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Stimulant for negative symptoms


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I am having a hard time since the antipsychotic I am taking, 50mg of amisulpride, has killed my voices. It was supposed it only blocks presynaptic autoreceptors so it actually enhance dopamine neurotransmision (actually, it is not sedating at all). I wanted to stop negative symptoms, not possitive ones.

But I am getting horribely depressed because I don't have my voices anymore.

I posted about it here:

My main concern are negative symptoms, so I was thinking on....:

Quote

I was thinking on asking the... I don't know how it's called.... when the medication is liquid and you put it in water... there is that option with amisulpride...

So I was thinking on:

1.

Amisulpride 25mg

Sertraline 25mg

Bupropion 150mg

Amisulpride at low dose blocks first presynaptic autoreceptors so it enhance dopamine transmision, plus bupropion it's a synergic action. It's also a potent inhibition of the enzime that metabolize sertraline so I wouldn't need to increase sertraline

 

2.

Amisulpride 25mg

Sertraline 50mg

Methylphenidate

 

3.

Sertraline 50mg

Methylphenidate

 

 

 

What do you think?

 

I handle possitive symptoms really well by my own.

Edited by OliverB
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(Glad it is having a positive effect for you!

I was going to suggest that you could probably try a different antipsychotic which blocks only presynaptic dopamine receptors, like low dose sulpiride (50-200 mg), or low dose flupenthixol 1-2 mg?), then that might help too.

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15 hours ago, mikrw33 said:

(Glad it is having a positive effect for you!

I was going to suggest that you could probably try a different antipsychotic which blocks only presynaptic dopamine receptors, like low dose sulpiride (50-200 mg), or low dose flupenthixol 1-2 mg?), then that might help too.

I am already taking a low dose of amisulpride (50mg). It helped with social negative symptoms, not too much with anhedonia and motivation.

Edited by OliverB
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10 hours ago, OliverB said:

I am already taking a low dose of amisulpride (50mg). It helped with social negative symptoms, not too much with anhedonia and motivation.

Gotcha. I was just saying perhaps one of those others might work better is all. But if you're satisfied with amisulpride then there's no reason to change. :) 

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On 1/17/2017 at 2:49 PM, OliverB said:

I was just given 18mg concerta.

Hey OliverB - that's good news! Glad to hear that it's helping.

I am curious - how did you get your pdoc to prescribe a Stimulant? In my experience, pdocs refuse to prescribe if there is any past indication of psychosis or mood instability. And get this: I'm not even officially diagnosed as Bipolar, I was previously on Ritalin for many months from a previous pdoc (he retired) the Ritalin helped immensely for my anhedonia/treatment-resistant depression), I am even currently on a mood stabilizer...and they will not prescribe it :-(

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1 hour ago, cloudmonger said:

Hey OliverB - that's good news! Glad to hear that it's helping.

I am curious - how did you get your pdoc to prescribe a Stimulant? In my experience, pdocs refuse to prescribe if there is any past indication of psychosis or mood instability. And get this: I'm not even officially diagnosed as Bipolar, I was previously on Ritalin for many months from a previous pdoc (he retired) the Ritalin helped immensely for my anhedonia/treatment-resistant depression), I am even currently on a mood stabilizer...and they will not prescribe it :-(

Well, It took me a year to convince him...

I guess he did because:

  1. It had passed a year and I wasn't improving when it's about negative symptoms, depressive symptoms, social life, college, etc. and when I tried Wellbutrin it didn't work enough and others AP didn't either.
  2. I am not prone to adiction (he told me this, literally, that I don't have a personality that's easily fall into adictions)
  3. Even when I had a psychotic break and I was delusional, he only saw me acting weird and was worried about me because he didn't understand my behaviour. I still did 3 examns, even if fully delusional, and pass them with good marks. I looked weird and a bit paranoid, but my life didn't go out of control. When the delusion about the second civil war ended, I told him.... and he was like "Oh, now everything makes more sense.".
  4. He has told me he believe I could live med free even experiencing psychosis because I tend to keep doing the diarly tasks even while deluded, and tend to be coherent about everything that's not related to the delusions.
  5. I don't easily act on the delusions or hallucinations. I just hear them and believe them passively (he thought I wasn't interested on social relationship while actually I was too busy hearing to the voices to talk to people)
  6. Basically, I 'hide' my psychosis really well, because of its own nature, I don't tend to share it or act on it (voices tell me to act normal and don't share anything when I am psychotic, and to keep doing what I am supposed to do in diarly life while thinking about the delusional stuff).
  7. I took Wellbutrin before and it didn't make me psychotic, moreover I feel really good with caffeine.
  8. He gave me the smallest dosage, the one kids take, told me he would be the next day available for an emergency appointment if I got any kind of extra psychotic symptom, he told me to tell him even if I didn't mind. 
  9. Oh, I told him I didn't mind about walls talking to me, he knows I am kinda... special. "Oh, walls are telling me to kill myself, fine. Cool psychedelic walls, I have to draw them and write too!". I don't do dangerous things even if I am generally comfortable with my hallucinations (even when I don't know they are) and agree with them. Anyway, he insisted if anything like this happened (talking walls), I had to tell him.
  10. I told him I won't go ER if I get psychotic (I know when I am unless I am having a full psychotic break because I feel weird, but I can't tell exactly what is real and what is not, I just know I am psychotic) because I don't want to be given an antipsychotic and I just don't mind about psychosis, I made him clear what it's causing more troubles are negative/depressive symptoms, he knows it, he had aknowledge over the time. I guess he likes my sincerity.
  11. He knows the main reason why I am unhappy, depressive, anxious, worried... and the main thing that will determinate my future it's if I can go college or not (this means I need to focus, I need to be motivated, enjoy, etc.). I am not able to work. So even if risky, it had a good potential to help me.
  12. I openly talked about Wonderland with him for the first time, and told him I wanted to ignore and focus on the present. I know  he considers Wonderland to be a delusion or hallucination even if it's just a different perception, Wonderlands eyes.
  13. Since taking a low dosage of an AP that blocks presynaptic autoreceptors (the cell doesn't know how much dopamine is enough and therfore it enhance its neurotransmision) my social related negative symptoms and communication got much better. He notices this, he said all the team did.
  14.  He was EXTREMELY doubtful about doing it. And he is a 60 years old psychiatrist with almost 40 years of experience. I asked the first time a year ago, asked again past friday, he told me he had to think about it throught the weekend, and finally on Tuesday 17 we talked and after thinking about it while talking with me, he agreed... doubting a lot, he looked so anxious and worried about it, the next day when I saw him in the hall (it's a day hospital) I told him "Ey, I am still alive and I have not broken.". He insisted a lot about the possibility of a psychotic break, the tuesday appointment was a 40minutes talk about the risks... he never ever took so many time to prescribe a med, and he asked me what I wanted from it a lot of time to make sure the risk was worth.
  15. I don't intend to take it "forever", I use it as a motivation/joy/energy boost to do therapeutic activities and other healhing activities, it's a tool, once I am able to do this by my own, I will stop taking it. The brain generally learns over repetition, and my pdoc has seen how I am willing to learn and how much effort I do, and how I can, he wouldn't have prescribed it if my intention was taking it 'forever' (with amisulpride I have almost overcame the social related negative symptoms, but it's with amisulpride, it's not amisulpride on it's own, it's because I do a lot of work). I made him clear my intention it's not solving everything with a magic pill but improving with my own work and a little initial help from the pill (18mg of concerta it's not enough to make me happy if I don't make an effort and work on it).
  16. I am being really active, possitive and with a really good atitude about my recovering, working really hard, not waiting it to just solve by its own. He noticed this, and was an important factor why he decided to give Concerta a try.
  17. Also, I told him pills should be used to treat symptoms and not disorders, even if the medication sheets says it's for X disorder, I find it absurd. There are people with bipolar who need an AP+Mood stabilizer, others who need an AD+mood stabilizer, others who are on AP+AD, or the three of them... He said he agreed with me, this is important because there are pdocs who believe meds only work for specific conditions, this kind of pdoc would never give an stimulant to someone without ADHD and will automatically diagnosed someone with bipolar if he gets manic/hipomanic on an AD even if there is no sign of mania or hypomania without an AD, even if the AD was given for OCD.

 

I guess... you should insist on the fact you took it in the past, it helped you a ton, others meds doesn't, it didn't cause you a psychotic break, why exactly you want it, what you expect about it, make him know you know the risks and then ask the pdoc why to don't try. I think telling them how hard you are trying to do therapeutic possitive things (excercise, cultural activities, art therapy, etc...) all by your own because you want to recover, but you need more strenght to do everything, could be really helpful to convince them.

 When it's about depression, tolerance it's build really easily, so it's not a solution by itself... sometimes it takes weeks, at others months, this is why they are reclutant to prescribe them for depression or related conditions, you could be anhedonia free for 6 months and then crash if you relay everything on the pill. The same happens to AD but usually they work for years and years before they stop working, and there is not a crash as severe as with the stimulants. 

The brain has the potential to heal throught activities, it's slow, it depends on your age and your brain plastisity, but think on people with adquired brain damage, some of them go from being unable to talk or walk to be almost completely functioning again! It's not perfect, and if the situation is severe a pill might be need as a boost, but if something may be done to improve, it should be try. 

Edited by OliverB
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19 hours ago, OliverB said:

Well, It took me a year to convince him...

I don't intend to take it "forever", I use it as a motivation/joy/energy boost to do therapeutic activities and other healhing activities, it's a tool, once I am able to do this by my own, I will stop taking it. The brain generally learns over repetition, and my pdoc has seen how I am willing to learn and how much effort I do, and how I can, he wouldn't have prescribed it if my intention was taking it 'forever' (with amisulpride I have almost overcame the social related negative symptoms, but it's with amisulpride, it's not amisulpride on it's own, it's because I do a lot of work). I made him clear my intention it's not solving everything with a magic pill but improving with my own work and a little initial help from the pill (18mg of concerta it's not enough to make me happy if I don't make an effort and work on it).

  1. I am being really active, possitive and with a really good atitude about my recovering, working really hard, not waiting it to just solve by its own. He noticed this, and was an important factor why he decided to give Concerta a try.
  2. Also, I told him pills should be used to treat symptoms and not disorders, even if the medication sheets says it's for X disorder, I find it absurd. There are people with bipolar who need an AP+Mood stabilizer, others who need an AD+mood stabilizer, others who are on AP+AD, or the three of them... He said he agreed with me, this is important because there are pdocs who believe meds only work for specific conditions, this kind of pdoc would never give an stimulant to someone without ADHD and will automatically diagnosed someone with bipolar if he gets manic/hipomanic on an AD even if there is no sign of mania or hypomania without an AD, even if the AD was given for OCD.

I guess... you should insist on the fact you took it in the past, it helped you a ton, others meds doesn't, it didn't cause you a psychotic break, why exactly you want it, what you expect about it, make him know you know the risks and then ask the pdoc why to don't try. I think telling them how hard you are trying to do therapeutic possitive things (excercise, cultural activities, art therapy, etc...) all by your own because you want to recover, but you need more strenght to do everything, could be really helpful to convince them.

 When it's about depression, tolerance it's build really easily, so it's not a solution by itself... sometimes it takes weeks, at others months, this is why they are reclutant to prescribe them for depression or related conditions, you could be anhedonia free for 6 months and then crash if you relay everything on the pill. The same happens to AD but usually they work for years and years before they stop working, and there is not a crash as severe as with the stimulants. 

The brain has the potential to heal throught activities, it's slow, it depends on your age and your brain plastisity, but think on people with adquired brain damage, some of them go from being unable to talk or walk to be almost completely functioning again! It's not perfect, and if the situation is severe a pill might be need as a boost, but if something may be done to improve, it should be try. 

Wow, OliverB what an informative, helpful post. Thank you. I find it amazing that despite all of your hallucinations & delusions, you are able to still forge on, pass exams, do what you need to do daily....!! I never have hallucinations or delusions, however had a full psychotic break (long long ago) was put IP and it nearly destroyed me (the episode AND the hospitalization experience), in fact, I've pretty much try to black it out (don't remember much).

It seems though that you are able to have insight and acknowledge these delusions and not let them take over for the worse. Or to the point where you are dysfunctional. I can't even conceive how a person is able to do that. You are very strong.

I agree, the stimulants are very helpful to get out of a serious low, but they don't work effectively forever (at least IMO) It's just discouraging that despite being on them in the past (with great experience) and the fact that A/D's (don't work for me - they either make me numb/lethargic/more depressed or agitated/anxious) A/Ps are a total nightmare for me. I feel pretty depressed about it.

Like you, I'm someone who has depended on caffeine most of my life (never abused any drugs) to get out of bed (started drinking coffee at 12 years old) It doesn't do much now - but seems it could be a sign that something is off with my dopamine system (not getting/retaining enough?) I had really high hopes for Wellbutrin but that did nothing for me. Don't know what else to try - seems most of the dopamine meds are A/P's. I have tried SNRI's at high doses and that was not effective either - just more side effects.

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6 hours ago, cloudmonger said:

Wow, OliverB what an informative, helpful post. Thank you. I find it amazing that despite all of your hallucinations & delusions, you are able to still forge on, pass exams, do what you need to do daily....!! I never have hallucinations or delusions, however had a full psychotic break (long long ago) was put IP and it nearly destroyed me (the episode AND the hospitalization experience), in fact, I've pretty much try to black it out (don't remember much).

It seems though that you are able to have insight and acknowledge these delusions and not let them take over for the worse. Or to the point where you are dysfunctional. I can't even conceive how a person is able to do that. You are very strong.

I agree, the stimulants are very helpful to get out of a serious low, but they don't work effectively forever (at least IMO) It's just discouraging that despite being on them in the past (with great experience) and the fact that A/D's (don't work for me - they either make me numb/lethargic/more depressed or agitated/anxious) A/Ps are a total nightmare for me. I feel pretty depressed about it.

Like you, I'm someone who has depended on caffeine most of my life (never abused any drugs) to get out of bed (started drinking coffee at 12 years old) It doesn't do much now - but seems it could be a sign that something is off with my dopamine system (notaregetting/retaining enough?) I had really high hopes for Wellbutrin but that did nothing for me. Don't know what else to try - seems most of the dopamine meds are A/P's. I have tried SNRI's at high doses and that was not effective either - just more side effects.

 

Oh, thank you, I have never seen myself as specially strong because of how I handle psychosis, I think the fact that It started when I was really young and my personality makes it feels natural... actually, when I lost most of my psychosis I felt so uncomfortable I wanted to be asleep all the time and took 100mg of diazepam in a day, I didn't know how to function without psychosis! I was so used to have voices almost all the time I got confused.

Uhm, there are some antipsychotic that at low dose enhance dopamine because they block presynaptic autoreceptors... but they should be taken at low doses, like amisulpride, sulpiride and flupenthixol. Amisulpride it's not available in the US but I don't know about the other two... have you tried anything like this?

I know side effects of AP can be horrible, I can't stand any at a therapeutic dosage for psychotic possitive symptoms. Therapeutic range for amisulpride is 400-800mg and I take 50mg...

Edited by OliverB
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25 minutes ago, OliverB said:

Oh, thank you, I have never seen myself as specially strong because of how I handle psychosis, I think the fact that It started when I was really young and my personality makes it feels natural... actually, when I lost most of my psychosis I felt so uncomfortable I wanted to be asleep all the time and took 100mg of diazepam in a day, I didn't know how to function without psychosis! I was so used to have voices almost all the time I got confused.

Uhm, there are some antipsychotic that at low dose enhance dopamine because they block presynaptic autoreceptors... but they should be taken at low doses, like amisulpride, sulpiride and flupenthixol. Amisulpride it's not available in the US but I don't know about the other two... have you tried anything like this?

I know side effects of AP can be horrible, I can't stand any at a therapeutic dosage for psychotic possitive symptoms. Therapeutic range for amisulpride is 400-800mg and I take 50mg...

Did the psychosis start out as a defense mechanism to protect you? I can see that if you've lived with it so long, it is your "Normal." Whereas, for someone like me, who has never experienced those symptoms (especially at an acute level) it was extremely traumatic, confusing and distressful....losing all connection to your identity and others. It's interesting that the psychosis is a way for you to function in the world, and for most - they see psychosis like as "far off the deep end" a person can go (many pdocs see it this way at least) Their first priority is to prevent this sort of break from reality.

Nope I have never tried (or heard of Amisulpride, sulpiride and flupenthixol) How does the amisulpride effect you? Is it sedating/anti-anxiety/calming etc? Or does it provide relief from another type of symptom (other than voices?) like quieting your mind or removing negative thoughts? obsessions?

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4 hours ago, cloudmonger said:

Did the psychosis start out as a defense mechanism to protect you? I can see that if you've lived with it so long, it is your "Normal." Whereas, for someone like me, who has never experienced those symptoms (especially at an acute level) it was extremely traumatic, confusing and distressful....losing all connection to your identity and others. It's interesting that the psychosis is a way for you to function in the world, and for most - they see psychosis like as "far off the deep end" a person can go (many pdocs see it this way at least) Their first priority is to prevent this sort of break from reality.

Nope I have never tried (or heard of Amisulpride, sulpiride and flupenthixol) How does the amisulpride effect you? Is it sedating/anti-anxiety/calming etc? Or does it provide relief from another type of symptom (other than voices?) like quieting your mind or removing negative thoughts? obsessions?

Amisulpride makes me less tired, activate me, but without causing anxiety. It reduces social related negative symptoms (like social anhedonia), and makes it easier for me to interact with the World.

It doesn't change my mind really much, just makes it easier to stay in the real World.

I guess the first mechanism I had to protect myself was dissociation, but because of chronic stress I ended up with psychosis. I had some psychotic symptoms since 8, but didn't enter the "psychotic land" until 11 or 12 when I started to hear a voice that narrated what I did, and heard to music while there wasn't anything playing music, ... I completely lost touch with reality at 14, I was really psychotic (too much voices mainly), locked myself in a bathroom than nobody used with food, coffee and a computer, from sleep deprivation and coffe I first got hypomanic and then manic (and cut myself because it was hilarious to bleed). Anyway, any of this wasn't traumatizing for me, I remember it like a psychedelic trip.

I never had a connection with "my identity" because of dissociation or with others because of my dysfunctional family and because we moved many times a year and I never had time enough to make friends. So I guess psychosis made me more company? Dissociation did too, my pdoc told me I dissociate a lot, I have something that's like an alter (non psychotic), it's like a second head, and had been there... since ever? I don't know, I think I am attached to my psychotic experiences, I miss when I thought a second civil war was about to begin and I was preparing everything and training to survive, at least I had something to do and to be busy. My real life is... boring, I just have college and the day hospital (and I haven't been able to attend to college because of anxiety and psychosis, hope this next semester I can, I am much better).

Edited by OliverB
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7 hours ago, OliverB said:

Update:

I am doing really well with 18mg of concerta. sometimes I take a second pill around 12:00am if I have too much work to do in the afternoon and evening and I am having a lazy day.

That is great news!

Just a thought ... if you take an extra pill sometimes during the day you might run out of meds before it can refilled again. 

Maybe next time you see pdoc you can ask for an increase in dose since it is helping you so much.  I know your pdoc was very reluctant about prescribing you this med.  So I'm really glad it is working for you :)

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On 1/20/2017 at 10:12 PM, OliverB said:

So I guess psychosis made me more company? Dissociation did too, my pdoc told me I dissociate a lot, I have something that's like an alter (non psychotic), it's like a second head, and had been there... since ever? I don't know, I think I am attached to my psychotic experiences, I miss when I thought a second civil war was about to begin and I was preparing everything and training to survive, at least I had something to do and to be busy. My real life is... boring, I just have college and the day hospital (and I haven't been able to attend to college because of anxiety and psychosis, hope this next semester I can, I am much better).

Seems like you are very creative...probably very smart also to use your mind/imaginative means to protect yourself and give yourself some needed company. I mean, the "bad voices" are not good of course...but sounds like you had some good from it. I'm sorry your childhood has been so traumatic. I don't know how I could possibly deal with that. Happy to hear that the stimulant is helping as well.

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Yap, I am going to tell my pdoc somtimes I take 2 pills.

And I also want to ask him about Ritalin 5mg. Some days I don't need energy through all day but only a certain points, so maybe those days, to take less med (18mg concerta vs 5mg ritalin), it would be a better idea to have Ritalin. Also, sometimes I don't know if I will be too tired to do soomething or not, and if it's in the early morning I can take the Concerta, but if it is after the afternoon I can't. Since Ritalin has a 2-5h half life I could take it even at 5pm.

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7 minutes ago, OliverB said:

And I also want to ask him about Ritalin 5mg. Some days I don't need energy through all day but only a certain points, so maybe those days, to take less med (18mg concerta vs 5mg ritalin), it would be a better idea to have Ritalin. Also, sometimes I don't know if I will be too tired to do soomething or not, and if it's in the early morning I can take the Concerta, but if it is after the afternoon I can't. Since Ritalin has a 2-5h half life I could take it even at 5pm.

Are you worried that it will stop working (the Ritalin or Concerta?) I was worried about this. It seems it works in the beginning (maybe for the first month) and then the major effects wear off and you increase or need to stop for awhile. That's the worrisome part of stimulants :-( Though maybe some people don't experience the tolerance thing.

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1 hour ago, cloudmonger said:

Are you worried that it will stop working (the Ritalin or Concerta?) I was worried about this. It seems it works in the beginning (maybe for the first month) and then the major effects wear off and you increase or need to stop for awhile. That's the worrisome part of stimulants :-( Though maybe some people don't experience the tolerance thing.

Yeap, I am. 

I am not taking Concerta this Friday, Saturday and Sunday to rest.

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