my idiot pdoc had let out of hand. Turned out to be a good call 

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I wish I could reduce.  But everything serves a purpose.  Lithium goes down and I go manic.  Fanapt goes away and I get really psychotic.  Zyprexa goes away and I get psychotic and my thinking gets cloudy.

The only ones that could possibly change--but that would be risky--are lamictal (solely because we haven't played with it before), xanaxXR (but I'd need a substitute), and klonopin (but I'd need a substitute); and prazosin (if I can live without it).

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Only one change since my last post in this thread but thought I'd update you anyways.

  • Lithium 900mg/d -  mood stabilization
  • Clozapine 325mg/d - psychosis and mood stabilization
  • Celexa 30mg/d - depression and anxiety
  • Xanax 0.5mg 4 times a day (increased from 3 a day) - anxiety and panic attacks
  • Pepcid 40mg/d - GERD/Acid Reflux
  • Colace BID - IBS-C

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Posted (edited)

*Aripiprazole 15mg - 1tb. QAM (15mg)  - /antipsychotic/anti-manic
*Divalproex sodium ER 500mg - 1tb. TID (1500mg) - mood stabilization
*Gabapentin 300mg - 2cap. QAM; 1cap. QPM (900mg) - anti-anxiety
*Mirtazapine 30mg - 1tb QHS (30mg) - Antidepressant/anti-anxiety/insomnia

*Trazodone 150mg - 2/3tb QHS (100mg) -insomnia
*Quetiapine 100mg - 2tb. QHS (200mg) - insmonia
*Vortioxetine 10mg - 2tb. QAM (20mg) - Antidepressant

 

Edited by morpheus

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Posted (edited)

Saw my pdoc Thursday (3/5/20). She increased my Latuda from 20 mg to 40 mg, which I am to take for 1-2 weeks, and then go up to 60 mg until I see her next time, at which point she said I may need 80 mg.

She specified "Vistaril" instead of just "hydrozyzine" on my prescription so they won't fill it as Atarax. Atarax doesn't do anything for me. Vistaril barely does anything. So I may as well have something that does barely something if I'm not allowed to have benzos from now until the foreseeable future.

Pdoc meds

  1. sertraline (Zoloft) 100 mg 1½ PO qam (150 mg)
  2. desipramine (Norpramin) 50 mg 1 PO qam
  3. Latuda (lurasidone) 40 mg 1 PO qpm cc 350 kcal x1-2wk, then 60 mg 1 PO qpm cc 350 kcal
  4. hydroxyzine pamoate (Vistaril) 50 mg 1 PO qd prn

Neuro meds

  1. oxcarbazepine (Trileptal) 600 mg 1 PO bid (1,200 mg) (also for bipolar)
  2. propranolol LA (Inderal LA) 60 mg 1 PO qam (essential tremor and anxiety/panic)
  3. Trokendi XR (topiramate ER) 50 mg 1 PO qam (also for bipolar)

ADHD/hypersomnia med from GP/NP

  1. dextroamphetamine (Dexedrine) 10 mg 2 PO tid (60 mg)

Supplements that have psychotropic effects

  1. MethylPro® L-methylfolate 15 mg 1 PO qam
  2. Vitamin D3 50,000 IU 1 PO qwk Sun

(Plus more meds for non-psych conditions...)

Edited by mikl_pls

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On 3/7/2020 at 8:09 AM, mikl_pls said:

Saw my pdoc Thursday (3/5/20). She increased my Latuda from 20 mg to 40 mg, which I am to take for 1-2 weeks, and then go up to 60 mg until I see her next time, at which point she said I may need 80 mg.

She specified "Vistaril" instead of just "hydrozyzine" on my prescription so they won't fill it as Atarax. Atarax doesn't do anything for me. Vistaril barely does anything. So I may as well have something that does barely something if I'm not allowed to have benzos from now until the foreseeable future.

Pdoc meds

  1. sertraline (Zoloft) 100 mg 1½ PO qam (150 mg)
  2. desipramine (Norpramin) 50 mg 1 PO qam
  3. Latuda (lurasidone) 40 mg 1 PO qpm cc 350 kcal x1-2wk, then 60 mg 1 PO qpm cc 350 kcal
  4. hydroxyzine pamoate (Vistaril) 50 mg 1 PO qd prn

Neuro meds

  1. oxcarbazepine (Trileptal) 600 mg 1 PO bid (1,200 mg) (also for bipolar)
  2. propranolol LA (Inderal LA) 60 mg 1 PO qam (essential tremor and anxiety/panic)
  3. Trokendi XR (topiramate ER) 50 mg 1 PO qam (also for bipolar)

ADHD/hypersomnia med from GP/NP

  1. dextroamphetamine (Dexedrine) 10 mg 2 PO tid (60 mg)

Supplements that have psychotropic effects

  1. MethylPro® L-methylfolate 15 mg 1 PO qam
  2. Vitamin D3 50,000 IU 1 PO qwk Sun

(Plus more meds for non-psych conditions...)

I hope you don't mind me asking, but what happened that your pdoc took you off all those meds? Were you weaned off of any of them? 

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On 3/7/2020 at 8:09 AM, mikl_pls said:

Saw my pdoc Thursday (3/5/20). She increased my Latuda from 20 mg to 40 mg, which I am to take for 1-2 weeks, and then go up to 60 mg until I see her next time, at which point she said I may need 80 mg.

She specified "Vistaril" instead of just "hydrozyzine" on my prescription so they won't fill it as Atarax. Atarax doesn't do anything for me. Vistaril barely does anything. So I may as well have something that does barely something if I'm not allowed to have benzos from now until the foreseeable future.

Pdoc meds

  1. sertraline (Zoloft) 100 mg 1½ PO qam (150 mg)
  2. desipramine (Norpramin) 50 mg 1 PO qam
  3. Latuda (lurasidone) 40 mg 1 PO qpm cc 350 kcal x1-2wk, then 60 mg 1 PO qpm cc 350 kcal
  4. hydroxyzine pamoate (Vistaril) 50 mg 1 PO qd prn

Neuro meds

  1. oxcarbazepine (Trileptal) 600 mg 1 PO bid (1,200 mg) (also for bipolar)
  2. propranolol LA (Inderal LA) 60 mg 1 PO qam (essential tremor and anxiety/panic)
  3. Trokendi XR (topiramate ER) 50 mg 1 PO qam (also for bipolar)

ADHD/hypersomnia med from GP/NP

  1. dextroamphetamine (Dexedrine) 10 mg 2 PO tid (60 mg)

Supplements that have psychotropic effects

  1. MethylPro® L-methylfolate 15 mg 1 PO qam
  2. Vitamin D3 50,000 IU 1 PO qwk Sun

(Plus more meds for non-psych conditions...)

I know we talked about this as a hypothetical in the past, but are you onboard with all this? Seems like she’s really targeting the depression side of things 

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