Ideas for med cocktail

[tbs14]

I suffer from the following 

Bipolar 1 Disorder with mixed features 

Borderline personality disorder 

Obsessive Compulsive Disorder 

Generalized Anxiety Disorder 

A ton of social anxiety but no formal dx 

Inhalant Use disorder 

Alcohol use disorder 

 

I have tried 

Buspar 45 mg

 

Vistaril 50 mg

Benadryl 50 mg

 

Concerta

Ritalin 10mg

 

Clonidine .02 mg

Guanfacine

 

Lithium 1200 mg

 

Trileptal 900 mg

Gabapentin 900mg

 

Abilify 15mg

Seroquel 200mg

Seroquel XR 300mg

 

Prozac 60mg

Luvox 10mg

 

Remeron 7.5mg

With no good results 

I'm currently taking effexor xr 225mg 

Depakote 1250mg 

Latuda 100mgs 

And vistaril for sleep but it doesn't work well 

I'm hitting the wall of frustration and feel like I've run out of options 

SSRIs and SNRIs make me super manic so I can't try a new one or up my dose for anxiety or depression 

I'm going through a really bad depression with a ton of anxiety obssesions, etc 

Anything would be very helpful 

Thanks 

[HydroCat]

As you posted:

You take Effexor as an antidepressant, tried Abilify and Seroquel as antipsychotic. In this category Risperidone or Zyprexa may be worth trying.

Lamictal is a mood stabiliser, like your Depakote but has a slight tendency to balance the depressed side of bipolar. Depakote is considered more on the anti-manic side.

It is weird that you were on Clonidine without trying “traditional” anti-anxiety meds like one of the many benzodiazepines out there.

I would think that SNRI (with its pro-manic tendencies) + a stabilizer like Lamictal may be a good combo.

It seems that you have tried the second and third line options before the obvious choices.

Anyway, I am not a doctor, just been exploring for some time now.

PS: There is of course the Lithium option.

Edited December 14, 2018 by HydroCat

[Iceberg]

5 hours ago, tbs14 said:

I suffer from the following 

Bipolar 1 Disorder with mixed features 

Borderline personality disorder 

Obsessive Compulsive Disorder 

Generalized Anxiety Disorder 

A ton of social anxiety but no formal dx 

Inhalant Use disorder 

Alcohol use disorder 

 

I have tried 

Buspar 45 mg

 

Vistaril 50 mg

Benadryl 50 mg

 

Concerta

Ritalin 10mg

 

Clonidine .02 mg

Guanfacine

 

Lithium 1200 mg

 

Trileptal 900 mg

Gabapentin 900mg

 

Abilify 15mg

Seroquel 200mg

Seroquel XR 300mg

 

Prozac 60mg

Luvox 10mg

 

Remeron 7.5mg

With no good results 

I'm currently taking effexor xr 225mg 

Depakote 1250mg 

Latuda 100mgs 

And vistaril for sleep but it doesn't work well 

I'm hitting the wall of frustration and feel like I've run out of options 

SSRIs and SNRIs make me super manic so I can't try a new one or up my dose for anxiety or depression 

I'm going through a really bad depression with a ton of anxiety obssesions, etc 

Anything would be very helpful 

Thanks 

I'd look at lamictal for the BP depression. If u feel maxed out on latuda I'd also look at rexulti or Vraylar as options. Equetro or tegretol can also be a mood stabilizer. Have u tried any amphetamines? Also the Ritalin dose is pretty low. Cytomel can have an AD effect but usually won't cause maina. Was the remeron just for sleep? That dose is also super low. Does ur doc use benzos? It seems like uve tried enough other stuff to justify it. What went wrong with lithium? I had issues at really high dose but good luck when I combined it with lamictal and was able to use a lower dose, risperdal can help with some of the anxious depressive symptoms as can some older typical antipsychotics. There is also always clozaril as last resort. I don't mean this as a blitz, just to demonstrate that it's not yet time to freak out about lack of options, there's still plenty of ideas left 

[tbs14]

Thank you so much for the responses 

 

I would like try lamictal but my genesight says that I am a very rapid metabolizer and would probably require a large dose which means a higher chance side effects

The lithium never really helped me it was always kept in my cocktail but finally my new psychiatrist brave enough to wean me off of it and I feel like I have clean slate 

Yes the Remeron was just for sleep but considering how fast it put weight on me I would be resistant to try it again. When I was put on it my diagnosis was major depression. And I had no appetite so it helped that but the constant food cravings are something that would make me want to try other options before resorting to remeron. 

I also need help in the sleep department. I've tried ambien, vistaril, seroquel with side effects that are reasonable long term or the med was ineffective.

I want to try Lunesta for sleep 

Im also interested in the off label use of marinol and lyrica for anxiety

My doctor my doctor is one of those who sees benzos as a more short term med like 3 weeks till an AD kicks in or for acute situation versus long term. 

[tbs14]

Also the concerta and Ritalin were added for added when I was inpatient and my dignosis was changed from bipolar unspecified to DMDD, inattentive ADHD and GAD but the stimulant threw me into a huge manic/mixed episode so that seems like an option to try out if all else fails 

[dancesintherain]

you'll find lots of debate on here about genesight.  some swear by it, some think it's a load of hogwash.

I tend to be of the mindset that if the drug sounds like it would be a good match for your symptoms, it's worth at least trying it.  say you find out the genesight profile is right--then sure, you stop it.  but there's always the possibility that you'll find a good fit based off of other reasons that suggest you should try it.

[tbs14]

Thanks for the input, definitely helps

[HydroCat]

FWIW, I've done one of these genetic tests, not specifically genesight but still.

Says that I'm a slow metabolizer of CYP1A2 and that caffeine should affect me like a strong stimulant.

... I drink 6 cups a day, two of which at night. Nothing. Sleep is excellent ?

[looking for answers]

31 minutes ago, HydroCat said:

FWIW, I've done one of these genetic tests, not specifically genesight but still.

Says that I'm a slow metabolizer of CYP1A2 and that caffeine should affect me like a strong stimulant.

... I drink 6 cups a day, two of which at night. Nothing. Sleep is excellent ?

funny you say that, says im an ultra rapid metabolizzer of CYP1A2.  and i can guzzle coffee like its nothing..........give me 4-5 20/24 oz cups a day and nothing.  also told me lamictal i rapidly metabolized, we tried, kept upping the dose, and it didnt work. some of the pain meds listed on there matchup with not working too...........however, a few things on there i have taken with success.....that it states i shouldnt have success with.

point being, its worth a try.

[Fluent In Silence]

Maybe the missing ingredient is Jesus? Or whisky or 80's disco music. It has to be one of those things.

[notloki]

Generic tests are iffy and without a geneticist to interpolate them they become even less valid.

[argh]

I’d ignore dna testing unless there is a necessity for it, such as well known and severe reactions, i.e.  hla-b 1502 testing prior to taking carbamazepine for Asians.

dont get me wrong, I would find it absolutely fascinating to read the results, however I would give any drug which seems to be a good fit for your symptoms, a try.

[cakepop]

[deleted]

 

Edited April 7, 2019 by cakepop

[looking for answers]

31 minutes ago, cakepop said:

Is GeneSight testing definite? My previous pnurse had me do it. I forgot to mention it to my current pdoc and it also slipped my mind at my last appt. But I just looked at my copy and the my new meds are in the no no categories (Zyprexa and Prozac).

Do I need to ask about different meds?

think that depends. are your meds working. 

[dancesintherain]

see above

[mmaryland]

32 minutes ago, cakepop said:

Is GeneSight testing definite? My previous pnurse had me do it. I forgot to mention it to my current pdoc and it also slipped my mind at my last appt. But I just looked at my copy and the my new meds are in the no no categories (Zyprexa and Prozac).

Do I need to ask about different meds?

No genesight testing is not definite. Mine said latuda would be better tolerated by my body compared to rexulti. Despite this, my response to rexulti was much better than latuda. On rexulti, my bipolar depression went away and I felt happy! On Latuda I could barely get out of bed I was so depressed. But it can still let you know a lot about how to dose certain medications because it will tell you if you are a normal, extensive, rapid,  or slow metabolizer of drugs X, Y, Z (for example, my results showed I was a poor metabolizer of drugs which were metabolized by CYP 2D6. This helped me understand that my dose of rexulti should always be half of what it would be otherwise) It also told me that I produce reduced amounts of folate and have a genetic mutation of 5-MTHFR, so I began using l-methylfolate to supplement

[cakepop]

[deleted]

Edited April 7, 2019 by cakepop

[looking for answers]

12 minutes ago, cakepop said:

Yes mine said I have the same gene mutation. I just haven’t tried the supplement yet. Almost all the SSRIs are in the category that says my body can barely process it. I guess I’ll have to email my pdoc on Monday and see what to do. I’m just trying to decide if I should continue taking the Zyprexa and Prozac until then but something tells me I should...

hi, you didnt answer the question though, are the meds working

[cakepop]

[deleted]

Edited April 7, 2019 by cakepop

[notloki]

What symptoms trouble you the most ?