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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Bob on June 21, 2008, at 17:03:45
Currently I am taking 450mg of Eskalith CR (Lithium) along with 10mg of Citalopram. A little over a week ago I began adding miniscule amounts of Abilify to the mix. By miniscule I do mean very small, as it little crumbs of a 2mg pill. I have slowly developed bouts of anger and irritation which are now become worrisome, even on these unbelievable small amounts (yes I do have a history of ridiculous sensitivity to psych drugs).
Anyway, I'm wondering whether I should risk continuing with this addition of Abilify, and try to counteract the anger with something else, or just give up and move on to something else. The Abilify has brough some much needed benefits like energy, drive, and some odd paradoxical mitigation of physical anxiety. I'm a little scared of what seems to be going on with the anger and irritability though and do NOT want to get in over my head as I've done so many times before.
Posted by dbc on June 21, 2008, at 17:45:06
In reply to Med choices for AP anger..., posted by Bob on June 21, 2008, at 17:03:45
D2 antagonism doesnt exactly feel nice. So yeah i'd imagine you'd be in a pretty crappy mood the first week or so of a normal dose.
Posted by Phillipa on June 21, 2008, at 19:37:48
In reply to Re: Med choices for AP anger..., posted by dbc on June 21, 2008, at 17:45:06
Isn't there another med you can try? Phillipa
Posted by Bob on June 21, 2008, at 20:02:08
In reply to Re: Med choices for AP anger..., posted by Phillipa on June 21, 2008, at 19:37:48
> Isn't there another med you can try? Phillipa
Well, if I add up all the possible combinations of psych meds I could try, I'd probably end up needing exponential notation, but I the experiments on myself are extremely dangerous and trying these days. I kind of liked certain aspects of Abilify, like the drive it was giving me, and the easing of muscle tension among others. Obviously I may have to give it up though.
Posted by Bob on June 21, 2008, at 20:02:49
In reply to Re: Med choices for AP anger..., posted by dbc on June 21, 2008, at 17:45:06
> D2 antagonism doesnt exactly feel nice. So yeah i'd imagine you'd be in a pretty crappy mood the first week or so of a normal dose.
Are you suggesting that the anger and irritation may subside?
Posted by bleauberry on June 21, 2008, at 20:22:34
In reply to Med choices for AP anger..., posted by Bob on June 21, 2008, at 17:03:45
I don't know abilify very well, only that comments here seem to make it look as though different doses have different effects. I would guess that it does not work the same in terms of partial serotonin agonism, partial dopamine agonism, serotonin antagonism, dopamine antagonism, at all doses in a linear pattern. At the miniscule dose, it is anyone's guess whether you are getting more agonism or antagonism or what.
If you have a weekend of a couple days where you could afford to write it off to a bad experience and weather through it, you might try a full 2mg just to see. At the miniscule dose you might be getting some of the stuff that isn't so good for you when the good stuff is at a higher dose? Just a thought. I say that mainly because people here have said how they felt energized at lower doses but calmer as the doses went up.
Yeah I know what you mean by getting in over your head. Me too, been there, done that, always a fear with a new med. Usually before throwing in the towel though I will manage to take a healthier dose than miniscule just to see. I don't want to walk away from a potentially good med without having made my best effort with it.
If an AP is in your future and abilify doesn't work out, Zyprexa stands a good chance of being more friendly. SLS mentioned in another post about adding Zyprexa while starting abilify, and then dropping zyprexa once stabilized on abilify. That was an interesting idea that makes sense to me. Or just take zyprexa by itself. Me and zyprexa were friends for a long time and if you want an irritation/agitation killer, it did a pretty good job of that. But again, I do understand the feeling of being in over your head and I definintely understand being abnormally sensitive to meds. Describes me pretty well.
Posted by dbc on June 21, 2008, at 20:25:23
In reply to Re: Med choices for AP anger... » dbc, posted by Bob on June 21, 2008, at 20:02:49
> Are you suggesting that the anger and irritation may subside?
Im suggesting you try the entire dose and roll with it.
Posted by Bob on June 21, 2008, at 23:27:37
In reply to Re: Med choices for AP anger..., posted by bleauberry on June 21, 2008, at 20:22:34
Thanks for the advice. Maybe I will give it a go at the full 2mg.
I asked my doc what he thought about the different responses at different doses thing, and he seemed to think that it would be almost impossible to predict for any single patient as to what type of response might be had at what dose threshold. From what I read here though, it seems that the 2mg level is below any type of flip-over thresholds anyhow.
I have thought about adding Zyprexa but that med scares the heck out of me in terms of sedation and more significantly, outrageous weight gain. My doc is very straight with me and says he as a few cases of patients who have gained massive weight- even 100 lbs!!! One poor woman is "stuck" on the drug and has gained copious pounds and developed diabetes. It also seems like many people have a terrible time with discontinuation of that drug. Still, unbelievably, I have not ruled it out, since I can't really afford to.
I'm also wondering if counteracting the Abilify with a benzo might work, but for me benzos tend to be depressogenic and are hell to discontinue.
I've got to think on this, I guess.
Posted by mav27 on June 22, 2008, at 1:52:28
In reply to Re: Med choices for AP anger... » bleauberry, posted by Bob on June 21, 2008, at 23:27:37
I'm going through a similar thing at the moment. I've just started taking a tiny amount of abilify.. probably around 1 mg or so as i've been cutting up a 5mg tablet into roughly thirds (but losing a fair bit to mushed up bits/crumbs ect) It's been making me irritable as well. I've been keeping it under control with clonazepam, just .25mg each day which has been just enough to keep the irritablility under control.
I tried the full 5mg of abilify once and boy was that a mistake.. i was vomiting for days and couldn't sleep a wink.
Posted by SLS on June 22, 2008, at 5:06:02
In reply to Med choices for AP anger..., posted by Bob on June 21, 2008, at 17:03:45
For anger:
Tegretol or Trileptal.
It makes sense to try Trileptal first since it is less sedating and without the risk of developing agranulocytosis that Tegretol has.
- Scott
Posted by Bob on June 22, 2008, at 11:28:16
In reply to Re: Med choices for AP anger... » Bob, posted by SLS on June 22, 2008, at 5:06:02
> For anger:
>
> Tegretol or Trileptal.
>
> It makes sense to try Trileptal first since it is less sedating and without the risk of developing agranulocytosis that Tegretol has.
>
>
> - ScottWhat are some common side effects with Trileptal? Does it have cognitive dulling and cause confusion?
Posted by Bob on June 22, 2008, at 11:29:43
In reply to Re: Med choices for AP anger... » Bob, posted by mav27 on June 22, 2008, at 1:52:28
> I'm going through a similar thing at the moment. I've just started taking a tiny amount of abilify.. probably around 1 mg or so as i've been cutting up a 5mg tablet into roughly thirds (but losing a fair bit to mushed up bits/crumbs ect) It's been making me irritable as well. I've been keeping it under control with clonazepam, just .25mg each day which has been just enough to keep the irritablility under control.
>
> I tried the full 5mg of abilify once and boy was that a mistake.. i was vomiting for days and couldn't sleep a wink.
Yeah, I think that for me, jumping in at 5mg would be quite a mistake. I'm already experiencing anger and insomnia at these low doses.
Posted by SLS on June 22, 2008, at 12:11:55
In reply to Re: Med choices for AP anger... » SLS, posted by Bob on June 22, 2008, at 11:28:16
> > For anger:
> >
> > Tegretol or Trileptal.
> >
> > It makes sense to try Trileptal first since it is less sedating and without the risk of developing agranulocytosis that Tegretol has.
> What are some common side effects with Trileptal? Does it have cognitive dulling and cause confusion?No. Not usually. I tried Trileptal, and didn't have any cognitive impairments with it.
Here is a list of the most often reported side effects:
Dizziness, somnolence, diplopia, fatigue, nausea, vomiting, ataxia, abnormal vision, abdominal pain, tremor, dyspepsia, abnormal gait.
From:http://www.rxlist.com/cgi/generic/oxcarbazepine_ad.htm
Of course, you will not get all of these side effects. You might not get any. Any time you evaluate a list of side effects produced by a drug, you must look at the statistics. There are some scary items listed as side effects, but most of them are rare or infrequent.
- Scott
Posted by Maxime on June 22, 2008, at 18:25:10
In reply to Med choices for AP anger..., posted by Bob on June 21, 2008, at 17:03:45
I'm not going to read all the posts, so sorry if i am repeating here:
- Depakote
- TegretolBoth are supposed to help with anger.
Maxime
Posted by Maxime on June 22, 2008, at 18:26:23
In reply to Re: Med choices for AP anger... » SLS, posted by Bob on June 22, 2008, at 11:28:16
>What are some common side effects with Trileptal? Does it have cognitive dulling and cause confusion?
It didn't cause any cognitive dulling at all. It made me a bit dizzy at first, but that's it.
Maxime
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