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Can anything be done med wise?


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I currently take the following:

Abilify 30 mg, Zyprexa Zydis 20 mg, Lamictal 300 mg, Klonopin 3 mg, Nuvigil 200 mg, Synthroid 50 mcg, Yaz, Metformin 2,000 mg, Topamax 200 mg, Flonase

 

I’m in desperate need of help. I can’t handle life. Stress. Anything. I had a traumatic experience with husband having cancer and now every cough or sniffle he makes completely panics me to the bone to the point of total consumption. I worry incessantly over his health. I don’t have a life or sense of self anymore. I’ve lost myself. I don’t enjoy anything or have anything or anyone in my life besides husband. I don’t treat people like they deserve to be treated. I’m a bad person. I do bad things to people. I just want to not wake up. I’m so exhausted. I go to bed wishing for death.

 

I see pdoc in 3 days. Can anything be done med wise? I don’t care if I die early. I don’t care if I’m numbed out completely. I’m thinking of asking for a 3rd AP again. Yes. I’m that bad off/crazy/losing it. I don’t care if it kills me. I don’t deserve to be alive anyway. Anything to stop the incessant worry and ruminations.

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It sounds like you might have psychotic depression as you seem to be having a lot of nihilistic delusions. I'm not an expert though, so don't hold me to that, that's just what I noticed from your OP and from what I identified in my experience, if that makes any sense.

There has to be a way to control your symptoms more efficiently than with three concurrent AAPs. Clozapine didn't do well for you. Sometimes first gen antipsychotics are good for people who don't respond to clozapine, I believe. I think loxapine might be worth a try for you. It produces amoxapine as a metabolite, which is a tetracyclic antidepressant. Low doses actually behave like an atypical antipsychotic (< 25 mg).

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Thinking of you Cheese. You sound incredibly distressed. I would try to tweak something in your current combo (like lower Nuvigil or increase Klon) to help the severe anxiety...sounds like an intense mixed episode, with psychotic depression. I've had that and it is Hell....I'm sorry. Get rest and treat yourself gently..you are NOT a bad person!! Good luck with your appt.

Edited by Blahblah
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11 hours ago, saintalto said:

Have you tried clozapine?

Thanks saint. Yes. My pdoc went up rapidly on the dose. I’m not sure if that’s why I failed it or not. But I had severe excessive drooling. I also paradoxically had a high WBC instead of a low one. I am an oddball I guess. But it kept going up with each dose increase and when I got off clozapine my WBC went back to normal. Also, the cost of blood work and the cost of the weekly pill fills were quite pricey. But at this point I could care less if it worked, I’d make a way for us to afford it. But I and my pdoc were worried about the WBC highness. I don’t know if she overshot the dose and I could have been fine on a lower one and had no high WBC and less drooling. But I also use a CPAP so the drooling was a major issue with using that. I don’t know if it’s worth revisiting at a much lower dose?

Edited by Wonderful.Cheese
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11 hours ago, argh said:

Carbamazepine ?

lamotrigine to 400 mg?

Drop nuvigil? It might be adding fuel to the mixed episode you might be in. If i was in your shoes, id drop something that might cause anxiety or mania first before adding on.

add in pregabalin/lyrica for the anxiety?

as bad as it seems, maybe a first gen AP. I know movement disorders scare you...they scare me too. But you’ve already gone nuclear. Haldol is supposedly the fastest. Maybe one that almost works like an aap like loxapine?

 I don’t remember if you’ve tried lithium..but if not..lithium? There is a famous pdoc, kay redfield Jamison. Manic as hell. Got on lithium and after some adjustments, it got her into remission.

 

Thanks argh. I’m on 2 anticonvulsant meds. I could ask about raising lamictal. But I don’t feel it does anything for me?

Without nuvigil I sleep all day and night. I’m scared as hell to return to that. I can’t live that way. I have been on it for 5 years without it causing issues I believe anyway. And my sleep dr just agreed to split the dose for me. Today is first real day of trying it out. 

Pregabalin is an idea. 

I can ask about loxapine in low dose. It does scare me very much. But this way of life is also very scary.

I have briefly briefly tried lithium. Took a bad OD of it and nearly died. After that no pdoc has really mentioned prescribing it for me again. I think they are worried about another OD possibility.

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10 hours ago, mikl_pls said:

It sounds like you might have psychotic depression as you seem to be having a lot of nihilistic delusions. I'm not an expert though, so don't hold me to that, that's just what I noticed from your OP and from what I identified in my experience, if that makes any sense.

There has to be a way to control your symptoms more efficiently than with three concurrent AAPs. Clozapine didn't do well for you. Sometimes first gen antipsychotics are good for people who don't respond to clozapine, I believe. I think loxapine might be worth a try for you. It produces amoxapine as a metabolite, which is a tetracyclic antidepressant. Low doses actually behave like an atypical antipsychotic (< 25 mg).

Thanks mikl. Yes I believe it is psychotic depression. It’s taken on a new level of its own. 

I can ask for loxapine. I worry about TD very badly. But I’m desperate. Is loxapine bad for TD? Can I ask you?

I also wonder if my pdoc went too rapidly up on the clozapine and overshot the dose. I don’t know at what point/dose my WBC went high and she worried about that in addition to the excessive drooling interfering with my CPAP machine. I don’t know if it would be worth revisiting or if she’d even let me. I don’t know if it’s worth it ether.  

 

8 hours ago, looking for answers said:

hang in there cheese, thinking of oyu

Thanks so much looking. I appreciate it. 

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56 minutes ago, Blahblah said:

Thinking of you Cheese. You sound incredibly distressed. I would try to tweak something in your current combo (like lower Nuvigil or increase Klon) to help the severe anxiety...sounds like an intense mixed episode, with psychotic depression. I've had that and it is Hell....I'm sorry. Get rest and treat yourself gently..you are NOT a bad person!! Good luck with your appt.

Thanks blah. I did just split my nuvigil dose up as per my sleep dr prescribed. I don’t know if that will help. 

I am hesitant to increase the klonopin because I don’t want to be tired and I also fear I’m on too high of a dose anyway. 

I’m sorry. I sound so negative. All I am is negative energy. I’m so sorry. 

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6 minutes ago, Wonderful.Cheese said:

I can ask for loxapine. I worry about TD very badly. But I’m desperate. Is loxapine bad for TD? Can I ask you?

I don't think it's any more prone to causing TD than something like risperidone (Risperdal), but I could be very wrong. My pdoc is under the impression that it causes EPS very badly and is a bad medicine, even in low doses, but everything I've read about it says it is good at doses < 25 mg. Maybe something like 5-10 mg to augment either daily or as needed might be something to ask your pdoc about. I've read case studies of loxapine and psychotic depression where the patient remits within weeks of starting the low-dose loxapine. If I find the link I'll post it.

5 minutes ago, Wonderful.Cheese said:

I’m sorry. I sound so negative. All I am is negative energy. I’m so sorry.

Please don't apologize, you have nothing to apologize for. We understand you're going through a hard time, and I totally understand your reservations of trying certain meds. :) Sometimes after you've tried everything "in the box," you have to start reaching "outside the box."

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11 minutes ago, Wonderful.Cheese said:

I also wonder if my pdoc went too rapidly up on the clozapine and overshot the dose. I don’t know at what point/dose my WBC went high and she worried about that in addition to the excessive drooling interfering with my CPAP machine. I don’t know if it would be worth revisiting or if she’d even let me. I don’t know if it’s worth it ether.  

That's always a possibility. She did go up rather quickly, but someone posted from the PI that said it was okay to go up as quickly as you did. Clozapine sounded like it really wasn't a match for you, especially with the sialorrhea.

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1 hour ago, mikl_pls said:

I don't think it's any more prone to causing TD than something like risperidone (Risperdal), but I could be very wrong. My pdoc is under the impression that it causes EPS very badly and is a bad medicine, even in low doses, but everything I've read about it says it is good at doses < 25 mg. Maybe something like 5-10 mg to augment either daily or as needed might be something to ask your pdoc about. I've read case studies of loxapine and psychotic depression where the patient remits within weeks of starting the low-dose loxapine. If I find the link I'll post it.

Please don't apologize, you have nothing to apologize for. We understand you're going through a hard time, and I totally understand your reservations of trying certain meds. :) Sometimes after you've tried everything "in the box," you have to start reaching "outside the box."

Thanks mikl for the good advice as always. In your opinion, is Prozac a good option at all? I know it’s paired with zyprexa sometimes and was called symbyax? Or would loxapine be best? Thanks for all the help. 

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30 minutes ago, argh said:

seeing that you currently have psychosis going on, prozac might not be the best option.

@jarn swears by loxapine iirc.

loxapine is a mid potency AP, the risk is moderate to low for movement disorders, especially among the APs. The pseudo AAP effect further reduces the risk.

Thanks argh! I will ask about it for sure. 

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Sorry yes I've been MIA.  Have you seen pdoc Cheese?  

Once I went up to 60mg in April of loxapine I've had slight tremors (not convinced these are med-related as they're very sporadic) and some very mild lactation.  Saw pdoc last week and he's dropped me down to 50mg.  Says the APs are way more dose sensitive than the AAPs.  I hope it works, because from a mental health perspective, loxapine has been life altering and amazing.  No more AAP merry-go-round and failures.  

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Loxapine pulled me out of a bottomless pit of a psychotic depression last summer I believe it was, or maybe two summers ago? Either way, it really helped me out, and all I needed was 5-20 mg as needed, mostly only taking 5-10 mg.

Loxapine metabolizes into the tetracyclic antidepressant amoxapine, which actually has atypical antipsychotic properties "built in."

If your pdoc would prescribe it, I highly recommend giving it a try, either as a PRN or regularly-dosed medicine.

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10 hours ago, jarn said:

Sorry yes I've been MIA.  Have you seen pdoc Cheese?  

Once I went up to 60mg in April of loxapine I've had slight tremors (not convinced these are med-related as they're very sporadic) and some very mild lactation.  Saw pdoc last week and he's dropped me down to 50mg.  Says the APs are way more dose sensitive than the AAPs.  I hope it works, because from a mental health perspective, loxapine has been life altering and amazing.  No more AAP merry-go-round and failures.  

Thanks jarn! No, I see pdoc this coming Friday. I will ask about low dose loxapine. I’m worried about TD but ugh. I’m out of options here. I feel hopeless. Maybe I can get off one of the other AAP’s I’m on if I can get onto loxapine successfully. 

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10 hours ago, mikl_pls said:

Loxapine pulled me out of a bottomless pit of a psychotic depression last summer I believe it was, or maybe two summers ago? Either way, it really helped me out, and all I needed was 5-20 mg as needed, mostly only taking 5-10 mg.

Loxapine metabolizes into the tetracyclic antidepressant amoxapine, which actually has atypical antipsychotic properties "built in."

If your pdoc would prescribe it, I highly recommend giving it a try, either as a PRN or regularly-dosed medicine.

I will definitely add this to my note for pdoc, to ask about low dose loxapine. In fact, I just added it to the note right now!

Is loxapine since it ends in -pine, similar to the other -pines? Such as olanzapine or quetiapine? I do the best on -pine meds. Especially olanzapine with quetiapine as second place. 

Will it help me sleep? Will it cause weight gain? Will it cause TD at low doses?

My hope would be to replace either Abilify or olanzapine with the loxapine if all goes well. Or have the loxapine as a PRN that I could take for episodes as they arise. I don’t know which scenario would be best. 

Sorry for the myriad of questions. I’m just really anxious for my appointment. I appreciate all your help so very much. 

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36 minutes ago, Wonderful.Cheese said:

Is loxapine since it ends in -pine, similar to the other -pines? Such as olanzapine or quetiapine? I do the best on -pine meds. Especially olanzapine with quetiapine as second place.

You know, I've always wondered that... I think it's the only "typical" that ends in "-pine..." Just checked, most end in "-zine" with the exception of a few. Loxapine is the only "-pine" typical, and it has been argued as potentially being an atypical. It's structurally related to clozapine I think, and hence to olanzapine. It has a similar binding profile to clozapine, too, with the added benefit of metabolizing to an antidepressant.

39 minutes ago, Wonderful.Cheese said:

Will it help me sleep? Will it cause weight gain? Will it cause TD at low doses?

It may help you sleep. It didn't for me, personally, but I know @browri said it helped him sleep a little. Weight gain is uncommon but not unheard of. Chances of TD are about on par with other typicals and possibly atypicals, I believe, but nowhere near as high as Haldol or Risperdal or anything.

41 minutes ago, Wonderful.Cheese said:

My hope would be to replace either Abilify or olanzapine with the loxapine if all goes well. Or have the loxapine as a PRN that I could take for episodes as they arise. I don’t know which scenario would be best.

I think replacing olanzapine with it would be ideal, but nothing really ever works out ideally, does it? lol. If you require more than 20-25 mg, you may consider something else like replacing the Abilify with Rexulti. Just a thought, since the loxapine loses its "atypicality" at doses above 20-25 mg.

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4 hours ago, mikl_pls said:

You know, I've always wondered that... I think it's the only "typical" that ends in "-pine..." Just checked, most end in "-zine" with the exception of a few. Loxapine is the only "-pine" typical, and it has been argued as potentially being an atypical. It's structurally related to clozapine I think, and hence to olanzapine. It has a similar binding profile to clozapine, too, with the added benefit of metabolizing to an antidepressant.

It may help you sleep. It didn't for me, personally, but I know @browri said it helped him sleep a little. Weight gain is uncommon but not unheard of. Chances of TD are about on par with other typicals and possibly atypicals, I believe, but nowhere near as high as Haldol or Risperdal or anything.

I think replacing olanzapine with it would be ideal, but nothing really ever works out ideally, does it? lol. If you require more than 20-25 mg, you may consider something else like replacing the Abilify with Rexulti. Just a thought, since the loxapine loses its "atypicality" at doses above 20-25 mg.

I’m thinking about asking for swapping Abilify for rexulti. I’ve been on Abilify for 11 or more years now. I don’t know if it does anything anymore to be honest. It’s just been kind of there this whole time. And since rexulti is similar to Abilify maybe things wouldn’t go south as far as with trying a typical like loxapine with which I have no real experience with. 

I’m worried about weight gain with rexulti. I’m finally losing weight. I have read it can be common? I will make a separate thread about rexulti. 

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9 hours ago, Wonderful.Cheese said:

I’m thinking about asking for swapping Abilify for rexulti. I’ve been on Abilify for 11 or more years now. I don’t know if it does anything anymore to be honest. It’s just been kind of there this whole time. And since rexulti is similar to Abilify maybe things wouldn’t go south as far as with trying a typical like loxapine with which I have no real experience with. 

I’m worried about weight gain with rexulti. I’m finally losing weight. I have read it can be common? I will make a separate thread about rexulti. 

I don't think Rexulti is really anything like Abilify. It's a totally different animal. It tends to be sedating for most people, and tends to need to be taken at bedtime or in the evening. I mean, once when I took it at 3 mg, it was moderately stimulating, but it wasn't as stimulating as Abilify was for me.

I will say Rexulti has a slightly higher chance in causing weight gain than Abilify, but not much I don't think... it has relatively low affinity for the receptors responsible for causing that. (5-HT2C and H1...)

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6 hours ago, Lapis.Lazuli said:

You could ask about a Lurasidone + Vortioxetine combo? There are studies showing that that combo has helped people with Schizophrenia with cognitive difficulties. I'm not sure about dosages. This combo was used for people who were considered treatment-resistant, even to Clozapine.

If your doctor said you have psychotic depression then you'll need to be on an anti-depressant for that. The psychosis goes away when the depression gets better. I think I read that psychotic depression has a pretty good prognosis.

Rexulti made me have terrible headaches when I got up to 3 mg per day. My doctor at the time wanted to put me on 4 mg per day but I couldn't handle the side effects. Then I was labeled a "complex case". I was told Rexulti and Abilify are very similar. I'm not sure if Rexulti would help if Abilify isn't helping anymore.

My pdoc really is against AD’s for me. I tend towards mania too easily from them. I’ve tried lurasidone with Abilify before and had terrible results. My psychosis worsened and i believe mania too and I thought my own dr was out to ruin my life and more. I got up to 160 mg of latuda. And other people here seem to really think that Abilify is very different from rexulti. I guess it’s worth a shot. 

8 hours ago, mikl_pls said:

I don't think Rexulti is really anything like Abilify. It's a totally different animal. It tends to be sedating for most people, and tends to need to be taken at bedtime or in the evening. I mean, once when I took it at 3 mg, it was moderately stimulating, but it wasn't as stimulating as Abilify was for me.

I will say Rexulti has a slightly higher chance in causing weight gain than Abilify, but not much I don't think... it has relatively low affinity for the receptors responsible for causing that. (5-HT2C and H1...)

Thanks mikl. I appreciate your knowledge as always. 

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Late to chime in but loxapine was weight neutral for me.  I've been able to lose weight on it (I gained weight too, but that's from my eating junk, not from AP type issues).  I do not know for certain but my guess is your risk of TD would be low at lower doses.  Loxapine is the first anti-psychotic I haven't had to max dose out at either.  

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20 hours ago, jarn said:

Late to chime in but loxapine was weight neutral for me.  I've been able to lose weight on it (I gained weight too, but that's from my eating junk, not from AP type issues).  I do not know for certain but my guess is your risk of TD would be low at lower doses.  Loxapine is the first anti-psychotic I haven't had to max dose out at either.  

Thanks jarn. I appreciate you sharing your experience! ❤️

 

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