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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 19 to 43 of 46. Go back in thread:
Posted by Phillipa on April 15, 2016, at 17:55:55
In reply to Re: medication: high cholesterol and triglycerides?, posted by linkadge on April 14, 2016, at 20:33:10
So lexapro & fluvoximine improve psychosis? Phillipa
Posted by linkadge on April 15, 2016, at 18:07:58
In reply to Re: medication: high cholesterol and triglycerides? » linkadge, posted by J Kelly on April 15, 2016, at 12:18:26
>I was in a complete psychotic break for nine >months. I thought people were living in my >attic. I was not only able to have "normal" >conversations with people but I fooled psych >docs and nurses in two psych hospitals as well. >I was a very clever psychotic.
So, your psychotic break was from parnate? From my experiences, med induced psychotic breaks can be much different from actual schizophrenia. Parante seriously messes with sleep cycles and can virtually completely supress rem sleep. Lack of rem sleep can cause psychotic type thinking in healthy individuals in only a few nights.
I should clarify that paranoid type psychosis(which tends to respond better to antipsychotics) often retains better cognitive function than those with disorganized type schizophrenia. However, paranoid type psychosis is more commonly associated with stimulants (and in this case MAOIs).
However, most people suffering natural course, schizophrenia, in a frankly psychotic state, will have difficulty hiding this. They may be able to hide certain delusions (which they feel they may be ridiculed for) but there are usually other indicators in their speech / thought process (or behavior).
For instance, spending time in the hospital with individuals who were hospitalized with schizophrenia, it is usually pretty obvious.
>Same here except it was Geodon. I'll never >forget the severe anxiety I felt (either from >the parnate w/d or the Geodon, not sure).
Geodon has some monoamine reuptake inhibiting capabilities. It is not the best antipsychotic to take during MAOI withdrawl (possible serotonin syndrome).
>Same. Although I've taken high doses of Ritalin >and never came close to being psychotic (that I >know of).
I take Ritalin too (low doses) and like you have never had a psychotic break. Ritalin doesn't supress REM sleep to the same extent as an MAOI.
>Out of desperation, I'm currently trialing >Nardil. I'm on 5mg Zyprexa and hoping that will >cover me. Fingers crossed.
Good luck. You've got a good doc that would let you try an MAOI again! Nardil may be a bit milder in that sense. It has a GABAergic metabolite (but then again it also metabolizes to PEA - the brains own version of amphetamine). You might want to try lower doses, and possibly skip doses if you feel strange thinking returning. The Zyprexa should help.
Linkadge
Posted by Phillipa on April 15, 2016, at 18:46:38
In reply to Re: medication: high cholesterol and triglycerides?, posted by linkadge on April 15, 2016, at 18:07:58
New study on my RN newsletter haven't read yet about adhd meds and depression. If pertenant will copy and paste
Posted by linkadge on April 15, 2016, at 20:47:48
In reply to Re: medication: high cholesterol and triglycerides? » linkadge, posted by Phillipa on April 15, 2016, at 17:55:55
Antidepressants are not exactly antipsychotics, however some are known to improve (and others worsen) some psychotic symptoms.
For some individuals with milder psychotic disorders (or prodromal issues) monotherapy with certain antidepressants can sometimes be all that is required.
There were a few studies on citalopram showing that it could alleviate psychotic and mood symtpoms in certain individuals.
SSRIs can lower dopamine which is the net effect of antipsychotics.
Linkadge
Posted by Phillipa on April 15, 2016, at 22:45:29
In reply to Re: medication: high cholesterol and triglycerides?, posted by linkadge on April 15, 2016, at 20:47:48
Link I didn't know this thank you. Phillipa
Posted by Lamdage22 on April 16, 2016, at 5:35:07
In reply to Re: medication: high cholesterol and triglycerides? » Lamdage22, posted by linkadge on April 15, 2016, at 17:33:17
> So, if you don't mind me asking, specifically what happens if you reduce the Seroquel?
Easily Paranoia. Actually it even happens now that i have not reduced it yet.
> Is it anxiety, insomnia, agitation, auditory hallucinations, distorted thinking?
Anxiety and Paranoia.
> Do you experienced the same symptoms you had before you started it, or different ones?
Hard to say. Why?
> You're right in that you have to reduce very slowly. There are some supplements (i.e. vitamin C) that may help reduce dopamine super-sensitivity rebound. Niacin is also worth trying.
I will look into it.
> I don't know if you can get the 25mg versions of Seroquel.
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Sure can but its not necessary yet.
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Posted by SLS on April 16, 2016, at 6:57:35
In reply to Re: medication: high cholesterol and triglycerides?, posted by linkadge on April 14, 2016, at 20:33:10
This is a brilliant list.
- Scott
> Some antidepressants are known to worsen psychotic symptoms, others are known to be neutral or even improve psychotic symptoms. See the list I made below (from the reading I do).
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> More Likely to Worsen (or induce) Psychotic Symptoms (top)
> More likely to improve psychotic symptoms (bottom)
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> Parnate
> Nardil
> Marplan
> Selegiline
> Desipramine
> Imipramine
> Wellbutrin
> Effexor
> Nortriptyline
> Amitriptyline
> Paxil
> Prozac
> Zoloft
> Trazodone / Nefazadone
> Remeron
> Trimipramine
> Ascenapine
> Celexa / Lexapro
> Fluvoxamine
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> For instance, for schizoaffective, I would probably try Lexapro (or fluvoxamine) over Effexor.
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> Also, something like ascenapine (a TCA antidepressant with antipsychotic effects) would probably leave your mood better and not have the same degree of metabolic side effects.
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> I just would avoid the double whammy of two atypical antipsychotics (esp. Zyprexa is notorious for screwing with metabolic profiles) if at all possible.
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Posted by Lamdage22 on April 16, 2016, at 7:07:05
In reply to Re: medication: high cholesterol and triglycerides?, posted by SLS on April 16, 2016, at 6:57:35
> This is a brilliant list.
> - ScottDo you feel it is accurate? My Dr asked me to try Wellbutrin.
> > Some antidepressants are known to worsen psychotic symptoms, others are known to be neutral or even improve psychotic symptoms. See the list I made below (from the reading I do).
> >
> >
> > More Likely to Worsen (or induce) Psychotic Symptoms (top)
> > More likely to improve psychotic symptoms (bottom)
> >
> > Parnate
> > Nardil
> > Marplan
> > Selegiline
> > Desipramine
> > Imipramine
> > Wellbutrin
> > Effexor
> > Nortriptyline
> > Amitriptyline
> > Paxil
> > Prozac
> > Zoloft
> > Trazodone / Nefazadone
> > Remeron
> > Trimipramine
> > Ascenapine
> > Celexa / Lexapro
> > Fluvoxamine
> >
> > For instance, for schizoaffective, I would probably try Lexapro (or fluvoxamine) over Effexor.
> >
> > Also, something like ascenapine (a TCA antidepressant with antipsychotic effects) would probably leave your mood better and not have the same degree of metabolic side effects.
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> > I just would avoid the double whammy of two atypical antipsychotics (esp. Zyprexa is notorious for screwing with metabolic profiles) if at all possible.
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Posted by Lamdage22 on April 16, 2016, at 7:10:30
In reply to Re: medication: high cholesterol and triglycerides?, posted by Lamdage22 on April 16, 2016, at 7:07:05
I may be able to give Trazodone a shot.
Also, i could try Rexulti and/or Viibryd.
Can trazodone be combined with SSRI/SNRI?
Posted by SLS on April 16, 2016, at 7:11:21
In reply to Re: medication: high cholesterol and triglycerides?, posted by linkadge on April 14, 2016, at 20:02:36
> It appears your are being treated for schizophrenia, bipolar and major depressive disorder, all at once.
This is very much how schizoaffective disorder, bipolar type is conceptualized. It was my observation with an old friend of mine (who has disappeared somewhere) that if you could prevent the mania, you thereby prevent the psychosis. Her illness followed a very predictable sequence of phases, although an unpredictable timing.
normal -> mania -> psychosis -> depression -> normal
> If your condition, for instance, is bipolar, then once you're on a mood stabilizer, this should greatly reduce (or eliminate) your need for antipsychotics.Exactly.
- Scott
Posted by Lamdage22 on April 16, 2016, at 7:16:24
In reply to Re: medication: high cholesterol and triglycerides?, posted by SLS on April 16, 2016, at 7:11:21
There is debate as to wether i am bipolar or not. Currently i am considered "type depressive".
There is no mania i go straight to extreme Paranoia. (And back to normal the next day).
Posted by SLS on April 16, 2016, at 7:29:04
In reply to Re: medication: high cholesterol and triglycerides?, posted by Lamdage22 on April 16, 2016, at 7:07:05
I would change a few things in the order of the list, but it is a nice way to configure a chart.
Wellbutrin is one drug that deserves to be further down the list in my opinion. Almost any antidepressant has the potential to trigger mania in a susceptible individual. However, Wellbutrin may be one of the least likely to do this. That has been the traditional position taken by doctors.
Funny - when Wellbutrin was first being studied, a few clinical investigators thought that it might actually act as a mood stabilizer.
By the way, a close friend of mine has schizoaffective disorder. Her schizoid symptoms include paranoia. She always thought that there was an intruder in the house. She was tried on Abilify and Seroquel to no avail. (I think the Abilify interfered with the Seroquel, but that's another story). Her doctor in the hospital made a brilliant move and placed her on Navane (thiothixene). It abolished the psychosis, but left her moderately depressed. Adding Saphris (asenapine) changed her life. She is now going to nursing school to become a RN and is working a job at the same time. Of course, I would love to see what would happen if the Navane were discontinued, but I wouldn't want her to change a thing if it is working so completely. Saphris cleared up her thinking, speeded up her sluggish thoughts, gave her more energy to accomplish things, and rid her of depression.
- Scott
Posted by SLS on April 16, 2016, at 7:34:23
In reply to Re: medication: high cholesterol and triglycerides?, posted by Lamdage22 on April 16, 2016, at 7:16:24
> There is debate as to wether i am bipolar or not. Currently i am considered "type depressive".
>
> There is no mania i go straight to extreme Paranoia. (And back to normal the next day).Wow. That sucks.
I wonder if chronotherapy would help - melatonin at night and light therapy in the morning. Just a thought. At the very least, you should be keeping a regular sleep-wake cycle.
- Scott
Posted by linkadge on April 16, 2016, at 7:36:31
In reply to Re: medication: high cholesterol and triglycerides?, posted by Lamdage22 on April 16, 2016, at 7:10:30
Trazadone is often combined with SSRIs or SNRIs (often to offset insomnia). Trazodone tends to be a bit weaker as an antidepressant (in lower doses) but can be good for insomnia / anxiety. There are studies with trazodone / antipsychotic combinations showing improvement in core symptoms with the addition of trazodone.
The list I made is by no means 100% definitive. It is possible that you respond very well to Wellbutrin. However, it acts predominantly on norepinephrine and dopamine. It has a different side effect profile than SSRIs. Chemically, it is related to amphetamine. It tends to be more activating / stimulating. It can supress appetite, occasionally cause seizures, and is associated with more psychotic side effects than say fluvoxamine.
You can get a good indication simply by googling "Wellbutrin + psychosis". Do the same for "fluvoxamine + psychosis".
For fluvoxamine, most articles are related to improving psychosis. For Wellbutrin most articles are related worsening psychosis.
Linkadge
Posted by Lamdage22 on April 16, 2016, at 7:41:20
In reply to Re: medication: high cholesterol and triglycerides?, posted by linkadge on April 16, 2016, at 7:36:31
I cant afford to worsen psychosis.
Posted by Lamdage22 on April 16, 2016, at 7:43:14
In reply to Re: medication: high cholesterol and triglycerides?, posted by Lamdage22 on April 16, 2016, at 7:41:20
Where would Viibryd be on that list? I could try this in the near future.
Over or under Effexor????
Posted by SLS on April 16, 2016, at 7:51:38
In reply to Re: medication: high cholesterol and triglycerides?, posted by Lamdage22 on April 16, 2016, at 7:10:30
> I may be able to give Trazodone a shot.
>
> Also, i could try Rexulti and/or Viibryd.
>
> Can trazodone be combined with SSRI/SNRI?I think I would place Saphris and Viibryd high on your list.
As for adding trazodone to a SSRI/SNRI, I'm sure you are aware of the concern over this type of combination causing serotonin syndrome. However, doctors used to add trazodone to MAOIs to treat insomnia. I am not too crazy about this idea. I once had a weird reaction when adding trazodone to a powerful MAO-A inhibitor (clorgyline) to treat drug-induced insomnia. Strangely, it affected my walking gait. I could barely get my legs to move to get me walking. There was no rigidity, but my legs would not do what my mind was telling them. Of course, I was more fascinated than scared. I smiled and chuckled the whole time. It wore off within an hour.
You know the drill. There are no guarantees that you would have a similar reaction. However, trazodone has the reputation of being relatively ineffective for depression.
- Scott
Posted by Lamdage22 on April 16, 2016, at 8:02:08
In reply to Re: medication: high cholesterol and triglycerides? » Lamdage22, posted by SLS on April 16, 2016, at 7:51:38
Every time i trial something and something bad comes out of it, i fear its permanent.
I am really anxious right now. But my doctor is ready to Rx Viibryd.
Posted by Lamdage22 on April 16, 2016, at 8:05:55
In reply to Re: medication: high cholesterol and triglycerides?, posted by Lamdage22 on April 16, 2016, at 8:02:08
Effexor is not very effective for me either.
What has been really effective was Sertraline. Suicide thoughts gone the next day at a starting dosage. Enthusiasm to do things.
Unfortunately, akathisia was really bad.
Maybe Viibryd will be my Sertraline minus the akathisia.
Posted by SLS on April 16, 2016, at 8:57:01
In reply to Re: medication: high cholesterol and triglycerides?, posted by Lamdage22 on April 16, 2016, at 7:43:14
As indicated by Linkadge, there are case reports of Wellbutrin producing or exacerbating psychosis. I would not disregard them, but I don't think the risk is as high as these ancedotes would lead one to believe. I could be wrong, but you can also do Google searches on all antidepressants and see that a drug like Prozac actually returns more hits than Wellbutrin.
Sometimes, Google will display multiple results because lots of people use the same piece of literature as a source. Then, other people use these secondary articles as their sources of information for tertiary articles. It can proliferate exponentially. You are better off doing:
1. Use scientific terms on Google e.g. "bupropion" instead of "Wellbutrin".
2. Use a database of scientific journal articles as can be found on the Pubmed interface of Medline.
This seemed to be a good review:
http://www.ncbi.nlm.nih.gov/pubmed/24201231
- Scott
Posted by Lamdage22 on April 16, 2016, at 11:43:39
In reply to Re: medication: high cholesterol and triglycerides?, posted by SLS on April 16, 2016, at 8:57:01
Scott, i will probably try Viibryd in the hopes that it will be better than Effexor and/or will have no sexual side effects.
Posted by Lamdage22 on April 16, 2016, at 11:48:29
In reply to Re: medication: high cholesterol and triglycerides?, posted by Lamdage22 on April 16, 2016, at 11:43:39
or, not.
It doesnt sound all too good.
Posted by SLS on April 16, 2016, at 13:42:34
In reply to Re: medication: high cholesterol and triglycerides?, posted by Lamdage22 on April 16, 2016, at 11:48:29
All I can tell you about Viibryd (vilazodone) is that it worked well for me briefly to treat bipolar depression. It produced absolutely no sexual dysfunction nor a reduction in libido. I liked it.
I did not try Brintellix (vortioxetine). It is not a potent serotonin reuptake inhibitor as is Viibryd. Perhaps it would be less likely to produce psychosis?
- Scott
Posted by Lamdage22 on April 16, 2016, at 14:16:11
In reply to Re: medication: high cholesterol and triglycerides? » Lamdage22, posted by SLS on April 16, 2016, at 13:42:34
> All I can tell you about Viibryd (vilazodone) is that it worked well for me briefly to treat bipolar depression. It produced absolutely no sexual dysfunction nor a reduction in libido. I liked it.
>
> I did not try Brintellix (vortioxetine). It is not a potent serotonin reuptake inhibitor as is Viibryd. Perhaps it would be less likely to produce psychosis?No that didnt do any good to me. I am more concerned with anxiety and paranoia than anything else right now. I just want to feel (and be) safe.
Posted by linkadge on April 18, 2016, at 16:24:39
In reply to Re: medication: high cholesterol and triglycerides?, posted by Lamdage22 on April 16, 2016, at 14:16:11
Based on the pharmacology, Viibryd would be a very decent medication to try for depression in psychosis or schizophrenia.
The reason being is that it is fairly selective towards serotonin and it is a 5-ht1a agonist. 5-ht1a agonists have antipsychotic and cognitive improving effects in their own right.
Linkadge
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