AAP's for TR PD/GAD/MDD?

[Arj72]

Good morning all about 5 years ago I was diagnosed with panic disorder  and MDD after a smoking cessation attempt left me a panicky mess.  I initially had a good response to Paxil, then Zoloft (on each 1-2 years a piece), but since Zoloft turned against me, I've been searching for a  med that could adequately resolve my symptoms with bearable side effects.  My med history as follows since Zoloft:

 

Lexapro: On up to 20mg/day over 6 months.  Caused significant apathy, restlessness and insomnia.  Attempted to add lamictal (anxiety and rash), and low dose amitriptyline (10-25mg to help with restlessness/insomnia) before I ultimately gave up because I didn't care about anything.

 

Effexor: On up to 112.5mg/day over 2 months.  Tried to gut this out but was causing severe restlessness and insomnia.

 

Clomipramine: On up to 75mg/day over 3 months.  Actually worked okay, but I couldn't poop/pee/spit and my penis became anesthesized.  Compounded with the inability to stay awake I had to get off, but before I did, we tried to add Prozac to help with energy levels.

 

Prozac: When that didn't work we went to Prozac mono-therapy but couldn't get past 10mg it was too damn stimulating, gutted it out for 12 weeks hoping it would reduce.

 

Cymbalta: up to 60mg/day 3 months.  Couldn't get past the nausea, fatigue and restlessness.  Maybe could've dealt with it if it adequately resolved my lingering symptoms. Tried adding Trileptal which only contributed to my nausea and paradoxically made my insomnia worse.

 

Brintellix: Made me angry, up to 20mg/day, 2 months. Discontinued after I started to get chest pains.

 

At this time, my pdoc at the time felt that I was merely suffering from iatrogenic effects of all the medication (hadn't had a panic attack in some time, and I was mostly just complaining about side effects rather than actual depression) and suggested weaning off.  Given the relatively long half life of Brintellix, he felt a quick taper to 10-5-0 would be adequate.  I went through typical withdrawals but the withdrawals never let up after 6 weeks when I started to have panic attacks again and was reinstated to:

 

Celexa: I got this from my PCP as I was unable to get into my pdoc.  Celexa presented with the same issues as Lexapro, except more fatigue and some general weakness.  Hung on for 6 months, up to 20mg/day.  Lower doses never helped with the apathy.

 

Remeron: 2 months, up to 45mg/day.  Remeron was great! Except I couldn't stay awake no matter how much I slept and I started to have a lot of anger which was directed at my wife and newborn baby. Oh yeah, and I could eat a metric ton without getting full.

 

Finally Lyrica: up to 150mg/day.  At 75mg/dose I started to get really weepy and mildly suicidal after each dose.  Given the relatively low dose and short time frame (1 month), was told that I could just discontinue. Those two symptoms resolved after discontinuation but I'm being presented with a whole host of other issues at the moment.

 

I have another post about Lyrica Withdrawal (if it exists) on the anti-convulsants board, but in short, I feel like shit (not sure if return of anxiety/depression or some kind of discontinuation syndrome).  However, my pdoc suggested that if it is a relapse, he wants to take a look at a low dose of the atypicals, specifically latuda, saphris and abilify as a potential next step.  Given I'm not on an AD at the moment, so I'm assuming he means an AAP monotherapy.

 

From what I could see Saphris is a derivative of Mianserin which preceded Remeron so I can kind of see where that's going, but still it's a different mode of action.  Other than that, Latuda and Abilify just has me shrugging.

 

Also I'm really concerned about the SE profile.  Any insight on EPS/Akathisia risks on low dose therapy?

 

My symptoms typically present as an ongoing stimulant like buzzing/anxiety/restlessness that ebbs/flows through the day, barely keeping below the panic threshold.  Up until recently, it followed a very diurnal pattern with significant improvements in the evenings.  I don't have a lot of somatic complaints in general but tend to get shortness of breath and muscle pain at times.  I do have periods of low moods/weepiness, although I'm not sure if it's my anxiety affecting my mood, vice-versa or both.

 

Any feedback would be greatly appreciated.

[San]

I've never taken latuda, but I found at low doses, (under 10mg, at and over 10mg I ended up with terrible akathasia - inner restlessness) helped a lot with depression, but I was also taking other medications as well. I ended up manic (I'm SZA, bipolar type, and was taking Luvox at the same time). It didn't do much for psychosis, but at my original dose of 6mg, I was definitely not depressed. Abilify is one of the first go-to AAP's for depression. It was weight neutral for me, but I couldn't get to a high enough dose for it to be a useful antipsychotic due to akathasia. I know many people that swear by Abilify. Generally, low doses are used for depression, and it's generally combined with an AD of some sort, usually an SSRI or SNRI. 

 

Seroquel and Zyprexa (Zyprexa and Prozac being a good combo) are also used for depression. They do have the weight gain factors (I'm currently on Seroquel, but not gaining weight) but are older, tried, tested and true, and help a lot. There are a lot of options with AAP's. Risperdal and Invega (same basic ingredient, Invega is newer and better tolerated) are also good for depression and mood stabilizatoin as well.

 

Have you ever been on Wellbutrin? That has dragged me out of deep depressions before with minor side effects, and no mania. What about Lithium? It can be used for depression on its own, or combined, and is proven to reduce suicidal thinking and actually repair the brain. Lithium does have some "scary" side effects at times, but if you're in the targeted dose range, they're minor, or non-existant.

 

Many meds can cause EPS or akathasia, but it depends on you. I'm prone to akathasia from meds, I've found. EPS at a lower dose generally doesn't happen too terribly often, but still can. With the AAP's, its less likely to cause EPS or TD (which is already rare). Meds like Cogentin or Artane, sometimes beta blockers, can be added if you do have any EPS, and they're very effective. It may take trial and error.

 

As for abilify, it is great for depression, even at low doses, and at the low doses, the side effects are minor. 

[jt07]

I found both Abilify and Risperdal helpful for treatment-resistant depression. Neither helped my anxiety though, and Abilify aggravated my anxiety at doses below 10 mg.

 

I found Trilafon and Haldol (typicals) helpful for anxiety. I also took Zyprexa which helps some people with anxiety and depression, but I couldn't handle the sedation. I literally nearly fell down the stairs the morning after taking my first dose of Zyprexa and made it to the couch where I stayed until 5:00 pm.

[Arj72]

I've never taken latuda, but I found at low doses, (under 10mg, at and over 10mg I ended up with terrible akathasia - inner restlessness) helped a lot with depression, but I was also taking other medications as well. I ended up manic (I'm SZA, bipolar type, and was taking Luvox at the same time). It didn't do much for psychosis, but at my original dose of 6mg, I was definitely not depressed. Abilify is one of the first go-to AAP's for depression. It was weight neutral for me, but I couldn't get to a high enough dose for it to be a useful antipsychotic due to akathasia. I know many people that swear by Abilify. Generally, low doses are used for depression, and it's generally combined with an AD of some sort, usually an SSRI or SNRI. 

 

Seroquel and Zyprexa (Zyprexa and Prozac being a good combo) are also used for depression. They do have the weight gain factors (I'm currently on Seroquel, but not gaining weight) but are older, tried, tested and true, and help a lot. There are a lot of options with AAP's. Risperdal and Invega (same basic ingredient, Invega is newer and better tolerated) are also good for depression and mood stabilizatoin as well.

 

Have you ever been on Wellbutrin? That has dragged me out of deep depressions before with minor side effects, and no mania. What about Lithium? It can be used for depression on its own, or combined, and is proven to reduce suicidal thinking and actually repair the brain. Lithium does have some "scary" side effects at times, but if you're in the targeted dose range, they're minor, or non-existant.

 

Many meds can cause EPS or akathasia, but it depends on you. I'm prone to akathasia from meds, I've found. EPS at a lower dose generally doesn't happen too terribly often, but still can. With the AAP's, its less likely to cause EPS or TD (which is already rare). Meds like Cogentin or Artane, sometimes beta blockers, can be added if you do have any EPS, and they're very effective. It may take trial and error.

 

As for abilify, it is great for depression, even at low doses, and at the low doses, the side effects are minor. 

 

Thanks for the feedback.  I was a little wary about Abilify in general as it seems to be activating (akathisia or not) at the lower doses.

 

I found both Abilify and Risperdal helpful for treatment-resistant depression. Neither helped my anxiety though, and Abilify aggravated my anxiety at doses below 10 mg.

 

I found Trilafon and Haldol (typicals) helpful for anxiety. I also took Zyprexa which helps some people with anxiety and depression, but I couldn't handle the sedation. I literally nearly fell down the stairs the morning after taking my first dose of Zyprexa and made it to the couch where I stayed until 5:00 pm.

 

I think my pdoc is generally avoiding Zyprexa and Seroquel for the sedation reason alone.  For some reason, my body is just unable to adjust to the sedation and I end up just completely zonked the whole time I'm on it (clomipramine/remeron as examples).

 

The hardest part of it all is that I am unable to tolerate benzos long term as well as they tend to depress my mood.

 

Sometimes I think to myself that I just need to get past (insert "withdrawals" "start up effects" "etc") and I'll be just fine, but I just can't seem to get past them.

[kateislate]

I'm guessing your pdoc doesn't want to try Wellbutrin because it's activating - but I'm wondering if it makes sense to add it to a drug like remeron, which worked for you but caused fatigue. Or one of the ones that caused apathy. To counteract those side effects. Just a thought.

I have depression and anxiety - but my anxiety is not so much panic as it is ocd, worry, racing thoughts - stuff in the head. Latuda works really well for me for those kinds of symptoms. It also helps a lot with mood. It's by far the most effective med I take and I haven't had any side effects.

I also have Zyprexa low dose for breakthrough symptoms, but I really don't like taking it as it makes me very flat. I haven't actually taken it in over a year.

[Ashley_NM]

I take lyrica now after suffering from this horrible inner restless/agitated/ couldn't sit still much less sleep feeling for months which eventually drove me to considering offing myself. My doc threw every antipsychotic and benzo at me and nothing helped, if anything it made it worse. Especially meds like saphris and latuda. I still haven't figured out why I had such a sudden onset of overwhelming restlessness/jitteriness but I know that the lyrica controls it and I've been able to go down to taking 2 meds a day instead of 10. Lyrica saved my life. I'll take the weight gain if I can keep my sanity.