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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by GingerbeerBloke on June 20, 2015, at 5:25:13
I've noticed that Aptiom seems to wear out a bit some hours before and after my scheduled dose. I'm on 1200mg and taking it for rage issues. I get some amount of outbursts during these wear-out times but otherwise I'm stabilized. I'm on a once-daily dose. It's been a month since I'm on Aptiom. Would a divided dose have a more stable effect on me? Please give me insight on why and why this happens even though it has a long half-life and if I need to divide the dose, what amounts should I divide it as.
I'm also going on pregabalin (but I'm adding Stablon first for my severe depression issues after having indifferent response on some SSRIs and one SNRI). I'm interested to know what is the best way to dose and titrate pregabalin and what issues I might come across (I'm aware of bioavailability issues with gabapentin). I'll be taking pregabalin for a few issues. One is to eliminate anxiety and reduce stress-levels greatly, that is in the hopes that I can function better and prevent irritability that may be fueled a bit by excess stress. I'm also hoping it might prevent rage attacks which I've hypothesized might be coming from pent-up sub-clinical seizure activity (after reading a bit about episodic dyscontrol syndrome). I've had very good response to aptiom (albeit a slightly incomplete response) which is remarkable considering I've dropped all antipsychotics and still functioning well after a month - all doctors said nothing but strong APs like risperdal and clozapine would work, I took the chance and aptiom monotherapy is working for me but I'm so unhappy about the persistent EPS and severe dystonia that I suspect might have become permanent from the APs. I'll also be taking pregabalin in the hopes that it will improve the quality of my sleep and give me deep sleep. Some people have had good AD response from it as well. So for my issues, please advise on what might be or your opinion on proper dosing.
Posted by SLS on June 20, 2015, at 6:38:56
In reply to Dosing Qs - aptiom/pregabalin, posted by GingerbeerBloke on June 20, 2015, at 5:25:13
Perhaps dosing 600 b.i.d. of Aptiom (eslicarbazepine) would be helpful.
As of 2013, no head-to-head comparison has been performed between Tegretol, Trileptal, and Aptiom with respect to efficacy and tolerability. What are your impressions of Aptiom, and why did you choose it? It seems that Aptiom is a best-kept secret. I will keep it in mind for myself. Just be careful of developing hyponatremia.
Not too long after Zoloft (sertraline) came out, doctors began using it to treat anger, hostility and rage. It was often combined with Tegretol (carbamazepine). Believe it or not, if Zoloft produces akathisia, or psychotic depression, Luvox would be a good drug to switch to. These two drugs act in opposite manners when they bind to the sigma-1 receptor / chaperone: Zoloft is an antagonist while Luvox is an agonist.
Why did you choose Stablon (tianeptinen)? Is it simply a theory on paper, or has it been found to work clinically for more severe depressions? Do you have any statistics to offer?
Thanks.
- Scott
Posted by GingerbeerBloke on June 20, 2015, at 16:47:17
In reply to Re: Dosing Qs - aptiom/pregabalin » GingerbeerBloke, posted by SLS on June 20, 2015, at 6:38:56
> Perhaps dosing 600 b.i.d. of Aptiom (eslicarbazepine) would be helpful.
>
> As of 2013, no head-to-head comparison has been performed between Tegretol, Trileptal, and Aptiom with respect to efficacy and tolerability. What are your impressions of Aptiom, and why did you choose it? It seems that Aptiom is a best-kept secret. I will keep it in mind for myself. Just be careful of developing hyponatremia.
>
> Not too long after Zoloft (sertraline) came out, doctors began using it to treat anger, hostility and rage. It was often combined with Tegretol (carbamazepine). Believe it or not, if Zoloft produces akathisia, or psychotic depression, Luvox would be a good drug to switch to. These two drugs act in opposite manners when they bind to the sigma-1 receptor / chaperone: Zoloft is an antagonist while Luvox is an agonist.
>
> Why did you choose Stablon (tianeptinen)? Is it simply a theory on paper, or has it been found to work clinically for more severe depressions? Do you have any statistics to offer?
>
> Thanks.
>
>
> - ScottSLS, I highly recommend Aptiom, it has worked more for me than I hoped. I'll list some of my impressions. I chose it because I had taken it once before at a very low dose (only for a few days though as an adjunct to APs) and preferred to retrial a drug I had already taken (anxiety issues I had at that stage) and favoured the once daily dosing and lack of tegretol's toxicity issues. I actually 'titrated' very rapidly to 800mg out of desperation. Took 400 the first day and next day on 800mg for the first three weeks. You will not believe the effect it had on me.
- For the few weeks, all anger, rage, any kind of stress was completely wiped away. I was better than even normal people could hope to be. I was absolutely placid and so so calm like I'd never been. I found a meaning to life again.
- And that WITHOUT /any/ sort of emotional blunting, anhedonia, the drug did not take away any of my feelings or change my thought processes
- It did not help severe depression perfectly, though it did help some as in I do not find myself weeping uncontrollably, though I can become very emotional and tearful
- For the first few days, I found a lot of somnolence, but that went away and I think one should muscle through that side effect and not quit the drug
- The drug does not knock me out. I find I can sleep at night again. But I can stay awake the whole night too and sleep in the morning if I want. The thing is though I CAN sleep and not suffer through having to stay multiple days with no sleep. I can get up when I want too. And no excess fatigue and somnolence. I like this drug a lot.
- I have zero cognitive issues. I can also think clearly and smartly.
- I have not experienced any dizziness or any 'drunken' feelings in my head.
- The only major SE I've experienced is terrible constipation for a while. That's one of the SEs that I also got from APs and was hoping I would get relief from and was so disappointed to have it with Aptiom. But things might be looking up, so to speak, as that problem might be getting a bit better for me, it's not been as troublesome the past few days.
- My pdoc added Zoloft for a few days but we dropped it as I got some ruminating thoughts.
- The only problem now is that since last week, Aptiom has decided to devalue our friendship and stop working perfectly for the rage and irritablity issues. I get some outbursts (short-lived, though) that do have an intense quality but thankfully I'm not going all-out violent and destructive, so it is still very succesful. I upped the dose to 1200 since last week, but I don't know if it will take a while to stabilize and that's why I'm thinking of playing around with divided dosing.
- All other benefits still remain
All in all, it has had remarkable success for me where many other drugs have failed, either due to SEs or lack of efficacy for my symptoms. I do highly recommend the drug. If you have any specific questions, I'll be happy to answer. Note though, I'm not taking the original brand of the drug as it is not marketed here in India, but I'm using a generic (Zefretol) by Sun Pharma. Sun Pharma seems very reliable and a big name here and I've no doubt the drug is well-tested and quality is good.I already mentioned why I want to add pregabalin in the hopes of increased benefits for my issues (which are basically those I've already mentioned in my previous post). Now I want to add Stablon too. SLS - I'm going with it due to my previous indifferent response to some SSRIs and one SNRI and the hopes to avoid anticholinergic/NE-reuptake effects of TCAs and other classes. I feel the NE hitting drug might activate me in uncertain ways. Stablon of course has mild side effects and seems to lack toxicity issues and I feel a completely different MOA might provoke favourable effects on my brain where others have failed to have sufficient impact. I rather try this before trying other meds. I don't know more about the drug than what is already available from posts and experiences previously by people on Babble and the info from places like Wiki, so I can't provide statistics, sorry, especially as the technical stuff in the literature is above my level of knowledge ( I do not have a science/medical background ) though I think Wiki does have citations for it's statement that it has efficacy for severe depression. Maybe you or someone knowledgeable can follow and read the studies and provide insight in human-readable language. :)
Thanks.
Posted by SLS on June 20, 2015, at 17:24:08
In reply to Re: Dosing Qs - aptiom/pregabalin » SLS, posted by GingerbeerBloke on June 20, 2015, at 16:47:17
Thank you for presenting such a detailed account of your experiences with eslicarbazepine (Aptiom). It is highly valuable.
Did you ever try oxcarbazepine (Trileptal)?
I tried Trileptal once. I remember it as being a very tolerable drug, but it did not help my bipolar depression. Maybe Aptiom would be better...
- Scott
Posted by herpills on June 20, 2015, at 22:39:13
In reply to Dosing Qs - aptiom/pregabalin, posted by GingerbeerBloke on June 20, 2015, at 5:25:13
Hello,
My advice regarding starting pregabalin, is to titrate slowly. I am finding it very helpful for anxiety, and it may be helping with mood issues as well...but I remember every time I went up by only 50mg, it almost seemed to give me a little instability of mood for a couple weeks, then that leveled off and it then seemed to act as a mood stabilizer, if that makes sense. I think it is a "strong" medication and needs to be used in a careful manner, especially in patients with a history of sensitivity to psych meds.
Posted by Horse on June 20, 2015, at 23:32:17
In reply to Re: Dosing Qs - aptiom/pregabalin » GingerbeerBloke, posted by herpills on June 20, 2015, at 22:39:13
I started pregabalin at 150, then 300 to 450, and finally 600 mg. For maintenance, I take 200 mg. daily. When needed I'll take 400 or 600 mg. that would be 200mg. 3x daily.
It really helps me...I don't take benzodiazapines...this helps with the anxiety orders I experience. Also, Pregabalin has an excellent effect on my mood. It's integral to my treatment.
Good luck
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