Non sedating AP add on

[Iceberg]

Hey all- 

so im in a tough spot here medwise, and hopeing for some wisdom.

currently on lith, lamictal, clozaril - hard to tell from my sig but all three  of those are maxed out. They’ve kept me from going thru any major episodes since I got ketamine like 1 1/2 ago. Unfortunately, as common in summer, the manic symptoms are creeping back- it’s common (disproportionately strong irritability, sleep issues- progressed from not getting up in AM to being exhausted in AM due to delayed sleep, and I’ve started weeding halcion which obviously isn’t great) 

this is pretty common for June/July, but if caught in time it plateaus. Howevereerr- my list of choice for an add on has become very small, so If anyone thinks im missing something let me know. The catch- I cannot take anything that’s often sedating, because it would be too much when combined with the clozaril.

here we go: basically all AAPs are out for various reasons, including those not in my sig (risp/Invega, or fanapt - which my doc doesn’t use for BP) He said he rarely uses saphris which I know can be sedating and also I don’t want to be  An experiment.

only “core” stabilizer I haven’t tried is tegretol- but this doesn’t seem ideal for something that will hope to be a pretty short trial that needs very fast results.

benzos- tried almost all of them, good for a lot of things, not so much for stopping these symptoms alone.

so to me it keeps coming back to typical antipsychotics, which I’ve had mixed results with. Perphenazine  not sedating but also not really useful at high doe. Thorazine very quick, but knocks me on my ass so hard it couldn’t ever be a daily med. so I guess that leaves prolixin, Navane, stelazine, loxapine And haldol (don’t think that would happen) prolixin And Navane are the least sedating right? I know  @mikl_pls (i think it was you, sorry if not) said that stelazine has been hard to find. I don’t really want a typical, but hoping it can be a short term to avoid anything too nasty.

also anyone ever herd of “molindone (moban)”....doc mentioned it once but I didn’t think it was in the US

anyway - thanks very much! 

 

 

[Butterflykisses]

I have a lot of experience with prolixin and haldol. 

Prolixin helped me with psychosis, but gave me almost like Parkinson's disease. I would shake so bad, it was AWFUL...and I was on a dose ranging from 5-30mg.

Haldol made me so RESTLESS to the point I couldn't sit at all. I will say it did "dull down" my personality...flat affect

 

 

[Iceberg]

10 minutes ago, Butterflykisses said:

I have a lot of experience with prolixin and haldol. 

Prolixin helped me with psychosis, but gave me almost like Parkinson's disease. I would shake so bad, it was AWFUL...and I was on a dose ranging from 5-30mg.

Haldol made me so RESTLESS to the point I couldn't sit at all. I will say it did "dull down" my personality...flat affect

 

 

Yeah akathisia is a big concern for me that’s part of why I’m not thrilled about the situation 

[jarn]

I take loxapine and don't find it sedating.  It was helpful during a recent hypo episode (I take it for psychosis, but used additional PRN for mood).  Really like it.  It's a typical, but I think it's supposed to be like a gateway to the AAPs.  No experience with other typicals I'm sorry to say.

[Iceberg]

2 minutes ago, jarn said:

I take loxapine and don't find it sedating.  It was helpful during a recent hypo episode (I take it for psychosis, but used additional PRN for mood).  Really like it.  It's a typical, but I think it's supposed to be like a gateway to the AAPs.  No experience with other typicals I'm sorry to say.

I thought it was one of those were it was sedating at low dose and activating at high dose (or the other way around) but maybe not 

[jarn]

It's hard to parse because at night I take it with other meds but I regularly take 10mg in the morning and am fine.  

[Iceberg]

31 minutes ago, jarn said:

It's hard to parse because at night I take it with other meds but I regularly take 10mg in the morning and am fine.  

Thanks- I’m not sure what the dose would be for a BP add-on, depends on what he’s comfortable with I guess. He’s Rx’d me Thorazine several times, but only short term or PRN basis. I was also on Perphenazine- but that was started before I switched to him 

[mikl_pls]

7 hours ago, Iceberg said:

so I guess that leaves prolixin, Navane, stelazine, loxapine And haldol (don’t think that would happen) prolixin And Navane are the least sedating right? I know  @mikl_pls (i think it was you, sorry if not) said that stelazine has been hard to find.

It was me who said that Stelazine is hard to find, at least in my part of the country.

Prolixin, IME, didn't do anything for me. I took 1 mg 3x/day for Tourette's disorder, and all it did was depress me a little. No akathisia though.

Never taken Navane, that one is also extremely hard to get a hold of in my part of the country too. It's virtually impossible to find a pharmacy that has it.

Stelazine is my absolute favorite AP, but like I said, it's very hard to find.

Loxapine is a great med for me. It squashes and psychosis or mania at just 5-10 mg. Not especially sedating for me, but for others it can be sedating. Below 25 mg, it acts like an atypical, but above that it looses its "atypicality." It's a very unique med among the typical APs.

Haldol is a freaking sledgehammer. Like @Butterflykisses said, Haldol will most likely flatten your affect, dull your personality, and make you feel just "gray." It has a high likelihood of causing EPS like akathisia and parkinsonism. I've taken 0.5-5 mg as needed which isn't too bad, but my dad was on up to 4 mg/day every day, and it messed him up pretty good... akathisia, parkinsonism, loss of fine motor skill control, etc. He couldn't even write his name while he was on Haldol.

I have heard of molindone, but I don't know if it's really on the market or not. I've looked into it because it supposedly has a potent antidepressant effect and energizing effect, but my pdoc isn't really willing to prescribe it, and I'd be afraid if she did that I'd take it to the pharmacy and they'd be like "what is this??" 

[Iceberg]

1 hour ago, mikl_pls said:

It was me who said that Stelazine is hard to find, at least in my part of the country.

Prolixin, IME, didn't do anything for me. I took 1 mg 3x/day for Tourette's disorder, and all it did was depress me a little. No akathisia though.

Never taken Navane, that one is also extremely hard to get a hold of in my part of the country too. It's virtually impossible to find a pharmacy that has it.

Stelazine is my absolute favorite AP, but like I said, it's very hard to find.

Loxapine is a great med for me. It squashes and psychosis or mania at just 5-10 mg. Not especially sedating for me, but for others it can be sedating. Below 25 mg, it acts like an atypical, but above that it looses its "atypicality." It's a very unique med among the typical APs.

Haldol is a freaking sledgehammer. Like @Butterflykisses said, Haldol will most likely flatten your affect, dull your personality, and make you feel just "gray." It has a high likelihood of causing EPS like akathisia and parkinsonism. I've taken 0.5-5 mg as needed which isn't too bad, but my dad was on up to 4 mg/day every day, and it messed him up pretty good... akathisia, parkinsonism, loss of fine motor skill control, etc. He couldn't even write his name while he was on Haldol.

I have heard of molindone, but I don't know if it's really on the market or not. I've looked into it because it supposedly has a potent antidepressant effect and energizing effect, but my pdoc isn't really willing to prescribe it, and I'd be afraid if she did that I'd take it to the pharmacy and they'd be like "what is this??" 

Yeah it’s also supposed to be known for weight neutrality-  but the conversation was over 6 years ago, and I could barely find anything about it even then

[notloki]

18 hours ago, Butterflykisses said:

I have a lot of experience with prolixin and haldol. 

Prolixin helped me with psychosis, but gave me almost like Parkinson's disease. I would shake so bad, it was AWFUL...and I was on a dose ranging from 5-30mg.

Haldol made me so RESTLESS to the point I couldn't sit at all. I will say it did "dull down" my personality...flat affect

 

 

 

Both are well known for EPS side effects like pseudoparkinsonism and akathisia. Haldol is good for knocking people out in emergency situations. The hospitals call it a B-52, a mixture of Haldol, Ativan, and Benadryl injected IM and the lights go out after that. Prolixin is liked among pdocs as it comes in a depot IM long acting injection. So if you get an EPS side effect and you are taking Prolixin the side effect will be with you awhile. Remember to take your pills or you will be put on a long acting injectable antipsychotic. There is a song called "Doing the Prolixin Shuffle". Sums up the powerful prolixin very well.