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alen

In need of serious medication advice

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@Iceberg After reading about the sedation related to Seroquel, I've decided to ask for Rexulti instead. Does it treat Bipolar 1 depression? How did it work for you?

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2 hours ago, alen said:

@Iceberg After reading about the sedation related to Seroquel, I've decided to ask for Rexulti instead. Does it treat Bipolar 1 depression? How did it work for you?

Currently, Rexulti is only approved for schizophrenia and as an adjunct to an antidepressant for major depressive disorder. However, Otsuka just announced that they started Phase III trials for bipolar mania. This would give it all of the same indications as Abilify. Then to really make it worth their while they would have to go after a separate bipolar depression indication, which Abilify does not have. Currently only Seroquel and Latuda are approved to treat bipolar depression specifically.

I'm curious about Rexulti myself. I'm very sensitive to akathisia. On most antipsychotics I can maintain at lower doses but when I hit a rough patch, the doses I have to be at to manage a mixed episode usually cause akathisia for me, so we started on Depakote to get me to a better baseline and prevent that from happening so we never have to go up to those doses on APs. Loxapine has become a background mood stabilizer for me whereas it was primary originally when I was taking Trileptal instead of Depakote. From studies, Rexulti has lower intrinsic activity at the D2 receptor and a 10-fold higher affinity for the 5HT1A and 5HT2A receptors, which means it has a lower rate of akathisia than Abilify. This was confirmed in trials where they compared Abilify and Rexulti directly. Akathisia in the Rexulti group was HALF that of Abilify. So those whose mood responded well to Abilify but couldn't tolerate it due to akathisia may do really well on Rexulti. However, Rexulti does appear to have a higher incidence of weight gain than Abilify.

What I'm finding now that I've gotten to the 1500mg of Depakote is that my agitation is pretty well managed and I don't have to usually take my 5mg PRN loxapine and rarely have to take 0.5mg alprazolam. But my mood has taken a modest downturn. Nothing I can't manage. And to be honest, from here it's hard to tell if I'm depressed or I'm just feeling "normal" and finally coming out of the hypomania from titrating from Trileptal to Depakote.

I'm thinking about asking my pdoc to decrease my Depakote back down to 1000mg and switching the loxapine out for Rexulti but wanted to hear some experiences that people have had with it. Thoughts?

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14 minutes ago, looking for answers said:

rexulti is similar to abilify

That it is. But similar is where it stops. Like I said, lower rate of akathisia by half, almost double the chance of weight gain, and additionally, it is less likely to cause activation in low doses the way that Abilify does. Many people report that the lower doses of Abilify are activating and it doesn't start to calm down until you get to 10mg or 15mg. Rexulti on the other hand seems to be sedating until you get to 2mg or so. Based on my reading though, when everything is said and done, Rexulti should be more tolerable for those that couldn't tolerate Abilify. But I won't argue that it is a patent extender. All they really did here was come up with a version of Abilify that is more tolerable but not necessarily more efficacious.

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1 minute ago, browri said:

That it is. But similar is where it stops. Like I said, lower rate of akathisia by half, almost double the chance of weight gain, and additionally, it is less likely to cause activation in low doses the way that Abilify does. Many people report that the lower doses of Abilify are activating and it doesn't start to calm down until you get to 10mg or 15mg. Rexulti on the other hand seems to be sedating until you get to 2mg or so. Based on my reading though, when everything is said and done, Rexulti should be more tolerable for those that couldn't tolerate Abilify. But I won't argue that it is a patent extender. All they really did here was come up with a version of Abilify that is more tolerable but not necessarily more efficacious.

yes, and many insurances dont cover it. its like 1000 a script if not covered

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Just now, looking for answers said:

yes, and many insurances dont cover it. its like 1000 a script if not covered

Lol yeah there is that. Mine will cover it and doesn't require prior auth or step therapy but it is a non-preferred brand so if I fill a 90-day at a retail pharmacy, it'll cost me like $180, but after the coupon card it should be about $15 according to the site.

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1 minute ago, browri said:

Lol yeah there is that. Mine will cover it and doesn't require prior auth or step therapy but it is a non-preferred brand so if I fill a 90-day at a retail pharmacy, it'll cost me like $180, but after the coupon card it should be about $15 according to the site.

someone i know said that card didnt work, it only works if u have like medicaid or no insurance

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1 minute ago, looking for answers said:

someone i know said that card didnt work, it only works if u have like medicaid or no insurance

"Patients are not eligible if they are under 18 years of age, or are covered in whole or in part by any state program or federal healthcare program, including, but not limited to, Medicare or Medicaid (including Medicaid managed care), Medigap, VA, DOD, or TRICARE."

Seems no different from any other savings card but there is a separate patient assistance program that you would use if you didn't have insurance.

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2 minutes ago, browri said:

"Patients are not eligible if they are under 18 years of age, or are covered in whole or in part by any state program or federal healthcare program, including, but not limited to, Medicare or Medicaid (including Medicaid managed care), Medigap, VA, DOD, or TRICARE."

Seems no different from any other savings card but there is a separate patient assistance program that you would use if you didn't have insurance.

maybe it was a different care

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@browri Thanks for all the info! I am now leaning towards trying out Seroquel because my depressive symptoms have yet to be managed and it's FDA approved for Bipolar depression like you said. I tried Latuda in the past and didn't feel a difference in my symptoms, either, but maybe two months wasn't enough to test it out. Bipolar depression is such a monster to treat!

Maybe starting a new thread about Rexulti could help you read about others' experiences, too. 

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1 minute ago, alen said:

@browri Thanks for all the info! I am now leaning towards trying out Seroquel because my depressive symptoms have yet to be managed and it's FDA approved for Bipolar depression like you said. I tried Latuda in the past and didn't feel a difference in my symptoms, either, but maybe two months wasn't enough to test it out. Bipolar depression is such a monster to treat!

Maybe starting a new thread about Rexulti could help you read about others' experiences, too. 

I read back on my post and realized that I missed one, olanzapine (Zyprexa) is also approved for bipolar depression when used with fluoxetine (Prozac). However those are your three OFFICIAL options. As far as I know, Otsuka and Lundbeck aren't currently going after a bipolar depression indication for Rexulti, at least not yet. Allergan and Gedeon-Richter tried to go after the MDD adjunct indication for Vraylar but the one trial they did didn't go too well for them. I believe they're also going for a bipolar depression indication for Vraylar now.

I've never taken Seroquel myself but I did respond really well to olanzapine, and I would go back to it if I didn't have any other choice despite the fact that it caused me to gain weight and increased my lipids and glucose, albeit moderately. I only needed 5mg which is a really low dose relatively speaking. Olanzapine most definitely had antidepressive effects as well as antianxiety effects but I was taking it with an antidepressant, so YMMV.

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46 minutes ago, alen said:

@browri Thanks for all the info! I am now leaning towards trying out Seroquel because my depressive symptoms have yet to be managed and it's FDA approved for Bipolar depression like you said. I tried Latuda in the past and didn't feel a difference in my symptoms, either, but maybe two months wasn't enough to test it out. Bipolar depression is such a monster to treat!

Maybe starting a new thread about Rexulti could help you read about others' experiences, too. 

Seroquel gave me

hope

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It was great for BP depression...not so great for mania but was weight neutral and didn't cause akathisia for me 

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Exciting updates!!

First of all, I really like my psychiatrist. He's nice, practical, listens to me, and cracked a joke about Seroquel at the end of our session, stating, "It can be sedating so just be careful if you're operating a chainsaw." lol

Secondly, we threw out the Abilify since it's done nothing for my depression and kept the Lamotrigine at 200 mg as a back-up mood stabilizer. Starting tomorrow, I'm titrating up to 300 mg of Seroquel XR and crossing my fingers that I'll feel better. Honestly, I just want my appetite back and to stop feeling like shit every day. Let's hope this works! Thanks again to everyone that replied! :)

 

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59 minutes ago, alen said:

Exciting updates!!

First of all, I really like my psychiatrist. He's nice, practical, listens to me, and cracked a joke about Seroquel at the end of our session, stating, "It can be sedating so just be careful if you're operating a chainsaw." lol

Secondly, we threw out the Abilify since it's done nothing for my depression and kept the Lamotrigine at 200 mg as a back-up mood stabilizer. Starting tomorrow, I'm titrating up to 300 mg of Seroquel XR and crossing my fingers that I'll feel better. Honestly, I just want my appetite back and to stop feeling like shit every day. Let's hope this works! Thanks again to everyone that replied! :)

 

That's great to hear, @alen! Will you be taking anything else besides Seroquel XR and Lamictal? It's definitely a good place to start.

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Hi I saw your post hope this can be of some help.

All the meds you are on I have been on. They didn't help me either.these are the meds I am on now.

Effexxor 225mg daily

Gabapetin 600mg 3x daily

Prozasin 4mg at night

Seroquel 300mg at night  

Trazadone as needed and I haven't needed it.

Gordon and lithium brought me down.I would cry over happy songs or even talking about good things was hard.

I am very happy now. These meds combo have saved my life. I am functional. I can work a job. I talk to people now sometimes I do talk alot but I will shut up eventually.

Keep in mind though I have been on meds since 2008. Takes trial and error to get you right. 

And for me I find psychdocs who are psych patients help the best. They know the pain and how meds work.

Ask you doc about the saliva test they have now. It tells them If your meds are working for you and if not what would. This is something new they are doing.

Hope it works out for you.

 

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I started off with Depakote.  It left me feeling depressed and paranoid.  I then switched to Lithium and really came together.  I had a short stint on 2700 mg of Trileptal, which did little to quell my symptoms.  I tried carbamazapine, which worked well for mania, but not so much for depression.  I also tried Gabapentin, which didn't work, and Verapamil, which didn't work.  The only other drug which has helped stabilize my mood is Keppra, but only as an adjunct.  Have you tried Lithium and Lamictal together?

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3 hours ago, phidippus said:

I started off with Depakote.  It left me feeling depressed and paranoid.  I then switched to Lithium and really came together.  I had a short stint on 2700 mg of Trileptal, which did little to quell my symptoms.  I tried carbamazapine, which worked well for mania, but not so much for depression.  I also tried Gabapentin, which didn't work, and Verapamil, which didn't work.  The only other drug which has helped stabilize my mood is Keppra, but only as an adjunct.  Have you tried Lithium and Lamictal together?

no lamictal with an AD, and seroquel+lithium..........its hard because they say they dont think im bipolar but dx me with it becasue i fail most traditional AD,

lithium seems to give me an energy boos and some anxiety, did it for u

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