Wonderful.Cheese Posted July 22, 2019 Share Posted July 22, 2019 (edited) So I’ve always needed 2 AP’s. I have TR psychosis. I am on zyprexa zydis 10 mg and I can’t up the dose of it at this point because of the fact that I’m losing weight and I really can’t jeopardize that because it’s the only good thing I’ve got going right now. I also take 35 mg of Abilify daily. I am thinking it’s time to ditch Abilify as it is #1 too much for me mood upper wise without a maxed out dose of a sedating AP in place (causing a high/mixed mood as I easily slip into these states) #2 causing compulsive behavior issues and has for some time but has increased lately because lack of maxed out sedating AP (online compulsive spending $$$$ especially and eating issues currently but in the past it has been urges and trips to casinos, etc.) #3 possibly causing some of the rage issues I’ve been experiencing (connected to the mixed/high mood). Which AP or AAP is good for mixed mood or severe symptomatic anger/Irritabiltity to the max, specifically? I’d love to be on just one AAP. But I don’t think that would fly with my pdoc. What are some good options? Anyone? Help? It would be in addition to the moderate dose of zyprexa zydis. Edited July 22, 2019 by Wonderful.Cheese Oops Link to comment Share on other sites More sharing options...
Wonderful.Cheese Posted July 22, 2019 Author Share Posted July 22, 2019 For options I only see: Risperdal, geodon (can’t recall how well it worked?), Invega (worked well enough), saphris (major weight gain), latuda (although this caused mania in the past), rexulti (but I really, really worry this will be similar to Abilify.....even though I know some have said it isn’t. I worry, it doesn’t have a mania indication and I worry about similar compulsive issues.), low low dose clozapine again (even though there was worry about my WBC and the drooling excessively and the cost $$$, ?????) A typical maybe. Although I deathly fear TD. I was prescribed haldol and couldn’t get myself to take it. But a PRN typical maybe? Not sure if that would fly with my pdoc. Link to comment Share on other sites More sharing options...
CeremonyNewOrder Posted July 22, 2019 Share Posted July 22, 2019 Hi Cheese, I just wanted to say that my experience with rexulti was way different from abilify. I've gotten no side effects and it seems like cleaner and more predictable than abilify. So far I'm taking it for mood (2mg) and for schizo the amount is 4mg. If my clozapine increase doesn't work, my pdoc is trying that. Haldol is nasty, no doubt about it BUT it is an excellent emergency drug so I think its a good idea so long as you don't take it regularly. My local ER always uses haldol for patients that are super psychotic or manic. 1 Link to comment Share on other sites More sharing options...
Rabbit37 Posted July 22, 2019 Share Posted July 22, 2019 I loved risperdal. I don’t recall whether it helped anger/irritation, but also don’t recalling it having any bad s/e that would exacerbate it. I’m sure you know it can increase prolactin levels, but that’s not a guarantee. I’d advise trying it at least. Fast acting, I saw a huge difference in less than three days. I took 2-3mg for several years. I don’t consider it sedating, but it made me tired enough to make me want to take it at night. it also apparently has a very short half life though, and if you skip a dose, beware. It is a bitch. 1 Link to comment Share on other sites More sharing options...
Butterflykisses Posted July 22, 2019 Share Posted July 22, 2019 I will share my experiences on the med(s) you are considering as an option: Atypical AP's Risperdal: Helped but not enough, I can't remember if it helped mixed episodes as I was primarily taking it for psychosis which only mildly helped Geodon: I became anxious and dysphoric on it, it always seemed to be working in the beginning but then a huge rage would happen (plus you have to eat a certain amount of calories with it Invega: LOVED it, but I ended up having a delusional episode on it and it gave me insomnia Saphris: Just made me sedated, wasn't on very long and didn't notice much of any benefit Latuda: I found this to be activating but in a good way. I felt very motivated and it really helped my anxiety Rexulti: No experience Low dose clozapine: I think clozapine is the only AAP that actually really helps mostly all of my psychotic and mood episodes, I am on 300mg and that seems to be the right dose. Also I had a blood test to see if my clozaril was in the right range and it was perfect, so if you do decide to get back on it ask to take the blood test to see if your levels are in the right range....in the past you could have been out of the range... Typical AP's Haldol: Gave me SEVERE akathisia and flat affect Prolixin: Gave me shaky hands All in all I prefer AAP's 1 Link to comment Share on other sites More sharing options...
DogMan Posted July 22, 2019 Share Posted July 22, 2019 I'm pretty cranky, with risperdal. The two are unrelated, risperdal came years before I became such a cranky person. I'm the depression flavour of Schizoaffective though. Only had 2 hypo/manic episodes as a reaction to celexa. Never mixed. Maybe I am just a grumpy old man now. 1 1 Link to comment Share on other sites More sharing options...
argh Posted July 22, 2019 Share Posted July 22, 2019 I'd vote for invega. Like risperidone, it is one of the aaps which bind tightly to the d2 receptors. Plus it seems like it sort of worked before. My buddy used to be a paramedic. He told me that it's im or IV I don't remember, haldol for something super quick. Not sure if he did it himself or when they get to the hospital. I'm on the phone, but I think summoning Mike would be proper. I don't remember the non AP/AAPs you tried before but those could be an option 1 Link to comment Share on other sites More sharing options...
Rabbit37 Posted July 22, 2019 Share Posted July 22, 2019 (edited) ... Edited July 22, 2019 by Rabbit37 3 Link to comment Share on other sites More sharing options...
Wonderful.Cheese Posted July 22, 2019 Author Share Posted July 22, 2019 Thank you thank you thank you! To everyone! You have really given me some hope, perspective, and guidance. Let’s hope my pdoc is on board. After heavy consideration and research, I think risperidone or Invega is my best bet to replace Abilify. It’s been forever since I was on risperidone and Invega I was on more recently. But I’m curious what the difference is between the two? Risperdal seems to have more indications, like for mixed moods specifically and prescribed at times for rage/Irritabiltity for people without autism but with MI’s (off label, however, so tread carefully with my brief “consumer reviews” research). Invega I recall helped me more with my psychotic stuff I was having. Would risperdal be more helpful than Invega? Or are they the same freaking thing? And yes lol. I do summon @mikl_pls! Good one @argh! Link to comment Share on other sites More sharing options...
DogMan Posted July 22, 2019 Share Posted July 22, 2019 56 minutes ago, argh said: I'd vote for invega. Like risperidone, it is one of the aaps which bind tightly to the d2 receptors. Plus it seems like it sort of worked before. My buddy used to be a paramedic. He told me that it's im or IV I don't remember, haldol for something super quick. Not sure if he did it himself or when they get to the hospital. I'm on the phone, but I think summoning Mike would be proper. I don't remember the non AP/AAPs you tried before but those could be an option i think being IM is part of the reason they use it. Easier to jab a thigh muscle on a non cooperative patient than to find a vein 1 Link to comment Share on other sites More sharing options...
Butterflykisses Posted July 22, 2019 Share Posted July 22, 2019 16 minutes ago, Wonderful.Cheese said: Thank you thank you thank you! To everyone! You have really given me some hope, perspective, and guidance. Let’s hope my pdoc is on board. After heavy consideration and research, I think risperidone or Invega is my best bet to replace Abilify. It’s been forever since I was on risperidone and Invega I was on more recently. But I’m curious what the difference is between the two? Risperdal seems to have more indications, like for mixed moods specifically and prescribed at times for rage/Irritabiltity for people without autism but with MI’s (off label, however, so tread carefully with my brief “consumer reviews” research). Invega I recall helped me more with my psychotic stuff I was having. Would risperdal be more helpful than Invega? Or are they the same freaking thing? And yes lol. I do summon @mikl_pls! Good one @argh! I believe Invega helped more with psychosis...(at least for me) mood wise it did not do much...So Risperdal may be your best bet...but @mikl_pls probably knows more.. 1 Link to comment Share on other sites More sharing options...
argh Posted July 22, 2019 Share Posted July 22, 2019 28 minutes ago, Wonderful.Cheese said: Thank you thank you thank you! To everyone! You have really given me some hope, perspective, and guidance. Let’s hope my pdoc is on board. After heavy consideration and research, I think risperidone or Invega is my best bet to replace Abilify. It’s been forever since I was on risperidone and Invega I was on more recently. But I’m curious what the difference is between the two? Risperdal seems to have more indications, like for mixed moods specifically and prescribed at times for rage/Irritabiltity for people without autism but with MI’s (off label, however, so tread carefully with my brief “consumer reviews” research). Invega I recall helped me more with my psychotic stuff I was having. Would risperdal be more helpful than Invega? Or are they the same freaking thing? And yes lol. I do summon @mikl_pls! Good one @argh! I believe invega is a metabolite of risperidone. Sort of like pristique is a metabolite of effexor. It doesn't quite matter what the indication is officially due to the FDA process, so it definitely can help..just not through that process Like for instance, lamotrigine (yes I seem obsessed but damn does it work well), for mdd or bp2. It's only indicated for bp1 1 Link to comment Share on other sites More sharing options...
Iceberg Posted July 22, 2019 Share Posted July 22, 2019 1 hour ago, Wonderful.Cheese said: Thank you thank you thank you! To everyone! You have really given me some hope, perspective, and guidance. Let’s hope my pdoc is on board. After heavy consideration and research, I think risperidone or Invega is my best bet to replace Abilify. It’s been forever since I was on risperidone and Invega I was on more recently. But I’m curious what the difference is between the two? Risperdal seems to have more indications, like for mixed moods specifically and prescribed at times for rage/Irritabiltity for people without autism but with MI’s (off label, however, so tread carefully with my brief “consumer reviews” research). Invega I recall helped me more with my psychotic stuff I was having. Would risperdal be more helpful than Invega? Or are they the same freaking thing? And yes lol. I do summon @mikl_pls! Good one @argh! Another vote for invega since you got along well in the past. So since risp/invega are so similar I’d go with what you thought worked. also an idea- Thorazine as a quick acting PRN for agitation 1 Link to comment Share on other sites More sharing options...
jarn Posted July 22, 2019 Share Posted July 22, 2019 I think for agitation you can't beat a typical (IMO). Loxapine worked miracles for me, when I was super agitated and rage-y. I've said before, I had 4 days of tongue movement when starting but then that's been it and it's been years. I don't ever see myself going back to an atypical. Also I was also maxed on AAP dosages and loxapine I'm not. I remember clearly the agitation flowing out of me with the first dose I took. Given how mixed you are right now I'd consider it. 1 Link to comment Share on other sites More sharing options...
mikl_pls Posted July 22, 2019 Share Posted July 22, 2019 2 minutes ago, jarn said: Loxapine worked miracles for me, when I was super agitated and rage-y. I second loxapine. In low doses (< 25 mg I believe), it is said to act more as an atypical antipsychotic. I loved loxapine, just 5-10 mg knocked my psychosis out cold and if I was rage-y it would calm me down super quick. Also, you don't have to take an AAP for this symptom. You could try a mood stabilizer on top of the two that you're taking (but then again, you'd be on THREE anticonvulsants...). Depakote works wonders I've heard for mania and agitation, but you'd have to half your lamotrigine because Depakote slows down the clearance of Lamictal. You could also try maxing out the Topamax to 400 mg/day if you're not already experiencing the ultra-dumbifying effect of Topamax. Also, as for what Geodon did to you, I think you said at one point it made you super manic. I can't really think of anything else right now. I hope this helps. 1 Link to comment Share on other sites More sharing options...
argh Posted July 22, 2019 Share Posted July 22, 2019 I skimmed this https://academic.oup.com/schizophreniabulletin/article/44/6/1381/4767778 Schizophrenia isn't exactly schizoaffective, but the treatment seem the same Long acting injectables seem to be the most effective vs oral, with the exception of clozapine Zyprexa is on top Invega tends to be close to the top. Are long acting injectables acceptable for you? 1 Link to comment Share on other sites More sharing options...
argh Posted July 22, 2019 Share Posted July 22, 2019 lithium perhaps? the original anti-manic 1 Link to comment Share on other sites More sharing options...
Wonderful.Cheese Posted July 22, 2019 Author Share Posted July 22, 2019 I guess I have a lot of options to ask my pdoc about. I’ll tell her what’s been going on and bring up a few options and see what she says. Thanks again to everyone. I’ll keep you all posted. Link to comment Share on other sites More sharing options...
argh Posted July 23, 2019 Share Posted July 23, 2019 how is your thyroid? thyroid medication can help your mood, without inducing mania. 1 Link to comment Share on other sites More sharing options...
mikl_pls Posted July 23, 2019 Share Posted July 23, 2019 4 hours ago, argh said: how is your thyroid? thyroid medication can help your mood, without inducing mania. I second this. Even if you're euthyroid, small tiny doses of either levothyroxine (T4) or liothyronine (T3) can help with mood and mood stability. 1 Link to comment Share on other sites More sharing options...
Wonderful.Cheese Posted July 23, 2019 Author Share Posted July 23, 2019 (edited) 6 hours ago, argh said: how is your thyroid? thyroid medication can help your mood, without inducing mania. Thanks for the idea! Thyroid is good. I keep up with my blood work with my endocrinologist and I take levothyroxine at 50 mcg currently. I just had it checked about a month ago and it was in the normal range. My GP wanted it checked too so she ordered labs even though my endocrinologist will want it checked in August before our appointment in beginning of September. Doesn’t hurt to keep a close eye on it though! ETA: I just checked and my TSH in mid June was 1.34 and it says the normal value is 0.4 - 3.99. So I’m good there I think, I hope? Edited July 23, 2019 by Wonderful.Cheese Added TSH value Link to comment Share on other sites More sharing options...
Wonderful.Cheese Posted July 23, 2019 Author Share Posted July 23, 2019 2 hours ago, mikl_pls said: I second this. Even if you're euthyroid, small tiny doses of either levothyroxine (T4) or liothyronine (T3) can help with mood and mood stability. Thanks! I’ve been on levothyroxine for years mostly at 50 mcg, started out at 25 mcg but was still high ish on TSH and symptomatic. Anyway I just checked and my TSH in mid June was 1.34 and it says the normal value is 0.4 - 3.99. So I’m good there I think, I hope? My endocrinologist usually orders the full thyroid stuff like T4 and all that good stuff. This was my GP who just ordered the TSH levels. My endocrinologist will want bloodwork in early to mid August for our early September appointment. So I guess we will get further info at that time. But I think things are good as of now. Link to comment Share on other sites More sharing options...
Wonderful.Cheese Posted July 23, 2019 Author Share Posted July 23, 2019 (edited) Husband doesn’t seem to really want me to go off Abilify. Even though I feel it’s time, it’s been 11 years steady on it minimum and without seroquel max dose to keep it in check things have gone south with it (IMO). I’ve become a compulsive, mixed, rage-a-holic. Although he agrees with me I should not go back to seroquel oddly enough. Edited July 23, 2019 by Wonderful.Cheese Link to comment Share on other sites More sharing options...
Wonderful.Cheese Posted July 23, 2019 Author Share Posted July 23, 2019 (edited) I fear I’m going to end up on 3 AAP’s again. I have a feeling my pdoc won’t want to take me off Abilify and will only want to add one on. Since I’m maxed out on Abilify and a zyprexa increase isn’t ideal at all. If I go to 20 mg zyprexa, I’ll just be tired and fat again and become diabetic and more. Right? I’ll be right back where I started.....almost a year ago now! (Back when I was on a max dose of seroquel XR, max dose of Abilify, and max dose of Invega!) Only this time it will be moderate dose zyprexa, max dose Abilify, and ? dose of risperdal/Invega/something else! Edited July 23, 2019 by Wonderful.Cheese Link to comment Share on other sites More sharing options...
the maze runner Posted July 23, 2019 Share Posted July 23, 2019 hi @Wonderful.Cheese you can try risperidone. 1 Link to comment Share on other sites More sharing options...
Iceberg Posted July 23, 2019 Share Posted July 23, 2019 45 minutes ago, Wonderful.Cheese said: I fear I’m going to end up on 3 AAP’s again. I have a feeling my pdoc won’t want to take me off Abilify and will only want to add one on. Since I’m maxed out on Abilify and a zyprexa increase isn’t ideal at all. If I go to 20 mg zyprexa, I’ll just be tired and fat again and become diabetic and more. Right? I’ll be right back where I started.....almost a year ago now! (Back when I was on a max dose of seroquel XR, max dose of Abilify, and max dose of Invega!) Only this time it will be moderate dose zyprexa, max dose Abilify, and ? dose of risperdal/Invega/something else! I forget, have you ever tried cutting the abilify dose? 1 Link to comment Share on other sites More sharing options...
Wonderful.Cheese Posted July 23, 2019 Author Share Posted July 23, 2019 49 minutes ago, the maze runner said: hi @Wonderful.Cheese you can try risperidone. Thanks! That is definitely something I'm going to ask about! 28 minutes ago, Iceberg said: I forget, have you ever tried cutting the abilify dose? I have never tried in the 11 or more years I've been on it to reduce the dose. Won't it be more stimulating at lower doses? This is what I understand about abilify but correct me if I'm wrong. This is my fear. I can't handle more stimulation. I'll blow a gasket. Link to comment Share on other sites More sharing options...
argh Posted July 23, 2019 Share Posted July 23, 2019 20 minutes ago, Wonderful.Cheese said: Thanks! That is definitely something I'm going to ask about! I have never tried in the 11 or more years I've been on it to reduce the dose. Won't it be more stimulating at lower doses? This is what I understand about abilify but correct me if I'm wrong. This is my fear. I can't handle more stimulation. I'll blow a gasket. Yes it should be more stimulating at lower doses. Ability is a dopamine agonist which had an intrinsic activity of 70% at the d2 receptors. Is ability more of an antidepressant that doesn't induce mania (in theory)? Or do you use it as an anti manic? Rexulti is sedating at lower doses but stimulating at higher. It also blocks more dopamine than ability at 40%. I believe that's how it works but we may want to begin the summoning ritual for Mike and browri 1 Link to comment Share on other sites More sharing options...
Iceberg Posted July 23, 2019 Share Posted July 23, 2019 52 minutes ago, Wonderful.Cheese said: Thanks! That is definitely something I'm going to ask about! I have never tried in the 11 or more years I've been on it to reduce the dose. Won't it be more stimulating at lower doses? This is what I understand about abilify but correct me if I'm wrong. This is my fear. I can't handle more stimulation. I'll blow a gasket. It is possible that it gets more activating, but is it possible that the zyprexa might squish that a bit? Link to comment Share on other sites More sharing options...
Wonderful.Cheese Posted July 23, 2019 Author Share Posted July 23, 2019 (edited) Pdoc was unhelpful. Zyprexa got doubled. Abilify got decreased by 5 mg. Edited July 23, 2019 by Wonderful.Cheese More details in blog Link to comment Share on other sites More sharing options...
Iceberg Posted July 23, 2019 Share Posted July 23, 2019 Zyprexa to 20? Link to comment Share on other sites More sharing options...
Wonderful.Cheese Posted July 23, 2019 Author Share Posted July 23, 2019 4 minutes ago, Iceberg said: Zyprexa to 20? Yes. And Abilify down to 30 mg. Link to comment Share on other sites More sharing options...
Iceberg Posted July 23, 2019 Share Posted July 23, 2019 Sorry... that sounds frustrating cheese. Hate it when pdocs don’t listen Link to comment Share on other sites More sharing options...
Wonderful.Cheese Posted July 23, 2019 Author Share Posted July 23, 2019 1 minute ago, Iceberg said: Sorry... that sounds frustrating cheese. Hate it when pdocs don’t listen Thank you for understanding. I appreciate it. Link to comment Share on other sites More sharing options...
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