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I'm curious: Has anyone successfully combined two AAP's?

To me, it seems like a good option.  For example, combining two AAP's at low-to-moderate dose where a high dose of either is intolerable.

From my pdoc's perspective, it increases potential interactions and ill-effects.

Thank you for any feedback or experience.  Just trying to stay hopeful about options...

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I've taken 2 together in the past (many different AAPs, in different combinations along the way).  I never put 2 and 2 together about interactions.  I think maybe some might, some might not, have the interactions.  It is like YMMV type-thing.

I am on one AAP right now, which is abilify.

I have taken these in the past, in different combinations (along with other meds):

Zyprexa, Abilify, Geodon, Seroquel, and Clozaril

The one thing that my pdoc focused on were the symptoms and doses of each med (which all varied from tiny to a high dose). So pdoc was looking at symptoms, rather than worrying about potential interactions from them being together as 2 AAPs.  I mean he did also look at side effects when I would start a med, and if no side effects (that I couldn't deal with) I'd stay on it.

So 2 AAPs together were successful at some points when taken together.

I think there will always be some potential interactions with any med/s, just not 2 AAPs together.  So maybe (ie) you can start one (see if side effects or not), then if you needed another AAP, if pdoc says ok to start a 2nd AAP, then it should be ok unless the side effects keep you from taking the med.  But I am not a DR ... just my personal thoughts.

Edited by melissaw72
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After my brain exploded and I landed inpatient on Monday (more on my blog soon because not relevant to this question), the psychiatrist kept me using seroquel at 100mg to help with sleep issues and some mood stabilization and then started ability at 5 (now at 10) mg for some possible psychosis and also mood stuff.

that said, she initially was planning to take me off one of the two before letting me out because of the risks associated with being on two.  It was largely all the side effects being combined as the concern.  However, she agreed to have that be an outpatient goal instead because it was at that point impossible to figure out which made more sense to remove because each had very clear reasons they were helping. 

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At 100 mg Seroquel does not have almost any antipsychotic activity. It is the antihistamine effects from iit that are making you sleepy and it is used for that as a sleeping pill.I would not say you are on  AP's.

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I'm taking two AAPs. In terms of actually achieving the the effect I want - mood stabilization (esp. depression) and anti-psychosis - it's pretty good. In terms of side effects, I'm really struggling to find a combination. I tolerate quetiapine very well but all other AAPs I've tried so far have caused me intolerable side effects.

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2 hours ago, aura said:

I'm taking two AAPs. In terms of actually achieving the the effect I want - mood stabilization (esp. depression) and anti-psychosis - it's pretty good. In terms of side effects, I'm really struggling to find a combination. I tolerate quetiapine very well but all other AAPs I've tried so far have caused me intolerable side effects.

Oh don't you just love the juggling game to find the ideal the drug. I'm currently doing the same.

 

Can I also ask OP and others: what is the advantage of combining meds? And why would your pdoc suggest this? Weren't you responding well enough to one?

This isn't something which hasn't been suggested to me by my pdoc, so I was interested.

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I take 30 mg abilify and 800 mg seroquel XR. 

I have not been on only one AAP in a very long long time. I was on 3 at one point for a while. 

There are always options I've learned. Keep fighting the good fight, quake. We're here for you. I worry about you. 

Oh and let me know if you have any specific questions about AP combining. I've been on many combos and tried every AAP except for the brand speaking new ones (Vraylar and rexulti oh and not clozapine either). 

 

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23 minutes ago, Hester said:

Oh don't you just love the juggling game to find the ideal the drug. I'm currently doing the same.

 

Can I also ask OP and others: what is the advantage of combining meds? And why would your pdoc suggest this? Weren't you responding well enough to one?

This isn't something which hasn't been suggested to me by my pdoc, so I was interested.

IME the advantage of combining two-three AAP's is how much better it works out for me. I've seen lots of pdocs both IP and OP (hell even IOP), and knowing my history they did not want me on only one AP. It was just not enough for me to stay out of IP. I did not respond to only one AAP and this was evidenced over many many years. I had been hospital free for 2 years and then was forced IP last summer. But since being back on abilify and seroquel, I have been free of the hospital for a year now. Which is good for me. 

Edited by Wonderful.Cheese
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I get akathisia on higher doses of almost every AAP.  My hope is that combining Geodon (more weight-neutral) with Saphris/Zyprexa (more appetite-increasing) would be a reasonable combo.

I have bulimia, and Seroquel- or Zyprexa-only causes a lot of ED symptoms and distress.  But Geodon-only causes insane akathisia.

Thank you for your replies and shared experience thus far!

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My doctors don't think that a mood stabilizer and one AAP alone are enough to control my illnesses, and there is evidence to support this. I was originally put on a second AAP to treat OCD comorbid with bipolar, but my therapist now thinks that it treated psychosis too. So yea... kind of like Cheese, with my history my doctors want me on two.

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There are some doctors who believe polytherapy with AAPs is a no-no, but I've seen plenty feel comfortable prescribing more than one AAP at a time. I think Seroquel is a pretty common one that is found in many AAP combos, from what I've seen on the boards here and elsewhere. I have been on low to moderate doses of Seroquel-Risperdal, and Seroquel-Abilify.

Edited by mjs190
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