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13 minutes ago, Juniper29 said:

Is he wanting to replace the gabapentin with Abilify/Geodon or add it on?

He wasn’t too clear however reading between the lines he’s considering both gabapentin and abilify/geodon to a lesser and greater extent as a mood stabilizer. So it would probably be a replacement, unless he’s thinking I still need something for anxiety.

abilify has been pretty good for you right? But it wasn’t enough without the gabapentin? Or is gabapentin strictly for anxiety in your case and that’s the only benefit it provided?

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23 minutes ago, argh said:

 

abilify has been pretty good for you right? But it wasn’t enough without the gabapentin? Or is gabapentin strictly for anxiety in your case and that’s the only benefit it provided?

Yeah, I like Abilify. It just doesn't seem to help my anxiety and actually made it worse at lower doses. Officially the gabapentin is for anxiety as my pdoc also doesn't consider it a mood stabilizer. It seems to kind of smooth things out and be calming.  Idk, they seem to complement each other for me at least.

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23 minutes ago, Juniper29 said:

Yeah, I like Abilify. It just doesn't seem to help my anxiety and actually made it worse at lower doses. Officially the gabapentin is for anxiety as my pdoc also doesn't consider it a mood stabilizer. It seems to kind of smooth things out and be calming.  Idk, they seem to complement each other for me at least.

Thank you. Yeah anxiety right now is sort of questionable as what should have worked did not, two SSRIs remeron hydroxyzine.

 

Did your Prozac ever touch your anxiety?

Edited by argh
Completing thoughts are hard

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1 hour ago, argh said:

Did your Prozac ever touch your anxiety?

Not that I can tell. It increased my anxiety pretty badly the last couple of times we increased the dose, and then after a while it leveled off, but it's hard for me to say whether it actually did anything positive for the anxiety in the end. I never found that Zoloft did much for my anxiety either.

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2 hours ago, argh said:

Thank you. Yeah anxiety right now is sort of questionable as what should have worked did not, two SSRIs remeron hydroxyzine.

 

Did your Prozac ever touch your anxiety?

What about any SNRIs ? Cymbalta, Effexor, pristiq, fetzima...the can definetly help anxiety long term...well especially the first two...and they can sometimes work when SSRIs aren't. Problem is that many people get short term startup anxiety when they start taking it

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3 hours ago, Iceberg said:

What about any SNRIs ? Cymbalta, Effexor, pristiq, fetzima...the can definetly help anxiety long term...well especially the first two...and they can sometimes work when SSRIs aren't. Problem is that many people get short term startup anxiety when they start taking it

Interesting. In general, if someone had a bad reaction on SSRIs, would they possibly do better on an snri?

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4 hours ago, argh said:

Interesting. In general, if someone had a bad reaction on SSRIs, would they possibly do better on an snri?

It's possible, but as with all things psych meds no way to tell for sure 

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So I started out with major depression.  I've never struggled with anxiety.  Then pdoc said BP2 after what I believe were two clear hypomanic episodes (my wife thinks I may have had others many years ago).  I developed depression when I was rather young and that's a marker for a possible later BP dx.  Although at my last appointment my pdoc apparently forgot what he told me before and said I'm not on the BP spectrum at all because my manic episodes didn't last at least two weeks.  That's not what the DSM says but oh well.  I'm getting the right treatment from him so I don't care what he calls it.  He just says "atypical depression" because in his words (and I agree) it doesn't look like MDD at all.

All that said... I had been doing well on wellbutrin, it really helps the depression a lot.  I was on remeron at night to counteract insomnia from the wellbutrin.  I wasn't going to give up wellbutrin because it was so effective and I've had dangerous suicidal tendencies.  But my moods still bounced all over the place.  I wouldn't stay depressed for more than a week or two.  It was on a somewhat predictable cycle, and then it became unpredictable.  I also seem to be easily triggered.  Therapy helps a lot with that.

So he put me on lamictal to do exactly what it's for:  the stabilize my mood.  It has worked wonders!  I have been stable and virtually depression free for months now.  I don't mean to get your hopes up if you can't take it, but maybe some research is in order to determine if you would have the same risk of rash or SJS with lamictal.  You may can try a very low dose.  The main risks are if you titrate the dose up too quickly (you can go as slow as you want to avoid that) or not stopping it as soon as the rash appears.  I'm not a doctor but as long as you start slow you can stop the day you get a rash and be alright.  That's just my uneducated opinion.  Follow your doctor's advice.

I recently sub'd my remeron for gabapentin because of memory and concentration problems with remeron.  My clear mind has returned (yay!), not sure yet if gaba will do the trick with sleep.  It's been hit or miss since I started last week.

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On 12/14/2018 at 5:57 PM, argh said:

Just checking in to thank everyone for their replies thus far

Why not try lithium? Lithium is the best mood stableizer in my opinion. 

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I want to second or third that low dose Abilify can increase anxiety. I had really bad anxiety below 10 mg. Abilify is GREAT for my depression but even at the highest dose doesn't really touch anxiety. For that, I have citalopram which helps me about as much as a benzo.

I'm not sure I would recommend Geodon as a mood stabilizer. Don't get me wrong, some people have a lot of success with Geodon, but it comes with a pretty nasty potential side effect. That side effect is random sedation. The kind of sedation that causes you to have to sleep. And some people have said that they got this even while driving. I don't want to bad mouth a med that helps a lot of people and that I have never taken, but I just want you to know that it wouldn't be my first choice as a mood stabilizer. Of course, I'm no doctor and YMMV.

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On 12/17/2018 at 11:13 PM, Riggs1 said:

Why not try lithium? Lithium is the best mood stableizer in my opinion. 

I've read that low dose lithium (under .08  blood level) is effective for bipolar spectrum disorders, so that's definitely a possibility.

Has anyone here taken on a low dose of lithium  for non BP1 issues?

On 12/18/2018 at 10:19 AM, jt07 said:

I want to second or third that low dose Abilify can increase anxiety. I had really bad anxiety below 10 mg. Abilify is GREAT for my depression but even at the highest dose doesn't really touch anxiety. For that, I have citalopram which helps me about as much as a benzo.

I'm not sure I would recommend Geodon as a mood stabilizer. Don't get me wrong, some people have a lot of success with Geodon, but it comes with a pretty nasty potential side effect. That side effect is random sedation. The kind of sedation that causes you to have to sleep. And some people have said that they got this even while driving. I don't want to bad mouth a med that helps a lot of people and that I have never taken, but I just want you to know that it wouldn't be my first choice as a mood stabilizer. Of course, I'm no doctor and YMMV.

Thanks for the heads up. I'm heavily leaning towards abilify if I do need to jump on an AAP.

IIRC you've mentioned that carbamazapine has been the backbone of your cocktail. Did you ever try oxcarbazapine?

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11 minutes ago, argh said:

I've read that low dose lithium (under .08  blood level) is effective for bipolar spectrum disorders, so that's definitely a possibility.

Has anyone here taken on a low dose of lithium  for non BP1 issues?

Thanks for the heads up. I'm heavily leaning towards abilify if I do need to jump on an AAP.

IIRC you've mentioned that carbamazapine has been the backbone of your cocktail. Did you ever try oxcarbazapine?

Personally oxcarbazapine (trileptal) was a sugar pill for me. I think there are a few people on here who really like it and I had one doc who used it as a first line option for new patients. My other three doc's and my inpatient attending thought it was pretty useless so I guess take from that what you will. I am not saying it never works (like I said some people on here have had good luck) but I wouldn't try it before the other tried and trues like lithium and tegretol/equetro (carbamazepine) 

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2 minutes ago, Iceberg said:

Personally oxcarbazapine (trileptal) was a sugar pill for me. I think there are a few people on here who really like it and I had one doc who used it as a first line option for new patients. My other three doc's and my inpatient attending thought it was pretty useless so I guess take from that what you will. I am not saying it never works (like I said some people on here have had good luck) but I wouldn't try it before the other tried and trues like lithium and tegretol/equetro (carbamazepine) 

Did Tegretol ever work for you? Just curious if it really was a matter of oxcarbazapine being weak vs those two relatives just didn't do anything for you?

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2 minutes ago, argh said:

Did Tegretol ever work for you? Just curious if it really was a matter of oxcarbazapine being weak vs those two relatives just didn't do anything for you?

Tbh I never took it, I was basing it more on the fact that it's more proven (as carbamazepine is actually approved for BP in equetro form) and *antecdotally* my docs have thought trileptal was down on the list as far as antiepileptics go...tho not in the sense that it's never used. We couldn't use it after trileptal failed cuz my idiot doc already had me on two other AEs (Depakote which I hate and lamictal which I am back on even though how much it actually helps is kind of unclear). After I switched docs I was plagued by mixed episodes and my doc(s) preferred to use antipsychotics for those, especially since I was on a super high lithium level so they felt I needed more help with sedating aps than with another mood stabilizer. At some point things went to shit and I had to do rounds of ECT so adding it was out of the question cuz it changes seizure threshold. It's basically one of two really common BP mania meds I've never tried (along with risperdal) so im not promoting tegretol I'm just sharing experience about trileptal...as I said tho I'm just one person among many who've tried it here so YMMV and all that

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46 minutes ago, Iceberg said:

Tbh I never took it, I was basing it more on the fact that it's more proven (as carbamazepine is actually approved for BP in equetro form) and *antecdotally* my docs have thought trileptal was down on the list as far as antiepileptics go...tho not in the sense that it's never used. We couldn't use it after trileptal failed cuz my idiot doc already had me on two other AEs (Depakote which I hate and lamictal which I am back on even though how much it actually helps is kind of unclear). After I switched docs I was plagued by mixed episodes and my doc(s) preferred to use antipsychotics for those, especially since I was on a super high lithium level so they felt I needed more help with sedating aps than with another mood stabilizer. At some point things went to shit and I had to do rounds of ECT so adding it was out of the question cuz it changes seizure threshold. It's basically one of two really common BP mania meds I've never tried (along with risperdal) so im not promoting tegretol I'm just sharing experience about trileptal...as I said tho I'm just one person among many who've tried it here so YMMV and all that

Understood. Thanks for the clarification.

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I've personally taken oxcarbazepine in the immediate release Trileptal form as well as Oxtellar XR. I REALLY liked it. Ultimately we determined I needed something more calming, hence the Depakote I'm taking now. But I REALLY like oxcarbazepine and would definitely go back to it. My cousin takes it for actual epilepsy and not a mood disorder and she likes it as well. It also is somewhat less likely to mess with liver enzymes than its predecessor carbamazepine (Tegretol).

I found oxcarbazepine to be soothing. My cousin said the same thing. I could actually feel the soothing effects of it an hour or two after taking it. However, I couldn't take it twice a day. I found that if I didn't take 300mg 3x/day and instead took it 2x/day I would feel the jitters starting around 2PM and lasting until my 6PM dose. It was annoying in a way so we switched to 1200mg of Oxtellar XR 2x600mg tablets. It fixed the problem perfectly and I didn't have to worry about taking it multiple times a day.

I would second again Abilify at low doses making your anxiety worse. I made it to 7.5mg over the course of 10 days, but I just couldn't make it to 10mg. I just couldn't do it. It was far too agitating for me. Rexulti has been a DREAM by comparison.

Geodon might be a bit dicey too. Someone already mentioned that random sedation, but for me the issue would actually be the cardiac side effects. Geodon is a norepinephrine reuptake inhibitor similarly to Seroquel. So after you take it you can sometimes feel your heart pounding in your chest. Combine that with Wellbutrin which is also a norepinephrine reuptake inhibitor and you MIGHT be a bit uncomfortable. I'm generally averse to anything that causes any sort of cardiac symptoms that mimic the physical symptoms of anxiety. It's why I haven't tried Geodon or Seroquel. We learned our lesson when my pdoc tried me on Fanapt. Bloody hell!

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