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Saw pdoc today. 

So my prolactin is elevated on Loxapine and I am lacatating.  That's with even reducing the dosage to 50mg (which dealt with the tremors).

Pdoc said taking meds to reduce prolactin not a good long term solution.  I could reduce loxapine even further (like 25mg!!!!) but there is the concern of psychosis plus I have mood instability right now and up periods he is concerned about.  I had been taking extra loxapine when they pop up to quash them.  So reducing it further isn't great.  

He wants to get the mood stuff under control.  He is concerned nothing in my current cocktail (loxapine, lamotrigine, gabapentin) helps with mania.  

Apparently val acid changes blood levels of lamotrigine (I think that's what he said) so that was out.  He offered me:

1)rexulti.  But I was hospitalized on Abilify, and in general have always had either breakthrough or full psychosis on AAPs

2)risperdal.  I have been on Invega in the past, and lactated at even a low dose (6mg).  He mentioned this as an option as I've been on most AAPs (and again, I don't feel AAPs work well for me from a psychosis perspective)

3)haldol.  This is what I picked.  We are starting a low dose - 2mg.  He wanted to see me in three weeks but I wasn't able to get until the 30th.  I have permission to go up to 3mg if I need to.  I saw my GP today as well and she will see me next Tuesday to make sure the change is going well and because she thought I seemed off.  

I am going off loxapine all at once.  Hoping that goes okay too, ugh.  

I don't know why I'm nervous, I've loved loxapine, but I am.  Possibly because I'm transitioning away from a med that worked really well for me.  And because if I lactate on Haldol I don't know what I'll do.  I retest prolactin in a couple of weeks.  

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10 minutes ago, jarn said:

Saw pdoc today. 

So my prolactin is elevated on Loxapine and I am lacatating.  That's with even reducing the dosage to 50mg (which dealt with the tremors).

Pdoc said taking meds to reduce prolactin not a good long term solution.  I could reduce loxapine even further (like 25mg!!!!) but there is the concern of psychosis plus I have mood instability right now and up periods he is concerned about.  I had been taking extra loxapine when they pop up to quash them.  So reducing it further isn't great.  

He wants to get the mood stuff under control.  He is concerned nothing in my current cocktail (loxapine, lamotrigine, gabapentin) helps with mania.  

Apparently val acid changes blood levels of lamotrigine (I think that's what he said) so that was out.  He offered me:

1)rexulti.  But I was hospitalized on Abilify, and in general have always had either breakthrough or full psychosis on AAPs

2)risperdal.  I have been on Invega in the past, and lactated at even a low dose (6mg).  He mentioned this as an option as I've been on most AAPs (and again, I don't feel AAPs work well for me from a psychosis perspective)

3)haldol.  This is what I picked.  We are starting a low dose - 2mg.  He wanted to see me in three weeks but I wasn't able to get until the 30th.  I have permission to go up to 3mg if I need to.  I saw my GP today as well and she will see me next Tuesday to make sure the change is going well and because she thought I seemed off.  

I am going off loxapine all at once.  Hoping that goes okay too, ugh.  

I don't know why I'm nervous, I've loved loxapine, but I am.  Possibly because I'm transitioning away from a med that worked really well for me.  And because if I lactate on Haldol I don't know what I'll do.  I retest prolactin in a couple of weeks.  

I’d try not to anticipate problems. Like you said it’s low dose, and haldol is quite effective. Even if it doesn’t work - there are lots of other psychosis treatment options 

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sorry you're having to make a change.  i hope that haldol treats you well.  i know it has the potential to help a lot.  i've considered it in the past and probably would in the future if things go further south than they are currently.

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53 minutes ago, jarn said:

Saw pdoc today. 

So my prolactin is elevated on Loxapine and I am lacatating.  That's with even reducing the dosage to 50mg (which dealt with the tremors).

Pdoc said taking meds to reduce prolactin not a good long term solution.  I could reduce loxapine even further (like 25mg!!!!) but there is the concern of psychosis plus I have mood instability right now and up periods he is concerned about.  I had been taking extra loxapine when they pop up to quash them.  So reducing it further isn't great.  

He wants to get the mood stuff under control.  He is concerned nothing in my current cocktail (loxapine, lamotrigine, gabapentin) helps with mania.  

Apparently val acid changes blood levels of lamotrigine (I think that's what he said) so that was out.  He offered me:

1)rexulti.  But I was hospitalized on Abilify, and in general have always had either breakthrough or full psychosis on AAPs

2)risperdal.  I have been on Invega in the past, and lactated at even a low dose (6mg).  He mentioned this as an option as I've been on most AAPs (and again, I don't feel AAPs work well for me from a psychosis perspective)

3)haldol.  This is what I picked.  We are starting a low dose - 2mg.  He wanted to see me in three weeks but I wasn't able to get until the 30th.  I have permission to go up to 3mg if I need to.  I saw my GP today as well and she will see me next Tuesday to make sure the change is going well and because she thought I seemed off.  

I am going off loxapine all at once.  Hoping that goes okay too, ugh.  

I don't know why I'm nervous, I've loved loxapine, but I am.  Possibly because I'm transitioning away from a med that worked really well for me.  And because if I lactate on Haldol I don't know what I'll do.  I retest prolactin in a couple of weeks.  

I'd second Ice's recs.

That said. Valproate does increase the amount of lamotrigine in your body The general rule will be for the pdoc to halve your dose or close to it.

from GSK: https://www.gsksource.com/lamictal

"Valproate increases lamotrigine concentrations more than 2-fold. (7, 12.3) "

There is also an interaction with birth control as it also (or maybe pill free week?) affects levels. Of course listen to your doc, but it's not out of the question/an automatic no.

Lithium?

Risperdal  (invega also) is actually the most likely of atypicals to cause lactation. It might be better than a typical however when it comes to lactation. Apparently it binds to the dopamine receptors more tightly vs other atypicals,  but not as much as typicals.

 

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2 hours ago, argh said:

I'd second Ice's recs.

That said. Valproate does increase the amount of lamotrigine in your body The general rule will be for the pdoc to halve your dose or close to it.

from GSK: https://www.gsksource.com/lamictal

"Valproate increases lamotrigine concentrations more than 2-fold. (7, 12.3) "

There is also an interaction with birth control as it also (or maybe pill free week?) affects levels. Of course listen to your doc, but it's not out of the question/an automatic no.

Lithium?

Risperdal  (invega also) is actually the most likely of atypicals to cause lactation. It might be better than a typical however when it comes to lactation. Apparently it binds to the dopamine receptors more tightly vs other atypicals,  but not as much as typicals.

 

Those were my pdoc's recommendations - I've picked Haldol.  

I've been on lithium twice, shit both times.  

Thanks Iceberg...trying to think it will go smoothly, just med-change jitters.  I'm not used to have ups be an issue!

Dances, thanks.  I will keep you updated on how it goes.   First dose in what, 3ish hours?  

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42 minutes ago, jarn said:

Those were my pdoc's recommendations - I've picked Haldol.  

I've been on lithium twice, shit both times.  

Thanks Iceberg...trying to think it will go smoothly, just med-change jitters.  I'm not used to have ups be an issue!

Dances, thanks.  I will keep you updated on how it goes.   First dose in what, 3ish hours?  

Gotcha. Good luck with the haldol.

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Thanks. 

The thing is, even if I were to do the val acid and balance it and lamotrigine, I'd still have to look for a new AP as the prolactin/lactation issue means I'd have to way reduce the dosage of loxapine to a point it won't act as an anti-psychotic for me.  And I tend to psychosis.  

At least though, this pdoc takes my whole 'short up/hyper periods' (last for 2hrs-2days) seriously and doesn't just write it off as agitation.  

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Ive read that haldol works fast but im surprised there is no cross titration.

are your prns listed enough to help you out if you need it? 
Im guessing ADs are out of the question right now as it might make things worse...plus changing too many things at once would obfuscate things.

reason i ask is that loxapine has a metabolite which is amoxapine, a fast acting tetracyclic AD.

just me thinking out loud.

your doc seems good, so im sure things will turn out fine.
At the very least the doc is also of the mindset that duration is arbitrary and you can get help or at least advice to catch  it when it starts and not when it’s full blown.

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Oh no cross titration - no idea why - but I'm not surprised.  My old pdoc who heads up the clinic used to take me off of Seroquel without a taper (sometimes I'd taper, sometimes not).  Mind you, tapering just delayed being sick as a dog for months, so yeah.  Other meds I forget - I think it's been a mix.  

Regardless, I was not too sedated last night - if anything, less tired than normal - and I'm up 30 minutes early and fairly awake.  I both don't feel sick and I do feel sick.  I suspect me being so awake is from not having any loxapine in my system/whatever withdrawal I'm going through - it's happened before - and I'm up out of bed in that 'I feel poorly enough I don't want to sleep but not so poorly I want to stay in bed' way.  

I suspect re: PRNs - liraglutide I take as an AD, and I'm not fussed about depression - I haven't been having more than 10 minutes upsets (if that) with the crash at the end of my short manic episodes - plus I've got the lamotrigine.  If I need to though, I can take the liraglutide, and it's fairly fast acting for me.  If I get more manic, I can go to 3mg of Haldol or I suppose take an ativan as I did that in April to help keep the hypo hypo and not mania.  It mostly just makes me out of it though.  

Man I do not want to go to work today but I will.  I don't have a lot of sick days at the new job, and I've used 3.5 already with colds etc.  Plus I should talk to my boss and tell him what's going on.  I'm going to ask if I can get a laptop (for some reason here we don't have them, though eventually everyone will) so on days I don't feel well I can work from home, plus - more appointments - which I am using vacation for and would rather not!!!!!!

I like this new pdoc so far - but I have a very new relationship with him - but I really like that he sees the short episodes as mood and not simply 'agitation' which is what old pdoc (head of the clinic) dismissed them as.  It's a clinic at a hospital with relationships with UofT, and they do a lot of research - I just turned down being part of a study because I would've had to do a FORTY FIVE minute MRI - I don't mind MRIs, I've had them on my ankle and brain MRIs for other studies I've done for the psych clinic - but I don't want to lie still for 45 minutes.  I don't know, I'd rather be at home with the cats.  Maybe eventually I'll change my mind.  They're looking at myelin sheaths or something (I don't quite remember) in bipolar people with an eye to developing new meds.  

I also like new pdoc because while he says I'm bipolar, I'm 'on the schizophrenic spectrum' and I think that fits best.  I've been dx'd SZA in the past, and I think that is what I am, but old pdoc said that while he wouldn't argue with someone who said I was SZA, he felt I thought like a BP person (whatever THAT means) so that was my dx.  Even though I do meet the diagnostic criteria for SZA as I do get psychotic when my mood is fine.  

Anyways, I'm blabbering, and should probably get ready for work.  

Thanks :) 

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@jarn good luck with haldol. It’s good to start low. My pdoc started me at 5 mg, three times a day! And I was on other AAP’s at the time as well.

It should be really helpful and I hope that it helps you a lot. Sending good vibes! Keep us posted.

I’m so sorry you had to get off loxapine. That stinks.

I don’t understand your pdoc’s DX? Bipolar on the SZ spectrum? Why doesn’t he just officially DX you with SZA BP type? I know treatment matters most and DX shouldn’t matter as much. But why call a fish a shoe? 

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"Thought like a Bp person" 🤔

Mysterious, lol

I'd be curious to know what that means too.

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Good luck with the haldol. It works well for me. I take 2.5mg in the morning and 5mg at bedtime. 

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5 hours ago, Wonderful.Cheese said:

@jarn good luck with haldol. It’s good to start low. My pdoc started me at 5 mg, three times a day! And I was on other AAP’s at the time as well.

It should be really helpful and I hope that it helps you a lot. Sending good vibes! Keep us posted.

I’m so sorry you had to get off loxapine. That stinks.

I don’t understand your pdoc’s DX? Bipolar on the SZ spectrum? Why doesn’t he just officially DX you with SZA BP type? I know treatment matters most and DX shouldn’t matter as much. But why call a fish a shoe? 

I asked about staying on loxapine and adding an AAP,  and he said absolutely not.  Oh well.  Sticking with the typicals.

I think he thinks I tend more to the bipolar side than the SZ side, but I agree, it's a bit silly.  Still, it's the closest I've gotten this clinic to say that, short of my old pdoc basically being 'You meet the diagnostic criteria but I still think you're BP'.  

5 hours ago, argh said:

"Thought like a Bp person" 🤔

Mysterious, lol

I'd be curious to know what that means too.

I don't know if it's a comment on my level of functioning?  But he didn't said function, he said thought like.  I should've asked.  I was a bit taken aback at the time though.  

 

53 minutes ago, rowan77 said:

Good luck with the haldol. It works well for me. I take 2.5mg in the morning and 5mg at bedtime. 

Thanks!  That's good to know!  

 

Right now I am super nauseous, I'm sure from loxapine withdrawal.  I haven't had any side effects attributable to Haldol that I can tell but I'm still on a baby dose AND I'm going from one typical to another so hopefully the acute dyskinesia that I had on start up of loxapine (went away after 4 days; tongue darting) won't happen.  If it dose, I won't worry unless it lasts.  

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Oh yes and I totally forgot to say.  Bit speedy and paranoid this morning (likely from stress I'm thinking?  Poor sleep from loxapine withdrawal).  

But I talked to my boss:

Me:  So, I just wanted to let you know what was going on

Boss:  Okay

Me:  I'm bipolar

Boss:  Oh, okay!

Me:  And they're changing one of my meds which I wasn't expecting

Boss:  Ahh

Me:  So I have more appointments, and I know I've already taken time off for appointments

Boss:  I don't mind

Me:  Well, I was wondering...would it be okay if I work from home on days/afternoons that I have appointments?

Boss:  I don't think we have a formal policy, but I've no problem with that

Me:  So would I just email myself my work, or, uh...

Boss:  I guess so?

Me:  Or...I was wondering....would it make sense for me to have a laptop?

Boss:  Sure!  That makes sense!  Just email IT!  

Me:  Okay, I'll copy you

Boss:  Great.  Hey, while I have you here, I have a question about this review I owe you...

And that was it.  My old job we all had laptops (nobody in my department currently does, though eventually we'll all get them) and I still wasn't allowed to work from home because it would be 'special treatment' and 'unfair to everyone else' so instead I almost got fired for missing so much work (apparently having a hypomanic episode was unfair to the organization, and it was NOT OKAY that I needed to take time for therapy...until I was forced to tell my VP, look, I'm bipolar, I had an episode, I'm taking time off for therapy (but it was PAID TIME OFF, I wasn't just fucking off) - and I had already disclosed to HR and management in my department, but not my VP, the whole thing was ridiculous).  It was so...easy.  I think I have trauma from how dysfunctional my old workplace was.  I was all scared to go in and ask and it went great.  My boss and I filled out the form today to approve my laptop and assuming we did it correctly I'll have it early next week.  

Edited by jarn
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And, if I can rant about my old VP, the only reason I took as much time off as I did when I was hypo or manic (it ended in delusions and paranoia and I can't go on the subway when  the trackers are monitoring me), whichever it was, is because my manager (who knew what was going on, well, not the psychosis) told me to!  And then I get in trouble!  UGH.  I hate my old workplace.

Edited by jarn

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I was pretty close to full-on delusional on the subway this morning.  A lot of my delusions have grown to centre around the subway and people tracking me (it's a long story).  And I saw a lady in shiny pants that I thought was a demon but I convinced myself she wasn't.  It was not a fun ride.  Super awake again too.  

Emailed pdoc when I got in to work (well, after I talked to Toby who said I should) and he said to increased the Haldol (to a whopping 3mg...he's really trying to keep me low, I expect I'll need to increase more if my experience on 2mg is anything to go by) and that I could take an ativan to help me sleep.  I eventually came out of it and reread my email to pdoc and it sounds slightly crazed.  I get worked up on the subway about the trackers.  I don't like them.  

Well, I have 5 days off now, so I won't be commuting (though will be going to Thanksgiving Brunch near my mom's Sunday - but I'll have Toby with me and he's like a psychosis security blanket, so I should be fine).  See my GP Tuesday as she wanted to see me more - she was not convinced it was okay not to be seen until October 30th (appointment with pdoc) and turns out she was probably right.   

Got more and more nauseous as the day wore on but it's abated now. 

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Haha I showed Toby the email and said I was worried I sounded crazy...he said 'No, you don't...mind you, I'm also kind of used to you being crazy, so maybe you do and it just sounds normal to me.'  He also knows all about the trackers and how they monitor me and report what I'm doing to THE people though.  

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7 minutes ago, jarn said:

Haha I showed Toby the email and said I was worried I sounded crazy...he said 'No, you don't...mind you, I'm also kind of used to you being crazy, so maybe you do and it just sounds normal to me.'  He also knows all about the trackers and how they monitor me and report what I'm doing to THE people though.  

Good support right there. Maybe prn it up to sleep. Sleep is good. Though the restless 6 or 7 hrs of light sleep doesn’t help.

its ok, i have written long rambling emails to my pdoc too. If its via some app and you send it but delete it before they read it...they like still have it. Glad i did delete mine from a while ago. I think id be pretty embarrassed if i reread it too.

good you got the time off..stress seems to make thing exponentially worse.

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3 minutes ago, argh said:

Good support right there. Maybe prn it up to sleep. Sleep is good. Though the restless 6 or 7 hrs of light sleep doesn’t help.

its ok, i have written long rambling emails to my pdoc too. If its via some app and you send it but delete it before they read it...they like still have it. Glad i did delete mine from a while ago. I think id be pretty embarrassed if i reread it too.

good you got the time off..stress seems to make thing exponentially worse.

The weird thing is, I'm still get lots of deep sleep.  But not as much overall sleep, and I'm hyper awake when I am awake which is very abnormal for me.  I am not usually AWAKE and now I feel ON and ALIVE though that dissipates as the day goes on and I feel pretty normal now.  In a non-tired way.   Normally I'm tired.  

I'm so taking an Ativan tonight.  Though I do like not being tired.  But I'm worried it's affecting me.  

It's coincidental I have the time off - we took off Friday and Tuesday (Thanksgiving in Canada is Monday) to go camping but it's just as well that's not happening.  

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