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


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1 hour ago, Iceberg said:

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 

 

Do you know how Rexulti compares to Latuda? I was on 20mg of Latuda which is the lowest therapeutic dose I believe. Is the equivalent dosage of that for Rexulti 0.5mg or 1mg, if you can answer that? If you can, please describe Rexulti to the best of your ability. I'm considering that as well. Thanks

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Rexulti was a bit activating at 2 mgs...latuda was a bit sedating at 40 and really sedating above 80. Latuda is approved for BP tho so you might have better luck with that for insurance. Rexulti has a "target dose" of 2 mg for depression but that doesn't mean much. They both can cause akathisia 

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37 minutes ago, Iceberg said:

Rexulti was a bit activating at 2 mgs...latuda was a bit sedating at 40 and really sedating above 80. Latuda is approved for BP tho so you might have better luck with that for insurance. Rexulti has a "target dose" of 2 mg for depression but that doesn't mean much. They both can cause akathisia 

If 2mg is the target range for depression than what is Rexulti's target range for schizophrenia, if there's one?

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20 hours ago, SheltieUnderdog said:

1. I will suggest Amitriptyline at my next appointment but is the drug typically covered by most insurances and is there a generic?

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

3. 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?

1. Amitriptyline is the generic name for Elavil. It's in the class of tricyclic antidepressants (TCAs). Nowadays Amitriptyline is mainly prescribed for Migraine Prevention, Neuralgia, and Insomnia. I'm about to be put on a member of its class, Clomipramine, which is mainly used for OCD. TCAs have their fair share of side effects and are known to be nastier than newer ADs. but they seem to be less severe than APs. Weight gain is a side effect of Amitriptyline, but the studies have only been for 4-12 week usage so long term weight gain isn't clinically known. Propranolol, a Beta-Blocker, is another good alternative for Migraine prevention. It too can cause weight gain but Mayo Clinic says the average weight gain is 2.6 lbs so that may end up being a better alternative. Honestly, you can bring these two options up and then ask your Neuro for any other suggestions because you believe Topamax is affecting your cognitive ability. 

2. Lamictal is an anti-convulsant. In higher doses it is used for seizure prevention but it is the gold standard in mood stability; mainly when dealing with the depressive side of a disorder. There was a clinical study done which showed promise with lamictal and schizoaffective disorder when dosage reached 400 mg, reaching considerable mood stability and complete remission from paranoid symptoms. (Ref.) It can cause drowsiness, vision changes, nausea, and a skin rash. I did develop blurred vision from Lamictal but I do not regret a thing; it's that good of a drug. 10% of people taking lamictal will develop a rash between 2-8 weeks of treatment. 1% of people develop a rash called Stevens-Johnson Syndrome which can be disfiguring and life threatening. Lamictal changed my life but I developed a rash 8 months into treatments and had to discontinue (although I'm starting to think it was from too high of a dose of Adderall so I'm titrating back up on Lamictal). I HIGHLY recommend this drug and here are some reviews so you can get an idea, both good and bad. 

3. I have not been on Lithium but it is a very popular drug for any kind of mood disorder. It has been used either with APs or as part of another cocktail for Schizophrenic disorders. You do have to get your blood drawn while on Lithium but I believe it's only every three months. 

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11 hours ago, SKC said:

1. Amitriptyline is the generic name for Elavil. It's in the class of tricyclic antidepressants (TCAs). Nowadays Amitriptyline is mainly prescribed for Migraine Prevention, Neuralgia, and Insomnia. I'm about to be put on a member of its class, Clomipramine, which is mainly used for OCD. TCAs have their fair share of side effects and are known to be nastier than newer ADs. but they seem to be less severe than APs. Weight gain is a side effect of Amitriptyline, but the studies have only been for 4-12 week usage so long term weight gain isn't clinically known. Propranolol, a Beta-Blocker, is another good alternative for Migraine prevention. It too can cause weight gain but Mayo Clinic says the average weight gain is 2.6 lbs so that may end up being a better alternative. Honestly, you can bring these two options up and then ask your Neuro for any other suggestions because you believe Topamax is affecting your cognitive ability. 

2. Lamictal is an anti-convulsant. In higher doses it is used for seizure prevention but it is the gold standard in mood stability; mainly when dealing with the depressive side of a disorder. There was a clinical study done which showed promise with lamictal and schizoaffective disorder when dosage reached 400 mg, reaching considerable mood stability and complete remission from paranoid symptoms. (Ref.) It can cause drowsiness, vision changes, nausea, and a skin rash. I did develop blurred vision from Lamictal but I do not regret a thing; it's that good of a drug. 10% of people taking lamictal will develop a rash between 2-8 weeks of treatment. 1% of people develop a rash called Stevens-Johnson Syndrome which can be disfiguring and life threatening. Lamictal changed my life but I developed a rash 8 months into treatments and had to discontinue (although I'm starting to think it was from too high of a dose of Adderall so I'm titrating back up on Lamictal). I HIGHLY recommend this drug and here are some reviews so you can get an idea, both good and bad. 

3. I have not been on Lithium but it is a very popular drug for any kind of mood disorder. It has been used either with APs or as part of another cocktail for Schizophrenic disorders. You do have to get your blood drawn while on Lithium but I believe it's only every three months. 

1. I cannot take Propanolol for 2 reasons. One, I am already taking Valsartan, another anti-hypertensive drug for high-blood pressure, and secondly I am currently undergoing allergy-shot treatments for chronic allergies which prohibits the use of Beta-Blockers. Truthfully, while I'm definitely going to discontinue the Gabapentin, I'm not entirely sure about stopping the Topamax as it has helped me dramatically for what it's intended to help me for despite possibly making me a little lethargic. I'll conclude by saying that there's absolutely no way the Topamax could be doing as much impairment as the Fanapt. I was taking the Topamax prior to starting the Fanapt and my cognitive functioning was much better than it is now taking the Fanapt. I will mention Amitriptyline to both my psych and my neurologist though and see what they have to say.

2. So basically you're promoting Lamictal because it can perform like an antipsychotic without the normal side effects that APs have so it may be a good fit for someone like myself who is seemingly intolerant to APs? Just to confirm, it has no akathisia and it doesn't impair thinking, right?

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Wouldn't say lamictal replaces an antipsychotic...and I always thought lithium was the gold standard. The thing is mood stabilizers help you stay out of episodes but typically don't treat psychosis as a monotherapy (typically, there are a few lucky ones) 

Usual doesn't cause too much in the way of side effects...higher doses Can cause some mental fog

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@SheltieUnderdog 1. Definitely stay on Topamax if you're receiving a benefit and it doesn't seem to impair you. Just because a medication is notorious for doing something doesn't mean it always will, so maybe you're the lucky one who escaped its "Dopamax" effect! You could still bring up amitriptyline to your docs but it is contraindicated with Topamax, meaning it could cause side effects by using them together. When I looked it up, it appears that both medications potentially increase internal body temperature and decrease sweating which could possibly lead to a heat stroke, so s/he may not like that combo even though major contraindicated combos are prescribed all the time. 

2. There are mixed clinical trials on whether Lamictal helps with Psychosis. Dating from 1998-2016, it's constantly debated so it's believed it just comes down to the individual. It MAY help your Psychosis, but the main reason for Lamictal use would be for instability of mood. It helps the regulation of both depression and mania so it is definitely on par (in my non-medically licensed opinion) with APs when it comes to mood regulation. There is no link between Lamictal and Akathisia. One of the major benefits of Lamictal is its relatively subtle side effect scale. There is the chance of the rash which is the biggest side effect and another common one is vision change. I personally had my vision start to turn worse while on Lamictal but it was nothing that caused me to need glasses. My vision went from 20/25 to 20/40, but I see this as completely inconsequential compared to the benefit I received.

About impairment of thinking; there is a chance of this with Lamictal. It's listed as an uncommon side effect. I personally am not sure if I experienced or not. When I went from 150 to 200, I began to have trouble finding words and became forgetful of where I put things and what I was doing. This wasn't a constant thing; just something that would happen more often than it used to. This effect subsided after about 2 months of being on 200 mg. That being said, I also have ADHD-Inattentive Type and was not on medication for that disorder at the time so it could have just been the Lamictal exacerbating the symptoms of my ADD.

 Fun fact, there's also some evidence that Lamictal helps with migraines, so that's another possible benefit. 

@Iceberg  It obviously depends on the individual person but Lamictal is considered first line over Lithium for mood disorders because of the lower chance of side effects and because Lithium require blood work every three months because it can easily become toxic. A combination of both of them has been shown to be even more effective than either one individually. 

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First line is different than gold standard. Also depends on the Situation. If you need fast results ex a hospital situation...lamictal is not your best bet considering it can take much longer to see the effect. Also lamictal has less established anti manic properties. I'm not saying it doesn't have a use  just that I would be careful relying on it as monotherapy for psychotic symptoms. 

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So I discontinued taking the Gabapentin today (I already had consent to do so by my psychiatrist when I called in complaining about the Fanapt 2 weeks ago) and I'm already noticing that I'm feeling sharper and talking a little more clearly yet not nearly as much as I would if I changed the Fanapt or stopped taking APs completely.

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  • 2 weeks later...

Just an update. The Fanapt 6mg was changed to Latuda 20mg on 2/27 and by the beginning of this month, I wasn't really noticing a drastic change in my speech patterns, just a slight increase in akathisia from when I was taking the Fanapt and my mind was slightly sharper overall. For example , I wasn't forgetting things as much but my speech was still shot. Dropping the Gabapentin did help but it still didn't bring me back to my former speech levels entirely.

So on 3/1, I felt like I had to do the inevitable and I discontinued the Topamax. Addmitedly, within a half a day, all of my mental faculties returned to me and my speech was restored almost immediately after the drug started wearing off. It's almost a miracle but I'm now without a medication to treat my headaches, migraines, tremors, and sound sensitivity except for Excedrin OTC. I did have consent from my neurologist to stop taking the Topamax at any point if deemed necessary but I will still have to contact his office first thing tomorrow to inform him of the change. I will bring up Amitriptyline at my next appointment as a replacement.

Additionally, I'm back to fighting the main side effect from antipsychotics, which for me was Akathisia. I'm realizing that I'm basically intolerant to the entire category of these drugs. Ive had multiple adverse side effects to all the ones I've been on so far in 7 years.  I strongly want to to consider alternatives such as Lithium or Lamictal in the future.

Thank you all for your input and helping me find an answer to this debilitating problem that is now resolved.

Edited by SheltieUnderdog
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