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5 hours ago, browri said:

That's great! Glad to hear that little bit of olanzapine is helping. There really is a lot of evidence that many cases of mild-to-moderate bipolar disorder can be treated on 5mg of olanzapine or less. I remember when I took 2.5mg of olanzapine for the first time it actually felt quite like a dream, a really good dream. Other than brexpiprazole, I've never been so compatible with a medication, except possibly loxapine.

Just a heads up that the swollen glands could be the result of the olanzapine, but it really could just be the time of year like you suggested, and maybe you're just getting sick. It might not hurt to do blood work to check for things like low white blood cell count. Your doctor will know better. But it would likely be similar to routing clozapine testing without the drug level monitoring. I believe it's a complete blood count and a comprehensive metabolic panel, and that's it. Pretty straight-forward.

Thanks! 

The psychiatrist I saw was a big fan of low doses and severe anxiety. 

My next bloods are due in February. Unless of course it gets bad enough to check in with that sooner. They don't feel so sore, and seem to have gone down a bit. But I'm keeping an eye out. 

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On 12/5/2019 at 3:11 PM, ~nestling~ said:

Thanks! 

The psychiatrist I saw was a big fan of low doses and severe anxiety. 

My next bloods are due in February. Unless of course it gets bad enough to check in with that sooner. They don't feel so sore, and seem to have gone down a bit. But I'm keeping an eye out. 

Using low-dose atypical antipsychotics for severe cases of anxiety makes a lot of sense actually. On the one hand, you can have someone who is experiencing anxiety that is rooted in generalized or social anxiety disorder, versus someone who experiences anxiety and agitation from bipolar disorder....yet they can many times manifest in the same way.

When pdocs give us benzos like lorazepam, clonazepam, or alprazolam for our anxiety, they simply increase our brain's response to GABA, which in turn causes a release of dopamine that relaxes us acutely. Low-dose AAPs combine preferential antagonism of the short form of dopamine receptors (pre-synaptic auto-receptors) as well as binding potently to and blocking serotonin receptors causing downstream dopamine release that is similarly sedating to benzos, yet altogether more intense because atypical antipsychotics typically combine this with potent antagonism of histamine receptors which calms via a whole different pathway. Quetiapine, clozapine, loxapine, and olanzapine also dissociate from post-synaptic dopamine receptors quickly allowing for normal dopamine signaling and good antidepressant effect, which inherently helps anxiety as well.

Once you get to higher doses, you lose some of this by more strongly blocking post-synaptic dopamine receptors.

It's really great that it's working so well for you, and I hope it continues.

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On 12/7/2019 at 4:48 PM, browri said:

Using low-dose atypical antipsychotics for severe cases of anxiety makes a lot of sense actually. On the one hand, you can have someone who is experiencing anxiety that is rooted in generalized or social anxiety disorder, versus someone who experiences anxiety and agitation from bipolar disorder....yet they can many times manifest in the same way.

When pdocs give us benzos like lorazepam, clonazepam, or alprazolam for our anxiety, they simply increase our brain's response to GABA, which in turn causes a release of dopamine that relaxes us acutely. Low-dose AAPs combine preferential antagonism of the short form of dopamine receptors (pre-synaptic auto-receptors) as well as binding potently to and blocking serotonin receptors causing downstream dopamine release that is similarly sedating to benzos, yet altogether more intense because atypical antipsychotics typically combine this with potent antagonism of histamine receptors which calms via a whole different pathway. Quetiapine, clozapine, loxapine, and olanzapine also dissociate from post-synaptic dopamine receptors quickly allowing for normal dopamine signaling and good antidepressant effect, which inherently helps anxiety as well.

Once you get to higher doses, you lose some of this by more strongly blocking post-synaptic dopamine receptors.

It's really great that it's working so well for you, and I hope it continues.

Thanks for the info! And for the good wishes. 

I do occasionally get surges of electric type energy in my legs, but it passes. Today I've felt really anxious for no discernible reason except hormones. I'm hoping it's just the hormones. 

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Last night I didn't sleep until 1 am [I went to bed around 12] because I had those weird electric surges in my right leg. Eventually I paced for a while, and it passed and I went to sleep. I know that it's from both my meds working together, as I had it earlier in the evening at my parents', since I eat and go to bed earlier there. I did sleep really well once I slept, but I definitely didn't want to get up this morning!
 

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20 hours ago, ~nestling~ said:

Last night I didn't sleep until 1 am [I went to bed around 12] because I had those weird electric surges in my right leg. Eventually I paced for a while, and it passed and I went to sleep. I know that it's from both my meds working together, as I had it earlier in the evening at my parents', since I eat and go to bed earlier there. I did sleep really well once I slept, but I definitely didn't want to get up this morning!
 

Sounds like RLS really. More than likely from something that stimulates serotonin activity, which points the finger at vortioxetine, but this wasn't a problem for you really until you added the olanzapine, right?

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2 hours ago, browri said:

Sounds like RLS really. More than likely from something that stimulates serotonin activity, which points the finger at vortioxetine, but this wasn't a problem for you really until you added the olanzapine, right?

I had RLS ALL the time on Aripiprazole, [except, strangely, at night!] which is why I came off it!

The sense of it as electric energy is new on the Olanzapine, yes. I take that and the Vortioxetine several hours apart, which may be too close. I'll see what my GP says when I see her on the 2nd January, I guess...

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20 hours ago, ~nestling~ said:

I had RLS ALL the time on Aripiprazole, [except, strangely, at night!] which is why I came off it!

The sense of it as electric energy is new on the Olanzapine, yes. I take that and the Vortioxetine several hours apart, which may be too close. I'll see what my GP says when I see her on the 2nd January, I guess...

hmmmm. sorry I don't have any more guidance here. I've never taken vortioxetine at night with a low-dose atypical antipsychotic, so I don't know what to expect. But what I do know is I find vortioxetine stimulating at 20mg. So I generally take it in the morning because it takes 7-11 hours to reach peak blood levels anyway after oral administration, which means sometime between 2PM and 6PM, not early in the morning right after I take it.

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4 hours ago, browri said:

hmmmm. sorry I don't have any more guidance here. I've never taken vortioxetine at night with a low-dose atypical antipsychotic, so I don't know what to expect. But what I do know is I find vortioxetine stimulating at 20mg. So I generally take it in the morning because it takes 7-11 hours to reach peak blood levels anyway after oral administration, which means sometime between 2PM and 6PM, not early in the morning right after I take it.

Thanks. I'll see how things go. It seems to get earlier and earlier, this restless legs thing. Maybe eventually it'll fizzle [ha!] out. 

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