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1 hour ago, mmaryland said:

met with psychiatrist last friday and was asked when/how i take/manage/remember to take my meds and when I mentioned I took my Vraylar in the morning she expressed concern and asked why I took it in the AM. I simply told her it doesn't sedate me at all and I struggle to keep up with multiple dosages per day and remembering to take meds in the evening. 

She suggested that even though I don't feel sedated or tired from taking Vraylar in the morning, in addition to 40mg Valium and 0.5mg Xanax, switching to dosing at bedtime (the Vraylar plus Valium) may decrease my need to use a sleeping aid. I can never win with antipsychotics and sleep. An atypical antipsychotic either knocks me out (seroquel, zyprexa) and leaves me super sedated next day and cognitively impaired, as well as "stable-blah or fails to produce activation or sedation (rexulti, vraylar, latuda). This puts me in a predicament because I have severe insomnia that must be treated or else I spiral out of control and become dysfunctional very rapidly. 

Since Vraylar doesn't help me fall asleep, I alternate between using small dose, 50mg, of seroquel and halcion 0.25mg. Here's the problem:

I don't feel at ease or comfortable taking to antipsychotics at the same time (Vraylar + Seroquel), but it works. Even my psychiatrist expresses a lot of concern about me taking two antipsychotics. We have explored other options, trust me almost of of them (sonata, ambien, edluar, mirtazapine, saphris, lunesta, temazepam, valium, xanax, clonidine, intermezzo, you name it, i've tried it except for belsomra), and after failing therapeutic response to several rounds of hypnotic sleeping medications I begged for halcion because I had been dying to do well on a sleep medication with a short half-life, quick onset of action, and little next day sedation. My doctor wrote my a script of 20 tablets for 45-60 days, but recently discussed "doing something about the triazolam (halcion)," meaning getting rid of it in the near future but it's the only thing that works for me! 

I wish Vraylar made me a even a little sleepy so it could aid in falling asleep but it just doesn't affect me that way. 3mg is my current dose, might an adjustment to 4.5mg produce more sedation or would it lead to more activation? Same question goes for dosing at 1.5mg instead of 3mg.

BTW I am glad this community is having such a great discussion on Vraylar, a very new "third-generation antipsychotic" which seems to be mostly effective. This topic has been helpful, informative, and a great source of patient's experiences with Vraylar.

I’m extremely grateful as well! I wonder if 1.5 is even a therapeutic dose? I was sooooo third on 3 but perhaps if I take it at night? But even taking mine T 6am, im still waking up at 330 am every night. But since I’m so tired on three maybe it’ll help me sleep. I dunno! ? I’m scared to try and even lose ONE night of sleep cause I’m a raving jerk the next day. I ended up hypomanic on Friday, she told me to stop Viibryd, then I felt awful all weekend, so now I’m back on it! ? I NEED my hypomania! Been too depressed for too long. Thanks SO much for your in depth reply!

1 hour ago, looking for answers said:

No sedation for me at 1.5 I take in am I actually get a boost

Me too!

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On 5/2/2018 at 1:30 PM, GettingUpThere said:

I’m extremely grateful as well! I wonder if 1.5 is even a therapeutic dose? I was sooooo third on 3 but perhaps if I take it at night? But even taking mine T 6am, im still waking up at 330 am every night. But since I’m so tired on three maybe it’ll help me sleep. I dunno! ? I’m scared to try and even lose ONE night of sleep cause I’m a raving jerk the next day. I ended up hypomanic on Friday, she told me to stop Viibryd, then I felt awful all weekend, so now I’m back on it! ? I NEED my hypomania! Been too depressed for too long. Thanks SO much for your in depth reply!

Me too!

Keep in mind that when you first go from 1.5mg to 3mg that it might be sedating for the first several days but then might change to being stimulating after it builds up in your system. My experience with Rexulti has been that 0.25mg and 0.5mg are both sedating doses with some minor stimulation during the day that you aren't sure is even really there. Then 0.75mg you start to really believe that Rexulti might be stimulating. By the time you get to 1mg, you know it can be. I have yet to go beyond 1mg. However, I know with each dose increase I would get less and less extra sedation and more stimulation. So the ratio of sedation/stimulation changes with each dose. And the half-life fundamentally modifies that ratio over time. If you want some extra mood stabilization, I would talk to my doctor about going up to 3mg and switching to night time for the time-being until it settles. And the "settling period" with Vraylar is really long. Like expect to go to 3mg and park there for 2-3 weeks, even 4 weeks if you can before you really decide how well it works for you. 

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23 hours ago, browri said:

Keep in mind that when you first go from 1.5mg to 3mg that it might be sedating for the first several days but then might change to being stimulating after it builds up in your system. My experience with Rexulti has been that 0.25mg and 0.5mg are both sedating doses with some minor stimulation during the day that you aren't sure is even really there. Then 0.75mg you start to really believe that Rexulti might be stimulating. By the time you get to 1mg, you know it can be. I have yet to go beyond 1mg. However, I know with each dose increase I would get less and less extra sedation and more stimulation. So the ratio of sedation/stimulation changes with each dose. And the half-life fundamentally modifies that ratio over time. If you want some extra mood stabilization, I would talk to my doctor about going up to 3mg and switching to night time for the time-being until it settles. And the "settling period" with Vraylar is really long. Like expect to go to 3mg and park there for 2-3 weeks, even 4 weeks if you can before you really decide how well it works for you. 

Ok thanks! I opted for the Vraylar so instead of 1.5 this am, I’ll try the 3 tonight. Thanks for the thoughtful and extensive reply! That helped a LOT. If this Vraylar ends up messing up, I’ll definitely try Rexulti next! I’m desperate for stimulation/motivation!

 

 Thanks ? so much. 

I’m going to try 3mg Vraylar tonight. Took in the am and slept all day! But it seems I definitely need it higher. Doesn’t sedate at this dose, but still isn’t helping motivation/depression much. Thanks everyone!

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On 5/5/2018 at 8:51 AM, GettingUpThere said:

Ok thanks! I opted for the Vraylar so instead of 1.5 this am, I’ll try the 3 tonight. Thanks for the thoughtful and extensive reply! That helped a LOT. If this Vraylar ends up messing up, I’ll definitely try Rexulti next! I’m desperate for stimulation/motivation!

 

 Thanks ? so much. 

I’m going to try 3mg Vraylar tonight. Took in the am and slept all day! But it seems I definitely need it higher. Doesn’t sedate at this dose, but still isn’t helping motivation/depression much. Thanks everyone!

Have patience with it. And I know when you're in a tough place, that is easier said than done. But with medications that have long half-lives, you need to give it lots of time to "settle". I had never taken anything with a super long half-life like Trintellix or Rexulti, but they actually TAUGHT me to be more patient. Historically I wanted medications to work overnight or within a day or two, but it just doesn't work that way with long half-lives. You need weeks not days.

I would say if you start taking 3mg at night and you aren't waking up in the middle of the night then stay at 3mg (unless your pdoc says otherwise) and continue taking it at night. Doesn't necessarily have to be the same time every night because of the long half-life, but if you notice it causes sedation shortly after taking it, make sure you take it as close as possible to when you go to bed. Looks like it takes 3-6 hours for Vraylar to reach peak plasma levels after taking it. So taking it at 7PM or 8PM should be a good time if you're in bed by 10PM or 11PM.

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2 hours ago, browri said:

Have patience with it. And I know when you're in a tough place, that is easier said than done. But with medications that have long half-lives, you need to give it lots of time to "settle". I had never taken anything with a super long half-life like Trintellix or Rexulti, but they actually TAUGHT me to be more patient. Historically I wanted medications to work overnight or within a day or two, but it just doesn't work that way with long half-lives. You need weeks not days.

I would say if you start taking 3mg at night and you aren't waking up in the middle of the night then stay at 3mg (unless your pdoc says otherwise) and continue taking it at night. Doesn't necessarily have to be the same time every night because of the long half-life, but if you notice it causes sedation shortly after taking it, make sure you take it as close as possible to when you go to bed. Looks like it takes 3-6 hours for Vraylar to reach peak plasma levels after taking it. So taking it at 7PM or 8PM should be a good time if you're in bed by 10PM or 11PM.

Thanks so much for such a thoughtful, supportive reply...people like you are what keeps my little hope in humanity alive. I actually go to bed at 9 because no matter what I can’t sleep later than four or five. Which sucks.

I’ve had horrible sleep for the past month waking every couple of hours and even though I took the 3mg last night, I still woke up for 2 hours from one to three! SO frustrating, and does not help my mood. So I’m grouchy yet again, snipping at my baby (dog) and can’t seem to smile at anyone. 

So tonight I’m saying screw it and taking a full dose of Xanax before bed before I start feeling rage again.  I don’t want to get addicted to it so I usually just take half the mg she gives me. 

You really helped educate me on this. I had no idea about how half-lives affect how long it takes to work. I have been on the 1.5 for a good few weeks, but I’m guessing I need the 3. 

Im so very grateful for your in-depth reply. 

Thanks ? 

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1 minute ago, GettingUpThere said:

Thanks so much for such a thoughtful, supportive reply...people like you are what keeps my little hope in humanity alive. I actually go to bed at 9 because no matter what I can’t sleep later than four or five. Which sucks.

I’ve had horrible sleep for the past month waking every couple of hours and even though I took the 3mg last night, I still woke up for 2 hours from one to three! SO frustrating, and does not help my mood. So I’m grouchy yet again, snipping at my baby (dog) and can’t seem to smile at anyone. 

So tonight I’m saying screw it and taking a full dose of Xanax before bed before I start feeling rage again.  I don’t want to get addicted to it so I usually just take half the mg she gives me. 

You really helped educate me on this. I had no idea about how half-lives affect how long it takes to work. I have been on the 1.5 for a good few weeks, but I’m guessing I need the 3. 

Im so very grateful for your in-depth reply. 

Thanks ? 

just by noticing a few things in your reply. Take your meds as prescribed. If you have a problem with the med or dosage or side effect,call your doctor, dont play around by taken half doses, or double doses. Your doctor will never be able to tell whats working of not working!

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Vraylar has taken me much time and dosage trial to adjust to. Eventually I went back down from 3mg to 1.5 at night.

full disclosure: I take quite a cocktail of meds. I take 50 mg seroquel, lamictal, prozac (1/2 in am 1/2 in pm) Topamax (which is used as a psych drug as well as migraine preventative for me) 

there are times when I can’t sleep so well, other times i get 6-8 hours night. 

I too remember having to take PRNs some nights in order to sleep on  Vraylar and it was with my doctor’s approval. We discovered 25 mg seroquel works well as a PRN in lieu of Xanax and I have that RX written ..

Hang in there. 

Also I notice with time change I’m having more trouble sleeping. In my experience with Vraylar it has been a good add on to my other meds and has helped with symptoms of paranoia, and depression too. 

I don’t think taking it on it’s own would work for me... that’s just my experience. 

Doctor always tells me first rule of psychiatry is Anchor your Sleep.

i hope you and your doc can get you through this.

i also think med changes are even harder as we age. 

Will be thinking of you and hoping things will settle for you.

I hope it helps knowing at least that you are not alone. 

Take care. 

 

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2 hours ago, looking for answers said:

just by noticing a few things in your reply. Take your meds as prescribed. If you have a problem with the med or dosage or side effect,call your doctor, dont play around by taken half doses, or double doses. Your doctor will never be able to tell whats working of not working!

The only thing she’s not aware of is taking half mg of Xanax instead of the full mg. Thanks 

 

 

51 minutes ago, BreakOnThru said:

Vraylar has taken me much time and dosage trial to adjust to. Eventually I went back down from 3mg to 1.5 at night.

full disclosure: I take quite a cocktail of meds. I take 50 mg seroquel, lamictal, prozac (1/2 in am 1/2 in pm) Topamax (which is used as a psych drug as well as migraine preventative for me) 

there are times when I can’t sleep so well, other times i get 6-8 hours night. 

I too remember having to take PRNs some nights in order to sleep on  Vraylar and it was with my doctor’s approval. We discovered 25 mg seroquel works well as a PRN in lieu of Xanax and I have that RX written ..

Hang in there. 

Also I notice with time change I’m having more trouble sleeping. In my experience with Vraylar it has been a good add on to my other meds and has helped with symptoms of paranoia, and depression too. 

I don’t think taking it on it’s own would work for me... that’s just my experience. 

Doctor always tells me first rule of psychiatry is Anchor your Sleep.

i hope you and your doc can get you through this.

i also think med changes are even harder as we age. 

Will be thinking of you and hoping things will settle for you.

I hope it helps knowing at least that you are not alone. 

Take care. 

 

Thanks ? 

Edited by GettingUpThere

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