Jump to content
CrazyBoards.org
Sign in to follow this  

Recommended Posts

Posted (edited)

Circumstances in my life are driving me to extreme levels of anxiety and tension, and benzos do very little if anything for me. The current PRN antipsychotics I use (Stelazine and Thorazine) either work and are not able to be ordered (Stelazine), or do little if anything at doses that aren't sedating and are too sedating at doses that actually do something for my anxiety (Thorazine).

I'm looking for an AP that isn't too sedating that will work for anxiety, and wonder if anyone has taken any of these for anxiety.

AP's and AAP's I've tried:

  • chlorpromazine (Thorazine: see above)
  • fluphenazine (Prolixin: took for Tourette's but did nothing for anxiety)
  • haloperidol (Haldol: an emotional sledgehammer--makes me feel zombified even in low doses)
  • loxapine (Loxitane: actually did quite a lot for me mood-wise, but not much for anxiety; nevertheless, pdoc refuses to prescribe it anymore... I suppose I could get it from my gdoc?)
  • pimozide (Orap: took for Tourette's, not fond of this one, did nothing, want to avoid because of cardiovascular side effects)
  • prochlorperazine maleate (Compazine: does nothing for me...)
  • trifluoperazine (Stelazine: see above)
  • aripiprazole (Abilify: currently taking, does a lot for mood, but does very little if anything for anxiety...)
  • Latuda (lurasidone: can't take anymore... insurance pays 50% of retail value of drug, so it's ridiculously expensive, even with copay card, and can never seem to qualify for PAP's)
  • olanzapine (Zyprexa: currently use PRN, but causes extreme weight gain after just days of using, which is a no-no for me as I'm already very obese and trying to loose weight)
  • quetiapine (Seroquel: not effective at any dose and causes weight gain)
  • Rexulti (brexpiprazole: caused worsened depression from a dose range of 0.25-3 mg, so no thanks... insurance only pays for 50% of this one...)
  • Saphris (asenapine: actually did quite a lot for my anxiety for quite a while, but began to flatten my affect, and eventually made me extremely dysphoric and have crying spells; besides, my insurance only pays for 50% of this one too)
  • Vraylar (cariprazine: worsened depression over a prolonged period of time while taking at 3 mg, didn't have enough strength to stabilize my mood at 1.5 mg, 4.5 mg caused extreme dysphoria and terrible akathisia, and insurance will only pay 50% of retail cost)
  • ziprasidone (Geodon: this one helps with psychosis, mood, and a little bit with anxiety, but at the dose that it helps with this, it is a bit too sedating to handle; this one may be worth revisiting, but the aripiprazole is hard as hell to get off of...)

I don't want to get mixed up with thioridazine (Mellaril)...

I've read that perphenazine has good anxiolytic effects, but can be sedating. I have idiopathic hypersomnia, so that would be a bad thing to combine with that.

I've read that thiothixene has a psychostimulant effect at low doses (below and around 10 mg/day), but I don't know anything about any anxiolytic effects it may have, and I imagine the stimulant effect it purportedly has at lower doses might not be good for anxiety. I would hope to get away with a low dose of this one since it's a FGA.

I've also tried all the other anxiolytic agents like Atarax, Vistaril, BuSpar, etc., SSRIs/SNRIs/SARIs/SMSs/various TCAs/amoxapine/mirtazapine/etc./various anticonvulsants, so I'm not looking for alternative advice, see my signature as to other meds I've tried before recommending an alternative to these two meds. The only anxiolytic agents I've not tried are the barbiturates and meprobamate (Miltown).

Can anyone who has had any experience with these two AP's give me any insight into their effects on anxiety?

Edited by mikl_pls

Share this post


Link to post
Share on other sites

While I don't think trilafon was super great for my anxiety. It was never very sedating even at high dose, and 2 pdocs both said they didn't see it usually sedate patients 

Share this post


Link to post
Share on other sites

I was briefly given Navane at low dose and it seemed to work well and for anxiety. 

Share this post


Link to post
Share on other sites
43 minutes ago, Iceberg said:

While I don't think trilafon was super great for my anxiety. It was never very sedating even at high dose, and 2 pdocs both said they didn't see it usually sedate patients 

Awesome. Thanks for the input!

17 minutes ago, wookie said:

I was briefly given Navane at low dose and it seemed to work well and for anxiety. 

Do you remember the dose/how often you took it and whatnot? I was leaning towards thiothixene since it seemed to be associated with less weight gain (at least from what I've read).

Share this post


Link to post
Share on other sites

I was on Trilafon 25 years ago, though it was for psychosis and not anxiety. It worked well and I don't remember it being sedating. But I gained around 30 pounds in 6 months.

Share this post


Link to post
Share on other sites
15 hours ago, mikl_pls said:

Awesome. Thanks for the input!

Do you remember the dose/how often you took it and whatnot? I was leaning towards thiothixene since it seemed to be associated with less weight gain (at least from what I've read).

I think I took 2mg in the morning. I was in college and not overly med compliant due to a lack of funds.  Plus roommates thought my meds were poisoning me so they threw them out.

Share this post


Link to post
Share on other sites

I only took it once,  a 10 or 20 mg dose. I was young and did not know I have been referred to a bad psychiatrist who pretty well prescribed Navane for everything. You might as well of called him Dr. Navane. I got a major case of torticollis with neck and head twisting. Quickly found another doc who straightened everything out, literally, and gave me a reasonable med for my symptoms, Tofranil (imipramine).  

Share this post


Link to post
Share on other sites

Trilafon was good to me. I took it as a kid in the combination pill Triavil (Trilafon + Elavil). The Trilafon kicked in immediately and was calming. Unfortunately, the Elavil was a different story, and it sedated the crap out of me. But the Trilafon was great. I think I would have been better off if I were just prescribed the Trilafon because anxiety was a large component of my depression at that time.

As to dose ... it was a low dose especially since I was only 12 or 13 years old. I believe the dose was less than 5 mg.

Share this post


Link to post
Share on other sites

Well, apparently Navane isn't made anymore either, so I called my NP and asked if he could call in some Trilafon. They only make the 4 mg and 8 mg pills. This is so ridiculous, the shortage of these drugs...

Thanks again everyone for your input!! :D 

  • Like 1

Share this post


Link to post
Share on other sites
Posted (edited)
1 hour ago, cakepop said:

I got 2 mg trilafon pills recently..,

I'm honestly thinking of either taking Geodon on top of the Abilify or switching to Geodon entirely. I have impulse control issues that I believe are stemming from the Abilify, and I've been having to take Namenda because of it. Geodon is the only other AAP that has touched my depression. Anxiety is another story though. I just wish there was something out there that could ameliorate my anxiety. Nothing seems to work, it has intolerable side effects, or my insurance either won't pay for it or they'll only pay for a small portion for it and the drug is expensive so I can't afford it. >8'U 

Edited by mikl_pls

Share this post


Link to post
Share on other sites
6 hours ago, cakepop said:

My Pdoc said it’s the only Antipsychotic that can be used as Monotherapy for depression.

That's really strange. I've never heard that. But then again, it does have SNRI-like properties, so I could see why your pdoc said that.

Share this post


Link to post
Share on other sites
10 hours ago, cakepop said:

My Pdoc said it’s the only Antipsychotic that can be used as Monotherapy for depression.

 

3 hours ago, mikl_pls said:

That's really strange. I've never heard that. But then again, it does have SNRI-like properties, so I could see why your pdoc said that.

It certainly is an odd statement to make, but perhaps I can see where her pdoc is coming from. Ziprasidone does have an affinity for the norepinephrine transporter of 44nM and an affinity for the serotonin transporter of 112nM. The issue is its poor bioavailability of 60% after a 500 calorie meal (reduced by as much as 30-50% in the fasting state) and its short half-life of 7 to 10 hours. So I'm not sure you could attain meaningful occupancy of those transporters when it is taken once daily in a low dose.

HOWEVER, ziprasidone is also a potent partial agonist of 5HT1A, 5HT1B, and 5HT2C as well as a potent antagonist of 5HT2A and 5HT7, highlighting the pharmacological effects that are most likely to have antidepressant and anxiolytic effect. Combine that with even low occupancy of the monoamine transporters, and you could potentially have a meaningful clinical effect.

Also keep in mind that Trintellix manages to have an antidepressant effect in many people at at just 10mg which only yields 40-45% serotonin transporter occupancy, when 60-80% occupancy or higher is usually required. This is likely because of its actions at 5HT1A, 5HT1B, 5HT3, and 5HT7. Allowing for an antidepressant effect at lower SERT occupancies through receptor modulation. Pdocs are basically rediscovering all of these atypical antipsychotics at their lower doses that they never paid attention to before because manufacturers encourage moderate dosing. Takeda says you should start Trintellix at 10mg and go right to 20mg at Week 2. It's really totally unnecessary for most people. Yes 20mg has a more robust effect. But the positive effect of 10mg isn't something to shake your head at and it's far more tolerable. Seroquel is another great example.

With that in mind, I've never personally taken ziprasidone so I don't have a frame of reference, but I've definitely seen it used in low-dose as an adjunct to an AD for depression in many cases.

Share this post


Link to post
Share on other sites
15 hours ago, mikl_pls said:

I'm honestly thinking of either taking Geodon on top of the Abilify or switching to Geodon entirely. I have impulse control issues that I believe are stemming from the Abilify, and I've been having to take Namenda because of it. Geodon is the only other AAP that has touched my depression. Anxiety is another story though. I just wish there was something out there that could ameliorate my anxiety. Nothing seems to work, it has intolerable side effects, or my insurance either won't pay for it or they'll only pay for a small portion for it and the drug is expensive so I can't afford it. >8'U 

Geodon + abilify sounds like playing with fire as far as anxiety goes

Share this post


Link to post
Share on other sites
11 minutes ago, Iceberg said:

Geodon + abilify sounds like playing with fire as far as anxiety goes

Yeah I wouldn't want to mix Geodon's NRI action with Abilify's agitation. The panic and anxiety that cakepop was describing reminds me of what Latuda would feel like after I took it and from a structural perspective Geodon and Latuda are not so different (although Latuda does not appear to have appreciable effect on monoamine transporters).

Share this post


Link to post
Share on other sites

I called every pharmacy in my city and a few cities over (a total of about 10 pharmacies) earlier today. All of them said the same thing. Stelazine was either back-ordered with no estimation of when it would be available (although Publix said it might be available by Feb. 11), and Navane, at all doses, simply seemed to just not exist anymore with no trace of its past existence in the last few years (except brand-name Navane, which Publix said may be available by Feb. 11 also, but it's super expensive...).

There are two manufacturers for Stelazine (Mylan and Upsher-Smith which apparently acquired Sandoz which was the brand I used to prefer), and just one manufacturer for Navane (Mylan). I don't see myself getting either of these meds at all. I can say goodbye to my dear friend Stelazine, and I have no hopes of ever being acquainted with Navane.

I called my doctor's office yesterday as my NP instructed me to if Navane wasn't available, and left a message with the nurse that Navane wasn't available and that I would like to try Trilafon. The only doses available at my pharmacy that can be ordered are 4 mg and 8 mg. I checked the next day and they hadn't called it in. The nurses there, I swear... nope... not going to say it.

So this evening, I sent a strongly-worded inquiry to Mylan (who manufactures/ed trifluoperazine and thiothixene) and Upsher-Smith (which apparently acquired Sandoz) (who manufactures/ed trifluoperazine), asking if they are still manufacturing these products, why there's such a shortage, and if they don't make it anymore, then I have demanded an explanation as to why they are ceasing production. If I don't get a response within 5-7 business days, I'm going to call these companies personally and see if I can get in touch with a human being.

This shit isn't okay.

  • Like 1

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Sign in to follow this  

  • Similar Content

    • By Cyclingsarah
      Hi guys,
      just started Lithium yesterday. I know it can take several weeks to work, but I already feel it clearing my head a bit.
      question tho. Can lithium make anxiety worse in the beginning - like SSRI’s? Because I now find myself very panicky
      I am also on lexapro and mirtazapine. 
    • By Cyclingsarah
      Just wondering. I have a lot of anxiety and am startinh lithium for bipolar disorder in a few weeks
    • By mikl_pls
      I have a prescription for Stelazine 2 mg tid, Navane 2 mg tid, and, while I know it's not an antipsychotic, Dalmane 15 mg qhs prn, and it has been virtually impossible to find around my area. My currernt pharmacy can't get it at all from their wholesaler, I tried Publix and they couldn't find any from their vendor nor could they find any Publix in the neighboring cities that carried it. The nice lady on the phone when I talked to Publix suggested I try pharmacies with a different wholesaler than theirs, like Walgreens, CVS (never giving my money to them again...), or Walmart.
      Has anyone else had trouble finding these meds?
    • By PurplePaisley
      I was on Olanzapine for about one year and during that time I did excessive spending which may have caused  lowering impulse control and consequently am now in bankruptcy.
      Have been off Olanzapine since December, 2018.
      In March went on Seroquel and experienced manic situations, where I was out of control (never had this happen to me before). I became excessively hostile towards a clerk in Walgreens, reduced my veterinarian to tears and alienated alot of my neighbors by my raging.  We upped the Seroquel thinking I was having my first manic episode, it only made everything worse.  Since coming off of Seroquel in last two weeks, I am now calm and the urge to act out aggressively is gone and I am mortally embarrassed about my behaviors.
      New psych doc now, former one retired.  Started Reluxti two days ago at .5 mg.  First day experienced some brain zaps and thinking it might have been due to the mixing of recently going off of Seroquel and introducing Reluxti.  Today, no brain zaps.  Taking Benadryl to help with insomnia as Rexulti may become stimulating. 
      I know this is a very expensive drug and being on Medicare I do not qualify for any of the manufacturer's savings plans. My new psych doc believes he can keep me on his extra supplies forever or until they go generic.  I am worried about being on this drug and loosing him as a psychiatrist and ending up with a co-pay of $400.00 a month and ending up in the Medicare Donut-hole very quickly. The trial pack he gave me has a 14 day supply.
      I recently did a gene study thru GenOMind.  I am an ultra-rapid metabolizer and subject to many skin issues.  When I first saw him, he became very frustrated with me and didn't believe me that I can't tolerate most of the behavioral meds out there but once he got the gene study, he then understood.  The only drug he would suggest is Rexulti. 
      I am in a quandary as to what to do about going on this very expensive medication with no way of paying for this and getting stuck on this drug should I loose my new psych doc and his many samples.
      Purple
       
       
       
       
    • By Britton777
      Hi everyone. I’ve been bouncing from one trial of medication to another for the past 4 1/2 years with adverse reactions. Nothing has helped. I just saw a new psychiatrist on Monday. An older gentleman who actually seemed to listen. He was also a longtime professor our local university. 
      My symptoms are treatment resistant insomnia, chronic, severe anxiety, chronic derealization, ocd (pure o) racing, intrusive thoughts (often presenting as songs looping in my head, but a switch can also go off in my head where I obsessively think about something to the point of it driving me crazy)  brain fog, depression. My body and brown simply will not turn off. I’m stuck in constant fight/flight.  I believe the lack of sleep is the catalyst for most of this (all of this started after sudden onset of insomnia) Maybe it wouldn’t go away with sleep, but I know it would get better. My main goal is sleep, but seems unattainable after 4 1/2 years.
      I have tried every medication under the sun (well, mostly) 
      The doctor decided to prescribe provigil (modafinil) which seems counterintuitive to me. He was clear that it could go either way. Possible that it could calm me down, possible that it could let me up and make my symptoms worse. 
      Luckily for me, since I am highly sensitive to medication, he is quite conservative  and said to only start with roughly 1/16 of a pill to see how I do. 
      Wondering what your thoughts are on this given my symptoms? Seems counterintuitive...but maybe it will help. So confused. 
×
×
  • Create New...