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I Think The Antipsychotic Fanapt Is Giving Me A Speech Impediment / Extremely Disorganized Speech.


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Speech in general has always been a little bit of an issue for me. I did see a speech pathologist in the past but I was about 12 and didn't care much to benefit from it then. Just for the record, I have always noticed that my speech is much sharper when I'm not taking antipsychotic medications. Strangely enough, I seem to speak the most clearly right before I have a relapse and I am becoming manic. Almost every antipsychotic I have taken has had a negative reaction on my speech but never as much as the most recent, Fanapt. I was recently switched from Latuda 20mg to Fanapt 6mg (once daily) to suppress akathisia. At first everything seemed fine and the akathisia which was a longtime battle of mine was tapering down just slightly on the Fanapt. Then a few weeks settle in and I start feeling like I've been hit by an 18-wheeler upon waking up and just overall sedated and "spaced out". I am forgetting things, mostly short-term memory loss. A few days ago I went into a retail pharmacy to buy a few specific things, walked inside the sliding doors and completely forgot what I walked inside for a few second, although I did ultimately remember a few minutes later. Not just this but I also seem to have developed blurred vision and can absolutely not drive or operate a vehicle on this medication.

Additionally my speech is completely shot and disorganized almost half the time. My speech patterns at times are almost like someone who is borderline cognitively impaired yet my IQ is in the 101-109 range (I am average). I'm forgetting words that once came easily to me and have to scan my brain hard for them, sometimes for over 10 minutes. Usually I know what I want to say but it either doesn't come out right or I just can't get it out in words. It's extremely frustrating and it's causing depression and I've threatened suicide to family and friends yet backed off that is how bad its become. I just want my ability to speak normally to be returned to me. I am coming off the Fanapt but would like to be given some suggestions as to what steps I should take to rehabilitate my speech and what medications are not disabling for someone's speech or what medications could counteract disorganized speech. My current psychiatrist is unsympathetic and doesn't care. And my initial question is can Fanapt cause a speech impediment?

Edited by SheltieUnderdog
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On 2/19/2018 at 2:25 AM, jt07 said:

What is your diagnosis?

Yes, it could be blamed on my illnesses (schizoaffective disorder, add, depression, anxiety disorder, and ocd) except the disorganized speech is far worse when I'm taking the antipsychotics versus not taking them at all and it has progressed even further with the drug Fanapt.

Edited by SheltieUnderdog
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I would bet that what you are experiencing is mostly due to your illness. It could be that the Fanapt aggravates the situation somewhat, but it really sounds a lot like negative symptoms to me though I'm not a doctor. If your doctor is ignoring you, you have to make him listen. Tell him that the situation is intolerable to you and is interfering with your functioning. Don['t just go in blaming it on a med.

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36 minutes ago, jt07 said:

I would bet that what you are experiencing is mostly due to your illness. It could be that the Fanapt aggravates the situation somewhat, but it really sounds a lot like negative symptoms to me though I'm not a doctor. If your doctor is ignoring you, you have to make him listen. Tell him that the situation is intolerable to you and is interfering with your functioning. Don['t just go in blaming it on a med.

I'm still saying that my speech patterns are much more fluent when I'm not taking the medication and it's been the worst on the Fanapt than anything else. Aren't negative symptoms present when you are taking the medications and when you're not taking them either way? My disorganized speech almost completely disappears for me when I'm off the antipsychotics. I could almost do public speaking if I wanted to off the meds. I think it's mostly drug induced and I'm more susceptible to it because of my illness.

As for my doctor, how am I supposed to make him do anything? He's not a therapeutic psychiatrist. The only thing he's going to do is change the medications or I can go awol which I've done before and face the consequences.

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17 minutes ago, Iceberg said:

What other aaps have you tried? What about trying an antidote for the akathisia ?

I've been on a ton of them from Haldol, to Abilify, to Zyprexa. The list goes on. Nothing cures the Akathisia. I've tried all the counteractive drugs they promote in their little business like Cogentin, Artane, Propanolol, Amantadine, Gabapentin, and Clonazepam. Nothing works. Not to mention I'm almost 300 pounds from this crap, (Ive sporadically gained over 145lbs on antipsychotic drugs).

Edited by SheltieUnderdog
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Nobody here is going to tell you to go off your meds. If you want to go off meds, you need to clear that with your doctor. I have to warn you about going AWOL from your doctor. If you are tempted to go off meds by yourself be aware that you can and likely will get considerably worse and you could face suicide, jail, or involuntary commitment to a mental hospital. You could be facing a court order to force you to take your meds which would likely be injections. Is that the sort of thing that sounds good to you?

If the meds are causing you disorganized speech, that is a really weird and unheard of side effect, especially if multiple meds caused it. I think you will find it hard to convince any doctor that the meds are causing disorganized speech.

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3 hours ago, jt07 said:

Nobody here is going to tell you to go off your meds. If you want to go off meds, you need to clear that with your doctor. I have to warn you about going AWOL from your doctor. If you are tempted to go off meds by yourself be aware that you can and likely will get considerably worse and you could face suicide, jail, or involuntary commitment to a mental hospital. You could be facing a court order to force you to take your meds which would likely be injections. Is that the sort of thing that sounds good to you?

If the meds are causing you disorganized speech, that is a really weird and unheard of side effect, especially if multiple meds caused it. I think you will find it hard to convince any doctor that the meds are causing disorganized speech.

That's what the psychiatrists mostly say. They blame everything on your illness and never the drug acting like the drugs are miraculous for the most part and the benefits always outweigh the negatives. Only if they had to follow their patients home and live with them and experience the side-effects second-hand and not just for 30 minutes in their office. Just to let you know, on this medication, I am extremely frustrated, irritable, and borderline suicidal. I've been to the hospital for it (suicidal thoughts) and just come out more resentful and angry than I was when I entered, pissed off at all the personnel and their fake help.  

Just to make you aware, I have already been through a lot of what you are mentioning. I went off my medication twice since I developed schizoaffective disorder and did well at first, regained my ability to speak normally, the akathisia dissipated  but then I relapsed 10 months later. I've had a court-order and probation time due to resisting arrest and I went to jail because I resisted the police a second time on the highway by motor vehicle through multiple counties. I'm aware that the chances of something happening again are very high if I choose to stop taking my medication.

The only thing is that on the medication I can't work, I can barely drive, I can't hold conversations with family members (because of the irritability and disorganized speech, which I believe is mostly medication induced). On the medication, I hibernate in my room watching television all day. I can't even play video games like I used to because of the blurred vision and sedation. And forget about picking up the guitar again, I'm way to sedated for that.

The thing is, I just don't want to be on this type of medication (Fanapt) and I don't want to be treated by my current psychiatrist who I've had the displeasure of being disserviced by for 5 years now. I think the answer for now is a medication switch and getting a new psychiatrist.

Currently I'm taking Fanapt 6mg (Once Daily), Clonazepam 2mg (As Needed), Gabapentin 600mg (As Needed), Topiramate 50mg (Twice Daily, Prescribed By My Neurologist For Migraine Headaches And Sound Sensitivity), And Valsartan 80mg, Atorvastatin 10mg.

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4 hours ago, Iceberg said:

Clozaril? 

My current psychiatrist is highly against putting me on that actually. You constantly have to get your blood drawn (once a month I heard) and there is still a risk for akathisia, although much lower. I would consider it, but I hear it has a lot of other really bad side effects. For example, I knew someone one it for a short time who was on it and he was  extremely sedated and constantly drooling and had to use the restroom to clean himself off every 15 minutes that's how bad it was. I don't see that ever happening to me because I see myself as more cognizant than this person was but it's still a warning sign that Clozaril could be as bad or worse than Fanapt in terms of disorganized speech and for nothing because you have to get your blood drawn. I would consider it as a last option though.

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Typically the drooling/zombie effect means your on too much. My doc does it by blood level and if I stay in range I'm a little drowsy but by no means incapacitated. It's also proven to work when others have failed. You are right tho there are many possible side effects- I drool at night and it can wake me up, I have slightly diminished reflexes (not to the point where I react slow but it effects when the doc hits your reflex at a general check up)...weight gain, but for me no where near as bad as zyprexa...some GI issues too. Plus the blood work although I think that's worth it if nothing else helps.  It's helped me a lot but I don't push it on others because the risk/benefit needs to be an individual decision...I was just wondering if it had come up before 

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17 minutes ago, Iceberg said:

Typically the drooling/zombie effect means your on too much. My doc does it by blood level and if I stay in range I'm a little drowsy but by no means incapacitated. It's also proven to work when others have failed. You are right tho there are many possible side effects- I drool at night and it can wake me up, I have slightly diminished reflexes (not to the point where I react slow but it effects when the doc hits your reflex at a general check up)...weight gain, but for me no where near as bad as zyprexa...some GI issues too. Plus the blood work although I think that's worth it if nothing else helps.  It's helped me a lot but I don't push it on others because the risk/benefit needs to be an individual decision...I was just wondering if it had come up before 

My reflexes are the slowest they've ever been on Fanapt. Like I said, I can't even play video games like I used to. In addition to that I have blurred vision as well. Funny that you mention Zyprexa, I was considering trying 2.5mg (I am very sensitive to dosing) as my next option. Unfortunately, I'm almost 300lbs (after gaining 145lbs since 2011) and I've read that weight gain is extremely severe on that particular drug. What was the akathisia like for you on Zyprexa? Do you even think a dose as low as 2.5mg will be able to effect my weight like that?

In addition to the weight, I have gastrointestinal issues as well but I'm not entirely sure if they're being caused by the medication but you mentioning it is making me think twice. I also have some drooling at night but I've had it on all the antipsychotics I've been on, not just one, and yes, it does wake me up.

Edited by SheltieUnderdog
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In addition to a change in my meds and changing my psychiatrist, do you think that seeing a speech therapist would be of benefit? I am 28 years old with schizoaffective disorder and I think it's mostly medication induced, so could it work or do you think it would be a complete waste of my time and money? I'm asking because from what I know, speech therapy is almost never entirely covered by health insurance and I will have to pay out of pocket for sessions.

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"Potential for Cognitive and Motor Impairment FANAPT, like other antipsychotics, has the potential to impair judgment, thinking or motor skills. In shortterm, placebo-controlled trials, somnolence (including sedation) was reported in 11.9% (104/874) of adult patients treated with FANAPT at doses of 10 mg/day or greater versus 5.3% (31/587) treated with placebo."  (Page 11, 5.16)


"The symptoms of this syndrome [Psychiatric Drug-Induced Cognitive Brain Impairment] include (l) Cognitive deficits, often first noticed as short-term memory dysfunction and impaired new learning, and difficulty with attention and concentration" (Page 7)

 

"The findings indicate that there is evidence for grey and white matter atrophy of the frontal brain, which cannot be explained by the severity of the disease alone but is also very likely a manifestation of long term effects of antipsychotics. . . .Five of eight studies . . . show reductions in frontal grey matter . . . correlated with antipsychotic dose. . . .More recent studies suggest that changes occur already in the first weeks of treatment."  (European Psychiatry, Vol. 30, pg. 65)

 

"The results revealed two findings: (1) better word comprehension was associated with increased [Grey Matter] volume . . . (2) better word and sentence production was associated with increased [Grey Matter] volume . . .The VBM analysis shows that [Grey Matter] volume . . . was positively associated with performance on *spoken word comprehension . . . we found that increased [Grey Matter] volume within the frontal region was associated with better [speech] production" 

 

The first two show that APs can absolutely cause cognitive impairment, which can include speech problems. The third shows that Aps can lead to the deterioration of grey matter and the fourth shows the connection between grey matter and speech. That all being said, all medication -especially psych meds- act differently for every person. You just may be intolerant to APs (since almost all of them cause this problem for you) like how there are people (me) who are intolerant to SSRIs. Our chemistry varies so these medications won't do the same for everyone. The best thing you can do is to not listen to people who say "it's not the meds." If you notice that your speech improves while you're not medicated and then devolves when you become medicated, that tells you that it's the medication. 

Now, looking at your current meds, I would try to find something different rather than Topamax. There's a reason it's referred to as "Dopamax/Stupamax". It is notorious for killing cognitive ability. I tried it after I had to come off of Lamictal and I felt like I went back into the first grade. Gabapentin is another med that can attribute to cognitive decline. I experienced that as well on 600mg a day and I see it in my mom because she's on 1800mg (combined with Tegratol) a day and talking to her can be frustrating at times because of the difficulty she has with thinking of words and forming sentences. So it could easily be that adding an AP on top of the Topamax and Gabapentin could just shoot the "cognitive impairment" side effect right to the top. 

For your Migraines, I'd recommend Amitriptyline over Topamax. It's a TCA so the initial side effects might be a bit harsh but it is a wonderful drug. It can pull triple duty for you as it is indicated for migraine prevention, depression, anxiety, etc. Now when it comes to medications that won't have the cognitive effect on you...that's hard to say because it depends on how severe the positive symptoms of your SZA are. It sounds like rage/irritability is a big part of what you might suffer from so I would recommend trying a combination of Lamictal and Lithium. 

Lamictal is an AMAZING drug. I had absolutely no control over my emotions and would switch rapidly throughout the day over the smallest of things. I would go from intense, irrational rage to depression so painful that I would call into work because it felt like all of my bones would shatter if I got out of bed. Lamictal 200mgs took 80% of that away just by itself. Only reason I had to come off was because I developed the rash so now I'm titrating back up slowly to hopefully avoid the rash again. But yeah, Lamictal can control the depression and the anger to an extent and then Lithium can pick up the rest. Lithium isn't really for depression; it's focus is on controlling Mania which Lamictal doesn't really help with. So they're a good duo. 

Obviously I'm not a doctor but this would be the course I would go if it seems like you can't do APs.

Edited by SKC
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1 hour ago, SKC said:

"Potential for Cognitive and Motor Impairment FANAPT, like other antipsychotics, has the potential to impair judgment, thinking or motor skills. In shortterm, placebo-controlled trials, somnolence (including sedation) was reported in 11.9% (104/874) of adult patients treated with FANAPT at doses of 10 mg/day or greater versus 5.3% (31/587) treated with placebo."  (Page 11, 5.16)


"The symptoms of this syndrome [Psychiatric Drug-Induced Cognitive Brain Impairment] include (l) Cognitive deficits, often first noticed as short-term memory dysfunction and impaired new learning, and difficulty with attention and concentration" (Page 7)

 

"The findings indicate that there is evidence for grey and white matter atrophy of the frontal brain, which cannot be explained by the severity of the disease alone but is also very likely a manifestation of long term effects of antipsychotics. . . .Five of eight studies . . . show reductions in frontal grey matter . . . correlated with antipsychotic dose. . . .More recent studies suggest that changes occur already in the first weeks of treatment."  (European Psychiatry, Vol. 30, pg. 65)

 

"The results revealed two findings: (1) better word comprehension was associated with increased [Grey Matter] volume . . . (2) better word and sentence production was associated with increased [Grey Matter] volume . . .The VBM analysis shows that [Grey Matter] volume . . . was positively associated with performance on *spoken word comprehension . . . we found that increased [Grey Matter] volume within the frontal region was associated with better [speech] production" 

 

The first two show that APs can absolutely cause cognitive impairment, which can include speech problems. The third shows that Aps can lead to the deterioration of grey matter and the fourth shows the connection between grey matter and speech. That all being said, all medication -especially psych meds- act differently for every person. You just may be intolerant to APs (since almost all of them cause this problem for you) like how there are people (me) who are intolerant to SSRIs. Our chemistry varies so these medications won't do the same for everyone. The best thing you can do is to not listen to people who say "it's not the meds." If you notice that your speech improves while you're not medicated and then devolves when you become medicated, that tells you that it's the medication. 

Now, looking at your current meds, I would try to find something different rather than Topamax. There's a reason it's referred to as "Dopamax/Stupamax". It is notorious for killing cognitive ability. I tried it after I had to come off of Lamictal and I felt like I went back into the first grade. Gabapentin is another med that can attribute to cognitive decline. I experienced that as well on 600mg a day and I see it in my mom because she's on 1800mg (combined with Tegratol) a day and talking to her can be frustrating at times because of the difficulty she has with thinking of words and forming sentences. So it could easily be that adding an AP on top of the Topamax and Gabapentin could just shoot the "cognitive impairment" side effect right to the top. 

For your Migraines, I'd recommend Amitriptyline over Topamax. It's a TCA so the initial side effects might be a bit harsh but it is a wonderful drug. It can pull triple duty for you as it is indicated for migraine prevention, depression, anxiety, etc. Now when it comes to medications that won't have the cognitive effect on you...that's hard to say because it depends on how severe the positive symptoms of your SZA are. It sounds like rage/irritability is a big part of what you might suffer from so I would recommend trying a combination of Lamictal and Lithium. 

Lamictal is an AMAZING drug. I had absolutely no control over my emotions and would switch rapidly throughout the day over the smallest of things. I would go from intense, irrational rage to depression so painful that I would call into work because it felt like all of my bones would shatter if I got out of bed. Lamictal 200mgs took 80% of that away just by itself. Only reason I had to come off was because I developed the rash so now I'm titrating back up slowly to hopefully avoid the rash again. But yeah, Lamictal can control the depression and the anger to an extent and then Lithium can pick up the rest. Lithium isn't really for depression; it's focus is on controlling Mania which Lamictal doesn't really help with. So they're a good duo. 

Obviously I'm not a doctor but this would be the course I would go if it seems like you can't do APs.

Thank You for the references.

My neurologist (who I was barely able to follow during a 1 hour appointment last week) is very supportive of Topamax. He says it's one of the best out there and he was hoping that it would decrease my weight because of the morbid obesity brought upon me by the APs. It has not worked successfully for that at 50mg.. It's helped tremendously with migraines, tremors, and sound sensitivity though. I did notice that on a day that I had once missed it, that I had felt a little less spaced out yet still sedated because of the Fanapt. I'm also experiencing the so-called pins and needles sensation from the drug as well in my hands and feet. I will suggest Amitriptyline at my next appointment but is the drug typically covered by most insurances and is there a generic?

I will mention to you that I haven't always been diagnosed schizoaffective. Prior to the most recent episode  that occurred, the same psychiatrist thought I suffered from Bipolar 1 With Psychotic Features. The psychiatrists in the jail system also believed it was Bipolar 1 With Psychotic Features as well. One thought it was a severe case of Mania. It wasn't until my release and I returned to the facility that it became definitive schizoaffective disorder.  I'm not making any judgments though, it could easily be schizoaffective disorder as much as it could be Bipolar 1.

Exactly what type of drug is Lamictal? What is it primarily used for and what are the common side effects?

I've been told that Lithium, although a mood-stabilizer, can treat psychosis (at least the hallucinatory aspects) at higher dosages. I'm not sure what your history / diagnosis is, but can you say this is true for yourself?

Yes, I am severely intolerant to APs. I get sedation, fatigue, cognitive impairment, akathisia,  memory loss, blurred vision, and developed severe gynecomastia from taking Risperdal, Invega, and Zyprexa in my teen years and early 20's. I am morbidly obese from sporadically taking these drugs over the past 7 years and they just keep pumping me full of them telling me to watch my weight. It's like they're telling me to watch my weight while simultaneously shoving me full of lard,that is how slow my metabolism has become and how hungry I am.

I'm currently living with other family members, so I would have to see if they're alright with Lithium in place of APs, primarily my mother. She already knows how much I suffer on APs, especially with the akathisia and now with the impaired speech so I don't understand why she couldn't be open to it my psychiatrist accepts the change. If I eventually movie out, I will pursue these changes myself if it doesn't happen sooner.

Thank You

Edited by SheltieUnderdog
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Lithium prevents the highs that cause the psychosis but isn't the same as an AP- although some argue it kinda is in that. Category....lamictal is a mood stabilizer for BP typically BP depression not really for psychosis. It seems like you have several aaps you haven't tried...abilify is known to not be sedating until high dose and typically causes little weight gain. Geodon can be weight neural and even a little activating for some (although I hate it). Clozaril is probably the most effective but also the biggest pain in the ass as far as side effects. Typically you would combine something with the lithium for psychosis but hey what do I know 

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27 minutes ago, Iceberg said:

Lithium prevents the highs that cause the psychosis but isn't the same as an AP- although some argue it kinda is in that. Category....lamictal is a mood stabilizer for BP typically BP depression not really for psychosis. It seems like you have several aaps you haven't tried...abilify is known to not be sedating until high dose and typically causes little weight gain. Geodon can be weight neural and even a little activating for some (although I hate it). Clozaril is probably the most effective but also the biggest pain in the ass as far as side effects. Typically you would combine something with the lithium for psychosis but hey what do I know 

Abilify was the first AP they prescribed me back in 2011 and I gained over 90lbs on it. I actually gained the most weight on Ability overall because it was the first one they ever prescribed me and I was thin before they did. Prior to the introduction of antipsychotics I was rather thin but had a weight problem before that in my late childhood and early adolescense. I heard that Geodon has a pretty bad reputation for akathisia so I've always stayed away from that particular drug. Keep in mind that I also suffer from severe gynecomastia in addition to the morbid obesity and currently not one plastic surgeon will operate on me due to my size. My BMI is out of their range. I did win a lawsuit against the pharmaceutical company of Risperdal and Invega but no plastic surgeon is willing to operate. Anyway the only atypical APs that I haven't really tried are Rexulti, Saphris, Clozaril, and Seroquel.

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Seroquel typically is bad for weight.personally my last 2 doc's were anti-saphris but I do kno that it can be really sedating for some lucky few...and I think-ish its not bad for weight. Rexulti was neutral for my weight but we had to bail cuz it wasn't touching any of the Manic symptoms awesome for depression tho. Clozaril is really for when you've tried most of your other options. It probably saved my life +s= great against mania and psychosis especially treatment resistant. Can help suicidal thoughts and irritability. Very low chance of akathisia.

--= weight gain can be bad. Drooling-typically while sleeping        Sedation can be pretty bad. Have to get frequent blood work. Assuming a doc will even prescribe it 

 

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