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22 minutes ago, Britton777 said:

I hear you and I appreciate you! What I’m really struggling with is OCD (in the form of racing thoughts, obsessive thinking and intrusive thoughts- including suicidal thoughts) from all that I’ve read, it doesn’t seem that rixulti is geared towards these conditions. That’s my worry/concern. 

currently struggling with the idea of not trying rixulti, and stopping Zoloft and remeron for 2 weeks to try Nardil. If I do this, Those are going to be some tough weeks, weeks I’m not sure I’ll make it through. THEN, if Nardil doesn’t work or help, I have to wait another 2 weeks to start a new med again. It’s a head decision when you’re as jacked up and in crisis mode as I am. 

THANK YOU ALL FOR BEING HERE FOR ME♥️

Your head chemistry might just be unique. Try rolling with that thought. With ocd is it ever possible to get obsessed with a positive thought or is the ocd inseparable from anxiety?

given the risks associated with a washout...benzo excluded, that sounds like something to do inpatient given the state you are in.

if you don’t want to go inpatient as you had a traumatic experience before, it sounds like it would be safer to start with rexulti.

has ect ever been an option?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4023099/

Tldr. Ect May work for severe cases of ocd.

 

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31 minutes ago, argh said:

Your head chemistry might just be unique. Try rolling with that thought. With ocd is it ever possible to get obsessed with a positive thought or is the ocd inseparable from anxiety?

given the risks associated with a washout...benzo excluded, that sounds like something to do inpatient given the state you are in.

if you don’t want to go inpatient as you had a traumatic experience before, it sounds like it would be safer to start with rexulti.

has ect ever been an option?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4023099/

Tldr. Ect May work for severe cases of ocd.

 

It does sound like something to do inpatient, but I am terrified to go inpatient. I have PTSD from my experiences inpatient. 

obsessive thoughts=anxiety and vice versus for me.always. Never good thought ocd. 

I did one treatment of ECT last June, but my oxygen went down to 70%, so they said no more:( 

is rixulti different  enough from the other atypical antipsychotics? I was put on 500 mg seroquel inpatient for 30 days and went completely crazy. They refused to take me off of it. Anxiety, OCD, panic attacks and suicidal thoughts were unbearable. 

 

Edited by Britton777

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26 minutes ago, Britton777 said:

It does sound like something to do inpatient, but I am terrified to go inpatient. I have PTSD from my experiences inpatient. 

obsessive thoughts=anxiety and vice versus for me. 

I did one treatment of ECT last June, but my oxygen went down to 70%, so they said no more:( 

is rixulti different  enough from the other atypical antipsychotics? I was put on 500 mg seroquel inpatient for 30 days and went completely crazy. They refused to take me off of it. Anxiety, OCD, panic attacks and suicidal thoughts were unbearable. 

 

Some circles seem to think so to the point of classifying aps that have dopamine agonism as third generation.

this is about abilify, but same idea. Rexulti would fall in this category.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2958217/

this paper is well above my capacity to understand but the abstract is pretty readable. Notably later in the article, the author even denotes differences between second generation aaps, such as how different in receptor affinity ratios are different for something like seroquel vs risperdal.

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8 minutes ago, argh said:

Some circles seem to think so to the point of classifying aps that have dopamine agonism as third generation.

this is about abilify, but same idea. Rexulti would fall in this category.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2958217/

this paper is well above my capacity to understand but the abstract is pretty readable. Notably later in the article, the author even denotes differences between second generation aaps, such as how different in receptor affinity ratios are different for something like seroquel vs risperdal.

Thanks. I’ll try to muddle through the article. 

I have a question....I tried l-dopa (I think it was velvet bean) and it fucked me up really bad, which makes me concerned about messing too much with dopamine....

Edited by Britton777

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7 hours ago, Britton777 said:

Thank you for responding. I just called my pharmacy and they said Marplan is not listed as unavailable, but it may be on back order. They had no way of knowing. Why would you think Marplan might be a better choice? Are you on an MAOI?

Marplan is a hydrazine derivative like Nardil, but comes with less metabolic side effects like weight gain and such, but it's not as stimulating as Parnate is.

Yes I'm on Parnate.

7 hours ago, Britton777 said:

Mom seeing my psychiatrist today and am not sure what to talk to her about as my appointments are only 10-15 mins. Any thoughts? I had multiple panic attacks during the night last night and am stuck in fight flight with severe derealization today. I’m very scared right now. I have been stuck in fight/flight with derealization for over 4 years, but haven’t had panic attacks like I’ve been having the last month in a long time. Benzodiazepines do not help me. Nothing does. 

Jeez that's quite a limited amount of time. Make very pointed, brief notes about what you want to talk about, or even hand them over to your pdoc.

7 hours ago, Britton777 said:

Do all MAOI medications have an amphetamine “type” base? Confused by the reviews I have read for MAOI’s (I’ve mostly read about Nardil) helping anxiety but having an amphetamine component to them. Seems counterintuitive..?? TIA

No, only Parnate and selegiline (Emsam). Nardil metabolizes into phenethylamine (PEA) which acts a little like amphetamine, but its duration of action is much shorter.

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37 minutes ago, Britton777 said:

Thanks. I’ll try to muddle through the article. 

I have a question....I tried l-dopa (I think it was velvet bean) and it fucked me up really bad, which makes me concerned about messing too much with dopamine....

With herbal supplements, or supplements in general, there is nothing to guarantee purity or efficacy. 

Beyond that, you can think of it in terms of purported moa does not equal equivalence.

example. There are a large number of SSRIs on the market. While they all perform serotonin reuptake, an ssri such as Paxil May have different effects on an individual than lexapro. Personally, Zoloft was a much different experience than Paxil. Zoloft was innocuous yet ineffective, while Paxil was fuck shit awful. Both are SSRIs. I’d be willing to try another if it came to that.

ive noticed a pattern in your posts where you will rule out an entire class of medications based on a broad category, given your experience with one or a few drugs in said category. If you had tried all of them as you stated with SSRIs, fair, exclude them, that makes sense.

There are definitely cases where that is practical, such as someone avoiding or proceeding with great caution with the use of a tca due to bipolar disorder.

in your case, unless explicitly contraindictated, you should judge each med on its own merit, not by class.

Edit: i seem to be on a posting spree today and have derailed this topic a bit. time to step away from the computer for tonight.

Edited by argh
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26 minutes ago, argh said:

With herbal supplements, or supplements in general, there is nothing to guarantee purity or efficacy. 

Beyond that, you can think of it in terms of purported moa does not equal equivalence.

example. There are a large number of SSRIs on the market. While they all perform serotonin reuptake, an ssri such as Paxil May have different effects on an individual than lexapro. Personally, Zoloft was a much different experience than Paxil. Zoloft was innocuous yet ineffective, while Paxil was fuck shit awful. Both are SSRIs. I’d be willing to try another if it came to that.

ive noticed a pattern in your posts where you will rule out an entire class of medications based on a broad category, given your experience with one or a few drugs in said category. If you had tried all of them as you stated with SSRIs, fair, exclude them, that makes sense.

There are definitely cases where that is practical, such as someone avoiding or proceeding with great caution with the use of a tca due to bipolar disorder.

in your case, unless explicitly contraindictated, you should judge each med on its own merit, not by class.

Edit: i seem to be on a posting spree today and have derailed this topic a bit. time to step away from the computer for tonight.

Thank you argh. Have a good night :) 

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43 minutes ago, mikl_pls said:

Marplan is a hydrazine derivative like Nardil, but comes with less metabolic side effects like weight gain and such, but it's not as stimulating as Parnate is.

Yes I'm on Parnate.

Jeez that's quite a limited amount of time. Make very pointed, brief notes about what you want to talk about, or even hand them over to your pdoc.

No, only Parnate and selegiline (Emsam). Nardil metabolizes into phenethylamine (PEA) which acts a little like amphetamine, but its duration of action is much shorter.

Thank you for your response. I’m not sure if you read the thread, but if so, what are your thoughts on me trying Nardil? (OCD, anxiety, panic, depression and derealization. Oh, and INSOMNIA. Major insomnia) 

my biggest concern besides trying something new which is difficult for me, is having to go off Zoloft and remeron for 2 weeks before trying Nardil. Zoloft and remeron aren’t working for me, or at least not well, but I’m scared of not being covered for 2 weeks and going off the deep end completely. I’m already in a very bad spot. Have been for over 4 years, but my panic attacks and even worse insomnia (didn’t think it could get worse) have been much worse the past month. 

Edited by Britton777

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38 minutes ago, Britton777 said:

what are your thoughts on me trying Nardil?

I think it's fine, but I thought you were concerned about the metabolic issues it might cause like weight gain.

39 minutes ago, Britton777 said:

my biggest concern besides trying something new which is difficult for me, is having to go off Zoloft and remeron for 2 weeks before trying Nardil. Zoloft and remeron aren’t working for me, or at least not well, but I’m scared of not being covered for 2 weeks and going off the deep end completely. I’m already in a very bad spot. Have been for over 4 years, but my panic attacks and even worse insomnia (didn’t think it could get worse) have been much worse the past month.

This I totally can understand. It's not that big a deal if you can tough it out, and if your pdoc is willing to let you use "bridging agents." These include atypical antipsychotics, mood stabilizers, tricyclic antidepressants, and stimulants.

You really only have to wait 5 half lives of the medicine for the washout.

  • For Zoloft, the half life is 26 hours. 26 h * 5 = 130 h / 24 = 5.41666... days (call it a week to be safe).
  • For Remeron, the half life is 20-40 hours. 20-40 h * 5 = 100-200 h / 24 = 4.1666... - 8.333... (call it about a week).

You'd really only have to wait about a week for your washout period rather than two weeks.

In the interim, you could start something like one of the secondary amine TCAs like nortriptyline, desipramine, protriptyline, or one of the TeCAs like amoxapine or maprotiline; an atypical antipsychotic like Abilify; a mood stabilizer like Lamictal (but the titration period is so long that you'd be on the MAOI before you hit the target dose, but low doses might just do the trick) or lithium; or a stimulant like Ritalin, Adderall, or Vyvanse, or the likes. As you start the MAOI, you can either come off the bridging agent, or even keep the bridging agent to enhance the efficacy of the MAOI.

If you're worried about going off the deep end, a TCA like nortriptyline with an AAP like Abilify might do you some good during the washout period.. Maybe even some lithium. But once you start the Nardil, you could start to cut back on the bridging agents (or keep them, up to you) as much as you want... you could be on Nardil only, or you could be on Nardil + all the bridging agents, and anything in between. 

Make sense?

Panic attacks and insomnia may need to be addressed by another medication or medications.

Hopefully the Nardil would sort out the Panic attacks, but if not, there are a number of medication options to go through. We would probably cross that bridge if we came to it though.

As for insomnia, have you ever tried doxepin, trazodone, or trimipramine?

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@Britton777 I see you have your gender listed as 'unicorn', but I was wondering if you would mind sharing your gender with the rest of the thread. Reason I say this is because outside the U.S. where pdocs are a bit more progressive, sometimes medroxyprogesterone (Depot Provera, birth control shot) is used to assist with mood stabilization. Perhaps part of your problem is hormonal if you are female, and birth control may help?

Also, have you been tested for the MTHFR gene mutation?

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3 hours ago, browri said:

@Britton777 I see you have your gender listed as 'unicorn', but I was wondering if you would mind sharing your gender with the rest of the thread. Reason I say this is because outside the U.S. where pdocs are a bit more progressive, sometimes medroxyprogesterone (Depot Provera, birth control shot) is used to assist with mood stabilization. Perhaps part of your problem is hormonal if you are female, and birth control may help?

Also, have you been tested for the MTHFR gene mutation?

I am 42 year old female. I had a full hysterectomy in March 2017 in hopes of it helping my situation, but it didn’t. I have something called mast cell activation disorder. The doctors said it was possible that fluctuations in hormones were causing my mast cells to go bonkers, so I elected to have the surgery (unfortunately) 

i do have one copy of each mthfr gene mutation. I have tried to supplement with different forms of methylfolate, including Deplin, but, like must things, it made me feel worse. 

Edited by Britton777

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13 hours ago, mikl_pls said:

I think it's fine, but I thought you were concerned about the metabolic issues it might cause like weight gain.

This I totally can understand. It's not that big a deal if you can tough it out, and if your pdoc is willing to let you use "bridging agents." These include atypical antipsychotics, mood stabilizers, tricyclic antidepressants, and stimulants.

You really only have to wait 5 half lives of the medicine for the washout.

  • For Zoloft, the half life is 26 hours. 26 h * 5 = 130 h / 24 = 5.41666... days (call it a week to be safe).
  • For Remeron, the half life is 20-40 hours. 20-40 h * 5 = 100-200 h / 24 = 4.1666... - 8.333... (call it about a week).

You'd really only have to wait about a week for your washout period rather than two weeks.

In the interim, you could start something like one of the secondary amine TCAs like nortriptyline, desipramine, protriptyline, or one of the TeCAs like amoxapine or maprotiline; an atypical antipsychotic like Abilify; a mood stabilizer like Lamictal (but the titration period is so long that you'd be on the MAOI before you hit the target dose, but low doses might just do the trick) or lithium; or a stimulant like Ritalin, Adderall, or Vyvanse, or the likes. As you start the MAOI, you can either come off the bridging agent, or even keep the bridging agent to enhance the efficacy of the MAOI.

If you're worried about going off the deep end, a TCA like nortriptyline with an AAP like Abilify might do you some good during the washout period.. Maybe even some lithium. But once you start the Nardil, you could start to cut back on the bridging agents (or keep them, up to you) as much as you want... you could be on Nardil only, or you could be on Nardil + all the bridging agents, and anything in between. 

Make sense?

Panic attacks and insomnia may need to be addressed by another medication or medications.

Hopefully the Nardil would sort out the Panic attacks, but if not, there are a number of medication options to go through. We would probably cross that bridge if we came to it though.

As for insomnia, have you ever tried doxepin, trazodone, or trimipramine?

Thank you for this:) yes, it does make sense.

 I am concerned about the metabolic effects, but I am much more concerned about getting my mental symptoms under control. I can’t even put into words the way I have felt 24/7 for over 4 years. It’s truly unbearable and torture to go though :( 

My psychiatrist has only used an MAOI in one patient 10 years ago, so she is a bit hesitant, but is willing to let me try, but she’s firm about waiting 2 weeks off Zoloft and remeron. 

I have tried everything you can imagine for sleep (including vitamins, minerals and herbs) and am paradoxical/adverse to all of it or they don’t help, but mostly make my symptoms worse. 

I did read all the reviews on askapatient.com on Nardil, and many said that it helped with anxiety and panic which is one of the reasons I am looking into this medication. I also read that it can cause some to feel manic or euphoric, which worries me. A few medications I have tried over the years have done this to me. Ones that I can remember are gabapentin, lyrica and naltrexone. 

I am also on geodon (20 mg X2) and Ativan. (in case you are wondering, I have tried upping my geodon, but it did not help my symptoms and made me feel worse) 

I’m sitting here this morning debating on whether or not to take Zoloft/remeron to begin the process of trying Nardil. I am also sitting here debating whether or not to try the rixulti. I’m so torn. I have had so many bad experiences with medications. 

What makes things so difficult for me and hard to wrap my head around is that I used to react typically (generally speaking) to medications. Seroquel and trazadone used to knock me out. I used to be able to take vitamins and minerals no problem. But for the past 10 (maybe longer) years, something happened and I became very sensitive and adverse. It just doesn’t make sense. Very frustrating. 

My bad reactions to medications is what has me so afraid of trying new things. I have yet to find anything that calms me down, I’m wondering if MOAI could do this for me? What could an MAOI possibly do for me? 

Edited by Britton777

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8 hours ago, Britton777 said:

I’m sitting here this morning debating on whether or not to take Zoloft/remeron to begin the process of trying Nardil. I am also sitting here debating whether or not to try the rixulti. I’m so torn. I have had so many bad experiences with medications. 

If I were you and I were as desperate as you are, I would go ahead and start the washout process, and start the Rexulti as a bridging agent, bad past experiences aside. What have you got to lose?

8 hours ago, Britton777 said:

My bad reactions to medications is what has me so afraid of trying new things. I have yet to find anything that calms me down, I’m wondering if MOAI could do this for me? What could an MAOI possibly do for me? 

Well it could help you or it could be a very bad thing for you... I mean, you don't know unless you try, but you're at the point where you have exhausted most 1st and 2nd line options, so again, what have you got to lose?

I have very treatment-resistant bipolar depression, and I've done several washouts for MAOIs numerous times and washouts after the MAOI to get back on regular antidepressants. If I can do that, YOU can do it too!

You got this! Go for it!

Edited by mikl_pls
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19 hours ago, Britton777 said:

My psychiatrist has only used an MAOI in one patient 10 years ago, so she is a bit hesitant, but is willing to let me try, but she’s firm about waiting 2 weeks off Zoloft and remeron. 

I’m sitting here this morning debating on whether or not to take Zoloft/remeron to begin the process of trying Nardil. I am also sitting here debating whether or not to try the rixulti. I’m so torn. I have had so many bad experiences with medications. 

My bad reactions to medications is what has me so afraid of trying new things. I have yet to find anything that calms me down, I’m wondering if MOAI could do this for me? What could an MAOI possibly do for me? 

You'll never know unless you try. Believe me, I have the same problem. If I think I'll fail at something, I won't even try it. A problem that I've been working on for a long time and many people experience. But the truth is the longer you take Zoloft/Remeron, the longer you have to go before you can try Nardil.

mikl_pls is right though. Rexulti would be a good bridging agent. It should calm you down in low doses like 0.25-0.5mg. It may take a few days to adjust, but Rexulti is a medication that you can likely take with the Nardil where you can't use Zoloft or Remeron. Although I think the combination of Nardil+Remeron would be far less likely to cause serotonin syndrome than Nardil+Zoloft.

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On 1/16/2019 at 8:17 PM, Britton777 said:

is rixulti different  enough from the other atypical antipsychotics? I was put on 500 mg seroquel inpatient for 30 days and went completely crazy. They refused to take me off of it. Anxiety, OCD, panic attacks and suicidal thoughts were unbearable. 

Here's a VERY recent study that showed Rexulti faired better than placebo in treating anxious depression and general anxious distress:

https://www.dovepress.com/adjunctive-brexpiprazole-in-patients-with-major-depressive-disorder-an-peer-reviewed-article-NDT

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Thank you everyone! What a great community this is♥️

Today was actually my 2nd day off Zoloft/remeron. I did not start rixulti. Holding off if possible. Luckily I have been tapering Zoloft and remeron for some time, so was on a very low dose. I’m doing quite well! Best I’ve felt in awhile :) hoping the effects of the antibiotic rifaxamin I took in December arexweerinf off. That shot really fucked me up. I’ve even gotten a little sleep which makes all the difference in the world.  I know they’re still in my system and withdrawal could hit me within the next week or so, keeping my fingers crossed ? 

maybe these meds, or all the meds I’ve been on for so long are part of the problem. Who knows.....

Hopfully I can pull through until I can try Nardil?

Edited by Britton777

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On 1/17/2019 at 5:14 PM, mikl_pls said:

If I were you and I were as desperate as you are, I would go ahead and start the washout process, and start the Rexulti as a bridging agent, bad past experiences aside. What have you got to lose?

Well it could help you or it could be a very bad thing for you... I mean, you don't know unless you try, but you're at the point where you have exhausted most 1st and 2nd line options, so again, what have you got to lose?

I have very treatment-resistant bipolar depression, and I've done several washouts for MAOIs numerous times and washouts after the MAOI to get back on regular antidepressants. If I can do that, YOU can do it too!

You got this! Go for it!

Thank so much for the encouragement! Have you found a go regimen to help you? The docs don’t know what to do with me. They don’t even know what to diagnose me with. I personally think it’s extreme anxiety, ocd and panic, but I do have times of raciness and irritability, so not sure. Lack of sleep is a killer. 

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36 minutes ago, Britton777 said:

Thank you everyone! What a great community this is♥️

Today was actually my 2nd day off Zoloft/remeron. I did not start rixulti. Holding off if possible. Luckily I have been tapering Zoloft and remeron for some time, so was on a very low dose. I’m doing quite well! Best I’ve felt in awhile :) hoping the effects of the antibiotic rifaxamin I took in December arexweerinf off. That shot really fucked me up. I’ve even gotten a little sleep which makes all the difference in the world.  I know they’re still in my system and withdrawal could hit me within the next week or so, keeping my fingers crossed ? 

maybe these meds, or all the meds I’ve been on for so long are part of the problem. Who knows.....

Hopfully I can pull through until I can try Nardil?

that very well could be. maybe try to see how long you can go without meds, prior to starting nardil or rexulti.

don't get me wrong, i'm pro-med and i'm probably going to take what i take for life...but in your case, after the med rollercoaster that went for years with zero to minimal improvement...this might just be what you need..to hold off. maybe even try to power through some of the withdrawal if it does come.

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32 minutes ago, Britton777 said:

Thank so much for the encouragement! Have you found a go regimen to help you? The docs don’t know what to do with me. They don’t even know what to diagnose me with. I personally think it’s extreme anxiety, ocd and panic, but I do have times of raciness and irritability, so not sure. Lack of sleep is a killer. 

My regimen changes all the time because, as I'm bipolar, meds are constantly stopping working... especially antidepressants. Plus, to make things more complicated, I'm very treatment resistant.

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