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Currently going through some psychotic thinking and depression.  Have bumped appointment with pdoc Monday morning.

 

Currently meds are in signature (Saphris 25mg, Latuda 80mg being the relevant ones here).

 

Saphris was bumped up due to some thought broadcasting AGES ago, about a year ago (just over) I had some psychotic issues and the Latuda got added - I think by my GP, though my psychopharm has never taken me off of it even though he doesn't like 2 AAPs at once.  

 

Prolactin is currently normal, but rising, and with stimulation, I lactate.  Non-med reasons being investigated if I ever get the referral.  

 

Past AAPs:

-Seroquel (more times than I can count, 800mg is my sweet spot, but even then, I have delusions, I just function well with them)

-Invega (prolactin issues, went on Bromocriptine, became psychotic, though pdoc says not due to bromocriptine)

-Geodon (twice; was so sedating the second time I fell asleep while walking)

-Abilify (twitchy at 30mg, lowered dose to 20mg, ended up in hospital...not sure if I was really suicidal or just had bad intrusive thoughts)

 

I may have been on others I've forgotten but I don't think so.

 

I don't see the point of Risperdal, because I've tried Invega.  Gained a lot of weight on Seroquel, not going on that, NOT going on Zyprexa because I am a runner and already heavy for a runner, can't make it worse.

 

What's left for me?  Typicals?

 

I am a bit freaked out.  I've missed 6 days of work since last Wednesday, thought broadcasting, people tracking me, that kind of thing.  

 

I like Saphris and Latuda because I feel like myself again on them, AWAKE, or I did.  Now I'm just fucked up.  Just when I think I'm getting better BAM it comes back.  

 

Help.  I'm in Canada so something like Fanapt isn't available.

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Is there room to bump up the AAP's you're on now more?

 

With the Abilify, do you think that was the reason you became suicidal, or do you think it would be worth giving it a second try?

 

I've heard that typicals get a bad rap and can be pretty useful, although I have no experience with them myself.  

 

What about talking to your doctor about adding another antidepressant?  Do you think if your depression and anxiety were better managed, you'd be less inclined towards psychosis?  

 

Also, are you going to therapy?  I know therapy doesn't help everyone, but my current therapist has helped me a lot with psychotic type thoughts.  She works with internal family systems therapy, which I find pretty helpful for me.

 

You are doing a lot of things right, though.  Exercise and eating well can be so beneficial to mental health.  I hate that you're struggling.

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20mg is considered the max dose of Saphris, so I'm already exceeding it.  I could go up on the Latuda I suppose but I also think that's why I'm lactating.  Unless I have a pituitary tumour, which is unlikely.  

 

I could give Abilify a second try.  It was weight neutral for me.  I'm just not sure my pdoc will want to go back to something that got me hospitalized.  

 

I have a therapist, but it's $120/session and I can't afford to go anymore, as I've taken over all bills for the family.  Even before I could only go 1/month.  I'm too stable for most groups and as I work a FT job they don't take place with timing that works for me, they're usually while I'm at work.  

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People can take up to 160mg of Latuda for SZ disorders. I read that in the PI sheet online.

 

So you could essentially "up to" double your dose of latuda.

 

Not saying you need double the latuda, but even like 100-120mg? I take 120 with no issues whatsoever.

When I see pdoc next he may bump it up but I don't know if I'm on board with that. I get psychotic, yes, but this may be as good as it gets. And I don't want any side effects either! So there! :P

 

I like Koa's suggestions too. Typicals or an AD increase may help too.

 

But I'd be more inclined to adjust a current med and see if that works, then to try and make a huge med change. Especially since you are mostly functional on these meds.

 

Latuda is approved for BP depression as well. So it may help with your depression, and thus lessen the psychotic stuff too.

Glad to hear about your husband getting a job! Yay!

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"DOSAGE AND ADMINISTRATION
 
 
LATUDA should be taken with food (at least 350 calories). Administration with food
substantially increases the absorption of LATUDA (2.3, 12.3).
 
• Moderate and Severe Renal Impairment: Recommended starting dose is 20 mg per day,
and the maximum recommended dose is 80 mg per day (2.4, 8.6).
 
• Moderate and Severe Hepatic Impairment: Recommended starting dose is 20 mg per day.
The maximum recommended dose is 80 mg per day in moderate hepatic impairment
and 40 mg per day in severe hepatic impairment (2.4, 8.6).
 
• Concomitant Use of a Moderate CYP3A4 inhibitor (e.g., diltiazem): LATUDA dose should
be reduced to half of the original dose level. Recommended starting dose is 20 mg per
day. Maximum recommended dose is 80 mg per day (2.5, 7.1)
 
• Concomitant Use of a Moderate CYP3A4 Inducer:
It may be necessary to increase the dose of LATUDA (2.5, 7.1)
 
WARNINGS: INCREASED MORTALITY IN ELDERLY PATIENTS WITH
DEMENTIA-RELATED PSYCHOSIS; AND SUICIDAL THOUGHTS AND BEHAVIORS
See full prescribing information for complete boxed warning.
 
• Elderly patients with dementia-related psychosis treated with antipsychotic drugs
are at an increased risk of death.
 
• LATUDA is not approved for the treatment of patients with dementia-related
psychosis (5.1).
 
• Increased risk of suicidal thinking and behavior in children, adolescents, and
young adults taking antidepressants (5.2)
 
• Monitor for worsening and emergence of suicidal thoughts and behaviors (5.2)
 
 
 
Indication Starting Dose Recommended Dose
 
Schizophrenia (2.1) 40 mg per day 40 mg to 160 mg per day
 
Bipolar Depression (2.2) 20 mg per day 20 mg to 120 mg per day"
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It might not.  I just don't see my pdoc wanting me to be on two psychosis-level doses of an AAP.  Maybe he'll surprise me though.

 

I've been reading about Haldol as it seems to be the most accessible of the typicals...I THINK.  Anyone have experience with it?

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Are there any meds you can take to counteract the lactation?

 

I think Latuda is a great med for a lot of people so I do wonder if raising the dose would help.

Edited by koa
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I can take Bromocriptine to counter the lactation.

 

But as I've said, since my pdoc does not believe in two AAPs, I doubt he'll raise the dose of the Latuda.

 

Does anyone have comments on Haldol or other typicals?

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hey jarn,

 

sorry to hear you're struggling with this. i know we don't have the same diagnosis, but i have taken nearly all antipsychotics at some point over the years so i'll share my experiences.

 

at this point (say, the past six to eight years) i do best on a combination of typical plus atypical. i also take relatively high doses most of the time, but i think that that's a diagnostic thing...? unsure. but i mention both of those things because it sounds like your psychiatrist might limit your combining and/or dosages. i don't know.

 

anyway, so, i'm currently on haldol injections plus (for me) low dose zyprexa.

 

typicals in general i've not found to make me gain weight...but then...i'm unusual insofar as i don't gain weight on atypicals either. i have other side effects, but i've always been overthin, if anything. i don't know why that is, but it's possibly attributable to my being hyperactive in general. i'm also a runner, so i get why weight gain would concern you.

 

with typicals, the main side effects i've had have been well controlled (ultimately...sometimes it's bumpy at first) by cogentin, propranolol, artane. probably the best ones have been haldol and prolixin for me. i also successfully took loxapine and stelazine, but that was long ago and i couldn't tell you much beyond that. i also have a lengthy history of discontinuations and once i stop something, it rarely works well for me again. thorazine also worked well, but i just maxed out in dosage. clopixol was ok, but then i came back to the states and it's not prescribed here. i haven't taken solian. i'm probably forgetting one, but that's what i can recall.

 

with atypicals, the best ones for me have been risperdal and zyprexa. geodon also was ok for a while. invega/fanapt combo sucked for me. latuda did nothing. seroquel i maxed out on. abilify i've not taken. i feel like i'm forgetting one here, too...but that's all i can recall off the top of my head. i would say though that in my experience risperdal and invega were totally different. risperdal worked really well for me (at around ten milligrams) until i discontinued. then when i went back on it, it didn't work as well and i had to take a higher dosage and got the whole prolactin problem and went off it. had i never discontinued, though, i think it would've continued to work well. zyprexa has been good for me. i've taken up to twenty milligrams concurrent with prolixin depot...and then haldol depot when the prolixin started failing.

 

if you have more specific questions i'll do my best to answer, but that's an overview of my experience. i hope it helps. xx

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oh...duh...i've also taken clozaril. how could i forget the demon clozaril?

 

it sucked for me with side effects and did nothing for command hallucinations, but i stuck it out for several months prior to doing ECT. it works wonders for most everyone else i know...at least in person people i know from programme and so forth.

 

it's a notorious weight gainer, though...as much as zyprexa is, i'd say, but it just never really got me together. in all fairness though i wasn't anywhere near stable when i was started on it as a last ditch effort of sorts and that could account for why it didn't work for me.

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Thank you SO much Melli!  That's super helpful.

 

I am super scared of Clozaril, yeah.  And I've heard it's bad for weight.  

 

I really appreciate it.  Typicals make me more nervous, I don't know why, I guess the movement stuff, but if he wants to change my antipsychotics then I'm really leaning towards Haldol.  

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i hear you on that and i can't deny that i've had some movement side effects. those have been really well contained by the things i mentioned above though. personally i had worse side effects from atypicals. clozaril...i was unable to have proper bowel movements. and i got orthostatic hypotension. plus i was incredibly light sensitive on geodon and i had problems feeling too hot on more than one. none of those things had remedies that i found.

i am afraid of tardive dyskinesia. definitely. and i think i would be a fool not to be. but i don't really know that that would be worse in a way, just because that isn't a guaranteed outcome--and what EPS symptoms i have do respond to other meds--and me without typical antipsychotics has proved repeatedly to be a total shit show.

it is a shitty pair of dice to have to roll, though, and i do relate to your concern about the risks. it sounds like it might be worth a shot to see if it helps and go from there. not everyone develops movement problems and even those who do don't all have the same persistence or severity to them. there's a lot of hope there that you won't is what i'm saying xx

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navane. my husband reminded me of that one. it also worked well. i think it's less associated with movement problems, too.

one other thing, in case it helps ease your mind: the dosage matters a lot in my experience. you could possibly stay on a much lower dosage and try lower potency things as well and that could help stave off side effects. Thorazine is lower potency than haldol, for example. but then when it's at higher dosages it has potential for more problems.

unsure if that big makes sense and if not let me know and i might be able to explain what i mean better in the morning xx

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The first thing he said to me this morning was 'I want to take you off one of these antipsychotics'.  

 

But my husband and I both said how well I'd been doing on the Saphris/Latuda combo until recently, and I said that I feel so much more like myself on this combo, and that family have commented on how different I seem.

 

So he said that while he does not like two antipsychotics past short term (and I'm now slightly over 1 year on both), he...

 

AGREED to leave me on Saphris and Latuda!  He's raising me to 120mg of the Latuda and will go up to 160mg if needed.  

 

Very happy about this.  I'm still interested in Haldol if this doesn't work, but I'm really happy he agreed with that.

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