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I've recently switched Abilify for Amisulpride, as augmentation to Effexor.

A few days later I was mentally hit by a train.
At this time I noticed that my SD side effects got a lot better.
Then I've increased the dosage of Amisulpride. Depression disappeared. SD returned.

Apparently, I can't go with Effexor (and Lamictal) alone for my depression, but I am too sensitive to Antipsychotic side effects.

Does anyone here have a good experience with a non-AP augmentation to antidepressant?

Edited by HydroCat
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yeah for me lithium was the savior. It pulled me out of the darkest place ive ever been, , may have saved my life. It did not pull me all the way out of depression. I needed many more augmentations. But dear god did it do the heavy lifting.

 

You are already on lamictal though. So how do you feel about the lamictal? for me it was "oK" for others ive heard alot of great things. Perhaps switching the lamcital for another anticonvulsant or such? Im no doctore, and im no med specialist by any means. just throwing ideas at a wall

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Since you're on Effexor, you could augment with mirtazapine (if it's available where you are). If mirtazapine isn't available, I believe its close relative, manserin, will probably do. It's very common to augment Effexor with mirtazapine here. Stahl calls it "California Rocket Fuel."

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Lamictal was no less than amazing when I started taking it. Maybe 200mg is too low.

I asked my pdoc about Mirtazapine and he wouldn't perscribe it to me because of sedation side effect, which I find odd since I am now on Clonazepam that some people take as a sleeping aid.

If it is possible that the SD is indeed caused by the APs then I would definitely want to take that “risk”.

Does Wellbutrin augmentation make sense instead of an AP?

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1 hour ago, HydroCat said:

Lamictal was no less than amazing when I started taking it. Maybe 200mg is too low.

Some people do need more than 200 mg. I find that when I'm on it, I need around 300-400 mg. Right now I'm titrating up on it and 150 mg isn't doing anything. When I first started it though, 200 mg was magic.

2 hours ago, HydroCat said:

I asked my pdoc about Mirtazapine and he wouldn't perscribe it to me because of sedation side effect, which I find odd since I am now on Clonazepam that some people take as a sleeping aid.

That is odd... I mean, yes, 15 mg will be sedating, but 30-45 mg will be less sedating and a bit more stimulating, especially 45 mg.

Mianserin is supposedly less sedating, but I hear it's less prescribed than mirtazapine in countries in which it's available.

2 hours ago, HydroCat said:

If it is possible that the SD is indeed caused by the APs then I would definitely want to take that “risk”.

If by "SD" you mean "sexual dysfunction," then there are APs that are less so associated with sexual dysfunction.

2 hours ago, HydroCat said:

Does Wellbutrin augmentation make sense instead of an AP?

Absolutely, unless you have a condition that requires an antipsychotic.

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2 hours ago, HydroCat said:

Lamictal was no less than amazing when I started taking it. Maybe 200mg is too low.

Over the years I have slowly dreamt up to 300 mgs of LTG. I wonder if you mightn’t try adjusting that before adding something new.

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Thanks for your replies.

My pdoc added an AP (.5mg Risperidone) when  we found that above-maximum dose of SSRIs weren't doing enough for my OCD. Never had SD issues on antidepressant alone and if I recall correctly - neither with SNRI+Risperidone.

In time I switched to Abilify, then slowly I became more and more flat, along with the SD side effect. Switched back to Risperidone (crazy side effects), once more to Abilify (flat again) and now to Amisulpride.

Lamictal was added along the way.

My pdoc sais that I need an AP because of my intrusive thoughts, but I was thinking that if I am *that* sensitive to them that 2.5mg Abilify makes me flat then maybe I need something different.

SD and flatness disappears in transition times, i.e when I am depressed and OC-ish.

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14 hours ago, mikl_pls said:

Have you ever tried sulpiride? It's sort of like amisulpride. Low doses might help you out and not cause SD. 

If I understand the pharmacology, they should be very similar, D2/D3 antagonists.

I am looking for something different to augment Effexor with, ideally something that could replace some of it and allow me to reduce the dosage of Effexor.
Maybe with less of an SSRI and no AAP I will be able to get my sex life back...

I'd really like to try Mirtazapine but it may not be an option. Does it make sense to try Buspar?

p.s. Wellbutrin was good for my depression (but not for OCD) when taken alone. Maybe a combination of Effexor+Wellbutrin is possible.

Edited by HydroCat
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On 1/2/2019 at 7:40 AM, HydroCat said:

If I understand the pharmacology, they should be very similar, D2/D3 antagonists.

I am looking for something different to augment Effexor with, ideally something that could replace some of it and allow me to reduce the dosage of Effexor.
Maybe with less of an SSRI and no AAP I will be able to get my sex life back...

I'd really like to try Mirtazapine but it may not be an option. Does it make sense to try Buspar?

p.s. Wellbutrin was good for my depression (but not for OCD) when taken alone. Maybe a combination of Effexor+Wellbutrin is possible.

Buspar absolutely makes sense. I'm not sure if it will help OCD much, but does make sense.

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Back on Abilify for the third time, stopping it was probably a bad idea to begin with. According to my pdoc, the dosage might have been too low for me and that is why it gave a weird/unstable effect.

He also said this time that Mirtazapine may be a good idea. Going back to the “blame it on SNRI” approach, I'm switching (some of?) Effexor for Mirtazapine.

Currently in transition... at the very least, I'm not bored :)

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On 1/8/2019 at 3:45 PM, l'appel du vide said:

I take Prozac with Rexulti and I have absolutely no SD. Never have. I'm a big advocate of Rexulti so I'd say maybe give that a try.

I second the Rexulti for sure. I love it. Despite how structurally similar it is to Abilify, it just does not compare based on my own experience.

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  • 1 month later...
On 1/17/2019 at 5:02 PM, HydroCat said:

I see a lot of good comments about rexulti.

Unfortunately, it is not (yet) available in my country.

I live in the Netherlands and I think it's still not available here, although I've read that it was supposed to get registered July 2018....
I've asked my pdoc about it, but she never heard of it.

Kinda silly....
 

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