Please help evaluate my mix

[laffytaffy]

I've perused the boards for similar posts, but thought I'd throw out an arguably selfish request for evaluations of my particular mix.  I know the answers are throughout the boards, but I hope to come to Cocktails for a tailored response.  I know redundant posting is faux pas on message boards.  In return I can only respond to threads where my input would be valuable.  I'll do so.

 

Current meds:  Lamotrigine (150 mg 2x daily), Latuda (80mg 1x daily), Escitalopram (10mg 1x daily), Bupropion XL 24 hr (300mg 1x daily), Amantadine (100mg 3x daily), Clonazepam (0.5mg 3x daily), Methylphenidate (50mg distributed throughout day)

 

History and Background:

 

I've seen the same psychiatrist for years and he trusts and works closely with me given our history.

 

I am diagnosed with major depression which is persistent and has been for years.  Another significant diagnosis is one or another form of anxiety - primarily social.  No panic problems, thankfully.

 

I am doing as well as can be and function well consistently.  I can tolerate medication changes well given experience.

 

Current Questions:

 

(1) Sleepiness, and Memory Problems

• Sleepiness has always been an issue, and I accept it to a big degree.  I've learned to time dosing properly for the most part.  
• Memory problems have grown and are very apparent in recent months.  I blame 5+ years of Clonazepam at 0.5mg 3x daily.  
• Latuda and Escitalopram do a lot for my particular anxiety.  I'd like to move benzos to an as needed basis.
• I was actually given stimulants to combat sleepiness - nothing to do with attention disorder

 

(1a) What can I change to minimize these, especially memory?  Is tapering off Clonazepam feasible or adequate?  What could be upped or added to mitigate its loss?

(1b) What might be causing memory problems other than Clonazepam?  Will awareness and cognition improve with its removal or is the damage done?

(1c) Given the necessity and value of much of my cocktail, what can I do to mitigate sleepiness with little change?

(1d) Is there any subset of drugs among those I'm taking that could be most blameworthy for cognitive problems or sleepiness?  That is, is there a simple switch?

 

 

(2) Akathesia, EPS, and Options

 

• Cogentin and its class are just not an option for me.  Blurred vision, chemical dry mouth, and cognitive problems are just not worth it.  I save it for dystonia in the emergency room.
• Amantadine has worked pretty well, but I cannot afford it on my upcoming insurance.  This is with certainty.
• I don't know how Propranolol will balance with the other meds.

(2a) Does anyone see implications of a switch from Amantadine to Propranolol given this cocktail?

(2b) Any suggestions for akathisia given this mix?  Cogentin is off the table.

(2c) Are the effects of propranolol on the circulatory system, norepinephrine, and blood pressure contraindications with the rest of my meds (in your experience)?

 

(3) Any other thoughts, experiences, advice, or criticism?

 

Thanks!

 

 

Past meds:  Cymbalta (caused anxiety), Strattera (caused even more anxiety), Remeron (sleep oddities), Lithium (don't remember), Risperdal (extreme dystonia - thank goodness for Cogentin), Cogentin daily (dry mouth and very blurred vision), Xanax (very briefly - too strong), Focalin (dexmethylphenidate), Geodon (first breakthrough), other?

 

Current meds:  Lamotrigine (150 mg 2x daily), Latuda (80mg 1x daily), Escitolopram (10mg 1x daily), Bupropion XL 24 hr (300mg 1x daily), Amantadine (100mg 3x daily), Clonazepam (0.5mg 3x daily), Methylphenidate (50mg distributed throughout day)

Edited April 12, 2014 by laffytaffy

[Wooster]

With regard to #1, have you worked with a tdoc for psychotherapy to complement your pharmacotherapy? Anxiety, when treated by a specialist, tends to respond quite well to effective psychotherapy.

I used lorazepam for about 4 years and Klonipin for about 2 years and had some cognitive dulling. After about 6 months off of benzodiazepines, and with some concerted effort to do "brain games" my cognition improved.

[shesellsseashells]

Lamictal can cause cognitive fuzziness.  I believe it somewhat impairs my short-term memory.  I have taken Propranolol for a number of years with no ill effects.

[melissaw72]

I have taken Propranolol for a number of years with no ill effects.

 

Propranolol is great for anxiety.  I started taking it again, but very little, and it really helps with anxiety in ways that xanax and klonopin don't.

[skibum801]

You're taking a lot of activating stuff, which is likely the culprit of the akathisia. I'm not really qualified to recommend a switch to Propanolol or against it, so I'll leave that to your doc. As for the memory and cognitive stuff, I woud think that the benzodiazepene is likely something you could taper off of with the help of a doctor. I would talk to the doc about your particular problems with your current meds and see if he can't figure something out. Best of luck.

[confused]

I have problems with sleepiness and memory problems, too.  I am not sure if it has to do with meds, illness or what.  Have you had a physical.  I had low thyroid and was anemic and getting that under control helped a lot with fatigue. I am taking a baby dose of lexapro I cut a 10mg pill in half per my pdoc's intstructions to see if the decrease from 10mg will help some with fatigue. When I am anxious I space out (dissociate) and I think that is part of my memory problems so the better I keep my anxiety under control the better I am all around.

 

Since you trust your pdoc you could ask these questions to him?

 

I don't have any experience with your second part.

 

People recommend exercise to me to help with anxiety, regulate sleep and build up energy.  You may be doing that already.  I walk but not enough.

[melissaw72]

 

and was anemic and getting that under control helped a lot with fatigue

 

I second this ... being anemic wipes me out.  I'm currently on iron supplements but when I go off of them I feel like lead, and it is hard for me to do anything.

 

Sylvan has great insight.

[Velvet Elvis]

FWIW, amantidine is an ancient medication that you should be able to find for pretty cheap.  I'm pretty sure I got it for under $10 a month.