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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Christ_empowered on July 26, 2016, at 10:32:08
The older literature on the neuroleptics recommends reducing to a dose below the initial dose for many/most patients. Even the newer literature mentions looking for the "lowest effective dose" with any neuroleptics, "atypical" or otherwise.
I go to a community/public mental health clinic. They're nice enough to me, and the treatment is fully covered by disability, so...yeah. Problem is...it seems that they're all about as much as you can tolerate. I mean, it could be worse...I'm not on injections or a court order, so that's good. I'm not any old school AP (they seem to use Haldol an awful lot there...).
Still, my symptoms have improved over time, and now I'm much, much better in terms of my level of functioning and all that good stuff. Quality of life has improved dramtically, too. Thing is...I"m starting to feel kinda...too calm, too tranquilized, etc.
When I was agitated and had been sick for years, I think the meds at the current doses made a lot of sense. Problem is...the meds just get piled on at this clinic, because dosage reductions and tapering seem to be foreign concepts, as best I can tell. I've read that happens at a lot of places, especially the community mental health clinics.
--sigh-- I'd like to see a reduction in my Abilify and a reduction or complete taper with the Trileptal. One reason I need wellbutrin is because the other 3 meds (Abilify, Trileptal, and Lamictal) are sedating and made my depression worse because of sedation and concentration difficulties. My doc also insists on always writing for as-needed gabapentin and keeping me stocked with a low dose of risperidone (2mgs tablets). I feel like...well, I feel like they really, really want me tranquilized, lol.
The doses are: 30mgs/Abilify, 1200mgs/Trileptal, 100mgs/Lamictal, and 400mgs/Wellbutrin SR. I think my main problem is severe, recurrent, sometimes psychotic depression. I did have 1 psychotic manic episode, but...there was a lot of psychosocial stuff feeding into that, too.
Any advice?!?! I don't think I can get to another doctor. My parents have resources, so I suppose I could get to a private practice doc and do self-pay for the sessions and use disability for the meds, but...I filed a medical board complaint years ago against a shrink, so now I've kind of been black balled with the private practice docs around here. Maybe somebody would take me...I dunno...
I just think I could probably do better on a lower dose of the Abilify and a lower dose (or complete elimination) of the Trileptal. Maybe bump the lamictal up to 150-200 or so...it has more solid data behind it than Trileptal, anyway.
Ugh. And the shrinks are weird. Maybe all shrinks are weird. Before this one prescribed Wellbutrin, he asked if I'd ever had a seizure. I told him that I thought I'd had one during Klonopin withdrawal, and his face turned red and he muttered something under his breath, then terminated the appointment a little bit early. I get the sense that everything's cool...as long as you "know your place."
ugh.
Posted by Tabitha on July 26, 2016, at 11:26:52
In reply to when to reduce dosages..., posted by Christ_empowered on July 26, 2016, at 10:32:08
I've concluded that there's a class-based thing happening with meds, which is I think what you're saying about "knowing your place". When I see private practice docs in an upscale part of town, I feel like I'm being treated as if the goal is to get me at my best functioning, which leads to different Rx than if the goal is to get 100% control of my condition. They're willing to spend time with follow-ups and work to reduce side effects.
When I have seen pdocs in busy clinics, I feel that the attitude is that I don't deserve extra effort to mitigate side effects, and my concerns are often dismissed. I have seen friends who need to work with public assistance clinics, and the care they report sounds even worse than the worst I have experienced.
So my conclusion is that it's worth the extra effort to obtain private practice care. If that's not an option, then I would recommend doctor shopping within your available network, hoping you'll get lucky and find an exceptional one.
It also might help to get very clear in your communication with your pdoc about the sedating effects, and that you'd like to make changes to get yourself functioning at the best possible level. It may be possible to get a better outcome with your current pdoc by improving communication.
Posted by jonhed on July 26, 2016, at 12:20:26
In reply to when to reduce dosages..., posted by Christ_empowered on July 26, 2016, at 10:32:08
"> I just think I could probably do better on a lower dose of the Abilify and a lower dose (or complete elimination) of the Trileptal. Maybe bump the lamictal up to 150-200 or so...it has more solid data behind it than Trileptal, anyway."I think that in a few years it won't be possible to get 30 milligrams of abilify, cause you get the anti-psychotic effects from 5-10mg and the dopamine blockade is enough on that dosage to be considered an anti-psychotic.
30 milligrams is only, in my opinion, needed when you have a tremendously amount of hallucinations that needs to be eliminated.
If you don't have that, i would say that you should talk to your doctor about tapering down to 5 or at the most 10mg abilify.
I very much like abilify in low dosages because of the stimulating, but yet anti-psychotic, properties it got, but when i was on 30 milligrams i felt like a zombie so i know the feeling.Upping the Lamictal to 200 milligrams is a very good idea, and why do you have trileptal if i may ask?
I to think that "lowest functional dosage" is the way to go, and especially when AP/AAPs have side effects that are very much dose dependent.
Have you tried 5 milligrams of abilify and a higher dose of Lamictal (200-250mg) before?
I think that it's enough, and you have your wellbutrin at a high dosage and seems to be happy with it's effects.
Go for it! You have nothing to lose.
I'm not a professional so just take this as advices, but i have been on every medication that you mention so it's just from my own experience i talk.
Kind regards / J
Posted by Christ_empowered on July 26, 2016, at 12:39:26
In reply to Re: when to reduce dosages..., posted by Tabitha on July 26, 2016, at 11:26:52
hi. thanks for the responses.
Tabitha...there is definitely a social class component to mental health treatment. I'm from a now "genteel" family--not rich, not middle-middle class-- so I'm diagnosed with bipolar I instead of schizophrenia or schizoaffective. I do not have to do injections or court orders, my shrink talks to me and seems to kinda sorta listen. Good times, I guess...
..except, its still public health. Its Rx treatment oriented to the max. This place doesn't even have group therapy, which is crazy ((not a big fan, but...still...I thought that was fairly standard...).
I'm glad you go to a more compassionate, more helpful doc in a good part of town. I may have to do...something...to get a shrink who will work with me.
30mgs Abilify is a bit much. I mean, it was helpful when I was crazy agitated and had not yet come out of lingering psychotic...stuff...from years of "falling through the cracks" of mental health, inc. That was a while ago, though, and now...I feel too tranquilized. 10-15mgs/day is fairly standard; 15 mgs/day used to be the target dose, the one in all the sample packs. I think a lower dose would be better for my mood, too.
Ugh. I'm hoping I can work something out with the current doctor. Its strange...I'm no longer what I'd consider full on sedated, but...30mgs of Abilify is too much...I'm too placid, too sedentary...
..what's strange to me is that Abilify can do this without any EPS. I'm glad I don't have EPS, but...kinda scary...
Thanks again for the replies.
Posted by SLS on July 26, 2016, at 19:05:35
In reply to when to reduce dosages..., posted by Christ_empowered on July 26, 2016, at 10:32:08
My initial reaction is that you should make one change at a time. It might be a good idea to bring the Lamictal dosage up before reducing the dosage of Abilify. That way, you would have more antidepressant coverage should you need it. Trileptal can act as a mood stabilizer with anti-manic, anti-anger, and anti-impulse properties. Be sure that you are stabilized and have optimized your dosages of Lamictal and Abilify before attempting to reduce the dosage of Trileptal.
I wonder if Reluxti would be less apt to produce the feelings that are upsetting you. It is a sister drug to Abilify, but less potent at D3 receptors. I'm sure that there are other differences, but I don't recall them right now. I am thinking of switching from Abilify to Reluxti should I get "stuck" in my recovery.
- Scott
Posted by Zyprexa on August 12, 2016, at 20:40:00
In reply to Re: when to reduce dosages..., posted by Christ_empowered on July 26, 2016, at 12:39:26
christ,
I think you should try cutting the pills of 30 you get. Just to try out what a lower dose would be like. Just a few mgs. that way you don't have to talk to your doc about it and feel stuck on a decision if it does not work out. that is what I do with my zyprexa. I get a 20mg pill and cut it, I usualy take 13 or 17 mg a day. I've found that docs don't like to be bothered with every little increase or decrease.
This is just to find out if it works. Just be aware of how you are doing and maybe consult with friends on it.
Posted by Zyprexa on August 12, 2016, at 20:45:37
In reply to Re: when to reduce dosages... » Christ_empowered, posted by Zyprexa on August 12, 2016, at 20:40:00
just be aware that you might have to put up with some side effects of the AP if you end up needing the higher dose.
when I take 13mg i get a little crazy and when I take 17mg I get a little tired, but I find that I need the 17 more often so I don't start acting weird.
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