Iceberg Posted March 10, 2017 Share Posted March 10, 2017 I have been on at least two AP/aaps in combo for years now, even though studies show it doesn't always help. Do you guys get benefit from antipsychotic combos? Right now I'm taking 2 plus a prn Thorazine and I'm really afraid the long term side effects wil nail me down the line. On the other hand, only ECT has been helpful...mood stabilizers haven't. I'm maxed on one (Vraylar) and my blood level is Maxed on another (clozaril). Of course both my mood stabilizer and my stimulant and my benzo are maxed too....so uh... Link to comment Share on other sites More sharing options...
melissaw72 Posted March 10, 2017 Share Posted March 10, 2017 4 hours ago, Iceberg said: I'm maxed on one (Vraylar) and my blood level is Maxed on another (clozaril). Of course both my mood stabilizer and my stimulant and my benzo are maxed too....so uh... I am not on 2 APs, but was wondering if it might be the time to consider trying another med/s in place of the vraylar and/or clozaril. Being at the max dose of each, including maxed doses on some other meds )stimulant and benzo), there is no room for improvement (ie you can't increase the doses of any of them), IMO. I think it is something that is worth asking your pdoc about. Link to comment Share on other sites More sharing options...
Iceberg Posted March 10, 2017 Author Share Posted March 10, 2017 Unfortunately, there isn't much I haven't tried...basically risperdal-invega which we don't want to do cuz I already had the "man boobs" problem from zyprexa ...and then saphris. Tried basically every other app and also a few typicals (still use the Thorazine) so unfortunately there is no obvious choice. It tends to go: stable on meds, have an episode, max that new med, stable, new episode, screwed and need a new med again....the Vraylar is new so I have some hope for that Link to comment Share on other sites More sharing options...
melissaw72 Posted March 10, 2017 Share Posted March 10, 2017 11 minutes ago, Iceberg said: Unfortunately, there isn't much I haven't tried...basically risperdal-invega which we don't want to do cuz I already had the "man boobs" problem from zyprexa ...and then saphris. Tried basically every other app and also a few typicals (still use the Thorazine) so unfortunately there is no obvious choice. It tends to go: stable on meds, have an episode, max that new med, stable, new episode, screwed and need a new med again....the Vraylar is new so I have some hope for that I know Rexulti is new also, have you tried that? *I haven't tried it, just know it is a new AP also. Link to comment Share on other sites More sharing options...
Iceberg Posted March 10, 2017 Author Share Posted March 10, 2017 Yep...actually that's what the Vraylar replaced Link to comment Share on other sites More sharing options...
Iceberg Posted March 10, 2017 Author Share Posted March 10, 2017 Also: geodon, latuda, zyprexa, seroquel, abilify Link to comment Share on other sites More sharing options...
melissaw72 Posted March 10, 2017 Share Posted March 10, 2017 What about these? Risperdal Invega Clozaril Saphris Fanapt Link to comment Share on other sites More sharing options...
Iceberg Posted March 10, 2017 Author Share Posted March 10, 2017 I'm on clozaril...like i said earlier I can't do risperdal/invega at a significant does due to prolactin issues....also doc and I were worried that + clozaril= zombie. saphris can be really sedating which I definitely don't need ive never heard of someone using fanapt for BP...maybe on the internet but that seems like a big shot in the dark...I have no idea what effect that would have thanks for trying to help tho Link to comment Share on other sites More sharing options...
Iceberg Posted March 10, 2017 Author Share Posted March 10, 2017 Most of the stuff I read said it worked for mania. But as a last resort, but didn't help depression so much...unfortunately I need more of a stabilizer cuz I already have the cloz....which is another reason to avoid risperdal Link to comment Share on other sites More sharing options...
Teh Gaben Posted March 10, 2017 Share Posted March 10, 2017 I've been using abilify and haloperidol for around a year now. It started off working ok, but has since lost its efficacy. My pdoc swears by haloperidol though, reackons it's really beneficial, as for me, I'm not so sure. Link to comment Share on other sites More sharing options...
Iceberg Posted March 10, 2017 Author Share Posted March 10, 2017 I always thought of it more for psychosis than long term stabilization especially for BP...or as a PRN Link to comment Share on other sites More sharing options...
Iceberg Posted March 10, 2017 Author Share Posted March 10, 2017 I did use perphenazine long term at a high dose though Link to comment Share on other sites More sharing options...
PsiloDream Posted March 18, 2017 Share Posted March 18, 2017 (edited) Two APs is generally considered redundant however what about using clozaril plus a strong D2 antagonist that doesn't do much else because clozaril is so broad-spectrum, same with zyprexa, as in it hits a ton of receptors but doesn't block them crazy crazy strongly like some of the old school antipsychotics i don't know much about vraylar, as far as its mechanism of action, have you considered a very strong D2 antagonist typical AP like prolixin or haldol with clozaril? That would theoretically cover the major bases fairly well, just my thoughts Edited March 18, 2017 by PsiloDream Link to comment Share on other sites More sharing options...
mjs190 Posted March 18, 2017 Share Posted March 18, 2017 Saphris can be helpful for both mania and mixed/depression in bipolar illness. One of the only reasons Fanapt isn't used frequently is because the drug company "messed up" the receptor binding profile of the drug when they first released it, so people were weary of using it. And I think thats caused a lot of problems for them in terms of the drug not taking off. But its a pretty potent D2 antagonist, among other things like alpha-1 blocking. Link to comment Share on other sites More sharing options...
Iceberg Posted March 18, 2017 Author Share Posted March 18, 2017 Psilo- that seems like a realllllly strong punch, and is be worried about side effects. Link to comment Share on other sites More sharing options...
PsiloDream Posted March 18, 2017 Share Posted March 18, 2017 I've known people who were on that combo and did very well. Remember, haldol (and prolixin for that matter) are now dosed much lower than they were previously, at least by competent psychiatrists. It's not as intense as you might think and honestly it's probably more rational side-effect wise and as far as being specific to what you're doing to you're brain than taking two different medications that do a whole bunch of things to whole bunch of receptors 1 Link to comment Share on other sites More sharing options...
Iceberg Posted March 19, 2017 Author Share Posted March 19, 2017 But haldol or Direct D2 typicals won't help depressive symptoms... Link to comment Share on other sites More sharing options...
PsiloDream Posted March 19, 2017 Share Posted March 19, 2017 Well you're maxed out on a mood stabilizer and a benzo, if you're feeling depressed I would take a look at being on high dose benzodiazepine as a possible culprit. Otherwise I wouldn't be looking to two atypical APs for depression help I mean are you trying to control psychosis here? That's what I assumed it would help if you explained your persisting symptoms Link to comment Share on other sites More sharing options...
Iceberg Posted March 19, 2017 Author Share Posted March 19, 2017 No...they aren't treating depression...it's the mixed episode ...that came after the depression ...the depresson predated the benzo...I have no go to for depresson at all ...if we are talking about psychosis I completly agree with your original suggestion It was more of a general question about taking two AP with more benefit than one Ap Link to comment Share on other sites More sharing options...
mikl_pls Posted March 22, 2017 Share Posted March 22, 2017 On 3/10/2017 at 0:35 PM, The Hitcher said: I've been using abilify and haloperidol for around a year now. It started off working ok, but has since lost its efficacy. My pdoc swears by haloperidol though, reackons it's really beneficial, as for me, I'm not so sure. This was actually what I was going to suggest... something like Abilify (or a dopamine partial agonist, which means you could keep the Vraylar for that matter), and top it off with a typical antipsychotic (doesn't necessarily have to be Haldol). Prolixin is dosed 1:1 as Haldol (e.g., 1 mg Prolixin = 1 mg Haldol), and like @PsiloDream said, they're dosed much lower than they used to be. You could ask your doctor about cross-tapering off the Clozaril and tapering onto a typical antipsychotic that hits the D2 receptors real hard like Prolixin (D2 Ki = 0.54 nM), Trilafon (D2 Ki = 0.765 nM, though I think you said you've already taken this), Navane (D2 Ki = 1.4 nM), or Stelazine (D2 Ki = 1.12 nM). For me, personally, Stelazine has a mood-brightening effect as well as tranquilizing effect. I also agree that the 4 mg Klonopin probably needs a gandering at... Perhaps something like clorazepate or diazepam would be better? Ask your pdoc and see what s/he thinks about it. Klonopin for me, if I go above 2 mg regularly, I get super depressed... Link to comment Share on other sites More sharing options...
Iceberg Posted March 22, 2017 Author Share Posted March 22, 2017 Thank guys for all your ideas. I can't take abilify but the Vraylar is basically the same idea. The clozaril was used because when I first started with my new doc I was on a high dose of perphenazine and it wasn't working and my last stupid doc also had me on two more aps. There are two problems with the typical approach. 1) I already have akathisia from Vraylar and I can't afford more...it makes me suicidal. 2) the clozaril acts more like a mood stabilizer for me...meaning it helps with depressive symptoms too which those D2 meds aren't great at...I have been more stable on clozaril+lithium than ever in the past. Also if you go off and then realize you need it you have to start the Bloodwork and refills on a weekly basis. Once was enough for me on that. The klonipin was added after the depression started and I haven't noticed any worsening....and with it I'm actually sleeping normally...for a week now...first time in years...and yes I kno, no "you'll get addicted please." Valium is what we used last time and it didn't quite do the trick the tricky thing is I'm on/been on/can't use...most treatments for depression. There has been some studies with Vraylar and negative symptoms (pdoc) so I guess maybe that could help a little. But the answer for me is adderall (again, I understand the risks). We just tweaked that to add some XR to boost my mood (hopefully) by avoiding the ir crash. My doc flat out told me that we can control mood extremes and other severe issues but that I will have more "in between" ups and downs....ex he didn't even blink when I said "suicidal thoughts" and he's right...I've been on 35 meds...it's time for some acceptance. Finally (sorry this is a forever post), clozaril is indicated to help suicidality in SZ and SZA. I kno I'm neither but I have definitely got that benefit. Idk maybe I'm just a weirdo when it comes to chemistry Link to comment Share on other sites More sharing options...
La La LOLocaust Posted April 15, 2017 Share Posted April 15, 2017 I'm currently on Saphris and Vraylar, but I think it's temporary. Will (hopefully, if insurance will cover it) wind up going up to the max dose of Saphris and dumping the Vraylar. Vraylar worked like a miracle for me, but the insomnia was so severe I had to call it quits. They dropped me from 6mg to 1.5 mg and currenlty a modest 5mg of Saphris but it's working wonders. Link to comment Share on other sites More sharing options...
aura Posted April 15, 2017 Share Posted April 15, 2017 I wonder if I really need to be on Seroquel or not. I've been well since adding on Zyprexa, but my doc doesn't want to take me off Seroquel in case it's the combo that's working. Link to comment Share on other sites More sharing options...
La La LOLocaust Posted April 15, 2017 Share Posted April 15, 2017 1 minute ago, aura said: I wonder if I really need to be on Seroquel or not. I've been well since adding on Zyprexa, but my doc doesn't want to take me off Seroquel in case it's the combo that's working. That's a heavy combo, but my advice is if it's working, stick with it. No sense in meddling where it could potentially be unhelpful or worse. Link to comment Share on other sites More sharing options...
Iceberg Posted April 15, 2017 Author Share Posted April 15, 2017 ive done Seroquel/zyprexa but my Seroquel was lower...but I was also on a third ap - idiot doc Link to comment Share on other sites More sharing options...
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