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How long can negative symptom relief take on atypical APs?


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I'm now diagnosed as simple-type (non-psychotic) schizophrenic (not MDD, according to a new psychiatrist of mine). The most "positive" symptom I have is this, essentially some kind of distressing self-sabotage that my brain does when trying to think of interesting topics. Everything else is cognitive impairment (all aspects really), poverty of associations, rigid, constricted and very non-lateral thinking, lack of motivation, certain aspects of newly-acquired immaturity, flattened affect and the persistent fatigue (not drug-related) that doesn't really fit anywhere in my diagnosis.

 

I've been started on 30 mgs of Abilify about a month ago. And no, it doesn't help at all. So the question is, is it possible that it will still at some time help with symptoms like this? Am I supposed to wait here? When does it become a red flag that the psychiatrist is just trying to get rid of me?

 

Or is the whole "negative symptom relief might take many months" thing just a myth from my country?

 

And what's next, really? Do any current drugs help with any of this? They say clozapine is next, but as far as I know, it's for treatment-resistant psychosis, not for treatment-resistant negative symptoms.

 

Am I just supposed to wait for new developments in medicine, completely intellectually (and physically, because of the fatigue) incapacitated in the meantime, spending each day convincing myself not to end my life?

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Have you been on any other meds than Abilify?  If not, there are LOTS of meds out there, in tons of various combinations. 

 

I would give Abilify at least 7-8 weeks to see if it affects you. 

 

Thank you for the reply.

 

Yeah, sorry, I left that unmentioned, the only clue was the "clozapine is next" thing. I've been on, well, essentially everything, or at least what they'd consider to be "everything" in my country. That includes: Risperdal (3 mg) alone (for at least 2 months) and in combination with Geodon (80 mg, I think, but for a way too short time), also Zyprexa (5 mg for most of the time, but also 10 to 12.5 mg for about a month) and (not in combination) Eglonyl (sulpiride, 400 mg) for about two months. Seroquel was tried, but just for a few days because I overreacted to the intense sedation. Oh, and a lower dose of Abilify (15 mg) for 2 months some time ago.

 

In the antidepressant department, I've been on Anafranil (75 to 150 mg) for several subsequent months, and on "weaker" ones for shorter periods of time, including Celexa/Cipramil (40 mg), Lexapro/Cipralex (20 mg), Zoloft (150 mg) and Effexor (225 mg).

 

And, huh, nothing helped at all, and nothing at all is clear. About the diagnosis, for example. How the hell, for example, is the fatigue explained by my current diagnosis of schizophrenia? And is that one and only thought-disorder-like symptom really a thought disorder and not something else? It doesn't seem to be described anywhere where it's talked about, well, thought disorders and schizophrenia in general. On the other hand, it's not described anywhere as a symptom of anything. Am I alone with it or am I just failing to describe it?

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I had fatigue and cognitive impairment, it felt like parts of my brain were shut down and they slowly started coming back and I made a gradual improvement over a couple of months, but I think the fatigue was part of the depression.

What you have described in your original post does sound like schizophrenia.

 

I know the APs helped my cognitive impairment I dont think they are considered negative symptoms.

 

If you have treatment resistant psychosis that doesnt respond to any APs including clozapine(tried for 6 months) you might want to look in to research chemicals such as CIQ: http://shared.web.emory.edu/whsc/news/releases/2010/10/selective-strategy-could-lead-to-new-approaches-against-schizophrenia.html

 

This stuff might also interest you:

http://apt.rcpsych.org/content/11/2/101.full

http://www.psychiatrictimes.com/schizophrenia/treatment-resistant-schizophrenia

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meds help, not overly noticeably though. you might get mates/family say stuff like "you seem more together lately" but chances are you won't notice yourself

 

things like cognitive behavioural therapy help, between the two, over months/years, you'll probably feel better. but choose a med, stick with it, don't chop and change, and don't selectively do the bits of CBT that sound enjoyable

 

it sucks, but welcome to MI

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Oh, so it is all about suppressing your suicidal drive just to survive day after day, doing nothing... waiting for psychiatry to advance.

 

I can't think about any things that I'm interested in, because then my brain starts to self-sabotage. What can one's life really amount to if one can't even think about interesting things in peace?

 

And I can't fill my time fulfilling my obligations, because now, the only obligation is to complete the final year of high school. And literature classes have become a special hand-crafted circle of hell for me, because they put the most emphasis on the cognitive functions that have suffered in me the most. I guess it would be all feasible if not for literature classes and the obligatory literature state exam. Now, however, I'm stuck listening to my classmates demonstrate their elite skills of analysis, synthesis, thought organization, essay writing and whatever else that now seem superhuman to me.

 

Can't really socialize for shit either. With such poverty of associations, I'm as interesting as a goddamn cucumber. Not to mention all the new faces in my class (after skipping a year) that I keep forgetting.

 

What am I really to do? Quit school, get a job? Just what kind of job can I really do? With all the fatigue and... stuff?

 

Oh, the fatigue. It's the first thing I noticed in my illness, really. It's like my energy dropped tenfold or more, overnight. One day I was healthy, the other day I couldn't really keep up with the classes and my own interests. Surreal, that's the word. That was about two years ago and I wouldn't have believed it would have anything to do with mental illness. Especially when it seemed, and still seems, so physical. With heavy flu-like muscles and head...

 

I got tested for everything, believe me. Brain MRIs, thyroid, Lyme, blood counts, blood sugar, enzymes, electrolytes, everything.

 

Then the psychiatric symptoms started appearing slowly and insidiously. Flattened affect, lack of motivation, word-finding difficulties, forgetfulness...

 

But okay, I'm gonna stop right here and let some perspective sink in, probably. I'm obviously exaggerating things because I'm in depressed mood.

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I finished school.  I was diagnosed in my sophomore year of high school.  In the US a long time ago, so maybe that doesn't pertain to you.  I was on haldol at the time and though it cut most of the hallucinations off it did nothing for my mood.  Things in medicine have become better since then.  Literature was difficult for me but I some how managed to pass.  There is hope.

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My disorder is very different from yours, but I wanted to pipe up and say that Abilify and time took care of my negative symptoms. However, on 30 mg of Abilify, I was sedated, lacked motivation and felt generally blah. So, the Abilify could be contributing to your fatigue especially. I have found that once my dose was decreased to 20 mg, my motivation came back, I'm more energetic and I'm excited about things again. YMMV. 

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My disorder is very different from yours, but I wanted to pipe up and say that Abilify and time took care of my negative symptoms. However, on 30 mg of Abilify, I was sedated, lacked motivation and felt generally blah. So, the Abilify could be contributing to your fatigue especially. I have found that once my dose was decreased to 20 mg, my motivation came back, I'm more energetic and I'm excited about things again. YMMV. 

 

Oh. That's obviously interesting, but could you perhaps mention what negative symptoms we're talking about here? Was there any cognitive dysfunction that it took care of, for example? Because in my case, there is, and it's overwhelming. But what do I know, maybe my perception of it all is just wildly exaggerated by the lack of motivation and poor mood.

 

And sadly, I've already been on a 15 mg dose previously for 2 months, and it didn't help at all. Like everything else. Then, again, a dose between 15 and 30 mg might just as well work as a whole different drug, can't it?

 

But anyway, thanks.

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  • 2 weeks later...

APs usually dont do shit for negative symptoms. They are all capable of doing as much as great things, but the chances they will is slim. Best things Ive tried for negative ones are amisulpride for alogia and theanine for alogia and anhedonia. For cognition piracetam does go a long way and sertindole is awesome, if it happens to be avaliable where you live.

 

Abilify does take 8-12+ weeks to start working though. Took me a good 12 weeks for sure.

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I find sarcosine helpful for negative symptoms. It helped within a week I think.

 

it's the best i've found for straight negative symptoms/post psychosis depression 

 

atypicals, i take zyprexa, for thought disorder and injections for the bulk, but neither does jack shit for negative symptoms for me.

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