Posted by Louisiana Sportsman on May 5, 2014, at 15:30:25
Right now, I am prescribed an attenuated prescription regiment as follows:
Brintellix 20mg.
Desoxyn 30mg.
Latuda 40mg.
Trokendi XR (Topamax) 200mg.
Xanax XR 0.5mg. TID
This is what I'm prescribed after we abated my medications from EIGHT.
I and my PDOC decided that I was on too many meds because three of my medications' mechanisms of actions could be utilized by other drugs within my regiment. Together, we decided to surcease [drug with agnate MOA is provided in brackets]: Gabapentin [Xanax XR], Lamictal [Topamax XR] and Nuvigil [methamphetamine].
Au courant, I believe that my present regiment is the optimum that psychopharmacology can administer. I have obeisance for the previous medications, sure. Do I miss them? So-so. The gabapentin, I have developed such a tolerance to it that I didn't even notice its effect-- same thing with the lamotrigine, I have no idea what it was doing for me. The Nuvigil is the only one I would like back and even then, there was a tolerance issue to where she wrote #60 150mg. (insurance QDD didn't notice?) equivalent to 600mg. modafinil, and I still didn't get much puissance. I still think its cessation has reduced my motivation. I have a strong feeling she will add it again.
Current symptoms:
* lack of motivation to progress my life
* chronic laziness
* emotional outbursts over minor things
* lay in bed on the computer during complaisant days outside
* "weird, nervous" anxious feeling arises, solicitous and disquieted-- tachycardia present, randomly on certain days that stops me from doing anything (not caused by methamphetamine, tested it)
* thoughts about death since my best friend overdosed on prescribed Xanax (guess he took the whole bottle) by my own PDOC that I sent him to which kills me inside. He told me earlier the evening the died that he was going to take some hydrocodone his mom gave him, and I told him that wasn't kosher. He mixed the two and died. I tried to help him with setting up the PDOC appointment-- not kill him. He was very stressed, anxious, insipid around people, and I would have wrote him a benzo as well; I guess he just made a mistake. Kills me inside everyday. Now, when I drive, for instance, I'll think about crashing into the median or something; whereas, before, it didn't bother me as much.
Ideas:
1. Switch Latuda to Geodon 80mg. or less-- this would give me energy at this lower dose-- reuptake of norepinephrine and 5-HT2C receptor activity providing a boost. It would give less dopamine occupancy (60% or <) at this dosage which may allow the Desoxyn to work better to improve motivation. Also, I would get the similar AAP serotonergic activity that Latuda provides. *** see alternative idea below** Also concomitantly add Aptiom (eslicarbamazepine) by the makers of Latuda, ironically, (April 2014) that is the cleanest --carbamazepine yet -- it is a metabolite of oxcarbamazepine that lacks epoxide metabolites that contribute to side effects and also allows rapid tiration (one week) to the 800mg. suggested maintenance dosage which comes in convenient pill. I think this would help with the emotional issues and the weird, anxious feelings and maybe the negative thoughts. It would be a good mood stabilizer since the discontinuation of Lamictal. For emotional outbursts, switch Xanax XR to Ativan SL 1mg. BID (I don't feel like my PDOC would want to give 3mg. of benzos yet) I'd try to save one for bedtime, but they'll probably be used during the day lol. I don't have a sleeping issue.
Sum it up:
* Switch Latuda 40mg --> Geodon 80mg. *** see alternative idea below***
* Augment Aptiom (eslicarbamazepine) 800mg.
Alternative idea to switching Latuda to Geodon is to add Protriptyline at about 30mg. I base it on one of the more well-written posts: http://www.crazymeds.us/CrazyTalk/index.php/topic/15793-protriptyline-vivactil-manufacturers/?p=108531
I think it would aggrandize the strength of my Desoxyn, and it may provide motivation and depression relief.
Appurtenant Ideas:
Nortriptyline
Oleptro ER, see my topic about it here: http://www.crazymeds.us/CrazyTalk/index.php/topic/25291-oleptro-xr-the-new-abilify/SSRI, see my my topic about it here: http://www.crazymeds.us/CrazyTalk/index.php/topic/25298-augmention-of-a-ssri-to-brintellix-not-overkill-a-theory-based-on-a-study/
Clomipramine (Anafranil): really well regarded extremely serotonergic TCA that may help symptoms-- and PDOC would likely augment modafinil if she wrote this
Ideas? Thoughts? Opinions? Inputs?
Share!
Thanks!
poster:Louisiana Sportsman
thread:1065262
URL: http://www.dr-bob.org/babble/20140419/msgs/1065262.html