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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 28 to 52 of 78. Go back in thread:
Posted by ed_uk2010 on June 4, 2018, at 16:38:07
In reply to Re: Switching from Abililfy to Saphris., posted by SLS on June 3, 2018, at 20:55:58
Hi Scott,
Sorry to hear that asenapine didn't suit you.
How quickly do you plan to stop Parnate?
Posted by sigismund on June 4, 2018, at 18:52:59
In reply to Re: Switching from Abililfy to Saphris., posted by SLS on June 3, 2018, at 20:55:58
>Things have turned foul on me. Not only did I lose the improvement that I enjoyed during the first week or two on Saphris, but I am feeling decidedly worse.
The effects of Saphris change with the dosage?
How can you know what dose might be helpful if the effect is not linear?
Just a thought.
Posted by sigismund on June 4, 2018, at 19:00:00
In reply to Re: Switching from Abililfy to Saphris. » SLS, posted by sigismund on June 4, 2018, at 18:52:59
There's a lot of 1s and 5s for Saphris on askapatient and not too many 3s. Doses from 5 to 20.
Posted by SLS on June 4, 2018, at 20:04:40
In reply to Re: Switching from Abililfy to Saphris. » SLS, posted by sigismund on June 4, 2018, at 18:52:59
> >Things have turned foul on me. Not only did I lose the improvement that I enjoyed during the first week or two on Saphris, but I am feeling decidedly worse.
>
> The effects of Saphris change with the dosage?
>
> How can you know what dose might be helpful if the effect is not linear?
>
> Just a thought.That's a very good thought!
Thank you.
- Scott
Posted by SLS on June 4, 2018, at 20:15:08
In reply to Re: Switching from Abililfy to Saphris. » SLS, posted by ed_uk2010 on June 4, 2018, at 16:38:07
> Hi Scott,
>
> Sorry to hear that asenapine didn't suit you.
>
> How quickly do you plan to stop Parnate?I have begun to taper the dosage of Parnate as of today. I've done this before, of course. One of the most prominent withdrawal symptoms has been profound fatigue. I guess it is similar to coming off of amphetamine. I might use Focalin judiciously to help create a bridge for the worst of it. Similarly, I can use Abilify as a bridge as was suggested by my doctor. I will try not to do this, though. One day at a time.
- Scott
Posted by Lamdage22 on June 4, 2018, at 21:42:11
In reply to Re: Switching from Abililfy to Saphris. » ed_uk2010, posted by SLS on June 4, 2018, at 20:15:08
That is why i have become more careful with med changes. I hope it turns out ok for you.
Posted by Lamdage22 on June 4, 2018, at 21:54:42
In reply to Re: Switching from Abililfy to Saphris. » ed_uk2010, posted by SLS on June 4, 2018, at 20:15:08
So what is the plan now? You are changing two parameters at the same time?
Posted by SLS on June 5, 2018, at 13:06:11
In reply to Re: Switching from Abililfy to Saphris., posted by Lamdage22 on June 4, 2018, at 21:54:42
Hi, Lamdage.
> So what is the plan now? You are changing two parameters at the same time?
The plan is to switch from Parnate to Trintellix. Right now, I am not taking Abilify or Saphris. Having already gone through the bulk of Abilify and Saphris withdrawals, I am reluctant to return to either one of them. My doctor suggested that I could go back to Abilify and use it as a temporary bridge if necessary as I taper Parnate and wait 7-10 days before beginning Trintellix.
- Scott
Posted by ed_uk2010 on June 5, 2018, at 15:09:45
In reply to Re: Switching from Abililfy to Saphris. » ed_uk2010, posted by SLS on June 4, 2018, at 20:15:08
>I have begun to taper the dosage of Parnate as of today.
How long do you think it will take Scott?
Posted by SLS on June 5, 2018, at 18:03:44
In reply to Re: Switching from Abililfy to Saphris. » SLS, posted by ed_uk2010 on June 5, 2018, at 15:09:45
> >I have begun to taper the dosage of Parnate as of today.
>
> How long do you think it will take Scott?I am hoping to discontinue Parnate in 10 days. I'll be pushing it. However, I am allowing myself flexibility in the taper period. I don't know what to expect with respect to the severity of depression. I am expecting profound fatigue, though. This is what I've experienced in the past. I'm guessing it is similar to amphetamine withdrawal.
My doctor will let me go with a 7-10 day washout period. Serotonin syndrome is a concern as I prepare to begin Trintellix treatment.
- Scott
Posted by ed_uk2010 on June 6, 2018, at 0:45:00
In reply to Re: Switching from Abililfy to Saphris. » ed_uk2010, posted by SLS on June 5, 2018, at 18:03:44
Hi Scott,
That is a fast withdrawal! But if you allow yourself flexibility it should be ok.
I can see why you would be keen to start something new, so it makes sense.
Hope it works out well. Let me know.
Posted by SLS on June 6, 2018, at 8:32:28
In reply to Re: Switching from Abililfy to Saphris. » SLS, posted by ed_uk2010 on June 6, 2018, at 0:45:00
> Hi Scott,
>
> That is a fast withdrawal! But if you allow yourself flexibility it should be ok.
>
> I can see why you would be keen to start something new, so it makes sense.
>
> Hope it works out well. Let me know.Thanks, Ed.
:-)
- Scott
Posted by Lamdage22 on June 25, 2018, at 10:27:06
In reply to Re: Switching from Abililfy to Saphris. » ed_uk2010, posted by SLS on June 6, 2018, at 8:32:28
Hey Scott,
how you doing? You are brave. Are you fully withdrawn from Neuroleptics? Just watch out before you get another destructive Mania/Psychosis phase. I think you have lost enough relationships to Psychosis. Me too :(
Keep us posted.
Posted by SLS on June 25, 2018, at 13:02:46
In reply to Re: Switching from Abililfy to Saphris., posted by Lamdage22 on June 25, 2018, at 10:27:06
Hi Lamdage.
> Hey Scott,
>
> how you doing? You are brave.:-)
> Are you fully withdrawn from Neuroleptics?
Yes.
> Just watch out before you get another destructive Mania/Psychosis phase.
That's great advice. Thank you. I'll try to be careful. I am relying on family members to recognize the emergence of mania. They know what to look for. I can only hope that I am receptive to their advice. So far, the only manic episodes I've had have been in association with MAOIs. It is likely that Abilify acted as a prophylactic against manic reactions to both Nardil and Parnate. Latuda maybe?
I have mostly recovered from withdrawal effects for having discontinued Abilify and Parnate. I didn't expect that I would be hit so hard. There is some residual anxiety, but the depression has stabilized. I am on day 4 of Trintellix treatment. I'm taking 5.0 mg/day. I felt numb and slowed-down initially, but that seems to be subsiding.
I needed to do something. I was stuck for too many years.
Thanks again.
- Scott
Posted by Robert_Burton_1621 on July 2, 2018, at 4:42:08
In reply to Re: Switching from Abililfy to Saphris. » Lamdage22, posted by SLS on June 25, 2018, at 13:02:46
I do hope the substitution of vortioxetine for parnate does the trick, Scott.
I tried vortioxetine between stopping parnate and then resuming it, unsuccessfully - the main effects were agitation and hyper-sexuality. However, my psychiatrist at the time, a specialist in TRD, had done his own study of the drug with 100 of his own TRD patients, and overall it was successful.
At one point I had looked into the properties of the drug, and it seemed to be rather similar to Abilify *without* the dopamine antagonism. That was only my initial impression.
Posted by SLS on July 2, 2018, at 8:26:56
In reply to Re: Switching from Abililfy to Saphris. » SLS, posted by Robert_Burton_1621 on July 2, 2018, at 4:42:08
Hi, Robert.
> I do hope the substitution of vortioxetine for parnate does the trick, Scott.
>
> I tried vortioxetine between stopping parnate and then resuming it, unsuccessfully - the main effects were agitation and hyper-sexuality. However, my psychiatrist at the time, a specialist in TRD, had done his own study of the drug with 100 of his own TRD patients, and overall it was successful.
>
> At one point I had looked into the properties of the drug, and it seemed to be rather similar to Abilify *without* the dopamine antagonism. That was only my initial impression.Thanks for the information, Robert. It helps to give me hope. I am on day 10 of treatment. I don't know what to think. I have some background anxiety, which isn't normal for me. Maybe this is how I experience the agitation you describe. Yesterday was not a good day, but not the worst. I will continue at 10 mg/day for two weeks until I see my doctor.
What dosage of vortioxetine did you try? How long did you take it for?
- Scott
Posted by ed_uk2010 on July 2, 2018, at 14:39:09
In reply to Re: Switching from Abililfy to Saphris. » Robert_Burton_1621, posted by SLS on July 2, 2018, at 8:26:56
> I have some background anxiety, which isn't normal for me. Maybe this is how I experience the agitation you describe.
Might it help to have a small dose of a benzodiazepine for a couple of weeks until you get used to the vortioxetine? Eg. lorazepam 0.5mg twice a day.
Posted by SLS on July 2, 2018, at 17:16:00
In reply to Re: Switching from Abililfy to Saphris. » SLS, posted by ed_uk2010 on July 2, 2018, at 14:39:09
> > I have some background anxiety, which isn't normal for me. Maybe this is how I experience the agitation you describe.
>
> Might it help to have a small dose of a benzodiazepine for a couple of weeks until you get used to the vortioxetine? Eg. lorazepam 0.5mg twice a day.Great idea.
I have been taking lorazepam 1.0 mg 2-3 times a day. It helps, but I am reluctant to depend on it. I probably worry too much about that.
- Scott
Posted by ed_uk2010 on July 3, 2018, at 16:03:05
In reply to Re: Switching from Abililfy to Saphris. » ed_uk2010, posted by SLS on July 2, 2018, at 17:16:00
>I have been taking lorazepam 1.0 mg 2-3 times a day. It helps, but I am reluctant to depend on it. I probably worry too much about that.
I was just thinking of before. You were able to stop it quite easily via careful reduction based on symptoms, right? Just taking a little bit if symptoms occurred.
Posted by Robert_Burton_1621 on July 11, 2018, at 4:40:22
In reply to Re: Switching from Abililfy to Saphris. » Robert_Burton_1621, posted by SLS on July 2, 2018, at 8:26:56
Scott, I went from 10 to 20 mg quite quickly (over a week), and stayed on 20mg for a month. But, for me, there was no improvement. The side-effects were disturbing: particularly the hyper-sexuality. But it was not pleasurbale. It was an *agitated* hyper-activity.
I ceased the vortioxetine and resumed parnate.
How are you going now?
Posted by SLS on July 11, 2018, at 10:11:22
In reply to Re: Switching from Abililfy to Saphris., posted by Robert_Burton_1621 on July 11, 2018, at 4:40:22
> Scott, I went from 10 to 20 mg quite quickly (over a week), and stayed on 20mg for a month. But, for me, there was no improvement. The side-effects were disturbing: particularly the hyper-sexuality. But it was not pleasurbale. It was an *agitated* hyper-activity.
That sounds unpleasant.
> I ceased the vortioxetine and resumed parnate.
Vortioxetine has a 66 hour half-life. How long are you waiting before resuming Parnate? Serotonin syndrome is a concern. I hope everything goes well for you.
> How are you going now?
It has been over a week since I discontinued vortioxetine, and I am still experiencing some residual adverse effects. They include brain-fog, cognitive slowing, and anxiety. They are improving gradually, though. I began taking Effexor two days ago. I am titrating up to 300 mg/day. Fingers crossed.
- Scott
Posted by ed_uk2010 on July 11, 2018, at 14:01:33
In reply to Re: Switching from Abililfy to Saphris. » Robert_Burton_1621, posted by SLS on July 11, 2018, at 10:11:22
I forgot you had to stop vortioxetine already.
Will you increase venlafaxine quickly? It seems that very high doses can cause a lot of fatigue for some users, so perhaps it is best not to aim for a really high dose initially.
Posted by SLS on July 12, 2018, at 9:16:56
In reply to Re: Switching from Abililfy to Saphris. » SLS, posted by ed_uk2010 on July 11, 2018, at 14:01:33
> I forgot you had to stop vortioxetine already.
>
> Will you increase venlafaxine quickly? It seems that very high doses can cause a lot of fatigue for some users, so perhaps it is best not to aim for a really high dose initially.Thanks, Ed.
I started at 75 mg/day. I'm now up to 150 mg/day. I'm still experiencing some anxiety, although it is dissipating gradually. I took 0.5 mg of Ativan this morning.
Depression is not as bad as it was last week. I am grateful for that.
- Scott
Posted by ed_uk2010 on July 12, 2018, at 13:12:41
In reply to Re: Switching from Abililfy to Saphris. » ed_uk2010, posted by SLS on July 12, 2018, at 9:16:56
I wonder whether the dose-response relationship of Effexor is quite flat when on an NRI-type TCA such as nortriptyline?
I was wondering whether you should avoid going above 225mg or so initially, just in case it's counter-productive. Maybe give it a few weeks before pushing too high?
I think the anxiety will improve a lot over the next few days since it seems so clearly related to vortioxetine. Hope lorazepam is helping.
Posted by SLS on July 12, 2018, at 14:40:31
In reply to Re: Switching from Abililfy to Saphris. » SLS, posted by ed_uk2010 on July 12, 2018, at 13:12:41
> I wonder whether the dose-response relationship of Effexor is quite flat when on an NRI-type TCA such as nortriptyline?
>
> I was wondering whether you should avoid going above 225mg or so initially, just in case it's counter-productive. Maybe give it a few weeks before pushing too high?
>
> I think the anxiety will improve a lot over the next few days since it seems so clearly related to vortioxetine. Hope lorazepam is helping.I think you are right about the anxiety. My doctor agrees with you. I'm guessing that the Effexor has made it worse temporarily. There is a trill in my voice and my hands are shaky.
Thanks for your contributions here on Psycho-Babble.
- Scott
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