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Amethyst674

List of AAPs I have taken and their side effects. Need Help.

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List of Atypical Antipsychotics and effects they have had

 

Zyprexa- Great Drug but major weight gain and hunger side effect. Only use it for emergencies.PRN.

Seroquel- Made me very hungry at night , did not sleep well and felt wired the next day

Saphris- Made me flat and unmotivated and depressed.  Took for almost 3 years.No problems with sex drive. Gained weight.

Perphenezine- Did not work

Latuda- Gave me Akathesia and Binge eating. Also very bad mood.Gained weight.

Risperdal-Made me have night terrors and hear voices

Lithium- Depression

Vraylar-Best.  Took for a year and a half. 3mg. Made me scared to drive and also I got tardive dyskinesia so had to stop it.  No problems with sex drive.Gained weight.

Abilify-Made me super anxious/panic and night terrors all the 3 different times I tried it. Lost weight. Good sex drive. Diahrrea.

Rexulti- Depression at 1 mg.

Geodon- Ended up going to the ER 6 times since March. Horrible gastritis. Got hospitalized for 2 days at Larkin hospital.  Became more stable and less gastritis when Dr. told me to take it 3 times a day.  Currently taking 40 TID with meals.  Has made me gain 10 more pounds.  Need to find new one because need to take it with high calorie meals and I am having gastric surgery. Also I have absolutely zero sex drive.

Depakote-Scared to take it due to liver failure, hair loss side effect and more weight gain.

Lamictal, Trileptal and Tegretol- Allergic.  Got Steven Johnson from Lamictal and Trileptal also gave me a very bad rash.

Don’t know what to take next. Need Help.

I don’t want to take INVEGA or FANAPT because they raise prolactin levels and cause problems with sex drive.

Edited by Amethyst674
Forgot Rexulti and Lithium

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Thought about clozaril? It's indicated for multiple AP failures

Also I liked rexulti 

Tried Lithium? 

What specifically are the symptoms that need addressing? 

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Not that it is an aap, but i would not  necessarily  throw out  depakote because of potential side effects you may not have. Jmho

 

i am sorry to hear you are having such trouble finding meds.  

Edited by confused

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Thank you.  Yes I did try Lithium.  I edited the list because I forgot to put in lithium and Rexulti.  I am trying to address rapid cycling and hypomania which I get when I am off AP.  For the one who suggested Depakote, I am afraid to take it because I already have fatty liver and my hair falling out would be my worst nightmare.  It happened to my good friend.  Plus weight gain is pretty bad with Depakote.  I heard it is also bad with Clozaril .  I just want to find something that manages my symptoms without putting a bunch of weight on me and killing my sex drive.  Thank you

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 I don't mean to sound negative but after a certain amount of med trials you kinda have to cut ur losses and pick the least of all evils. Idk of a med that you haven't tried that hits all the symptoms without possible significant side effects, and unfortunately with AAPS that usually means weigh issues. I understand clozaril is a big step and I may not want it either but it was that or ECT for me. You could always go out of the box and try to combine a typical and an atypical

Edited by Iceberg
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I agree with Iceberg. There is no side effect free med. Sadly, most of the AAPs cause weight gain. Also everyone reacts differently to meds so you can't say Invega or Clozapine are bad before trying them. 

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I have thought of revisiting rexulti at a higher dose but the problem was on 0.5 I was fine. But once I hit 1 mg the depression got bad. So I don't know if a dose increase would be a good idea.  As for clozapine,  isn't that for schizophrenia?  And how much weight gain is the usual.  I ask this because I am having gastric surgery and I don't want to throw away 10/thousand dollars only to gain back all the weight. I curse the Dr who first put me on AAP. I lived fine for 38 years without them. Now there is nothing I can do.  I become very agitated without them.  I am seeing a new pdoc on the 26 and I am going to see what she recommends.  Thanks all for your input. 

 

 

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Well the recommended dose for rexulti depression is 2-3 mgs. Do u think that the rexulti actually made you depressed or just wasn't working? I've never seen depression listed as a side effect. As for clozaril, it's approved for schizophrenia, but it's used for many things when many other options Have failed including schizoaffective, bipolar, other psychotic disorders, and maybe even severe psychotic depression but I'm not sure of that one. I think the rule of thumb is three failed aps should be tried first. However if you are BP II with somewhat contained symptoms I'm not sure it's a good add on because it's strong suit is combating refractory mania first. Also it's a very love/hate thing with pdocs. Some stand by it and some Won't touch it so you'll have to see how the new doc feels 

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I, too, have become very depressed and very moody on Rexulti every single time I've tried it. I made it up to 3 mg and it is just not the right medicine for me. If you try it again, I would say start from 0.25 mg and titrate very slowly, and if you get a positive response, even if it's at 0.25 mg or 0.5 mg, it might be a good idea to just stay there.

I think clozapine would also be a fair candidate, given how many AAPs you've tried. Just know that you will have to get blood work done weekly for the first 6 months after starting it, then every other week for the second 6 months, then every 4 weeks after one year for the duration of treatment. You'll be a pincushion! The weight gain and propensity for diabetes are all dose-dependent from what I understand. Perhaps you won't need a high dose. Yes it is indicated for treatment-resistant schizophrenia, but it is used for bipolar and even treatment-resistant depression in low doses. It's even used for essential tremor, too. 

I agree with going outside of the box and trying a typical antipsychotic or the combination of a typical and atypical (like a low dose of both...) Like consider one of the most innocuous atypicals you've ever taken, and try it at a low dose along with a typical (whether it's a high or low potency would depend on which one it is. 

I remember you told me that Abilify 5 mg was too much for you, perhaps Abilify 2 mg or even splitting in half for 1 mg, could be combined with a small dose of a high potency typical, like Stelazine 1-2 mg bid. Typically you don't want to combine two dopamine antagonists; according to Stahl, you want to combine two antipsychotics with complimentary mechanisms of action. Clozapine plus a typical would also work because its metabolite, N-desmethylclozapine, is a D2/D3 partial agonist similar to Abilify (intrinsic activity at D2 is less than Rexulti's, and D3 instrinsic activity is near that of Vraylar).

Edited by mikl_pls
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Did you ever try Propranolol along with Latuda?  I was on 120mg of Latuda and it was the best med I have ever been on next to Clozapine.  I had to stop Latuda because of severe leg movements that cogentin didn't stop.  Now I'm back on Latuda and the Propranolol has completely taken away all EPS that I had before.  It also seems to calm me down a little.  I'm only on 60mg of Latuda right now, I probably need to be on 100mg or more.  But anyway, you might try Latuda again with Propranolol, it's a really good med and i am losing the weight I gained while on Zyprexa.  If you do try Clozapine it's a great med as well.  I just got sick of being poked every time I needed a refill.  It got old really quick.  The weight gain sucked as well. 

Hope you feel better soon. 

Edited by gb84

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If you do look at a typical+atypical strategy, I agree that stelazine is a good suggestion and I would also look at prolixin many say it's not a weight gainer. @mikl_pls makes a good point about clozaril being dose dependant- since I've switched to a lower dose my weight has been steady ish 

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1 hour ago, Iceberg said:

If you do look at a typical+atypical strategy, I agree that stelazine is a good suggestion and I would also look at prolixin many say it's not a weight gainer. @mikl_pls makes a good point about clozaril being dose dependant- since I've switched to a lower dose my weight has been steady ish 

I absolutely love Stelazine. It's not a weight gainer, either, as long as you are able to watch what you eat. It is absolutely wonderful for anxiety, too. I also didn't gain with Prolixin, but I was only taking Prolixin PRN. Personally, it wasn't very effective at all for me, even at doses as high as 5 mg (which really isn't that high a dose, but my pdoc didn't want me to take even remotely high doses of that med).

I'm really glad to hear that clozapine at low doses isn't as much of a weight gainer, that is good to here! (both for OP and for myself should I ever need to take clozapine...)

Another thing to watch out for with clozapine is sialorrhea (hypersalivation that could lead to drooling) due to clozapine being a potent M4 muscarinic full agonist as well as its metabolite, N-desmethylclozapine, being a potent M1 muscarinic full agonist. This could also theoretically lead to hyperhidrosis, too.

As far as mitigating weight gain and excessive appetite goes, you could take metformin (Glucophage) (which I believe you told me you already are doing). This would produce a very moderate weight loss and appetite restricting effect while also reducing fasting glucose levels that may be elevated by the antipsychotic(s). 

Trazodone (Desyrel) and nefazodone (Serzone) both metabolize into meta-chlorophenylpiperazine (mCPP), which is a non-selective serotonin agonist (at most receptors) and releasing agent. So while trazodone and nefazodone act as 5-HT2A/2C antagonists, their metabolite, mCPP, acts as a 5-HT2C partial agonist, which decreases appetite and encourages weight loss.

The anticonvulsant zonisamide (Zonegran) can act as a mood stabilizer while also causing weight loss and appetite loss to a degree similar to that of topiramate (Topamax) (which I know you told me you tried and couldn't tolerate).

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Thanks for all your help. I will be going to the new PDOC armed with all this information. 

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I have another question.  I am having the Gastric Sleeve procedure done on Sept 20.  Ideally I would be off AAP's to avoid being unable to lose weight or ending up gaining it back.  From your experience, which is a good AP or AAP that does not cause weight gain? (See above list of AAP's I have failed on)

 

Thank you

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Well on that list you basically rule out every AAP (depending on where you live). If you need containing of manic symptoms you might need to talk to your pdoc for second and third line options, including typical antipsychotics. Are you trying  to treat more depression mix or mania mix cycling? There are a few meds that are very powerful against mania/irritation/psychosis. The ones that usually cause the least weight gain are called high potency including haldol, stelazine, prolixin,  and some high-ish potency like loxapine and Navane. They (typically) cause less weight gain but you get a lot of other shit like EPS, dystonia, prolactin issues and tremor. And sometimes marked sedation but that's a big YMMV. Many think that typicals at significant doses give you more chance of tardive effects. One way to counter this is to combine one of your most successful aaps and combine with a typical at low doses. I've done it before and it wasn't exactly fun but I was able to avoid some of the weight and eventually the sedation. Too bad perphenazine didn't work for you...what dose did u hit? That was what my doc combined with. Also, there is this little known med called moban that I considered with a doc once- supposed to be weight neutral first gen. But for any of that u'd need a very flexible pdoc 

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Thanks.  I have my pdoc tomorrow. I will be going armed with all this info.I'm particularly interested in Stelazine and Amoxipine,.

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Only read your opening post but what're you trying to treat? 

I habe schizophrenua so you may be different, but I notice you don't have any typicals/first generation antipsychotics on your list. They are more likely to cause movement issues and I always take them with either propranolol, cogentin, or artane, but if you don't want to go the clozapine route, I have had much success with loxipine, navane, stelazine, haldol depot, and prolixin depot at various points in my life. Thorazine even worked for a while before I maxed out on it. 

Best of luck with whatever route you choose. 

PS I'm currently on clozaril and zyprexa. Among other things. 

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6 minutes ago, mellifluous said:

Only read your opening post but what're you trying to treat? 

I habe schizophrenua so you may be different, but I notice you don't have any typicals/first generation antipsychotics on your list. They are more likely to cause movement issues and I always take them with either propranolol, cogentin, or artane, but if you don't want to go the clozapine route, I have had much success with loxipine, navane, stelazine, haldol depot, and prolixin depot at various points in my life. Thorazine even worked for a while before I maxed out on it. 

Best of luck with whatever route you choose. 

PS I'm currently on clozaril and zyprexa. Among other things. 

Part of the trick tho is finding a pdoc who is comfortable with really using that stuff

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