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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Christ_empowered on September 21, 2012, at 12:25:14
I think I need a little boost for my Abilify (30) and Neurontin (900). I guess I could ask about a dosage increase on the neurontin, but my doc is big on keeping doses low.
My problems are anxiety, especially in social situations, and agitation. I don't particularly care for SRI drugs over the long haul, although they're OK for relatively short term (few months) use for severe problems (like when I had psychotic depression).
My problem is that I do think I need something to help get me to the point that I can a) go to vocational rehab w/o freaking out; b) socialize, also without freaking out; and c) reduce my agitation levels. One would think that the max dose of Abilify plus Neurontin would=no more agitation. What's strange is that its some kind of inner agitation that keeps my thoughts looping and prevents normal socializing and such.
I don't want another antipsychotic at any dose. My doc had mentioned low-dose Haldol. I threw out extremely low dose perphenazine strictly as-needed. My doc gave that a thumbs down, and I gave Haldol a thumbs down, since typical neuroleptics make me dysphoric and unable to think clearly.
So, I guess that leaves antidepressants. I was thinking Surmontil because its apparently a tranquilizer. At high doses, some studies suggest it can help psychosis. Awesome. So, I don't think it will flip me into agitation.
Then again...sooooo sedating. I liked jono's idea of wellbutrin+sri, but that would have me on 4 drugs. Maybe Effexor, and just ramp it up until I feel better? Cymbalta scares me a little bit, because I already took in a hospital and found it somewhat numbing.
Ugh. What to do? BuSpar is out, btw. So is day time vistaril.
Posted by phillipa on September 21, 2012, at 12:35:31
In reply to Trimipramine?, posted by Christ_empowered on September 21, 2012, at 12:25:14
Strange you found cymbalta numbing as took it self when new it agititated me second time took it but first time at 60mg I was fine with benzos. Phillipa
Posted by SLS on September 21, 2012, at 14:05:47
In reply to Trimipramine?, posted by Christ_empowered on September 21, 2012, at 12:25:14
Trimipramine did not sedate me at all. However, I had taken various TCAs previously, so I wasn't exactly a virgin. Still, I am guessing that if you do experience sedation, there is a good chance that it will dissipate over time.
I can hardly believe that I am saying this, but according to what you would like a drug to do, amoxapine might help. The molecule is 1/2 TCA-like and 1/2 loxapine-like. It even acts as a potent 5-HT2a antagonist.
Trimipramine is the logical choice if you are looking to avoid monoamine reuptake inhibition. However, if this feature is not important to you, I think nortriptyline is a drug for you to consider.
- Scott
Posted by Christ_empowered on September 21, 2012, at 16:50:42
In reply to Re: Trimipramine?, posted by SLS on September 21, 2012, at 14:05:47
Isn't there EPS with that? I'm not criticizing your selection; rather, I'm just thinking out loud. The reason the antipsychotic action of Surmontil (in high doses) appealed to me was because I was thinking...OK, AP in high doses, probably won't trigger anything "crazy" in lower doses. My psychosis is fairly well-controlled. I just don't want to get flipped into an episode of some sort.
Honestly, I don't know if I can even get a tca. Its Public Mental Health, and they're pretty much all about risk reduction, so its probably going to have to be something newer. Do you think medium dose Remeron? Then again...my shrink (effective dose of neuroleptic, low dose everything else) probably wouldn't want to go mid-to-high dose, at least not to start.
Are there any good, anxiolytic, anti-agitation meds you can think of that might get good results reasonably quickly, at a fairly low starting dose? I do like the wellbutrin+sri idea, but my doc would probably be like...one or the other. Or shoot down wellbutrin altogether, given my recent history of agitation and mild psychosis. Actually, she shot down ANY AD a while ago. I thought a low dose of something might curb my looping thoughts.
Maybe I should just give the neurontin more time before I start playing "better living through chemistry" ?
Thanks for any thoughts you may have, SLS (or anyone else, for that matter).
Posted by jono_in_adelaide on September 21, 2012, at 19:39:52
In reply to Trimipramine?, posted by Christ_empowered on September 21, 2012, at 12:25:14
Trimipramine works mainly by blocking the 5HT2 receptors, so I dont know how much more benifit it will give ontop of an atypical - could you give nortriptyline a try?
Posted by jono_in_adelaide on September 21, 2012, at 20:45:35
In reply to Re: Trimipramine?, posted by jono_in_adelaide on September 21, 2012, at 19:39:52
And, as for being on 4 meds.... so what, if it works?
I said somthing similar to my psychiatrist once, and he said "well, have you ever taken Codral (A popular cold and flu product in Australia) and I of course said yes, and he replied that that contained 4 medications.... an analgesic, a decongestant, an antihistamine and a cough suppressant..... so if I was prepared tot ake 4 medications for a cold, then surely it would be ok to take 4 medications for a crippling, life threatening decision.
If you realy only want one med, I'd go nortriptyline or bupropion, if you are willing to go 2 meds, I'd go either of these with an SSRI
Posted by SLS on September 21, 2012, at 23:38:37
In reply to Re: Trimipramine?, posted by jono_in_adelaide on September 21, 2012, at 20:45:35
> And, as for being on 4 meds.... so what, if it works?
>
> I said somthing similar to my psychiatrist once, and he said "well, have you ever taken Codral (A popular cold and flu product in Australia) and I of course said yes, and he replied that that contained 4 medications.... an analgesic, a decongestant, an antihistamine and a cough suppressant..... so if I was prepared tot ake 4 medications for a cold, then surely it would be ok to take 4 medications for a crippling, life threatening decision.
>
> If you realy only want one med, I'd go nortriptyline or bupropion, if you are willing to go 2 meds, I'd go either of these with an SSRI
I agree with all of this, for what it's worth.
- Scott
Posted by SLS on September 21, 2012, at 23:51:44
In reply to Amoxapine?!?!, posted by Christ_empowered on September 21, 2012, at 16:50:42
Have you tried Luvox (fluvoxamine)? Generally speaking, it is the least activating SSRI and is sometimes anxiolytic or sedating. It might help treat your looping obsessive and intrusive thoughts while reducing anxiety.
http://www.ncbi.nlm.nih.gov/pubmed/20373470
- Scott
Posted by phillipa on September 22, 2012, at 18:53:35
In reply to Re: Luvox (fluvoxamine)? » Christ_empowered, posted by SLS on September 21, 2012, at 23:51:44
Been on it for years as you know and I do still need benzos but other than ativan it potentiates the effects of other benzos. Maybe this is the reason was only ad never ever had a side effect on? Phillipa
Posted by rjlockhart37 on September 25, 2012, at 20:27:33
In reply to Re: Trimipramine? » jono_in_adelaide, posted by SLS on September 21, 2012, at 23:38:37
your going to have to think of something your doctor will approve....You should look into Luvox....maybe increasing your abilify to 40mg, wellbutrin causes agaition in some cases bad...but if you tolerate it for the first couple weeks...try it.
rj
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