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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Christ_empowered on May 20, 2015, at 13:42:22
Not a full taper. Noooooooooooo...not yet.
I'm on 30 Abilify. I also take: 1200 Trileptal, 100 Lamictal, 400 Wellbutrin SR, and low dose PRN neurontin, rarely. I used to need PRN risperdal now and then, but the wellbutrin somehow cleared up a lot of the agitation and even some of the low grade hallucinations. Weird, huh?
I think I'd like to get down to 15/Abilify. I think I'd be able to concentrate better and also the TD risk would be lower.
The next pill down from 30 is 20, and that's a big taper down.
In terms of symptoms and stability, how do you know when you can reduce your AP/AAP? Keep in mind, I go to a community mental health clinic. They won't reduce unless I bring it up, cuz a lot of what they do is put people in chemical straight jackets. Since my people are behind me, I have more leeway than I would otherwise...its always good to be white, male, and have upper middle/upper class people behind you, am I right? Right.
So...yeah...when can I safely reduce, you think?
Posted by Tomatheus on May 20, 2015, at 16:03:40
In reply to when can you reduce AAP/AP dosage?, posted by Christ_empowered on May 20, 2015, at 13:42:22
Christ_empowered,
I'm definitely not an expert in this area, but I tend to think that the process of deciding when to reduce the dose of a medication is probably more of an art than a science. I tend to favor striving to take the lowest necessary dose of medications, especially antipsychotics, but what one person considers to be "necessary" isn't likely going to be the same as what somebody else considers to be "necessary." Certainly, you don't want to lower your dose to the point where you would be considered unstable and in need of hospitalization. And if the medications are helping to improve your functionality and/or quality of life, then you'd also risk interfering with those things if you allow your dose to be reduced too low. But sometimes lowering the dose of your medication could actually improve functionality and/or quality of life, and I think that it can be hard to predict when reducing your dose would be more beneficial overall and when it might be more harmful overall.
Again, I'm not an expert or a doctor, but I think that reducing your Abilify dose slowly would be a safer option than reducing it more abruptly. Do you think that maybe asking your doctor about prescribing 20-mg tablets with some 5-mg tablets so you can take 25 mg for a while might be an option?
Tomatheus
Posted by Christ_empowered on May 20, 2015, at 16:39:32
In reply to Re: when can you reduce AAP/AP dosage? » Christ_empowered, posted by Tomatheus on May 20, 2015, at 16:03:40
hey Tomaetheus,
The problem is Abilify is so freakishly expensive. Getting a 20mgs Rx plus a 5mgs Rx can't happen on my drug coverage, since you get 1 atypical Rx per month. I could ask for samples, but I'm on disability, and they usually reserve samples for people w/o health coverage, understandably.
Good idea though. I was thinking take try to get an Rx for more neurontin and then go to 20, so the neurontin could sedate a little bit while I taper down a notch. But...its community mental health. They apparently don't often Rx neurontin, and they've been trying to taper mine completely, even though I only rarely take it, and then as a sleeping pill.
Ugh. I guess option B would be a switch to seroquel or the xr and then a gradual taper off that. Or..something like that. I dunno.
I realize that I need an AP/AAP in my life, and its been Abilify for a while now...I just don't want to stay at the max dose, not when I'm starting to truly recover. Honestly, I think a lot of the reason I needed 30 was because of "treatment" (electroshock isn't fun), not because of any "psychotic disorder."
Anyway...thanks for your reply.
Posted by stan_the_man70 on May 21, 2015, at 6:09:51
In reply to when can you reduce AAP/AP dosage?, posted by Christ_empowered on May 20, 2015, at 13:42:22
C_E:
Based on my experience Abilify is fairly easy to withdraw from. You will have very few days at the start when things will be drastically bad, but it stops fairly quickly. Depends on how slowly you taper, depends on how long you been taking it, depends on what else you taking, depends on your general health, depends on how many times you tried to stop earlier.
Also depends on what else you are doing to occupy your mind, your time, your energy, and your needs.
There have been other posts, by other people, on how to reduce off antipsychotics such is zyprexa, which is a lot more difficult.
I had also suggested earlier on how to create a daily log of your activities - pills, dosage, morning/night dosage, sleep hours, mood rating, energy level, anxiety level, psychosis level, physical activity hours, social activity hours, mental activity hours - etc - It's in a different post. It's extremely essential in case you are doing any increase or taper for any medication - this way you will not panic - and know when to up the medication again in case you are in the danger zone.
As has been stated before - you need to try out till you find a diet that suits you (raw or vegan or juicing or smoothies or health foods), physical activity level to one that suits you (sports or gym or aerobics or stretching or martial arts), mental activity (job or creative work or music or study or brain exercise games in person or website), social activity (religious or arts or festivals or outdoors or volunteering) and so on.
So far I have not found any kind of a magic formula or cure or relief or solution or otherwise. That's sad. But that should not stop anyone else.
(no flames please)
Posted by tom2228 on May 21, 2015, at 11:09:55
In reply to Re: when can you reduce AAP/AP dosage?, posted by Christ_empowered on May 20, 2015, at 16:39:32
> hey Tomaetheus,
>
> The problem is Abilify is so freakishly expensive. Getting a 20mgs Rx plus a 5mgs Rx can't happen on my drug coverage, since you get 1 atypical Rx per month. I could ask for samples, but I'm on disability, and they usually reserve samples for people w/o health coverage, understandably.
>I get not wanting to pay two copays so what about two and a half tablets of the 10s? The insurance company has to understand needing 25mg if that's what your doctor orders, since there's single tablet for that and no way to get around it. and it's more likely to work if the script is written for the dose to be split up throughout the day, which necessitates smaller tablets if that's what it seems your doctor wants.
Well anyway that's what works for my insurance company. I would highly suggest going to the pharmacy and having them try to run the 25mgs in different dosing options and see what the insurance company will cover beforehand. Good luck
And I recently titrated from 12.5mg to 2.5mg of Zyprexa. I had the intention of switching to Saphris and did sort of a cross titration up to 10mg Saphris and 2.5mg Zyprexa. The anxiety and rebound was pretty bad since this all happened in 2ish weeks. I think the Saphris made it easier to get off most of the Zyprexa until it became clear that the Saphris itself was contributing to the anxiety and I got off that too. There were benefits to being on the higher doses of the antipsychotics that were appropriate for that time in my life, but I am doing much better on just 2.5 Zyprexa now. I've also been on 4mg Abilify this whole time.
What about a PRN of low-dose Zyprexa to assist the titration if it gets rough?
Posted by phidippus on June 11, 2015, at 0:50:06
In reply to when can you reduce AAP/AP dosage?, posted by Christ_empowered on May 20, 2015, at 13:42:22
Why do you want to reduce it?
Eric
Posted by SLS on June 11, 2015, at 10:03:14
In reply to Re: when can you reduce AAP/AP dosage? » Christ_empowered, posted by phidippus on June 11, 2015, at 0:50:06
> Why do you want to reduce it?
>
> Eric
I was going to ask the same question.C_E, are you looking to try another medication or perhaps some alternative treatment? I know you have tried to discontinue Abilify several times already. So far, the results of these decisions have allowed for major deteriorations in your condition. One can make the argument that your deteriorations were actually the result of a withdrawal rebound worsening of symptoms instead of a true relapse. Perhaps you can ask your doctor if he has witnessed this in his any of his other patients. I am inclined to believe that any immediate deterioration is a signal of eventual relapse. You might want to try Saphris, depending on the details of your illness presentation. If paranoia or suspiciousness along with depression are problems, Saphris might be ideal according to my doctor and personal observations of a friend of mine who suffers from schizoaffective disorder. Even so, it makes sense to begin another AAP while still taking Abilify so as to avoid a relapse. A cross-titration might be the best way to go. I really don't know.
- Scott
Posted by Lamdage22 on July 16, 2015, at 5:03:18
In reply to Re: when can you reduce AAP/AP dosage? » phidippus, posted by SLS on June 11, 2015, at 10:03:14
Saphris was not strong enough an antipsychotic to be approved for schizophrenia in germany.
Posted by Lamdage22 on July 16, 2015, at 5:05:09
In reply to Re: when can you reduce AAP/AP dosage? » Christ_empowered, posted by Tomatheus on May 20, 2015, at 16:03:40
3 to 6 months of stability?
This is the end of the thread.
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