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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 26 to 50 of 69. Go back in thread:
Posted by SLS on May 24, 2003, at 19:26:44
In reply to Re: abilify/trileptal/zoloft, posted by cybercafe on May 24, 2003, at 18:42:22
> > Hi Mitch.
> >
> > A partial agonist binds to a receptor just as does an agonist or antagonist. However, it does not always stimulate the receptor into action. I would guess that it probably depends on which of the alternating states (conformations) the molecules exist as they switch back and forth between their different three dimensional arrangements. I'm not sure though.
>
> could it be that it stimulates as much as dopamine, but doesn't bind for as long (i.e. less affinity)?
>http://idp.med.ufl.edu/Core/6002/Outln2B/S2BL6.html
Posted by e503 on May 24, 2003, at 22:28:06
In reply to Re: abilify/trileptal/zoloft, posted by SLS on May 24, 2003, at 19:26:44
hi all- wanted to let you know that thursday night was the last day we gave ben abilify. He is now off of it and the trileptal and only on zoloft. Glad to let you all now that he had a better day today....actually saw him smiling!!!!
How long will it take to get the trileptal really out of his system, so I can tell how he is just on the zoloft?
thanks,
elise
Posted by Ritch on May 25, 2003, at 10:59:36
In reply to Re: abilify/trileptal/zoloft, posted by e503 on May 24, 2003, at 22:28:06
> hi all- wanted to let you know that thursday night was the last day we gave ben abilify. He is now off of it and the trileptal and only on zoloft. Glad to let you all now that he had a better day today....actually saw him smiling!!!!
>
> How long will it take to get the trileptal really out of his system, so I can tell how he is just on the zoloft?
> thanks,
> elise
Hi elise, it may already be gone. It's been a couple of weeks right? From what I remember it (Trileptal) is eliminated mostly by the kidneys and it washes out rather quickly compared to the Abilify and even Zoloft.
Posted by Ritch on May 25, 2003, at 11:10:18
In reply to Re: abilify/trileptal/zoloft, posted by SLS on May 24, 2003, at 12:14:29
> Hi Mitch.
>
> A partial agonist binds to a receptor just as does an agonist or antagonist. However, it does not always stimulate the receptor into action. I would guess that it probably depends on which of the alternating states (conformations) the molecules exist as they switch back and forth between their different three dimensional arrangements. I'm not sure though.
>
>
> - Scott
>
>Scott- here are two lines in the link you posted that comes the closes for me to understand this I think ;)
B. When is a partial agonist a good therapeutic agent?
1. the safe dose range can be greatly extended (the maximum response only reaches the sub-100% value and stays there as a plateau)
2. when the antagonist properties of the partial agonist are desirable (blunting effects of endogenous substances, for example)(example: pindolol)
Would a partial agonist be analogous to a pistol that is cocked and ready to fire which is easy to uncock relative to other pistols? This is that "goldilocks" thing with Abilify isn't it? It isn't supposed to bind tightly (hence it is a partial agonist), so the molecule doesn't stay "stuck" on receptor?
Posted by e503 on May 25, 2003, at 11:49:24
In reply to Re: abilify/trileptal/zoloft » e503, posted by Ritch on May 25, 2003, at 10:59:36
> > hi all- wanted to let you know that thursday night was the last day we gave ben abilify. He is now off of it and the trileptal and only on zoloft. Glad to let you all now that he had a better day today....actually saw him smiling!!!!
> >
> > How long will it take to get the trileptal really out of his system, so I can tell how he is just on the zoloft?
> > thanks,
> > elise
>
>
> Hi elise, it may already be gone. It's been a couple of weeks right? From what I remember it (Trileptal) is eliminated mostly by the kidneys and it washes out rather quickly compared to the Abilify and even Zoloft.
>
Yes, it's been a couple weeks (I think!) off trileptal. WHat about the abilify? I gave him 2.5 mg. the last time (for 3 days) last 3 days ago. When can I expect to see what he is like off the abilify?
thanks,
elise
Posted by SLS on May 25, 2003, at 12:05:28
In reply to Partial agonists » SLS, posted by Ritch on May 25, 2003, at 11:10:18
Hi Mitch.
> > A partial agonist binds to a receptor just as does an agonist or antagonist. However, it does not always stimulate the receptor into action. I would guess that it probably depends on which of the alternating states (conformations) the molecules exist as they switch back and forth between their different three dimensional arrangements. I'm not sure though.
> Would a partial agonist be analogous to a pistol that is cocked and ready to fire which is easy to uncock relative to other pistols? This is that "goldilocks" thing with Abilify isn't it? It isn't supposed to bind tightly (hence it is a partial agonist), so the molecule doesn't stay "stuck" on receptor?
Perhaps one way to conceptualize a partial agonist is to think of it as a duplicate key that wasn't cut properly. Sometimes it unlocks the door and sometimes it fails to unlock the door, depending on how you jiggle it in or out. It is possible to turn the key half-way before it stops, thereby changing the length of the bolt, but not enough to clear the hole. The door cannot be opened.I tried. :-)
Regarding Abilify, I haven't read enough about the details regarding how and why it behaves differently in the presence of varying concentrations of dopamine within the synapse.
- Scott
Posted by Ritch on May 25, 2003, at 13:19:16
In reply to Re: abilify/trileptal/zoloft, posted by e503 on May 25, 2003, at 11:49:24
> > > hi all- wanted to let you know that thursday night was the last day we gave ben abilify. He is now off of it and the trileptal and only on zoloft. Glad to let you all now that he had a better day today....actually saw him smiling!!!!
> > >
> > > How long will it take to get the trileptal really out of his system, so I can tell how he is just on the zoloft?
> > > thanks,
> > > elise
> >
> >
> > Hi elise, it may already be gone. It's been a couple of weeks right? From what I remember it (Trileptal) is eliminated mostly by the kidneys and it washes out rather quickly compared to the Abilify and even Zoloft.
> >
>
>
> Yes, it's been a couple weeks (I think!) off trileptal. WHat about the abilify? I gave him 2.5 mg. the last time (for 3 days) last 3 days ago. When can I expect to see what he is like off the abilify?
> thanks,
> eliseElise, I can't remember what the half-life of Abilify is (40 hrs or so?). Anyhow a "washout" usually is considered to be about five-seven half-lives of time elapsed since the last dose, so *if* the half-life of Abilify is 40 hrs (i.e.), it would be about 200-280 hrs of time for it to be "washed out", give or take some of course. Maybe ten days or so since the last dose? hope this helps some.
Posted by Ritch on May 25, 2003, at 13:23:13
In reply to Re: Partial agonists » Ritch, posted by SLS on May 25, 2003, at 12:05:28
Posted by SLS on May 25, 2003, at 13:37:31
In reply to Re: abilify/trileptal/zoloft » e503, posted by Ritch on May 25, 2003, at 13:19:16
> Elise, I can't remember what the half-life of Abilify is (40 hrs or so?). Anyhow a "washout" usually is considered to be about five-seven half-lives of time elapsed since the last dose, so *if* the half-life of Abilify is 40 hrs (i.e.), it would be about 200-280 hrs of time for it to be "washed out", give or take some of course. Maybe ten days or so since the last dose? hope this helps some.
The half-life of Abilify is about 75 hrs.
http://sl.schofield3.home.att.net/medicine/psychiatric_drugs_chart.html
- Scott
Posted by e503 on May 25, 2003, at 22:32:25
In reply to Re: abilify/trileptal/zoloft, posted by SLS on May 25, 2003, at 13:37:31
A question about ben and his zoloft. He typically takes it 50 mg./am and 25 mg. in the afternoon. School said after 12 he gets "totally noncompliant". Since he's been off the abilify, etc. I have noticed this about the zoloft....after ben takes it, about 2 hours later, he is really happy and "bopping" around...listening to music, whatever. Around 2 hours after that (4 hours after his dose) he starts to get "flat" and REALLY OBSESSIVE. It lasted (flatness,obsessiveness) until about 6 hours after his a.m. dose and then he was not so obsessive or "flat". So what is the story here? can anyone help? He is autistic, but these obsessions are really intense when he is "flat". I am thinking about taking him off zoloft and tryinng something else (or nothing). I am wondering if the zoloft could be causing some of these obsessions? HELP!
elise
Posted by Ritch on May 26, 2003, at 16:32:16
In reply to Re: abilify/trileptal/zoloft-ZOLOFT????, posted by e503 on May 25, 2003, at 22:32:25
> A question about ben and his zoloft. He typically takes it 50 mg./am and 25 mg. in the afternoon. School said after 12 he gets "totally noncompliant". Since he's been off the abilify, etc. I have noticed this about the zoloft....after ben takes it, about 2 hours later, he is really happy and "bopping" around...listening to music, whatever. Around 2 hours after that (4 hours after his dose) he starts to get "flat" and REALLY OBSESSIVE. It lasted (flatness,obsessiveness) until about 6 hours after his a.m. dose and then he was not so obsessive or "flat". So what is the story here? can anyone help? He is autistic, but these obsessions are really intense when he is "flat". I am thinking about taking him off zoloft and tryinng something else (or nothing). I am wondering if the zoloft could be causing some of these obsessions? HELP!
> eliseElise, given the super long half-life of the Abilify (75 hrs.-thanks Scott), it might be a good idea to make sure enough time has elapsed before any new med changes occur to allow the Abilify to wash out-it's possible this recent phenomena may disappear on its own. Also, since he is bipolar-some of it might be attributable to his mood cycling. Cycling changes often occur when meds are started and stopped. If you can rule out these things-then you might ask his doc about dosing the Zoloft 25mg 3x daily and spread it out some more.
Posted by e503 on May 30, 2003, at 9:49:48
In reply to ZOLOFT???? » e503, posted by Ritch on May 26, 2003, at 16:32:16
> > A question about ben and his zoloft. He typically takes it 50 mg./am and 25 mg. in the afternoon. School said after 12 he gets "totally noncompliant". Since he's been off the abilify, etc. I have noticed this about the zoloft....after ben takes it, about 2 hours later, he is really happy and "bopping" around...listening to music, whatever. Around 2 hours after that (4 hours after his dose) he starts to get "flat" and REALLY OBSESSIVE. It lasted (flatness,obsessiveness) until about 6 hours after his a.m. dose and then he was not so obsessive or "flat". So what is the story here? can anyone help? He is autistic, but these obsessions are really intense when he is "flat". I am thinking about taking him off zoloft and tryinng something else (or nothing). I am wondering if the zoloft could be causing some of these obsessions? HELP!
> > elise
>
> Elise, given the super long half-life of the Abilify (75 hrs.-thanks Scott), it might be a good idea to make sure enough time has elapsed before any new med changes occur to allow the Abilify to wash out-it's possible this recent phenomena may disappear on its own. Also, since he is bipolar-some of it might be attributable to his mood cycling. Cycling changes often occur when meds are started and stopped. If you can rule out these things-then you might ask his doc about dosing the Zoloft 25mg 3x daily and spread it out some more.Two nights ago he was just taking 50 mg. zoloft at night. He was okay, but he did have increased agitation later in the day. So....we went back to 75 mg. zoloft at night. Guess what? I get a call that he was HORRIBLE....non compliant, running around, self talking, etc. So...I decided to try your suggestion of 25 mg. 3 x a day. I gave him 25 mg. this a.m. and just spoke to the teacher. She said he is better than yesterday as far as compliance is concerned, but is doing some self talk. He will get his next dose at 12:00. I am anxious to see how he is. Ritch (mitch?)- scott, what do you is going on with this zoloft? It's as if he takes it at night and he is fine, but in the day he is "rebounding" or something. I thought it was supposed to stay in your system for 24 hours,. Anyways, if this doesn't work, any other suggestions? I do not know if, in fact, he really is bipolar or not. He has been on so many meds for so long that i don't know if it is him or the meds that have set him off. HELP!
elise
Posted by Ritch on May 30, 2003, at 10:33:40
In reply to Re: ZOLOFT???? » Ritch, posted by e503 on May 30, 2003, at 9:49:48
> > > A question about ben and his zoloft. He typically takes it 50 mg./am and 25 mg. in the afternoon. School said after 12 he gets "totally noncompliant". Since he's been off the abilify, etc. I have noticed this about the zoloft....after ben takes it, about 2 hours later, he is really happy and "bopping" around...listening to music, whatever. Around 2 hours after that (4 hours after his dose) he starts to get "flat" and REALLY OBSESSIVE. It lasted (flatness,obsessiveness) until about 6 hours after his a.m. dose and then he was not so obsessive or "flat". So what is the story here? can anyone help? He is autistic, but these obsessions are really intense when he is "flat". I am thinking about taking him off zoloft and tryinng something else (or nothing). I am wondering if the zoloft could be causing some of these obsessions? HELP!
> > > elise
> >
> > Elise, given the super long half-life of the Abilify (75 hrs.-thanks Scott), it might be a good idea to make sure enough time has elapsed before any new med changes occur to allow the Abilify to wash out-it's possible this recent phenomena may disappear on its own. Also, since he is bipolar-some of it might be attributable to his mood cycling. Cycling changes often occur when meds are started and stopped. If you can rule out these things-then you might ask his doc about dosing the Zoloft 25mg 3x daily and spread it out some more.
>
> Two nights ago he was just taking 50 mg. zoloft at night. He was okay, but he did have increased agitation later in the day. So....we went back to 75 mg. zoloft at night. Guess what? I get a call that he was HORRIBLE....non compliant, running around, self talking, etc. So...I decided to try your suggestion of 25 mg. 3 x a day. I gave him 25 mg. this a.m. and just spoke to the teacher. She said he is better than yesterday as far as compliance is concerned, but is doing some self talk. He will get his next dose at 12:00. I am anxious to see how he is. Ritch (mitch?)- scott, what do you is going on with this zoloft? It's as if he takes it at night and he is fine, but in the day he is "rebounding" or something. I thought it was supposed to stay in your system for 24 hours,. Anyways, if this doesn't work, any other suggestions? I do not know if, in fact, he really is bipolar or not. He has been on so many meds for so long that i don't know if it is him or the meds that have set him off. HELP!
> eliseWell, there is one "good" thing-you are down to just one medication (which has never happened to me!). Zoloft always had this delayed activation effect on me. First, a zoned-out feeling while it was kicking in, then a zingy, restlessness that would occur six+ hrs. post-dosing. The simplest thing to do for now would be to tinker with the dose timings and keep the total daily dose the same-given you had some success with doing that previously. It just sounds like if his dose is too high in the day he zonks out, but the med seems to help a lot. Has his doctor mentioned any alternatives for Zoloft? I was just wondering if his doctor also wasn't quite "firm" in his diagnosis either-still speculating?
Posted by e503 on May 30, 2003, at 11:56:07
In reply to Re: ZOLOFT???? » e503, posted by Ritch on May 30, 2003, at 10:33:40
> > > > A question about ben and his zoloft. He typically takes it 50 mg./am and 25 mg. in the afternoon. School said after 12 he gets "totally noncompliant". Since he's been off the abilify, etc. I have noticed this about the zoloft....after ben takes it, about 2 hours later, he is really happy and "bopping" around...listening to music, whatever. Around 2 hours after that (4 hours after his dose) he starts to get "flat" and REALLY OBSESSIVE. It lasted (flatness,obsessiveness) until about 6 hours after his a.m. dose and then he was not so obsessive or "flat". So what is the story here? can anyone help? He is autistic, but these obsessions are really intense when he is "flat". I am thinking about taking him off zoloft and tryinng something else (or nothing). I am wondering if the zoloft could be causing some of these obsessions? HELP!
> > > > elise
> > >
> > > Elise, given the super long half-life of the Abilify (75 hrs.-thanks Scott), it might be a good idea to make sure enough time has elapsed before any new med changes occur to allow the Abilify to wash out-it's possible this recent phenomena may disappear on its own. Also, since he is bipolar-some of it might be attributable to his mood cycling. Cycling changes often occur when meds are started and stopped. If you can rule out these things-then you might ask his doc about dosing the Zoloft 25mg 3x daily and spread it out some more.
> >
> > Two nights ago he was just taking 50 mg. zoloft at night. He was okay, but he did have increased agitation later in the day. So....we went back to 75 mg. zoloft at night. Guess what? I get a call that he was HORRIBLE....non compliant, running around, self talking, etc. So...I decided to try your suggestion of 25 mg. 3 x a day. I gave him 25 mg. this a.m. and just spoke to the teacher. She said he is better than yesterday as far as compliance is concerned, but is doing some self talk. He will get his next dose at 12:00. I am anxious to see how he is. Ritch (mitch?)- scott, what do you is going on with this zoloft? It's as if he takes it at night and he is fine, but in the day he is "rebounding" or something. I thought it was supposed to stay in your system for 24 hours,. Anyways, if this doesn't work, any other suggestions? I do not know if, in fact, he really is bipolar or not. He has been on so many meds for so long that i don't know if it is him or the meds that have set him off. HELP!
> > elise
>
> Well, there is one "good" thing-you are down to just one medication (which has never happened to me!). Zoloft always had this delayed activation effect on me. First, a zoned-out feeling while it was kicking in, then a zingy, restlessness that would occur six+ hrs. post-dosing. The simplest thing to do for now would be to tinker with the dose timings and keep the total daily dose the same-given you had some success with doing that previously. It just sounds like if his dose is too high in the day he zonks out, but the med seems to help a lot. Has his doctor mentioned any alternatives for Zoloft? I was just wondering if his doctor also wasn't quite "firm" in his diagnosis either-still speculating?Is it possible that that (delayed activation) is happening with Ben; that he is "sedate" (compliant) in the a.m., and then every day at 11:30 he gets noncompliant? This is 4 1/2 hours after his a.m. dose. I spoke to the doctor this a.m. He wants me to keep him on zoloft for another week at this dosing, he is concerned that the abilify is not out of his system yet (last dose 2.5 mg. 8 days ago). Then to cut back 25 mg. He seems to be "stuck" on this abilify. He is saying that maybe i should see if i could get it "compounded" to 1 mg. and start ben on a 1 mg. dose.
Posted by e503 on May 30, 2003, at 19:32:47
In reply to Re: ZOLOFT???? » Ritch, posted by e503 on May 30, 2003, at 11:56:07
> > > > > A question about ben and his zoloft. He typically takes it 50 mg./am and 25 mg. in the afternoon. School said after 12 he gets "totally noncompliant". Since he's been off the abilify, etc. I have noticed this about the zoloft....after ben takes it, about 2 hours later, he is really happy and "bopping" around...listening to music, whatever. Around 2 hours after that (4 hours after his dose) he starts to get "flat" and REALLY OBSESSIVE. It lasted (flatness,obsessiveness) until about 6 hours after his a.m. dose and then he was not so obsessive or "flat". So what is the story here? can anyone help? He is autistic, but these obsessions are really intense when he is "flat". I am thinking about taking him off zoloft and tryinng something else (or nothing). I am wondering if the zoloft could be causing some of these obsessions? HELP!
> > > > > elise
> > > >
> > > > Elise, given the super long half-life of the Abilify (75 hrs.-thanks Scott), it might be a good idea to make sure enough time has elapsed before any new med changes occur to allow the Abilify to wash out-it's possible this recent phenomena may disappear on its own. Also, since he is bipolar-some of it might be attributable to his mood cycling. Cycling changes often occur when meds are started and stopped. If you can rule out these things-then you might ask his doc about dosing the Zoloft 25mg 3x daily and spread it out some more.
> > >
> > > Two nights ago he was just taking 50 mg. zoloft at night. He was okay, but he did have increased agitation later in the day. So....we went back to 75 mg. zoloft at night. Guess what? I get a call that he was HORRIBLE....non compliant, running around, self talking, etc. So...I decided to try your suggestion of 25 mg. 3 x a day. I gave him 25 mg. this a.m. and just spoke to the teacher. She said he is better than yesterday as far as compliance is concerned, but is doing some self talk. He will get his next dose at 12:00. I am anxious to see how he is. Ritch (mitch?)- scott, what do you is going on with this zoloft? It's as if he takes it at night and he is fine, but in the day he is "rebounding" or something. I thought it was supposed to stay in your system for 24 hours,. Anyways, if this doesn't work, any other suggestions? I do not know if, in fact, he really is bipolar or not. He has been on so many meds for so long that i don't know if it is him or the meds that have set him off. HELP!
> > > elise
> >
> > Well, there is one "good" thing-you are down to just one medication (which has never happened to me!). Zoloft always had this delayed activation effect on me. First, a zoned-out feeling while it was kicking in, then a zingy, restlessness that would occur six+ hrs. post-dosing. The simplest thing to do for now would be to tinker with the dose timings and keep the total daily dose the same-given you had some success with doing that previously. It just sounds like if his dose is too high in the day he zonks out, but the med seems to help a lot. Has his doctor mentioned any alternatives for Zoloft? I was just wondering if his doctor also wasn't quite "firm" in his diagnosis either-still speculating?
>
> Is it possible that that (delayed activation) is happening with Ben; that he is "sedate" (compliant) in the a.m., and then every day at 11:30 he gets noncompliant? This is 4 1/2 hours after his a.m. dose. I spoke to the doctor this a.m. He wants me to keep him on zoloft for another week at this dosing, he is concerned that the abilify is not out of his system yet (last dose 2.5 mg. 8 days ago). Then to cut back 25 mg. He seems to be "stuck" on this abilify. He is saying that maybe i should see if i could get it "compounded" to 1 mg. and start ben on a 1 mg. dose.update.....they said at school he was "super"...best he's been in weeks. I am beginning to think that maybe he is just too sedate for him to be non compliant...i don't know. I gave him his third 25 mg. today at 5:30. He seemed to be okay until about then. He started acting "zoned out" (ritch like you, maybe???)and two hours later 7:30 p.m. he got somewhat sedate, but yet pacing more. It's really strange.
Posted by Ritch on May 30, 2003, at 22:38:14
In reply to Re: ZOLOFT???? » Ritch, posted by e503 on May 30, 2003, at 11:56:07
> > > > > A question about ben and his zoloft. He typically takes it 50 mg./am and 25 mg. in the afternoon. School said after 12 he gets "totally noncompliant". Since he's been off the abilify, etc. I have noticed this about the zoloft....after ben takes it, about 2 hours later, he is really happy and "bopping" around...listening to music, whatever. Around 2 hours after that (4 hours after his dose) he starts to get "flat" and REALLY OBSESSIVE. It lasted (flatness,obsessiveness) until about 6 hours after his a.m. dose and then he was not so obsessive or "flat". So what is the story here? can anyone help? He is autistic, but these obsessions are really intense when he is "flat". I am thinking about taking him off zoloft and tryinng something else (or nothing). I am wondering if the zoloft could be causing some of these obsessions? HELP!
> > > > > elise
> > > >
> > > > Elise, given the super long half-life of the Abilify (75 hrs.-thanks Scott), it might be a good idea to make sure enough time has elapsed before any new med changes occur to allow the Abilify to wash out-it's possible this recent phenomena may disappear on its own. Also, since he is bipolar-some of it might be attributable to his mood cycling. Cycling changes often occur when meds are started and stopped. If you can rule out these things-then you might ask his doc about dosing the Zoloft 25mg 3x daily and spread it out some more.
> > >
> > > Two nights ago he was just taking 50 mg. zoloft at night. He was okay, but he did have increased agitation later in the day. So....we went back to 75 mg. zoloft at night. Guess what? I get a call that he was HORRIBLE....non compliant, running around, self talking, etc. So...I decided to try your suggestion of 25 mg. 3 x a day. I gave him 25 mg. this a.m. and just spoke to the teacher. She said he is better than yesterday as far as compliance is concerned, but is doing some self talk. He will get his next dose at 12:00. I am anxious to see how he is. Ritch (mitch?)- scott, what do you is going on with this zoloft? It's as if he takes it at night and he is fine, but in the day he is "rebounding" or something. I thought it was supposed to stay in your system for 24 hours,. Anyways, if this doesn't work, any other suggestions? I do not know if, in fact, he really is bipolar or not. He has been on so many meds for so long that i don't know if it is him or the meds that have set him off. HELP!
> > > elise
> >
> > Well, there is one "good" thing-you are down to just one medication (which has never happened to me!). Zoloft always had this delayed activation effect on me. First, a zoned-out feeling while it was kicking in, then a zingy, restlessness that would occur six+ hrs. post-dosing. The simplest thing to do for now would be to tinker with the dose timings and keep the total daily dose the same-given you had some success with doing that previously. It just sounds like if his dose is too high in the day he zonks out, but the med seems to help a lot. Has his doctor mentioned any alternatives for Zoloft? I was just wondering if his doctor also wasn't quite "firm" in his diagnosis either-still speculating?
>
> Is it possible that that (delayed activation) is happening with Ben; that he is "sedate" (compliant) in the a.m., and then every day at 11:30 he gets noncompliant? This is 4 1/2 hours after his a.m. dose. I spoke to the doctor this a.m. He wants me to keep him on zoloft for another week at this dosing, he is concerned that the abilify is not out of his system yet (last dose 2.5 mg. 8 days ago). Then to cut back 25 mg. He seems to be "stuck" on this abilify. He is saying that maybe i should see if i could get it "compounded" to 1 mg. and start ben on a 1 mg. dose.It seemed that the Abilify was doing something positive, but since it accumulates a lot due to its long half-life it is hard to tell what *dose* is "right". Pharm companies use such high dosages to ensure their meds get approved, but when you get them out there and people are using them day to day-the dose is often just way too high.
Posted by Ritch on May 30, 2003, at 22:40:47
In reply to Re: ZOLOFT????, posted by e503 on May 30, 2003, at 19:32:47
> > > > > > A question about ben and his zoloft. He typically takes it 50 mg./am and 25 mg. in the afternoon. School said after 12 he gets "totally noncompliant". Since he's been off the abilify, etc. I have noticed this about the zoloft....after ben takes it, about 2 hours later, he is really happy and "bopping" around...listening to music, whatever. Around 2 hours after that (4 hours after his dose) he starts to get "flat" and REALLY OBSESSIVE. It lasted (flatness,obsessiveness) until about 6 hours after his a.m. dose and then he was not so obsessive or "flat". So what is the story here? can anyone help? He is autistic, but these obsessions are really intense when he is "flat". I am thinking about taking him off zoloft and tryinng something else (or nothing). I am wondering if the zoloft could be causing some of these obsessions? HELP!
> > > > > > elise
> > > > >
> > > > > Elise, given the super long half-life of the Abilify (75 hrs.-thanks Scott), it might be a good idea to make sure enough time has elapsed before any new med changes occur to allow the Abilify to wash out-it's possible this recent phenomena may disappear on its own. Also, since he is bipolar-some of it might be attributable to his mood cycling. Cycling changes often occur when meds are started and stopped. If you can rule out these things-then you might ask his doc about dosing the Zoloft 25mg 3x daily and spread it out some more.
> > > >
> > > > Two nights ago he was just taking 50 mg. zoloft at night. He was okay, but he did have increased agitation later in the day. So....we went back to 75 mg. zoloft at night. Guess what? I get a call that he was HORRIBLE....non compliant, running around, self talking, etc. So...I decided to try your suggestion of 25 mg. 3 x a day. I gave him 25 mg. this a.m. and just spoke to the teacher. She said he is better than yesterday as far as compliance is concerned, but is doing some self talk. He will get his next dose at 12:00. I am anxious to see how he is. Ritch (mitch?)- scott, what do you is going on with this zoloft? It's as if he takes it at night and he is fine, but in the day he is "rebounding" or something. I thought it was supposed to stay in your system for 24 hours,. Anyways, if this doesn't work, any other suggestions? I do not know if, in fact, he really is bipolar or not. He has been on so many meds for so long that i don't know if it is him or the meds that have set him off. HELP!
> > > > elise
> > >
> > > Well, there is one "good" thing-you are down to just one medication (which has never happened to me!). Zoloft always had this delayed activation effect on me. First, a zoned-out feeling while it was kicking in, then a zingy, restlessness that would occur six+ hrs. post-dosing. The simplest thing to do for now would be to tinker with the dose timings and keep the total daily dose the same-given you had some success with doing that previously. It just sounds like if his dose is too high in the day he zonks out, but the med seems to help a lot. Has his doctor mentioned any alternatives for Zoloft? I was just wondering if his doctor also wasn't quite "firm" in his diagnosis either-still speculating?
> >
> > Is it possible that that (delayed activation) is happening with Ben; that he is "sedate" (compliant) in the a.m., and then every day at 11:30 he gets noncompliant? This is 4 1/2 hours after his a.m. dose. I spoke to the doctor this a.m. He wants me to keep him on zoloft for another week at this dosing, he is concerned that the abilify is not out of his system yet (last dose 2.5 mg. 8 days ago). Then to cut back 25 mg. He seems to be "stuck" on this abilify. He is saying that maybe i should see if i could get it "compounded" to 1 mg. and start ben on a 1 mg. dose.
>
> update.....they said at school he was "super"...best he's been in weeks. I am beginning to think that maybe he is just too sedate for him to be non compliant...i don't know. I gave him his third 25 mg. today at 5:30. He seemed to be okay until about then. He started acting "zoned out" (ritch like you, maybe???)and two hours later 7:30 p.m. he got somewhat sedate, but yet pacing more. It's really strange.
Don't be surprised if ultimately 12.5 mg 3x daily ends up working better. Who knows? The increased "pacing" is a relatively common side effect of SSRI's that I have gotten in the past. It is like a restless-legs thing.
Posted by e503 on May 31, 2003, at 9:37:06
In reply to Re: ZOLOFT???? » e503, posted by Ritch on May 30, 2003, at 22:40:47
Ben had been taking buspar and it did seem to help him before. Any thoughts about zoloft/buspar combination?
elise
Posted by Ritch on May 31, 2003, at 10:24:05
In reply to Re: ZOLOFT /BUSPAR?, posted by e503 on May 31, 2003, at 9:37:06
> Ben had been taking buspar and it did seem to help him before. Any thoughts about zoloft/buspar combination?
>
> eliseWell, the first question to ask would be why the Buspar got canned the last time-was it because of the med itself, or was there something that was presumed to be better it was replaced with, etc. I've tried buspirone three different times since it came out. The first was with lithium, to see if I could get off the benzodiazepine I was taking at the time (back in the '80's). The switch didn't work because I have panic and buspirone doesn't address that. The second time was with desipramine to reduce the anxiety the desipramine was causing. That didn't work either-didn't make things worse-it just didn't seem to help. The third time was with Celexa and it definitely helped reduce the "physical" agitation and restlessness of the SSRI. However, I kept increasing the dose and got up to 15mg/day and starting having temper spells, so it got stopped. After it was stopped-I began to definitely have increased anticipitory anxiety and obsessive worrying--so I knew it was helping, but I never restarted at a lower dose. Buspar does seem to have a special synergy with SSRI's for some reason. You could ask his doctor about a possible retrial of buspirone if you don't want to hassle with Abilify (and compounding) again. If I start it again, I want to be very patient and start off at a very low dose, however.
Posted by e503 on May 31, 2003, at 20:25:34
In reply to Re: ZOLOFT /BUSPAR? » e503, posted by Ritch on May 31, 2003, at 10:24:05
> > Ben had been taking buspar and it did seem to help him before. Any thoughts about zoloft/buspar combination?
> >
> > elise
>
> Well, the first question to ask would be why the Buspar got canned the last time-was it because of the med itself, or was there something that was presumed to be better it was replaced with, etc. I've tried buspirone three different times since it came out. The first was with lithium, to see if I could get off the benzodiazepine I was taking at the time (back in the '80's). The switch didn't work because I have panic and buspirone doesn't address that. The second time was with desipramine to reduce the anxiety the desipramine was causing. That didn't work either-didn't make things worse-it just didn't seem to help. The third time was with Celexa and it definitely helped reduce the "physical" agitation and restlessness of the SSRI. However, I kept increasing the dose and got up to 15mg/day and starting having temper spells, so it got stopped. After it was stopped-I began to definitely have increased anticipitory anxiety and obsessive worrying--so I knew it was helping, but I never restarted at a lower dose. Buspar does seem to have a special synergy with SSRI's for some reason. You could ask his doctor about a possible retrial of buspirone if you don't want to hassle with Abilify (and compounding) again. If I start it again, I want to be very patient and start off at a very low dose, however.I gave ben 5 mg. buspar 2 times today. He was better-didn't have much, if any, agitation and less obsessions. I know it is supposed to take 2 weeks (?) to "kick in", but I believe it did help today. I do think that he is somewhat "flat" and sedate. I am thinking about your comment about decreasing the zoloft to 12.5 instead of 25.....well, I actually am thinking about somehow reducing the zoloft to total 50 mg./day from 75 to see if this helps his "flat" affect, but I am not sure if I should do it yet, or wait a few weeks and see what happens with the buspar. What do you think? He is better, but certainly not as "perky" or fun as he can be! I do think we are closer to "Ben"as I remember him than we have been since February (trileptal, abilify, risperdol, etc.) What do you think?
elise
Posted by Ritch on June 1, 2003, at 10:01:50
In reply to Re: ZOLOFT /BUSPAR? Scott and Ritch?, posted by e503 on May 31, 2003, at 20:25:34
> > > Ben had been taking buspar and it did seem to help him before. Any thoughts about zoloft/buspar combination?
> > >
> > > elise
> >
> > Well, the first question to ask would be why the Buspar got canned the last time-was it because of the med itself, or was there something that was presumed to be better it was replaced with, etc. I've tried buspirone three different times since it came out. The first was with lithium, to see if I could get off the benzodiazepine I was taking at the time (back in the '80's). The switch didn't work because I have panic and buspirone doesn't address that. The second time was with desipramine to reduce the anxiety the desipramine was causing. That didn't work either-didn't make things worse-it just didn't seem to help. The third time was with Celexa and it definitely helped reduce the "physical" agitation and restlessness of the SSRI. However, I kept increasing the dose and got up to 15mg/day and starting having temper spells, so it got stopped. After it was stopped-I began to definitely have increased anticipitory anxiety and obsessive worrying--so I knew it was helping, but I never restarted at a lower dose. Buspar does seem to have a special synergy with SSRI's for some reason. You could ask his doctor about a possible retrial of buspirone if you don't want to hassle with Abilify (and compounding) again. If I start it again, I want to be very patient and start off at a very low dose, however.
>
> I gave ben 5 mg. buspar 2 times today. He was better-didn't have much, if any, agitation and less obsessions. I know it is supposed to take 2 weeks (?) to "kick in", but I believe it did help today. I do think that he is somewhat "flat" and sedate. I am thinking about your comment about decreasing the zoloft to 12.5 instead of 25.....well, I actually am thinking about somehow reducing the zoloft to total 50 mg./day from 75 to see if this helps his "flat" affect, but I am not sure if I should do it yet, or wait a few weeks and see what happens with the buspar. What do you think? He is better, but certainly not as "perky" or fun as he can be! I do think we are closer to "Ben"as I remember him than we have been since February (trileptal, abilify, risperdol, etc.) What do you think?
> eliseWell, first thing, make sure his doctor knows what you are doing and you get blessed to do so. Second, why did you guys take him off the buspar previously? Were you replacing it with something else? The "perkiness" may have been a mild drug-induced mania or part of his natural cycling pattern. You say he seems more normal now than ever? Now, that you've added buspar back in I would stick with where you are at now for three full weeks and see what happens, IMO. So, his primary diagnosis is autism? Is the bipolar dx just speculative?
Posted by e503 on June 1, 2003, at 10:36:38
In reply to Re: ZOLOFT /BUSPAR? Scott and Ritch? » e503, posted by Ritch on June 1, 2003, at 10:01:50
> > > > Ben had been taking buspar and it did seem to help him before. Any thoughts about zoloft/buspar combination?
> > > >
> > > > elise
> > >
> > > Well, the first question to ask would be why the Buspar got canned the last time-was it because of the med itself, or was there something that was presumed to be better it was replaced with, etc. I've tried buspirone three different times since it came out. The first was with lithium, to see if I could get off the benzodiazepine I was taking at the time (back in the '80's). The switch didn't work because I have panic and buspirone doesn't address that. The second time was with desipramine to reduce the anxiety the desipramine was causing. That didn't work either-didn't make things worse-it just didn't seem to help. The third time was with Celexa and it definitely helped reduce the "physical" agitation and restlessness of the SSRI. However, I kept increasing the dose and got up to 15mg/day and starting having temper spells, so it got stopped. After it was stopped-I began to definitely have increased anticipitory anxiety and obsessive worrying--so I knew it was helping, but I never restarted at a lower dose. Buspar does seem to have a special synergy with SSRI's for some reason. You could ask his doctor about a possible retrial of buspirone if you don't want to hassle with Abilify (and compounding) again. If I start it again, I want to be very patient and start off at a very low dose, however.
> >
> > I gave ben 5 mg. buspar 2 times today. He was better-didn't have much, if any, agitation and less obsessions. I know it is supposed to take 2 weeks (?) to "kick in", but I believe it did help today. I do think that he is somewhat "flat" and sedate. I am thinking about your comment about decreasing the zoloft to 12.5 instead of 25.....well, I actually am thinking about somehow reducing the zoloft to total 50 mg./day from 75 to see if this helps his "flat" affect, but I am not sure if I should do it yet, or wait a few weeks and see what happens with the buspar. What do you think? He is better, but certainly not as "perky" or fun as he can be! I do think we are closer to "Ben"as I remember him than we have been since February (trileptal, abilify, risperdol, etc.) What do you think?
> > elise
>
> Well, first thing, make sure his doctor knows what you are doing and you get blessed to do so. Second, why did you guys take him off the buspar previously? Were you replacing it with something else? The "perkiness" may have been a mild drug-induced mania or part of his natural cycling pattern. You say he seems more normal now than ever? Now, that you've added buspar back in I would stick with where you are at now for three full weeks and see what happens, IMO. So, his primary diagnosis is autism? Is the bipolar dx just speculative?Yes, Ben's primary diagnosis is autism. As far as bipolar dx, I really don't know for sure. The doc says it's "different", but I am not so sure if it was just some "mania"/agitation induced by some meds. Can you not be bipolar and still get "manic"/agitated by meds? Ben is adopted so we do not know his biological background.
I wouldn't say he is as "normal" as ever....I would say he is "better". Yes, maybe this perkiness could have been hypomania (drug induced). As far as this buspar/zoloft is concerned, it so far seems to be better, but he is quite sedate...almost flat. I am wondering what would happen if I did decrease his zoloft dose.....I thought buspar did not cause sedation. I will call the pdoc tomorrow- but I am wondering what you think about the sedative effect of the two in combo.
elise
Posted by e503 on June 1, 2003, at 10:39:42
In reply to Re: ZOLOFT /BUSPAR? Scott and Ritch? » e503, posted by Ritch on June 1, 2003, at 10:01:50
Oh yah, the reason we took him off buspar from what I remember was when he was agitated on the trileptal, abilify, zoloft, buspar mix, for some reason the doc thought maybe it was too much serotonin or something like that????? told me to stop it. I don't th ink the doc thinks much of buspar, but I will tell you that I th ink it DEFINITELY makes a difference for Ben when he does take it. I was the one who suggested it when he started it again recently with the other mix, He had been on it previously and it did help.
Posted by Ritch on June 1, 2003, at 14:51:20
In reply to Re: ZOLOFT /BUSPAR? Scott and Ritch?, posted by e503 on June 1, 2003, at 10:36:38
> > > I gave ben 5 mg. buspar 2 times today. He was better-didn't have much, if any, agitation and less obsessions. I know it is supposed to take 2 weeks (?) to "kick in", but I believe it did help today. I do think that he is somewhat "flat" and sedate. I am thinking about your comment about decreasing the zoloft to 12.5 instead of 25.....well, I actually am thinking about somehow reducing the zoloft to total 50 mg./day from 75 to see if this helps his "flat" affect, but I am not sure if I should do it yet, or wait a few weeks and see what happens with the buspar. What do you think? He is better, but certainly not as "perky" or fun as he can be! I do think we are closer to "Ben"as I remember him than we have been since February (trileptal, abilify, risperdol, etc.) What do you think?
> > > elise
> >
> > Well, first thing, make sure his doctor knows what you are doing and you get blessed to do so. Second, why did you guys take him off the buspar previously? Were you replacing it with something else? The "perkiness" may have been a mild drug-induced mania or part of his natural cycling pattern. You say he seems more normal now than ever? Now, that you've added buspar back in I would stick with where you are at now for three full weeks and see what happens, IMO. So, his primary diagnosis is autism? Is the bipolar dx just speculative?
>
> Yes, Ben's primary diagnosis is autism. As far as bipolar dx, I really don't know for sure. The doc says it's "different", but I am not so sure if it was just some "mania"/agitation induced by some meds. Can you not be bipolar and still get "manic"/agitated by meds? Ben is adopted so we do not know his biological background.
>
> I wouldn't say he is as "normal" as ever....I would say he is "better". Yes, maybe this perkiness could have been hypomania (drug induced). As far as this buspar/zoloft is concerned, it so far seems to be better, but he is quite sedate...almost flat. I am wondering what would happen if I did decrease his zoloft dose.....I thought buspar did not cause sedation. I will call the pdoc tomorrow- but I am wondering what you think about the sedative effect of the two in combo.
> Oh yah, the reason we took him off buspar from what I remember was when he was agitated on the trileptal, abilify, zoloft, buspar mix, for some reason the doc thought maybe it was too much serotonin or something like that????? told me to stop it. I don't th ink the doc thinks much of buspar, but I will tell you that I th ink it DEFINITELY makes a difference for Ben when he does take it. I was the one who suggested it when he started it again recently with the other mix, He had been on it previously and it did help.>elise
Well, he was certainly on quite a few meds there! His doc probably wanted to start eliminating things so he could try to get an idea of what was causing the problem and probably thought Buspar wasn't doing much for him anyhow-so if it got pitched then it would just make things easier to untangle without it in the mix-just a hunch. It could have been helping to trigger a mild serotonin syndrome as well (since Zoloft and to some extent Abilify both inhibit serotonin reuptake). The only thing I've found buspar good for (and only combined with an SSRI) was the thing it is indicated for-generalized anxiety-and that's it. The manufacturer pushed buspar for everything imaginable (aggression associated with mental retardation being one) back in the '90's, before it was about to go off-patent, and I think it may have left pdocs quite skeptical. I think it's utility is simply narrower than what many had thought. Tell us what his pdoc says about the Buspar+Zoloft.
Posted by e503 on June 2, 2003, at 14:43:36
In reply to Re: ZOLOFT /BUSPAR? Scott and Ritch? » e503, posted by Ritch on June 1, 2003, at 14:51:20
Teachers said ben was a little hyper, noncompliant and self talking a LOT today. COuld the zoloft and buspar combo be causing this? still at 75 mg. zoloft and 10 mg. buspar. He did go to sleep very late last night....but I thought it was possibly because he slept in yesterday. I am not sure. It's a drag because he was MUCH better the last day or so since we added the buspar. Maybe it's just now "kicking in"?
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