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Looking for a new med combo


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Currently I'm on 200mg of Seroquel (non XR). Started at 100mg in October, was stable until Feb, upped to 200mg and was fine until the last week, Don't feel like upping again after a month (at this rate It'll be out of my budget next month).


The combo I'm looking at is:

 

Risperdal + Prozac + Doxepin 

 

Risperdal for  a Moodstabalizer, prozac (or wellbutrin or zoloft or whatever is cheap) for an AD, and doxepin for sleep. 

 

I need to keep this under $50 a month  with either Costco or Walgreen's prescription drug savings plan.

 

The other combo is Oxcarbazepine + AD + doxepan. Any suggestions? 

 

 

Previously I've been on (as a combo)

 

Abilify + Seroquel + trazodone + propranolol + Lamictial (all at once) 

 

Wellbutrin + Lamictial

 

Zyprexa


Depakote

 

Seroquel (current) 

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Picking your own med cocktail seems like a terrible idea to me, especially a price-driven one. I know meds are expensive but I would recommend talking to your pdoc or going to the websites of your med manufacturers and seeing if they have any affordability programs. I know nothing about this but have heard in some ads phrases like "if you can't afford your meds contact us and maybe we can help" It's worth a shot. 

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I mean, it's all there in your cocktail, if your doctor is okay with it, but it may turn out to be the wrong one for you. Did you pick these meds solely based on price? Have you tried a patient assistance program for expensive meds? I would never be able to afford Invega but I get it free through Johnson & Johnson's assistance program. I don't know if you're in the US, but if you are, look over their eligibility requirements or any other PA program. 

 

FWIW, Invega (which I think is the same thing as Risperdal basically?) works well for me as a mood stabilizer, but I have to stay on the max recommended dose (12mg) to remain stable. Prozac, Zoloft, and Wellbutrin were nothing but mania for me. Never tried doxipen, but I'm on a different TCA for depression (not sleep) that usually works pretty well. Whatever you end up on, I hope you find something that works within your price range.

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Lithium would be an obvious choice to try next IMO. Generally for a bipolar cocktail (in my experience) first a mood stabilizer is started and other things (AP, AD etc.) are added later if they are needed. It's generally better to add things one by one so you know which drug you can attribute which benefits and side-effects to. Starting those three meds at once would be very confusing.

 

I don't really think it's good to try to be your own doctor, but I have had my doctor give me choices before. When I was first diagnosed I was given the choice of lithium, lamotrigine, valproate or olanzapine as my mood stabilizer. That's partly why I suggested lithium. Out of those, it's the only one you haven't tried. Here in Australia, it's regarded as the best one and is considered the first-line treatment option.

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I think the best thing to do is have an honest conversation with your dr. about what you are looking for. Only your doctor knows your symptoms in enough detail to figure out what and if a low cost medication will work for you. Going in with a preset list is a bad idea, because you are not a psychiatrist, and you can't insert your Internet browsing and user-story documentation in place of medicine school.

If you are in the US, almost every drug manufactured (the brand name ones, anyway) have patient assistance programs. I go to pparx.org to see what plans cover the meds I take. Application is simple, usually a simple form, a space your dr fills out or attaches a script, and some sort of proof of financial need like tax returns. Approval is fast (less than 2-4 weeks). I was on zyprexa, one of the most expensive oral psychotropic drugs, for a year on patient assistance and didn't pay a dime.

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so...maybe I missed this, but what symptoms are you currently experiencing? you said that you're not stable, but in which direction? irritability? depressed mood? elevated mood?

 

I'm not going to play pdoc with your answers...that's really dangerous...but it doesn't really work to give you suggestions without knowing what you're dealing with. For example, adding a more traditional mood stabilizer could help if you're going in an upward direction, adding an antidepressant might help if you're going downward (and haven't had a manic/hypomanic reaction to an AD before), trying a different AAP could be helpful if you're all over the board or having anxiety/sleep issues, etc.

 

and yes, to the degree that it's finance driven, you've gotten a few posts about how to handle that one.

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Guest Vapourware

I've always saw AAPs to have mood stabilising properties, but should not be used as a sole mood stabiliser. Somewhat in the same vein as many AAPs have mood boosting properties, but it wouldn't be used as the sole mood booster. My pdoc suggested Zyprexa to me because it has mood boosting and stabilising properties, but he still prescribed an AD [sertraline] and a mood stabiliser [lamotrigine] as the main meds for those purposes. 

 

You really should discuss any changes with your doctor. They have the requisite training to work out what is best. Going generic will save you money. There are plenty of meds out there which are generic. 

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Being bipolar is expensive. It sucks but that's the truth of it. You are going to be hard pressed to stay under 50 if you end up needing a "cocktail." My solution is to search your local community for organizations that help with prescription costs for the non-insured. I know there are a few around me, and I'm not in New York or some other huge metro area.

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  • 2 weeks later...

was on seroquel (tried twice) frm pdocs-instant suicidal ideations and worsening depression/ pdoc pute on trileptal (oxcarmazapine)-again started debilitating worsening depression the spurratic "ideations" until intense constant ideations and depression- (i had doubl vision on tegretol so he switchd to trileptal)- trileptal was VERY dangerous for me-about 2 seconds frm going bak into hospital- im tapering off this past week to see how it goes without trileptal in my system-for "depression" mood pf bp1 pdoc has me on "mirapex" (dopamine) careful with ur cocktails. review all side effects befor taking anything. some pdos just keep giving u mor brain crap until ur either siocidal or a vegetable! my pdoc threw his hands in the air wen i told him im getting off trileptal- sometimes u just hav to go with ur instincts wen a med isnt rite. i cant take most antipsychotics bc/they r dopamine blockers amd i take dopamine for depression. cant take most "mood stabilizers" either bc worsens dep and hav hallucinations and ideations.- im on a very rocky rd with this illness (past ten yrs treated -actually MIStreated) and its a daily struggle-but b smart and research first as well as talk to ur pdoc. they necer seem to tell u all the side effects of meds. thats what got me to this site wen i was terrified about trileptal (oxcarb.). ive had it with pdocs and their constant skeptisism about ur symtpoms ur experiencing and my being a ten yr lab rat- they dont like to b intellectually challenged

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  • 4 weeks later...

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