Latuda costs to much. Other AAPs for Bipolar depression?

[crtclms]

I am very upset that I have to quit Latuda for financial reasons. It is the best med I have ever taken, I've been totally stable on it. And now I have to step off the roof into thin air, and try again. I don't know if I'll ever feel this good again. As you can tell, I am upset.

What are other atypicals (that have generics) are good for Bipolar depression? I'm very leery of trying Seroquel, mostly because of weight, but also because of sedation. My SIL is on Seroquel, too, and it has been an unmitigated disaster, so that is affecting my bias.

Sorry to wander off topic. Can anyone help?

Or should I be thinking an anti-depressant instead of an atypical?

[sam78]

If you're willing to wait, then Abilify might be a good choice. It only recently went generic. The generic is in stock at pharmacies but it will take some time before the price of it drops. The last I checked it had dropped in price by about 25%. Still, for a medication that costs $500, that isn't much of a drop.

At the same time, the makers of Abilify, have just recently introduced a new atypical antipsychotic called Rexulti. It is supposed to be the follow up drug to Abilify because they are structurally similar. There is a chance that this might hasten the price drop in Abilify.

If you go the antidepressant route, then Wellbutrin is considered the AD which is least likely to induce mania in bipolar patients.

[geekything]

All my meds except for Latuda are generic and relatively cheap (see below), so Latuda sticks out like a sore thumb at my monthly pharmacy visit. It certainly adds up.

I notice you're already on lithium+lamotrigine? That's already supposed to be a pretty good maintenance treatment for bipolar depression -- although you may have noticed from my posts I'm only just titrating up, so I can't give proper feedback. Does the lithium+lamotrigine not work for you for depression?

Give you're on a mood stabilizer, you could always talk to your p-doc about an AD as there'll be less chance of a triggering effect from one. My fluoxetine hasn't triggered anything (up or down) since lithium was introduced earlier in the year. Fluoxetine is generally dirt cheap and the long half-life can be useful if you do want to get off it.

I did ask my p-doc if there was a cheaper alternative to Latuda -- his response was that he could give me some samples if I managed to come by his office one afternoon whilst he's around. Maybe you could try this -- every little bit counts, right? If you're in the U.S. (I'm not), there's also a Latuda Savings Card that you can apply for: http://www.latuda.com/bpd/latuda-savings.html

Sorry you're going through this.

[iaawal]

For what it's worth AD's have never done shit for my bipolar depression. I'm on two right now. And before the effexor I was on a prozac/wellbutrin combo. They're good for anxiety and focus so I keep them. Even my boss thinks that my old pdoc was treating me like a unipolar patient with all the AD's.

For bipolar depression your only two other options are seroquel and abilify since those are approved for bipolar depression. You could always venture off into an AAP that's not approved for bipolar depression and see if it helps you. Just because it's not approved for it doesn't mean it won't help YOU.

AD's are worth a shot to see if it helps, if it doesn't help with depression maybe it'll help with something else (like me I use the effexor for anxiety and before that I used the prozac for anxiety).

[Siggmin]

My depression just recently reemerged, so my pdoc and I decided to try an antidepressant. I'm SZA: Bipolar type, so I run the risks of mania and psychosis when trying a new AD. My pdoc and I decided on Wellbutrin, as even she agreed it's the best for not triggering a significant mania in Bipolar depression. I'm starting on a very low dose: 150mg of Wellbutrin XL. So far it's kept me awake in the day when all I used to do was sleep. 

Wellbutrin is worth a try. My pdoc just said to monitor myself closely, and if I feel I'm headed into mania or psychosis, then discontinue the med immediately. 

I know Abilify and Seroquel really didn't help my depression. I was up to the max dose, 30mg, for Abilify and it didn't help anything at all. Seroquel just caused weight gain, and I still had trouble sleeping while on it. But that's just me. Anyway, I hope you and your pdoc find a med that works for you... Good luck!

[IcePrincess88]

Seroquel has always worked wonders for me. Wellbutrin is also AMAZING, but for me it didn't start getting amazing until the higher dosage. I was also on Celexa for years and that worked great for me until I built up a tolerance after so long. I hope you find what your looking for.

[crtclms]

I've tried abilify, and it made me manic. I know it's a really good med, so I was disappointed.

And I agree that Wellbutrin is a good med for bipolar depression, I was on it 20 years. It recently pooped out. That was part of the reason I was on Latuda.

Augh, seroquel. I'm scared of it, which I can't say about too many other meds. I know everyone is an individual, but I am a fat individual. I'm actually not at my worst weight, which is where I'd like to keep it.

I've had trouble with SSRIs pre-mood stabilizer, but it is something to think about, now that I *am* on a mood stabilizer.

Geekything, The lithium and lamictal did help with my depression, significantly. But I was really depressed when I started it. Even with the improvement, I still wasn't up to par. My old pdoc, who I saw before Latuda came onto the market, tried some stuff ( Geodon and abilify), and then started talking about sometimes "our" mood couldn't be ideal, and I should use mindfulness. At that point, we thought the Wellbutrin was still helping, but less than it had.

But with Latuda, I feel like I am in remission. I am really upset about this.

So it looks like Seroquel or an anti-depressant. There is no way my nurse would prescribe something off label. Meds suck.

[larkspur]

I went off Latuda this spring and recently started Seroquel. I really expected the worst. I thought I would be tired all the time and want to eat everything. Totally not the case for me! I haven't gained a pound and I don't have crazy carb cravings (I had those on Saphris, ugh), and it really worked fast. I think I'd been on it for one or two weeks when I really started feeling significantly better. I take a low dose (200mg IR all at night) and it's really doing a great job for me. I wake up with more energy, I feel rested, my mood is much better, and suicidal ideation is all but gone. 

I hope your experience with Seroquel will be as positive as mine has been. Try not to expect the worst! Seroquel was one of the first AAPs approved for bipolar depression. Almost everyone on here that I've talked to has really liked it. Good luck!!

[drchemy]

@crtclms

A trick you might try with latuda is if you are on the 40 mg dose purchase the 80 mg dose for your prescription and cut the pills in half.  The price of the 80 mg pill is the same as the 40 mg.

[aquarian]

My psychiatrist offered to write me a prescription for double my dose of one of my meds once (mirtazapine) so that I could split the pills and have the prescription last twice as long. It only works though if you're taking a low enough dose so that double the dose is within reason. For instance, I take 300mg of venlafaxine xr and prescribing double that dose would probably not be approved by any insurance company or maybe even the pharmacy.

She also currently prescribes me 20mg generic adderall twice per day even though I split the pill into quarters and take just 5-10mg/day (she's aware of the pill splitting and was the one who suggested it). It's a lot cheaper and easier to only get a script for it a few times a year vs. every month needing a fresh prescription, and it works because I take such a low dose. Obviously it wouldn't work for someone who already takes close to the max recommended daily dosage.

[Chantho]

For me personally, Zyprexa worked for the depression side. I had to quit it because of cost, but it's cheaper than Latuda by a fair chunk. I think generic was about $100. I'm now on Loxitane, and it's working well, but it's not approved for bipolar anything really. TBH I thought my pnurse was crazy when she prescribed it, but for some reason it works for me. 

[Wonderful.Cheese]

@crtclms

I like Seroquel. I don't know if the XR would be cheaper for you but I'm losing a good amount of weight on it. My diet has not changed.

Or I say splitting a tab of latuda into two tabs as others have said to try. The biggest dose of latuda in one pill is 120 mg. So you could take up to 60 mg a day by splitting.

Rexulti and vraylar are out but I'm sure that's super spendy too. Invega, zyprexa zydis, symbyax, Geodon, are all generic. Ever tried saphris?

Or is there any way your current dr would fight hard for you to get an appeal for it to be less costly? I have no idea if this could work. But if you've tried several AAP's then this shows you have exhausted the other options.

Or could you get samples? I know this is not a long term solution, however.

What about a legit Canadian pharmacy? It would be cheaper and you could still split the pills making the cost hopefully quite affordable! You can shop around to find the best price if your pdoc agrees and writes you the prescription for like 90 days worth.

A savings card? http://www.latuda.com/bpd/latuda-savings.html

I just hate that you had to give up your miracle med. That is absurd!

I hope this helps and that one of these options works out for you!

Edited April 17, 2016 by Wonderful.Cheese
Link

[crtclms]

Right now, I am off the Latuda, even if I got the larger size and split it, it would be over $500 a mo., and we're both on disability.

Right now,  I have been taken off risperadone (which I HATED), and am just on Lamictal, lithium, and back on wellbutrin (which seems to be working). I have to talk to my new pdoc about anxiety.

[looking for answers]

IM on seroquel and latuda, the latuda at a low dose seems to be helping, id like to try higher. BUt my pdoc is giving me samples.........

 

my insurance says is 1k per month, if i use a savings card its 875. thats just not doable :-( im not sure what to do

[looking for answers]

And I don’t want something sedating .

 

theres nothing else for bipolar depression 

[dancesintherain]

you might want to start a new thread on it if you're looking for ideas--there have been some drugs that have come out since this one (Rexulti comes to mind as being approved, or at a  minimum, used frequently for bipolar depression...that said, I don't know about the pricing).  Also, what's sedating for one person isn't necessarily sedating for another.  Which is frustrating when you're looking for ideas, but can help when you're trying things.  For example, Zyprexa puts most people to sleep in an instant.  I take It at night because of that risk, but it doesn't sedate me for unknown reasons.  So sometimes it's worth trying around just to see what you get.  Do you need the antipsychotic impact or just the mood-stabilizing/anti-depressant impact?  Because if it's just the anti-depressant impact, there are many more options out there. 

[looking for answers]

Rexulti is not approved by insurance they rec ability which I didn’t do well on but would try again

3 minutes ago, dancesintherain said:

you might want to start a new thread on it if you're looking for ideas--there have been some drugs that have come out since this one (Rexulti comes to mind as being approved, or at a  minimum, used frequently for bipolar depression...that said, I don't know about the pricing).  Also, what's sedating for one person isn't necessarily sedating for another.  Which is frustrating when you're looking for ideas, but can help when you're trying things.  For example, Zyprexa puts most people to sleep in an instant.  I take It at night because of that risk, but it doesn't sedate me for unknown reasons.  So sometimes it's worth trying around just to see what you get.  Do you need the antipsychotic impact or just the mood-stabilizing/anti-depressant impact?  Because if it's just the anti-depressant impact, there are many more options out there. 

Anti depressant I’m already on seroquel and lithium

[dancesintherain]

any other of the antidepressants listed in this thread (if you want to keep the question here) fall into the not-yet-tried category?  

[looking for answers]

It’s hard to start a new thread on my phone. I am looking at the things listed I just can’t cant do more swdating

[jacques]

I don't have a lot of experience with different medications, but risperdal has worked wonders for me. It didn't completely kick out all the depression, but it really helped. I haven't been having suicidal thoughts on it. Actually, the only times I've had suicidal thoughts since starting it were when I went off my meds back in September.

[looking for answers]

I felt funny on risperdal