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I'm on the following meds, all in daily total mg - Abilify 35 mg, Klonopin 1.5 mg, Invega 12 mg, Lamictal 300 mg, Seroquel XR 800 mg, Yaz, Nuvigil 200 mg, Synthroid 25 mcg, Metformin 1000 mg, Topamax 50 mg, Lunesta 3 mg PRN, Vistaril 150 mg PRN

I see pdoc on Wednesday. 

I'd like to get off Seroquel and Abilify. I'd like to stay on invega and start Latuda (or something else). I've had it with side effects from Seroquel (pre diabetes and weight gain and depression and fatigue) and I believe Abilify has mostly stopped working for me. 

I hope invega will control the highs and psychosis and Latuda controls the lows and psychosis. Klonopin controls anxiety well enough. Lamictal helps mood too. 

Is this stupid? In the past no Seroquel has meant bad psychotic thinking and mania and the hospital. I've been on Seroquel and Abilify for 10 years give or take. Help? 

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Sounds like you need to streamline...I wouldn't automatically just add back the latuda...if see how u do on just invega first...hey maybe it'll work...what about another mood stabilizer instead ? (If your schizoaffective). Another option is a newer med with some agonist action on dopamine receptors....Vraylar and rexulti. Vraylar is said by some to control negative symptoms 

Edited by Iceberg
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44 minutes ago, Iceberg said:

Sounds like you need to streamline...I wouldn't automatically just add back the latuda...if see how u do on just invega first...hey maybe it'll work...what about another mood stabilizer instead ? (If your schizoaffective). Another option is a newer med with some agonist action on dopamine receptors....Vraylar and rexulti. Vraylar is said by some to control negative symptoms 

You're right. I might do well just getting off Seroquel and staying on invega and abilify. I might feel a lot better.

I am schizoaffective you are correct.

I am interested in vraylar as well. In the past I've wanted to try it. 

Thank you so much for your input and the ideas! That helps a lot!

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9 hours ago, Iceberg said:

For me Vraylar is very benign...to the point where It's hard to tell how much it really helps...but I would tell people it's worth a shot

Ok thanks. I haven't heard the greatest things about vraylar to be honest from what I've read here and there. Hmmm

I did the best on zyprexa (a hospital pdoc called it my miracle med) but what's the point of going back on that? It's worse than Seroquel for weight gain and higher blood sugars. Isn't it? 

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Maybe taper off either Abilify or Seroquel first and make sure your psychosis is controlled? I wouldn't d/c more than one AP at a time, especially at those doses of Abilify and Seroquel. That Abilify might be doing more for you than you think. It has such a long half-life that tapering it takes a long while. The Seroquel you could probably taper quicker, and have a much better idea of how much it's benefiting you. If your goal is to reduce meds, I wouldn't cross-taper to Latuda yet, I would wait and see how things go (slowly) coming off one of your existing meds.

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On 5/21/2017 at 7:10 PM, Wonderful.Cheese said:

Abilify 35 mg, Klonopin 1.5 mg, Invega 12 mg, Lamictal 300 mg, Seroquel XR 800 mg, Yaz, Nuvigil 200 mg, Synthroid 25 mcg, Metformin 1000 mg, Topamax 50 mg, Lunesta 3 mg PRN, Vistaril 150 mg PRN

[...]

I hope invega will control the highs and psychosis and Latuda controls the lows and psychosis. Klonopin controls anxiety well enough. Lamictal helps mood too. 

In the past no Seroquel has meant bad psychotic thinking and mania and the hospital. I've been on Seroquel and Abilify for 10 years give or take. Help? 

4

I agree, you definitely need to streamline. You are on the max dose on two antipsychotics and 5 mg past the max dose on another. It's best to try to be on one antipsychotic if possible, but if you must be on two antipsychotics, a strong, therapeutic dose of one plus a low dose of the second is usually indicated, which means the adjunctive antipsychotic must be of antipsychotic potency at a low dose (in other words, not something like 100 mg Seroquel...)

So you need prophylaxis against highs, lows, and psychosis, and doing without Seroquel has equated to psychosis, mania, and hospitalization, even with two other max dosed antipsychotics on board...

Seroquel is a very low-potency antipsychotic, but has high-potency 5-HT2A antagonism relative to its D2 antagonism, especially its active metabolite, norquetiapine. I wonder if this has something to do with the ratio of 5-HT2A to D2 antagonism...
Quetiapine's ratio is 1.0779:1
Norquetiapine's ratio is 4.0889:1
Paliperidone's ratio is 4.947:1
(And aripiprazole's ratio, which isn't really contributory, is 1:18.421)
I wonder if you would do better with an antipsychotic with much stronger 5-HT2A antagonism? Have you ever tried Saphris or Geodon?

Another thing you could probably try is slowly titrating off of the Seroquel and one of the other two as well (one at a time of course, but if it were me, I'd titrate off the Invega and keep the Abilify), and add a high-potency first-generation antipsychotic, like Haldol, Prolixin, Trilafon, Stelazine, Navane, etc. It wouldn't have to be dosed that high...  The reason I would keep the Abilify is that it's a dopamine partial agonist, and combined with a typical antipsychotic, the pharmacological profiles make them compliment each other well (that's what I've read about this combination technique anyway...).

Something else you might try is to add another mood stabilizer. Carbamazepine (Tegretol) is often added to patients with treatment-resistant psychosis with mood elevation. Of course with it being a CYP-inducer, you'd have to double your Lamictal dose to 600 mg if you were to take that... Depakote/Depakene are also an option, but weight gain is a major risk with those... Lithium also, but again, weight gain, but also other problems like kidney, thyroid, etc.

You also could try an increased Klonopin dose, which itself has mood-stabilizing properties.

What's the Topamax doing for you?

That's a LOT of Vistaril! Is that for sleep, anxiety, agitation, mania?

Edited by mikl_pls
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3 hours ago, mikl_pls said:

I agree, you definitely need to streamline. You are on the max dose on two antipsychotics and 5 mg past the max dose on another. It's best to try to be on one antipsychotic if possible, but if you must be on two antipsychotics, a strong, therapeutic dose of one plus a low dose of the second is usually indicated, which means the adjunctive antipsychotic must be of antipsychotic potency at a low dose (in other words, not something like 100 mg Seroquel...)

So you need prophylaxis against highs, lows, and psychosis, and doing without Seroquel has equated to psychosis, mania, and hospitalization, even with two other max dosed antipsychotics on board...

Seroquel is a very low-potency antipsychotic, but has high-potency 5-HT2A antagonism relative to its D2 antagonism, especially its active metabolite, norquetiapine. I wonder if this has something to do with the ratio of 5-HT2A to D2 antagonism...
Quetiapine's ratio is 1.0779:1
Norquetiapine's ratio is 4.0889:1
Paliperidone's ratio is 4.947:1
(And aripiprazole's ratio, which isn't really contributory, is 1:18.421)
I wonder if you would do better with an antipsychotic with much stronger 5-HT2A antagonism? Have you ever tried Saphris or Geodon?

Another thing you could probably try is slowly titrating off of the Seroquel and one of the other two as well (one at a time of course, but if it were me, I'd titrate off the Invega and keep the Abilify), and add a high-potency first-generation antipsychotic, like Haldol, Prolixin, Trilafon, Stelazine, Navane, etc. It wouldn't have to be dosed that high...  The reason I would keep the Abilify is that it's a dopamine partial agonist, and combined with a typical antipsychotic, the pharmacological profiles make them compliment each other well (that's what I've read about this combination technique anyway...).

Something else you might try is to add another mood stabilizer. Carbamazepine (Tegretol) is often added to patients with treatment-resistant psychosis with mood elevation. Of course with it being a CYP-inducer, you'd have to double your Lamictal dose to 600 mg if you were to take that... Depakote/Depakene are also an option, but weight gain is a major risk with those... Lithium also, but again, weight gain, but also other problems like kidney, thyroid, etc.

You also could try an increased Klonopin dose, which itself has mood-stabilizing properties.

What's the Topamax doing for you?

That's a LOT of Vistaril! Is that for sleep, anxiety, agitation, mania?

I have read your post. Thank you so much! I don't have time to properly reply at this moment but I will after I see tdoc. I hope to have time then!!!!! 

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5 hours ago, mikl_pls said:

I agree, you definitely need to streamline. You are on the max dose on two antipsychotics and 5 mg past the max dose on another. It's best to try to be on one antipsychotic if possible, but if you must be on two antipsychotics, a strong, therapeutic dose of one plus a low dose of the second is usually indicated, which means the adjunctive antipsychotic must be of antipsychotic potency at a low dose (in other words, not something like 100 mg Seroquel...)

So you need prophylaxis against highs, lows, and psychosis, and doing without Seroquel has equated to psychosis, mania, and hospitalization, even with two other max dosed antipsychotics on board...

Seroquel is a very low-potency antipsychotic, but has high-potency 5-HT2A antagonism relative to its D2 antagonism, especially its active metabolite, norquetiapine. I wonder if this has something to do with the ratio of 5-HT2A to D2 antagonism...
Quetiapine's ratio is 1.0779:1
Norquetiapine's ratio is 4.0889:1
Paliperidone's ratio is 4.947:1
(And aripiprazole's ratio, which isn't really contributory, is 1:18.421)
I wonder if you would do better with an antipsychotic with much stronger 5-HT2A antagonism? Have you ever tried Saphris or Geodon?

Another thing you could probably try is slowly titrating off of the Seroquel and one of the other two as well (one at a time of course, but if it were me, I'd titrate off the Invega and keep the Abilify), and add a high-potency first-generation antipsychotic, like Haldol, Prolixin, Trilafon, Stelazine, Navane, etc. It wouldn't have to be dosed that high...  The reason I would keep the Abilify is that it's a dopamine partial agonist, and combined with a typical antipsychotic, the pharmacological profiles make them compliment each other well (that's what I've read about this combination technique anyway...).

Something else you might try is to add another mood stabilizer. Carbamazepine (Tegretol) is often added to patients with treatment-resistant psychosis with mood elevation. Of course with it being a CYP-inducer, you'd have to double your Lamictal dose to 600 mg if you were to take that... Depakote/Depakene are also an option, but weight gain is a major risk with those... Lithium also, but again, weight gain, but also other problems like kidney, thyroid, etc.

You also could try an increased Klonopin dose, which itself has mood-stabilizing properties.

What's the Topamax doing for you?

That's a LOT of Vistaril! Is that for sleep, anxiety, agitation, mania?

I have tried saphris and it worked but I ate in my sleep tons and tons of food. Just incredible amounts of random food! I gained 40 lbs min. very rapidly. So I unfortunately had to stop it. I tried it a second time even. Same bad side effects. 

Geodon didn't work for me. I was IP and it was tried for almost 3 months. A switch to abilify made a great difference and I could go home after so long.

My new pdoc wanted me to take abilify and haldol (eliminating Seroquel). I started 5 mg haldol three times a day. I got very worried about TD. So I stopped haldol after only days of trying it. That's the only typical I've tried. I'm scared of them. Would such a low dose automatically mean TD years down the line?

So after stopping haldol I started the invega 12 mg and the over medicated mess got worse. But the messages from the radio and TV have stopped mostly after invega.

I've never tried tegretol. I'd be willing to try it. I've already got thyroid issues so I'm leary of lithium. Depakote worries me because of weight issues.

Tomorrow I plan on asking for an evening Klonopin dose because of anxiety in the evenings. It's been a wonder drug for my anxiety. I've been on as much as 3 mg total a day.

Topamax just got added for weight loss and hopefully it will work for mood as well.

I can take take 50 mg vistaril three times a day. I take it PRN for anxiety or agitation mostly and sometimes if I need to sleep better. If I'm really bad off I'll take 100 mg vistaril at once.

Sorry for the super long reply!

Lastly I halved my Seroquel dose to 400 mg last night. I will tell pdoc tomorrow.

I wonder if either trying haldol with abilify or staying on invega and abilify are my best options. I respond the best to AP's and have been so much better on two of them instead of one. Not constantly in and out of hospitals anymore.

On 5/22/2017 at 11:23 AM, dtac said:

Maybe taper off either Abilify or Seroquel first and make sure your psychosis is controlled? I wouldn't d/c more than one AP at a time, especially at those doses of Abilify and Seroquel. That Abilify might be doing more for you than you think. It has such a long half-life that tapering it takes a long while. The Seroquel you could probably taper quicker, and have a much better idea of how much it's benefiting you. If your goal is to reduce meds, I wouldn't cross-taper to Latuda yet, I would wait and see how things go (slowly) coming off one of your existing meds.

Thank you too! I will focus on getting off Seroquel first I think for sure. One thing at a time. It's hard to be patient. But it will be worth it.

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3 minutes ago, Wonderful.Cheese said:

I have tried saphris and it worked but I ate in my sleep tons and tons of food. Just incredible amounts of random food! I gained 40 lbs min. very rapidly. So I unfortunately had to stop it. I tried it a second time even. Same bad side effects. 

2

That's very unfortunate! Saphris usually doesn't do that to people, but I understand how it is when you get a side effect from a medicine that no one else seems to get! Especially when it comes to weight gain! (Jeez! It sure sucks!)

4 minutes ago, Wonderful.Cheese said:

Geodon didn't work for me. I was IP and it was tried for almost 3 months. A switch to abilify made a great difference and I could go home after so long.

That's also unfortunate... Geodon is a really tricky antipsychotic to take, especially for psychosis. It needs to be dosed higher, 120-160 mg/day, sometimes even up to a maximum of 320 mg/day. The key to making sure this antipsychotic is successfully taken is taking each dose with at least 500 calories of food to ensure proper absorption; otherwise, if there is inadequate caloric intake to go along with it, it will decrease its absorption, effectively decreasing its dose to a less-than-efficacious therapeutic level, causing breakthrough psychosis and/or mania (whichever one is taking it for).

That's good that the Abilify worked well enough for you that you were able to go home! It just seems unfortunate that you say it seems like it might not be effective anymore. There are actually case reports of people needing up to 60 mg of Abilify, so it isn't unheard of to take much higher doses than 30 mg. You'd have to speak with your pdoc about whether that would be worth pursuing, especially with your combination, or whether increasing it could allow you to consolidate your combo.

12 minutes ago, Wonderful.Cheese said:

My new pdoc wanted me to take abilify and haldol (eliminating Seroquel). I started 5 mg haldol three times a day. I got very worried about TD. So I stopped haldol after only days of trying it. That's the only typical I've tried. I'm scared of them. Would such a low dose automatically mean TD years down the line?

Wow, 5 mg 3x/day of Haldol to start with? In my opinion, that's kind of a hefty dose to be taking on top of another antipsychotic... I think that would be appropriate for monotherapy, but even with monotherapy, I would think you would start lower and go up slower, that is unless your psychosis was very severe. But still, as an adjunctive agent, I still don't think that much Haldol would be necessary to start with, maybe eventually to work up to, but start low and go up slowly to see if you respond to a lower dose so you could potentially be dosed more conservatively.

According to Stahl's Prescriber's Guide, Haldol can be initiated anywhere from 1 mg to 15 mg/day given once daily or in divided doses. According to Epocrates, it says "Start: 0.5-2 mg po bid-tid for moderate symptoms, 3-5 mg po bid-tid for severe symptoms." This is my uneducated opinion, but I would be inclined to believe that if Haldol were to be combined with another antipsychotic, the "moderate symptoms" dose range would be used first, then if needed, titrate up to the "severe symptoms" range.

Other typicals exist that may not be as TD-inducing as Haldol (I think Haldol is regarded as the worst offender of TD...).

  • Prolixin, for example, is a decent one with high potency, and while it does have a high incidence of EPS, I don't really hear too much about TD as a result of it as I do from Haldol... Stahl says initial dosing is 0.5-10 mg/day in divided doses, and Epocrates says to start 2.5-10 mg/day divided every 6-8 hours.
  • Trilafon, another high-potency phenothiazine, also has a high incidence of EPS, but for some reason, I haven't read about TD as much coming from it. Stahl says "4-8 mg 3x/day," Epocrates says the same thing. As an add-on, though, you might need a lower dose, like 2-4 mg 2-3x/day? I'm just guessing based on how multiple drugs inhibit each others' metabolism.
  • Stelazine (my favorite...), high-potency phenothiazine: Epocrates: "Start: 1-2 mg po bid, dose: 2-5 mg po bid." Stahl: "initial: 2-5 mg twice a day, increase gradually over 2-3 weeks."
  • Navane, a high-potency thioxanthene: Epocrates: "2 mg po tid if mild/moderate, 5 mg po bid if severe; dose: 2-5 mg po bid-tid," Stahl: "initial: 5-10 mg/day"

Another typical, which I've been very interested in trying (my pdoc won't let me try it) is loxapine (Loxitane), because at low doses, it behaves like an atypical antipsychotic (it has a higher affinity for 5-HT2A than D2 receptors, but apparently affinity for D2 exceeds 5-HT2A in higher doses, making it more "typical" again). It also produces the tetracyclic antidepressant amoxapine (Asendin) as an active metabolite, which could help with depressive symptoms. According to Stahl, when dosed < 50 mg/day, especially 5-25 mg/day, it behaves the most like an atypical. But above 50 mg/day, it loses its "atypicality." This could be another possibility for an adjunctive agent, though where in your regimen it may fit I don't know. I just thought I would mention it for interest.

I don't know for sure if lower doses of typicals would keep TD from occurring, keep it at bay longer, or have no effect on when it would develop (if it were to develop) at all. Supposedly the atypicals can have just as much of a risk of inducing TD as the typicals do if they are dosed high enough, and even though TD isn't as much of a problem with the atypicals (or at least that's the common perception/belief), it's still very possible for TD to develop from atypicals (and does in a population of patients). So I really don't know if lower doses of typicals mean less risk of TD... I do know that they are dosed much lower now than they were back in the day, which is when the reports of TD were really coming in. Maybe if they did some long-term studies on the use of first-gens with more conservative dosing, it might reveal some insight, but unfortunately, there's a huge stigma about the typicals AND the majority of the interest lies in the newer atypicals, and while it just so happens that some people don't respond adequately to the atypicals, can't tolerate them, or do better on the typicals, it's highly unlikely that any real studies will ever be done on the typicals ever again, I don't think.

45 minutes ago, Wonderful.Cheese said:

I've never tried tegretol. I'd be willing to try it. I've already got thyroid issues so I'm leary of lithium. Depakote worries me because of weight issues.

Tegretol is a pretty nice medicine, but it does have a risk for some pretty severe side effects. I'd read up about it and/or ask your pdoc about them before really considering going on this drug. Again, you'll have to double your Lamictal dose if you take Tegretol to maintain the same plasma levels of Lamictal in your system since it speeds up Lamictal clearance from your body.

In fact, you'll have to double the dose of Abilify, too, and possibly many of your other medications. So this would definitely be worth some major planning and consideration between you and your pdoc.

I don't blame you one bit whatsoever on the lithium and Depakote... I've steered clear of those for those very reasons myself. Tegretol is usually weight neutral for just about everyone.

48 minutes ago, Wonderful.Cheese said:

Topamax just got added for weight loss and hopefully it will work for mood as well.

1

Certainly! The first time I took it, only when I got to 200 mg/day, I had a short-lived albeit marked improvement in mood, but also my tremor and Tourette's almost vanished completely. Then with a slight med tweak, everything went back to hell in a handbasket again. I continued to take it, didn't try 400 mg/day, until I got kidney stones from it. I switched to Zonegran and haven't looked back. Unfortunately, I didn't get weight loss benefits from either... :x I think I've read females are more prone to getting the weight loss and anorexigenic benifits from Topamax and Zonegran than males are.

I'm not sure, but you might also have to increase the dose of Topamax if you take Tegretol.

52 minutes ago, Wonderful.Cheese said:

Sorry for the super long reply!

No, you have nothing to apologize for! It's me who's leaving the long replies... XD

53 minutes ago, Wonderful.Cheese said:

Lastly I halved my Seroquel dose to 400 mg last night. I will tell pdoc tomorrow.

Hopefully you can successfully come off of it this time without having relapses in symptoms and having to be hospitalized!

54 minutes ago, Wonderful.Cheese said:

I wonder if either trying haldol with abilify or staying on invega and abilify are my best options. I respond the best to AP's and have been so much better on two of them instead of one. Not constantly in and out of hospitals anymore.

It really might be worth a shot... Maybe not necessarily Haldol, but certainly a high-potency first-gen + Abilify (or even Vraylar or Rexulti, eventually, don't want to switch things up too much all at once), maybe with an increase in dose of Abilify to 40 mg for now? Or like you said Abilify + Invega, maybe try an increase in Abilify here to 40 mg as well? You'll probably have to get your pdoc to write a PA to your insurance company to let you fill 60x 20 mg for a month... You could also ask about switching the Seroquel for Loxitane and keeping the Abilify and Invega, but then you'd still be on 3 antipsychotics... but if you were on Loxitane, at least you'd probably be on a lower dose, and not on a full dose like on Seroquel.

Best of luck to you! Let us know what your pdoc says. I'm really curious as to what your pdoc decides to do.

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22 hours ago, mikl_pls said:

It's true! I swear! Stahl indicates it in his Prescriber's Guide.

I was on 240 mg geodon while at a state hospital at one point before it was determined that it wasn't helping me very much. I know people who were on at least that amount there and even more. So it is used that high dose wise that I've seen anyway. 

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And to update! I had my appointment! It was an extremely uneventful pdoc appointment. I don't know what to think.

She tried reassuring me about being on 3 AP's. She said she has some patients taking 3 who need 3 long term and have been taking them long term.

My options were try clozapine (she said it's stronger...but I'm afraid of it ugh) or leave everything the same and ride this out and see if I get less depressed. She is leary of starting an AD and I am too. I don't want more pills and also mania and psychotic things worsen for me with AD's. 

Oh she did say if I wanted to take less pills I could switch to the injection of invega and abilify. But I meant more like I want less meds in general (not just the actual number of pills). 

I am to take my bedtime Klonopin dose at 5 pm instead of adding an additional dose. So no more bedtime Klonopin but evening instead I guess? 

So no changes and I'm supposed to ride this out and see her in a month. 

Oh I'm supposed to try the light therapy box again. Ugh I feel like people can watch me through it (like a portal) and I feel like it will burn my eyes badly. She told me it won't do that. So I dragged the damn thing out of the closet. She said to stop it if I notice mania. Hmmm

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4 hours ago, Wonderful.Cheese said:

And to update! I had my appointment! It was an extremely uneventful pdoc appointment. I don't know what to think.

She tried reassuring me about being on 3 AP's. She said she has some patients taking 3 who need 3 long term and have been taking them long term.

My options were try clozapine (she said it's stronger...but I'm afraid of it ugh) or leave everything the same and ride this out and see if I get less depressed. She is leary of starting an AD and I am too. I don't want more pills and also mania and psychotic things worsen for me with AD's. 

Oh she did say if I wanted to take less pills I could switch to the injection of invega and abilify. But I meant more like I want less meds in general (not just the actual number of pills). 

I am to take my bedtime Klonopin dose at 5 pm instead of adding an additional dose. So no more bedtime Klonopin but evening instead I guess? 

So no changes and I'm supposed to ride this out and see her in a month. 

Oh I'm supposed to try the light therapy box again. Ugh I feel like people can watch me through it (like a portal) and I feel like it will burn my eyes badly. She told me it won't do that. So I dragged the damn thing out of the closet. She said to stop it if I notice mania. Hmmm

I would seriously consider the Clozapine. I know I too was terrified about it before I took it but it has reduced my symptoms by about 70-80% and the only side effect I get is sedation (which has been treated with Adderall). Generally speaking, if several anti-psychotics fail you then you should try Clozapine. While I can not know if it will work for you, it has a pretty good track record for treating treatment resistance psychosis. Also if it works for you, you'll only have to take one AP, thereby reducing your chances of getting diabetes or weight gain.

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  • 1 month later...

I hope you've made some progress. I was thinking that since Abilify worked for you, maybe try Rexulti, similar medication and also indicated for schizophrenia as well as MDD. Rexulti really helps my highs and mania and be titrated up to 4mg. This might possibly help with your psychosis and schizoaffectiv -bipolar type. I take it for bipolar at 1.5mg and find it very effective.  Equetro, an XR carbanazene, might be an option for bipolar highs and mania. Am wondering if your sleep disorder might be contributing to manic, and further exacerbating psychoses or psychotic episodes. In that case, getting a good sleeping medication might help. I know both you and your were nervous to start an antidepressant because of possible mania induction, but mirtazapine is great for sleep and for some an amazing antidepressant as well. It sucks that the really good meds for sleep and psychosis have not so good metabolic effects. 

I think Latuda would be a good option for the bipolar lows also. It's one of the few indicated specifically for bipolar depression. If you haven't tried Risperdal, it's indicated for schizoaffective and bipolar, might want to bring it to ask your doctor about it.. You could also look into lithium? It is more for bipolar mania, but is a good medication for bipolar overall. Litihum did wonders for me. 

One more thing. I learned from someone on this form about a medication called loxapine, an antipsychotic used for shcizophrenia. You should check it out, I know it was just approved as Adasuve, an inhalation powder http://www.adasuve.com/

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6 hours ago, mmaryland said:

I hope you've made some progress. I was thinking that since Abilify worked for you, maybe try Rexulti, similar medication and also indicated for schizophrenia as well as MDD. Rexulti really helps my highs and mania and be titrated up to 4mg. This might possibly help with your psychosis and schizoaffectiv -bipolar type. I take it for bipolar at 1.5mg and find it very effective.  Equetro, an XR carbanazene, might be an option for bipolar highs and mania. Am wondering if your sleep disorder might be contributing to manic, and further exacerbating psychoses or psychotic episodes. In that case, getting a good sleeping medication might help. I know both you and your were nervous to start an antidepressant because of possible mania induction, but mirtazapine is great for sleep and for some an amazing antidepressant as well. It sucks that the really good meds for sleep and psychosis have not so good metabolic effects. 

I think Latuda would be a good option for the bipolar lows also. It's one of the few indicated specifically for bipolar depression. If you haven't tried Risperdal, it's indicated for schizoaffective and bipolar, might want to bring it to ask your doctor about it.. You could also look into lithium? It is more for bipolar mania, but is a good medication for bipolar overall. Litihum did wonders for me. 

One more thing. I learned from someone on this form about a medication called loxapine, an antipsychotic used for shcizophrenia. You should check it out, I know it was just approved as Adasuve, an inhalation powder http://www.adasuve.com/

Well I'm still on the same combo. Thanks for all the suggestions. I will keep all of them in mind. My pdoc is not keen on cutting back on my combo. She says she has other patients on 3 AAP's who do well and have taken them long term. I'm not too hot on the idea of being on all three - invega and abilify and Seroquel - but I'm doing so much better. I don't want to end up back in the hospitals ever again. 

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19 minutes ago, Wonderful.Cheese said:

Well I'm still on the same combo. Thanks for all the suggestions. I will keep all of them in mind. My pdoc is not keen on cutting back on my combo. She says she has other patients on 3 AAP's who do well and have taken them long term. I'm not too hot on the idea of being on all three - invega and abilify and Seroquel - but I'm doing so much better. I don't want to end up back in the hospitals ever again. 

Glad to hear that! I actually just met with my doc today and she expressed concern over me being on Seroquel and Rexulti. I do have concern about being on two AAPs, but if it's what works for me I would rather keep it. She asked if I wanted to keep one or the other but honestly they both do something completely different for me. The Seroquel eliminates mania and allows me to sleep during bipolar mania, but Rexulti has helped with my mood, decision making, and impulsiveness. There is no comparing Seroquel and Rexulti because one knocks me out and eliminates mania within an hour while the other allows me to function on a daily basis with a more organized routine, and helping me be more responsible in general. Rexulti helps clear my head and I feel like I can better manage stress on it. Also, I've been noticing a huge decrease in desire to drink since being on Rexulti and other manic-associated behaviors like spending sprees, sexual promiscuity, etcetera. 

I am on a large cocktail of medication and honestly would love to reduce it, but it's so hard picking and choosing which medications to remove because I don't want to relapse or fall into depression or mania. I finally feel stable and can function regularly so I'm significantly scared to change things up after going through so many medications and finally finding a combination (although large) that legitimately  addresses my disorders and symptoms.

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The three aps thing...and all of them are atypical. I've done it with an atypical a typical and one for sleep but that seems heavy...YMMV I guess...ur pdoc must be rather brave. Are they high doses?

EDIT: sorry I forgot about the original post...they are pretty high...well I guess If your tolerating it there is something to be said for not rocking the boat too hard 

Edited by Iceberg
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