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How many tries did it take before you foung the right cocktal?


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i've found several working ones over the years so i'm unsure how to answer...

 

what i currently take is probably the best i've been on for....at least three or four years. but when i was younger things worked for me more readily and i had fewer to take overall. 

 

so, maybe, let's say that in the past twenty years, i've had at least five or so really solid combinations that worked consistently for more than six months. a couple worked for several years. i truly cannot say how many combinations i've been on to get those five ish solid ones. i've been on at least three fully different combinations in the past fifteen months. 

 

a lot of time is spent adjusting a basic template though, and that template has remained the same for quite awhile. 

 

by template i mean medication types.

 

i hope that helps.  i truly didn't think that anything would work after clozaril failed and two things have, decently well. one really quite well. so, i hope you find your best fit sooner than later. 

 

best to you x

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I'm still a work in progress.  I started taking meds when I was 11 and I'm now (almost) 39.  I did have some years of stability in there.  Part of the issue was that I was originally diagnosed with MDD but I believe it changed to bipolar when I was in my 20s.  However, I was not diagnosed with bipolar disorder until my 30s.  My current cocktail isn't quite where it needs to be, but I think I'm getting there.

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I was diagnosed with BP in 2005 and only located a cocktail that stabilised me in 2012.  Even then, that only lasted two years and I'm in the process of acclimating to an adjusted version of that.  

 

I like what mell had to say about finding a basic template of medication classes and working within that - I think that's pretty much what my pdoc has been trying to do.

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I like what mell had to say about finding a basic template of medication classes and working within that - I think that's pretty much what my pdoc has been trying to do.

 

one further note about that, for me:

 

it took years to get the template that is working for me now. when i was more treatment responsive the template was a bit different, but still included the basics, you could say. since 2008-2009 it's been the same one. 

 

but sonic i think once you find that template...there can be a lot of adjustments, and it sucks that it's such a balancing act i've found, but...it's huge to have. it makes it seem possible. 

 

best wishes to you on working out yours, mia x

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best wishes to you on working out yours, mia x

 

 

thank you mell, and the same to you.

 

(edit - what I meant there was, I hope you continue to do well within your current parameters!)

Edited by miab
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It takes a while. I've had a couple of combo's that worked well, but had to stop taking them due to side effects, or being switched pdocs.. But now I'm on a good combo. It works. About 6-7 years.

 

Thanks for a great response melli, and others. 

 

For some, they can get on the right combo immediately. For others, they aren't so lucky. I read in another thread about a genetic test that is in the US that can estimate how well a psychiatric medication can work. Let me see if I can find it. It's covered by Medicare. Unfortunately it's not available in Canada, but I know many are in the US. I'm not sure how accurate it is, but it is a start.

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I've tried many meds over the years, but the course of my illness has not always been the same. The med that kept me mostly stable for some years was one of the first several I tried, but others were added and subtracted over the years as I became symptomatic in various ways. I've even added back in stuff years later and had completely different side effect profiles and degrees of effectiveness. I don't know that I believe anymore that there is such a thing as a single cocktail that will obliterate all of my symptoms, but through trial and error I've found a couple of combinations over the years that have been really useful for periods of time. The one I'm on now is pretty good, but not perfect. I know it's a really frustrating process. I hope it comes together for you soon.

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I've been working on finding a cocktail that works for more than 8 years now. I can't remember how many cocktails I have tried. For a while there I had a pdoc that changed my meds every two weeks, so I could easily have missed something that was working. I am on only my second cocktail this year. It seems to be working now that I have added an antidepressent, but we'll see. Only time will tell.

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A very long time.  Years.  It was very frustrating trying to find the right combination of meds.  It eventually happened though.

 

But it will happen, just give it time (easier said than done though).  I hope things all work out for you soon.

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It took me 10 years to find the right combo, and then things started to fall apart about 6 years later, and I haven't truly been full stabilized since, so that is 8 years.

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it's been trial and error here since 2004-5-ish.  Much of the problem contributing to the drawn-out timeframe has been inconsistent access to medical care and insurance.  Rarely being with any one doc for very long had made Dx-ing difficult (and still undefined) and med trials often got cut off by insurance lapses before I could find out what does/doesn't work.  I really need therapy as much, if not more than, meds.  And finding the right therapy and therapist sometimes seems even trickier than finding the right meds.  I've got two good docs helping me a lot right now but I'm not sure how long I'll have access to them.

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I think mine will always be a WIP. I've had several that worked great for a while but eventually couldn't do the job anymore. Though there has been one "staple med" in my combo for several years now (Invega), others have had to be changed around numerous times. I'm hoping this most recent one will keep me stable for a long time to come, though. 

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It actually didn't take me very long to find a cocktail that worked. About a year. But, that cocktail wasn't perfect. It stopped my depression but, I continued to hallucinate, no matter my dosage of antipsychotic. Though to be fair, I've only tried two antipsychotics. My most recent cocktail did the job (aside from hallucinations) for a little while. Then I started getting depressed. Then we added a med. Now we're taking away a med.  

 

So, in a week, my cocktail will consist of Effexor XR and Lamictal, plus PRN propranolol. Hopefully this does the trick for a while. I foresee us having to add an antipsychotic in the future though, considering that I have a psychotic disorder. May we all find a perfect med one day. 

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It took eleven years to find a really good one that has worked with only minor tweaks for almost three years now. Before that I spent several years on a cocktail that was utterly and totally wrong, and a few on mixes that were better than nothing, and a year or a few months here and there on ones that were good-ish for a while.

 

Edit: And I just had another change, discarding Lexapro in favor of Cymbalta; seems worth is so far, but stay tuned!

Edited by Gearhead
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My cocktail ain't perfect but at least I have some marbles in my head.....This has been the almost the same one except I have taken abilify and Invega........I was also on gabapentin and xanax plus zyprexa and ambien.....I will be exploring in the future if the effexor being bumped up to 150mg doesn't work.......Klonopin has always been good to me and I never abuse it......I have been on prozac to when my pure o OCD first started.....other than that well I have also been on luvox and geodon.....the reason I don't take those meds anymore was to see if something else would work.

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Still looking for the right one. Granted I've only been on meds for 5 months but have been on 8 so far. The addition of zyprexa worked wonders for me but I was barely awake and got EPS less than 2 weeks into it. Here's hoping the lithium/fluoxetine combo works. 

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I wasn;'t going to post here...because....I feel somewhat guilty.

 

But I am still on my very first cocktail.

I am blessed, I know. 

 

-_-

That's pretty awesome, water. I'm glad! 

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  • 3 months later...

2 years, that was 15 years ago. Worked great for over a year! Best success with little or no side effects. Then Big Pharm got in the game in a big way influencing pdocs to keep trying some thing new and improved. It's been down hill ever since for me.

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I didn't go on any psych meds until 2009, as I had refused to take any medications for several years prior to that. The first meds/med combinations that were tried either didn't work or had too many side effects. I've been on roughly the same combination for over a year now though, and it works pretty well. There is only so much meds can do however, especially because I have an eating disorder and am not in recovery currently. The eating disorder behaviors interfere with the meds effectiveness and also just make me feel like shit, so it can be hard to assess how well the medications are working when the ED is really bad. 

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i was lucky, the first prescription i got worked for me, but as my illness progresed it became a lot harder to get me/keep me stable, im still not quite there but in a better position than i was a few years ago.

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It had been over 2 years since I started my Bipolar journey and trying to find the right med combinations.  I think now I am on a good combination (in my sig) and I am feeling very stable, no extreme high's or lows so far.

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Still searching.

Wellbutrin

Ambien

Trazodone

Remeron

Prozac

Effexor

Celexa

Paxil

Lamictal (refused to take, so doesn't count)

Temazepam

*Ambien CR

Lithium

**Zyprexa

Seroquel

Neurontin

Lexapro

***Abilify

****Ritalin

*works sometimes, but only when combined with remeron

**ding, ding! ding! we have a winner! But only for mania and mixed states.

***only been on a month, so too early to say

****start in 11 days.

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I'm okay on my current one (Saphris, Prozac, Ativan and Lithium). I haven't had any manic episodes or rapid cycled. Have had hypomanic episodes though. Depression is back so I'm guessing if that doesn't go away there will be changes by my next pdoc appointment. 

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  • 2 weeks later...

I was once on a good cocktail, and my meds (especially lithium) definitely blunts some of my bad moods. I'm coming off Wellbutrin, and am on Latuda. I am very happy with it, except for the co-pay. I am going to appeal to Medicare, because I've tried 3 other meds in that class, but I guess we'll see.

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Taken me 26 years and my cocktail still isn't ideal. Damn psych meds and their horrible side effects...

My spelling of meds may be wrong, it is as I remember them.

Started with Prothiedin Domotherapin... Fuck that shit is strong. Stopped it after only being able to drool into my cornflakes for a week. Became scared of psychiatrists after that and took a while to see one again...

Then SSRI's - have tried quite a few... Citralopam and the optical isomer of it can't remember the name... And peroxitine. SSRI's don't work very well on me... They may as well be crystal meth... I can not sleep and become even more mentally unstable... I had one psychiatrist insist I keep taking the optical isomer of citeralopam and after three days with no sleep I was in a totally crazy psychosis.... Shaking....anxiety.... Felt horrid

Largactil or Thorazine or thioridazine..... So fucking strong... Total sedative... Could only sleep and slur... Developed twitches... Had an evil headache from it...

Seroquel.... Again so fucking strong sedative wise - slept for over 15 hours a day...

Tricyclics... Amytryptaline.... Yuck... Oh my gosh did it give me pimples... Erupted over entire body...

MAOI's.... Can't remember the names... These felt like I imagine cocaine would feel.... I felt good... Too fucking good.... I developed an ego and knew more than everyone else and told them so.... Became horrid to be around. Quite a change from my normal reticent self...

Clonazipam. Finally something that fucking worked with the least horrid side effects.... Was only given limited doses.... :(

Lithium.... Sooooo.... Deeeaaaad in the head. Yuck.

Epilim.... Holy fucking shit that shit is strong... Felt like a drill bit burrowing into my head crushing whatever is there.,...

Haloperodol.... Goodbye three weeks... I have no idea what happened...

Diazepam.... Goodby stress hello sleep...

Tramadol.... Some time after being treated for psych symptoms I discovered I had a brain tumour. Finally doctor would believe me when I said I had electric shocks going down one side of my body.... 300mg/day.... Felt like heaven compared to the psych shit. Relieved a lot of my anxiety.... After radiotherapy stopped that as it no longer hurt....

Then more regular dose of clonazipam.... Cause it fucking works for me! Well for two years until I started getting evil headaches on it... Then switched to lorazipam 6 years ago. Consistent dose of 30x1mg tablets per 3 months for the last six years...

Olanzapine.... Was put on this as part of a compulsory treatment order... Hated it... Still do... Was on 20mg per night but. So. Much. Sleeping... Lowered to 10 mg and more recently 5mg.... Really really hard to get off as I can't sleep without it... Also when I try stopping psychosis can creep back.... Still 5mg's is an improvement. Oh, and olanzapine made me put on 30kgs.

And a number of different sleeping tablets, herbal remedies (St. John's wort dose similar things to me as SSRI's)....

Oh... And beta blockers... Propranolol ... Didn't do much. And another one which I can't remember the name of... Didn't 't do much likewise....

And now I am on bupropion to help with smoking cessation and give me a lift... Has helped with ciggies... And lowering my dose of olanzapine... Don't notice much of a mood lift and do get quite a few dizzy spells/spinning out moments now...

That's all I can remember as of this moment, may have missed some....

I like lorazipam the most as it works on my anxiety with the least side effects. Often it energises me . And olanzapine does suck but it does keep psychosis at bay... Wish I could get an antipsychotic with less sedative effects....

Edited by AnxiousAmy
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It is too early to tell, but I may have found it. Just need to adjust the dose and frequency of Ritalin. I've been on the med merry-go-round this time for 8-1/2 months so far. I got really lucky with zyprexa early on, and the rest was all about trying to treat sleep and depression. Oddly, the Ritalin seems to make me sleep better, so I may be able to ditch the ambien cr.The last time I tried to find the right pills, I was misdiagnosed as MDD. That time lasted maybe 9 months with zero success. I gave up at that point. Then years later tried one more pill out of the blue and it mostly cured my headache problem. Considering that some people have been searching for years, sometimes without success, I apologize for any griping I may have done.

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Don't apologise. 8-9 months of up and down with meds is quite full on. It is the changing times that are hardest - waiting till things take effect and even out.

I actually have been on the same meds for the last 6 years and apart with problems with sedation, I am *reasonably* stable. I do have ups and downs, I think that is to be expected w my issues. Mostly, psychosis and anxiety.

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  • 2 weeks later...

Depends on a few definitions.

Once BP was diagnosed, it two meds and maaybe two/three months to find the right med/dose? I got LUUUUCKY. Lamictal didn't work out three weeks in, Depakote was next, two-ish months to get to my effective dose (which is lower but still effective range) and felt improvement three days after hitting the dose.

In the midst of Lamictal/Depakote wrangling I ended up with clonazepam for PRN use.

soooomewhere in my actual or close-to effective dose of Depakote, I started triallingmethylphenidate IR. NO. Not for me. But we gave it a good go. Then Concerta, which I got the generic version of until the pdoc said 'EWWWWW you need to switch.' So overall maybe a year and a half... ish... on some form of methylphenidate.

In my first IP stay a year after my BP Dx, I got zopiclone and Seroquel PRNs added on.

Then near the end of last year I asked my pdoc about investigating Dex instead of keeping with Concerta.

Sooooo... from BP Dx to eventually divalproex, Concerta, and all my PRNs, maybe... a year and a half I think? Then I wanted to explore Dex instead of Concerta but like was all BUUURRRN MIR BUUURRRRN sooo figured bad time for a med change. Went to Dex some six months later I think. Old cocktail, year and a half. Current cocktail, ehhh... two years? Ish? Longer? Hard for me to pinpoint w/o a big calendar 'cause I think better with my hands.

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Oh and add almost another year to that - the year's worth of cognitive behavioural therapy was pretty much entirely before I started trialling mood stabilizers. It's DEFINITELY part of my cocktail - I don't go anymore, but the skills I developed there help me a LOT and I often use them with meds and just... yeah anyway.

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  • 3 weeks later...

Well, I was diagnosed in early 2011, and put on trazodone, lithium, and later Ativan.  The Ativan was fine, though only moderately effective.  The other two were horrible, mostly in the form of uncontrollable muscle spasms in my legs, hands, and face.  The lithium had other fine effects such as weight gain (50 pounds) and dulling everything, not to mention it wasn't all that effective at what it was supposed to do, which was stabilize my moods and treat bipolar depression.

 

After about 8-10 months of that, my pdoc and I realized I was being poisoned by the lithium for no good reason and switched me to Lamictal along with a couple of other things in the hopes of treating my agitation and anxiety.  We went through a number of drugs (see my signature) before settling on a successful trio with some adjuncts.  Now I take Lamictal, Wellbutrin, and Saphris, and that combo takes care of 2/3 of my symptoms.  The other 1/3 are addressed by Ritalin, Ambien, Klonopin, and Haldol. I also take low-dose lithium for its neuroprotection and mild mood stabilizing (at that dose). Some of those are recent additions to the cocktail so I have to reserve judgment for a later time, but I feel good about the current setup.  I feel like it covers all the bases.

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You know, I've been on meds since autumn of 2000, and we just had to tweak them again: dropped the Lexapro, added Cymbalta instead, reduced my Seroquel XR. Bipolar is a moving target, and as you age and live your life and so forth your needs are going to change. There right combo today will quite likely not be quite right a couple of years down the road.

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