What are the overall best (atypical) antipsychotics for Depression, Anxiety, Agitation, OCD, Bipolar...?By Adolf
"Best" as in being effective with fewer side effects. Which ones were the best for you? Which ones did you take? What condition(s) did you treat? What side effects did you get? How did the antipsychotics compare to "conventional" antidepressants?
Can antipsychotics be an alternative to "conventional" antidepressants? What are the risks? What are the benefits? Do they make you a tomato with time? Psychiatrists prescribe them more often in recent times, it seems.
I started process of switching from Cymbalta to Remeron on March 25, and took my last dose of Cymbalta a few days ago. Other than a few days of extreme irritability, things have been going surprisingly smoothly. Except that I can't sleep. Not really. I'm rapid-cycling between moments of being awake and instantly dreaming as soon as I close my eyes. The waking moments seem precipitated by startling effects in the dream state, that usually have nothing to do with the content of the dream itself. The worst of these is the sudden sensation of being physically attacked by an evil presence. It seems to take me a little bit longer to wake up during these instances. Or at least that's how I perceive it.
How much of this is potentially the residual Cymbalta withdrawal effects, and how much of this is the "strange or unusual dreams" listed as a possible side effect of the Remeron?
And more importantly, how long can I expect this to last? If you experienced disturbed dreams while on Remeron, how long did it last for you, and did it turn out to be a deal breaker?
I apparently have very treatment-resistant OCD. My pdoc hasn't said it, but I have gathered this from my profound lack of insight into my obsessions, psychotic preoccupations, and the fact that OCD is not only interfering with life, but treatment as well.
I have tried novel strategies like memantine (30 mg), lamotrigine (400 mg), zonisamide (400 mg), topiramate (400 mg), etc. I've tried somewhat high doses of SSRIs (my pdoc hates prescribing anything at max dose) (fluoxetine 80 mg, fluvoxamine 100 mg (nightmare), escitalopram 10 mg (nightmare), sertraline 200 mg), SNRIs (venlafaxine XR 825 mg!!, duloxetine 120 mg, desvenlafaxine 150 mg, Fetzima (joke...)), Viibryd 40 mg, Trintellix 20 mg, etc., clomipramine 225 mg. I've tried various antipsychotics (typical and atypical) alongside SSRIs: fluphenazine 1 mg tid, perphenazine 4 mg tid, trifluoperazine 5 mg bid, haloperidol 1 mg tid to 5 mg x1, pimozide 2 mg bid, etc. Nothing seems to really help. Basically, if there's a way to treat it, I've probably tried and failed it or tried it partially due to conservative prescribing habits of my pdoc.
I have not tried low-dose clomipramine + SSRI, supratherapeutic doses of SSRIs (pdoc won't hear of it...), higher doses of typical antipsychotics (for acute psychotic preoccupations), certain antipsychotics (thioridazine, clozapine, etc.). I'm thinking about seeking a second opinion from another pdoc soon because my current pdoc is no longer helping me. She just keeps me on the same useless regimen and never wants to change anything, pats me on the back saying "you're better than you think you are," and sends me on my way. The office staff are severely understaffed, and one of them in particular always bitches me out after my sessions because it's so late, but it doesn't matter if I take 5 minutes or 55 minutes... she's going to bitch me out no matter what about it. She never says anything to the people who go back there and take two hours though. Just me, because I'm at the end of the day. It royally pisses me off and I'm about to snap at her, and I really don't want to (the office staff person). I'm also about to snap at my pdoc and ask if she'd rather the meds kill me or me kill me due to inadequate medication. I know meds aren't all there is in treatment, but she seriously has to budge for something to change.
I am seeing a therapist, but he's new and still getting to know me, so nothing has been done yet. He's taking notes and asking thorough questions though. I like him so far. He actually has a white dry-erase board in his office that he uses to illustrate things he's trying to convey to patients, and he's the only therapist with one in that whole office. I wish I could see my original therapist though. She's known me since I was 9 years old... She knows me like no other mental health practitioner knows me, and has the most extensive history on me. Last I saw her, she was in "partial retirement," which meant she blocked off half her office to this new guy (ex-pastor gone family counselor), disposed of all her notes on all her patients, sent half of her patients to this new guy, and kept the other half of her patients (mostly younger patients she said). I saw her twice or 3 times during that time, and she dismissed me after that. I wasn't really seeing her for my own purpose, but because of a problem I had I didn't know how to deal with. I tried calling her semi-recently when I was looking for a counselor several times, texting her, everything, and never got an answer, so I assumed she fully retired.
Anyway, I didn't mean to digress so much in this post.
Please help. Obstructive sleep apnea condition and chronic migraines with insomnia. Also, I am very nocturnal.By SheltieUnderdog
I'll get to the coinciding physical symptoms eventually. I have always had trouble sleeping through most of the night like the majority of people do with ease and very naturally sleep through the majority of the day when most people are awake. I honestly have always preferred not to see the morning (I find it utterly depressing) except I am obligated to get places like doctor's appointments, stores, and restaurants before they close for the day and I would like the be awake and ready to leave my home by the early afternoon on a consistent basis. Since I was 12 years old, my addiction to being nocturnal and having an abnormal or irregular circadian rhythm has gotten progressively worse. So much to the point where I will fall asleep as the sun is rising and wake up when it's setting or it will be dark again by the time I wake up! I am being deprived of too many things, missing doctor's appointments, or not being able to get my car to the auto mechanic before he / she closes for an oil change. I eventually want to get a part-time job (currently living on SSI) and i imagine that my job would take place in the late afternoon or the evening shift but how could I even hold down a job that was a full-blown a graveyard shift under these circumstances!? My insomnia which can be attributed to the fact that I was formerly diagnosed with bipolar 1 with psychotic features and am now diagnosed with schizoaffective disorder, ocd, and add (possibly adhd). Sometimes if I stay awake later than I really want to (preferably between 1 and 3am to be able to wake up by the early afternoon) then I will just remain awake into the next day in order to guarantee that I will make the appointment or obligation and get to it in a state of sheer exhaustion barely able to follow the doctor or specialist as they're explaining things to me. Sometimes I have gone two or even three nights in a row without getting any shuteye because the appearance of it being nighttime awakens me. The only time that my insomnia (but not the sleep apnea or chronic migraines) was under better control was when I was on court ordered injections which were anti-psychotics and along with outright despising the process of getting those injections, I had a plethora of other side effects like akathisia (inability to sit still), lethargy, fatigue, sedation, and severe weight gain at the same time. I've been on Latuda 20mg for a couple of years now with little to no side effects and I plan to stay on it and never be subjected to having to take anti-psychotic injections ever again after my experiences with them when I had to involuntarily take them by court order.
Now I also have some other issues going on in addition to the insomnia and nocturnal sleep cycle. I have ehlers-danlos syndrome type 3. I was diagnosed with severe obstructive sleep apnea after a sleep study ordered by my pulmonologist in the beginning of 2018 shortly after I got off of the anti-psychotic injections and I was 308 pounds (my heaviest ever weight, my height is 5'8). As of December 2019, my weight is 281 and I've been at a weight set-point since the end of 2018 where my weight is no longer fluctuating anymore (cannot easily lose or gain weight). I hated the mask / cpap machine or was cpap intolerant and sent it back to the surgical supply company within a couple of weeks. My ENT is not recommending the oral surgery or UPPP procedure because of how severe the sleep apnea is and I don't want a tracheotomy. He said that I'm too obese to use Inspire. I can't find an oral surgeon who does maxillomandibular advancement surgery. The obstructive sleep apnea and tmj syndrome which I've suffered from for over a decade combined are giving me chronic migraines and still sometimes when I take my prescription strength pain relievers from my rheumatologist. I wake up feeling like I was hit by an 18-wheeler stumbling to the bathroom sink with my eyelids glued together (look up the medical term blepharitis, I get that in my sleep too). Sometimes the migraines are so bad that I will force myself to eat and drink a small amount and take something like Excedrin PM or other types of nighttime pain relievers and fall back asleep and wake up again slightly less messed up because I had more rest even later in the day. Another major problem is that even if I somehow get a better nights sleep one night, the next night I will be so energized once it gets dark that I will do another all-nighter until the sun is coming up and the cycle or revolving door starts all over again.
I used to be prescribed sedatives like Trazadone and Clonazepam but my new psychiatrist (been seeing her for a little over a year) insisted that I come off of them until the sleep apnea was successfully treated because me taking them before going to sleep with that medical condition was too dangerous. I recently found a dental sleep specialist hours away from where I live which designs oral appliances specifically for treating sleep apnea and tmj syndrome and I've been trying to set up an evaluation but they are forcing me to do another sleep study at home because the last one I did at the sleep lab was in March 2018. I recently went to my local CVS and picked up generic Benadryl or diphenhydramine 50mg and I found something recently at 7-Eleven called doxylamine succinate which is labeled as a strong sleep aid. I am sleeping with a wedge pillow and I eventually want to invest in a bed with an adjustable mattress to keep myself on an incline.
If anyone else has any input that you think could be helpful on how I could fend off the insomnia and be less nocturnal on a consistent basis, it would be appreciated.