![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by LouisianaSportsman on May 11, 2012, at 23:03:16
Hey, everyone!
My primary interest for around two years now has been pharmacology. First, it began when I started substance abusing my senior year of high school. I am rather intelligent and wanted to be informed about what I was putting in my body; thus, I joined bluelight.ru, a website which is dedicated to harm reduction, and I must say that I learned quite a bit about pharmacology albeit focused on recreational drugs. I have also lurked on this forum for awhile and it is hands down the best.
I went to one college for engineering, but I dropped out and switched to a different college where I attempted Pre-Pharmacy. My unsuccessful attempts are correlated with my opiate addiction problem.
Now, I am studying Agribusiness. I am embarking on my junior year of college, and Im set to graduate on time. I have been sober for around a year, and my grades have drastically improved. My interests have switched towards legitimate pharmacology; essentially, things my PDOC would prescribe. I have quit using non-prescribed medications and take medication as prescribed. I decided to grow up.
In the past, before growing up, I had a previous PDOC during the time of my illegal drug use and mania who did not diagnose me with Bipolar II (which I believe is absolutely correct). She prescribed me Zoloft, Strattera, and Concerta. I was not pleased with her, so I went to my GP; basically, I told her that I wanted 50mg. Vyvanse, 150mg. Lyrica BID, and to continue 50mg. Zoloft. Easy scripts. After my DUI and other personal problems, my parents forced me off these medications. They were good for ADHD and GAD but made me manic. I did not notice any change in depression with the sertraline, before and after, and no side effects which seem weird. My parents made me switch to a new PDOC.
I really like my current PDOC. I believe he was very good in diagnosing me and has been fair with medication. Ive only had four visits in four months. I believe that he would listen to my proposals about psychotropic therapy. He had me discontinue the sertraline. We also had a failed attempt with bupropion and after I was stabilized on lamotrigine, the visit after he prescribed the clonazepam.
My diagnoses are as follows:
314.01 Attention-Deficit/Hyperactivity Disorder, Combined Type, 296.89 Bipolar II Disorder, 296.31 Major Depressive Disorder, Recurrent, Mild, 300.02 Generalized Anxiety Disorder
I am prescribed the following:
#90 amphetamine salts 10mg. PO, two tablets QAM, 1 tablet QPM for 314.01
#30 lamotrigine 200mg. PO QD for 296.89
#60 lamotrigine 25mg. PO QD for 296.89
#60 clonazepam 0.5mg. PO PRN QD for 300.02The clonazepam has made me feel more normal than any other drug except, perhaps, the previously prescribed pregabalin. With the 250mg. daily dosage of lamotrigine, I do not notice many chaotic mood swings, and it has been very effective. I want to switch my current Adderall to Dexedrine, but for the most part it manages my ADHD symptoms well.
The major depression is not being treated. Let me explain. I get periods of what I call The Sadness, which I suppose is endogenous. Its a feeling like I want to cry. It ruminates around and takes up a large portion of the day. I get bored of my life and lack motivation. While it has always been present in some form, it has actually gotten worse since I discontinued substance abuse, especially opiates, but trust me, everything else is better. Im not sure if it is PAWS or not.
Also, circumstances have contributed to make The Sadness worse. I suffered from cannabis psychosis during the time in which I engaged in fraternity parties, road trips, and frequent sex; somehow, the world was more magical during this (manic) time. I began to believe in Solipsism and I believed that everything around me existed for me. I was amazed by just the mere existence of life, I would say The Sadness was eradicated during this time. While stoned and opiated, I would suffer some depersonalization and exist in a dream-world. It is ineffable, and I have almost forgotten what it was like. Admittedly, in terms of happiness, this would be a good part of my life, but I was too manic and not going anywhere.
Lets cut to the chase: a medication for my MDD.
My PDOC suggested augmentation of a Seroquel XR 300mg. target dose. I dont like the idea of a weight-gaining neuroleptic with lots of side effects, however.Im not sure if Zoloft caused the prior mania or not, but I think conventional approaches to depression would be suitable since I have clonazepam to calm potential manic episodes (haven't had any in a long, long time), and I also now live with my parents.
While I have GAD (perhaps associated with my depression), I have no social anxiety and I am President of a campus organization and, also, I promote the campus to prospective students.
Still, here comes the The Sadness; its almost as if I can feel it creeping up on me; I just want it to go way!I feel as if though The Sadness is somewhat related to elements of Borderline Personality Disorder (undiagnosed).
Using criteria, The Sadness has these elements of BPD:
#Frantic efforts to avoid real or imagined abandonment and a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. (My girlfriend)
#Identity disturbance: markedly and persistently unstable self-image or sense of self. (My emotions and transition to being sober from mania.)
#Impulsiveness in at least two areas that are potentially self-damaging (e.g.,excessive spending, reckless driving)
However.
This best describes The Sadness:
***Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days).
Chronic feelings of emptiness ***Does anyone have suggestions of a medication augmentation that could possibly reduce elements of my dysphoria?
Thank you,
LouisianaSportsman
Posted by LouisianaSportsman on May 12, 2012, at 1:12:47
In reply to Suggestions for meds augmentation? (BP2, GAD, MDD), posted by LouisianaSportsman on May 11, 2012, at 23:03:16
I was hoping that someone can come up with a fresh idea.
(tl;dr looking for depression relief without increased anxiety for bp2 depression with borderline features)
Please ignore this below if you have a fresh idea.
1. Retry sertraline concomitantly with Nortriptyline. (Dosage?)
2. Nortriptyline monotherapy
3. Effexor
4. low dose Zyprexa + fluoxetine + metformin
5. Lithium
Posted by SLS on May 12, 2012, at 9:19:12
In reply to Suggestions for meds augmentation? (BP2, GAD, MDD), posted by LouisianaSportsman on May 11, 2012, at 23:03:16
Hi.
I'm pretty sure that people are having a difficult time suggesting things for you. You have quite a few things going on, and you have been on some sophisticated treatment regimes. I don't think I can offer any new ideas for you.
My first question is to know whether or not you have had any psychotherapy. My second question is what is your family history with regard to mental illness.
Have you tried Trileptal (oxcarbazepine or Tegretol carbamazepine)? These two drugs are cousins and are reported to reduce impulsive behaviors and anger, and are often chosen in combination with an antipyshotic to treat BPD. I have seen Zyprexa work well in this role.
Believe it or not, Topamax 100 mg can work well when bipolar mixed-states are present. If one begins at 25 mg and increases the dosage by 25 mg per week, much of the cognitive side effects can be avoided.
Nortriptyline is a good TCA that goes well with SRI drugs like Zoloft and Effexor.
Abilify makes a good augmenting agent when combined with Lamictal.
Anafranil (clomipramine) is probably the most effective tricyclic available. It acts as a SNRI and has anticholinergic (muscarinic) properties. There are some who believe that anticholinergic agents can act as antidepressants. There is some work currently in progress investigating intravenous scopolamine.
Which MAOIs have you tried?
You might have a bipolar spectrum disorder with comorbid ADHD. Low-dosage lithium (300-600 mg/day) could be helpful along with the Lamictal and Klonopin to help contain the mania, stabilize mood oscillations, and prevent rapid cycling.
Adding the Seroquel is justified according to the clinical studies that have been performed on it. You won't know how the drug effects you until you reach dosages of 200 mg and higher. Weight-gain? I don't know if this applies globally. Try it and see what happens. The metabolite of Seroquel is a norepinephrine reuptake inhibitor.
From your own reporting, it seems that retaining the Klonopin is a good idea, regardless of in what direction you choose to go.
Personally, I like Abilify, Lamictal, Effexor, and nortriptyline. Some people have been voicing a preference for Zoloft to combine with nortriptyline.
Geodon and Latuda are two antipsychotics with antidepressant properties that are usually are devoid of weight gain. Saphris, another antipsychotic, is being investigated for treating bipolar mixed-states and bipolar depression.
Namenda (memantine) might be helpful as an adjunct to the stimulant for treating ADHD. It does not seem to work for bipolar depression, but it seemed to help me a bit when I combined it with Parnate.
Do any of these ideas appeal to you?
For Bipolar IV (depression with mania generated by medication only), I take:
Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg
prazosin 8 mgGood luck.
- Scott
Posted by Phillipa on May 12, 2012, at 9:57:30
In reply to Re: Suggestions for meds augmentation? (BP2, GAD, MDD) » LouisianaSportsman, posted by SLS on May 12, 2012, at 9:19:12
The abilify sounds good according to what I've read lately for bipolar. Yes complicated to the layman. Scott has good suggestions. Phillipa
Posted by bleauberry on May 12, 2012, at 13:09:01
In reply to Suggestions for meds augmentation? (BP2, GAD, MDD), posted by LouisianaSportsman on May 11, 2012, at 23:03:16
It seems to me you might want to focus on med choices that offer some sort of backdoor indirect ttweeking in the opioid system. The clues I saw in your post would lead me to think in that direction. Things that could fit that category would be effexor, savella, tca's.
Posted by ron1953 on May 12, 2012, at 13:34:58
In reply to Re: Suggestions for meds augmentation? (BP2, GAD, MDD) » LouisianaSportsman, posted by SLS on May 12, 2012, at 9:19:12
> Have you tried Trileptal (oxcarbazepine or Tegretol carbamazepine)? These two drugs are cousins and are reported to reduce impulsive behaviors and anger, and are often chosen in combination with an antipyshotic to treat BPD. I have seen Zyprexa work well in this role.
--------------------------------------------------
If impulsive behaviors and anger are a concern, then the taking of Klonopin should be addressed. Klonopin has been known to produce/exacerbate these symptoms. Not only have I read about it; I've experienced it.
Posted by SLS on May 12, 2012, at 13:46:25
In reply to Re: Suggestions for meds augmentation? (BP2, GAD, MDD), posted by ron1953 on May 12, 2012, at 13:34:58
> > Have you tried Trileptal (oxcarbazepine or Tegretol carbamazepine)? These two drugs are cousins and are reported to reduce impulsive behaviors and anger, and are often chosen in combination with an antipyshotic to treat BPD. I have seen Zyprexa work well in this role.
> --------------------------------------------------
> If impulsive behaviors and anger are a concern, then the taking of Klonopin should be addressed. Klonopin has been known to produce/exacerbate these symptoms. Not only have I read about it; I've experienced it.
That's a good thought. Without having more information, behavioral disinhibition is a valid concern.
- Scott
Posted by SLS on May 12, 2012, at 13:47:18
In reply to Re: Suggestions for meds augmentation? (BP2, GAD, MDD), posted by bleauberry on May 12, 2012, at 13:09:01
> It seems to me you might want to focus on med choices that offer some sort of backdoor indirect ttweeking in the opioid system. The clues I saw in your post would lead me to think in that direction.
Which clues?
- Scott
Posted by LouisianaSportsman on May 12, 2012, at 18:41:02
In reply to Re: Suggestions for meds augmentation? (BP2, GAD, MDD) » bleauberry, posted by SLS on May 12, 2012, at 13:47:18
It may sound like I am responding to SLS only, but I have tried to include everyone's input!
I have not had any psychotherapy, unless reading books counts lol. My mom takes Cymbalta and my dad takes Pristiq. My grandmother takes Prozac. They all have unipolar depression; whereas I have a bit more going on.
As far as your anticonvulsant suggestions go; no, I have not tried a carboxamide nor Topamax. I would be more interested in a target dose of 100mg. Topamax, however. I know its supposed to help you lose weight, but Im just slightly overweight and wear a size small/medium so its not the end of the world. Lamotrigine has been awesome.
I dont like the idea of blood tests, so I would like to avoid TCAs and lithium salts, but clomipramine as monotherapy does seem attractive.
I have not tried a MAOI. I think Parnate would be very good, but Im not sure if my PDOC would risk it with my Adderall which has been very effective. Emsam patch? I have good insuranceSo based on the fact as that I dont like blood tests and I doubt that my PDOC would want to do concomitant dosing of anything with an SSRI. I also just dont like the idea of an AP to be honest, unless absolutely needed. I really don't want to go back to a SSRI/SNRI either since I was so proud to get off Zoloft and I very occasionally want to take acid (I see nothing wrong with it.). So, based on your suggestions and my criteria, it leaves: Effexor (my dad responded well), Trileptal, and Topamax.
My dad has responded tremendously well with Pristiq. Do you think that or the XL would be good to try next? If it doesnt take care of all the symptoms, then I would consider augmenting with, in order of preference: Seroquel XR (especially if my dose of amphetamines are raised), Abilify, Geodon, and Latuda. Ive read that Abilify (know anything more about this, Phillipa) and Geodon raise anxiety in some people (probably a chance with all APs) Wellbutrin did this for sure.
I do want to give memantine a shot in the future and I have been wanting to for awhile now. My PDOC is all about one thing at a time, but hes not so strict straight to the book that he wouldnt prescribe it I dont think. I also dont think he would be so quick to prescribe Parnate although I dont think it is the worst of ideas. I also not see him prescribing Savella unless we try out more alternatives. I know nothing about Savella? Why do you think it would be a good option, bleauberry?Are blood tests absolutely needed for all TCAs? Ive read that is very important with nortriptyline.
Ron1953, Klonopin actually did cause one impulsive episode and I feel like that was it. Subjective, yes, but I just got that feeling. I like the idea of a benzo with a long half-life because I really want to eat a benzo everyday. My PDOC is all PRN about it but then he prescribes me #60. Switch to diazepam?
In terms of tweaking the opioid system, I believe bleauberry was referring to my prior opiate addiction. I know that venlafaxine is related to Tramadol. I was taking buprenorphine (from the street) and it was not the worst antidepressant, but I don't want to continue that nor do I think I would get it prescribed since I'm no longer addicted to opiates.
So far, Im thinking Trileptal or Topamax. Does anyone think it might be better than Effexor for my symptoms?
(Des)venlafaxine monotherapy seems to be most likely. Is it true that SNRIs are more safe for Bipolars? I doubt itd increase anxiety like Wellbutrin. Its effects on NE are so ridiculous low that the term SNRI is a bit O_o to me. If not effective, like I said, continue to augment. Do you think that venlafaxine would be more effective than Trileptal or Topamax? Would about raising the dose of Lamictal? My PDOC says he never goes above 300mg.
Thanks for all the input!
Posted by LouisianaSportsman on May 12, 2012, at 19:03:06
In reply to Re: Suggestions for meds augmentation? (BP2, GAD, MDD), posted by LouisianaSportsman on May 12, 2012, at 18:41:02
I forgot to mention, I was considering Symbyax. I am dubious about it now since I'm not sure about Zyprexa and how strong it is and the side effects. I made a Microsoft Word document that contains graphs to give to my PDOC to encourage him to write me Symbyax.
It is a lot to read and I don't expect anyone to read the whole thing; regardless, I will post the plain text here. I am sorry that it does not reference the studies. Remember, this is a case I was making to my PDOC about prescribing me Symbyax.
---------------------***************************************
I would like to try Symbyax for Bipolar Depression/Anxiety and, also, as a way to possibly reduce clonazepam treatment. This front page explains my reasons and the subsequent pages are my evidence to back up my idea.
Symbyax allows the ability the concomitant efficiency of an antidepressant that is indicated for anxiety with the addition of Zyprexa, with similar effects as Seroquel XR, to protect against a manic episode. I would rather be on long-term Prozac (and low dose olanzapine) than long-term high-dose Seroquel. Zyprexa alone is not effective as a monotherapy like Seroquel XR; however, I believe the augmentation and synergistic effects of the Zyprexa and Prozac combination are superior to Seroquel XR in one convenient, name-brand, pill for easy titration. Dosing control is one problem; however, since we are aiming for below threshold antipsychotic effects (3mg.), the issue of dosage increase can be satisfied by augmentation of generic fluoxetine or an increase to a higher dose of Symbyax, I really like the synergistic feel of the one pill. 2.5mg. Xyprexa is not a high enough dose to function as an antipsychotic with D2 occupation similar to Seroquel XR 300mg. 2.5 mg. Zyprexa (due to lower H2 shown below) is proven to have less sedation than that dose of Seroquel with the same 5-HT2 occupancy even at such a low dose. 5mg Zyprexa = 50mg Seroquel = 3mg Risperdal.
I think Symbyax would be very effective for my Bipolar Depression/Anxiety. If not:
I can tell the effects of Zyprexa apart from Prozac; thus, continuation of fluoxetine treatment is a possibility with olanzapine discontinuation and if an adequate response from fluoxetine is not obtained, augmentation with Abilify, indicated for Bipolar, may be effective because I believe that AD + Abilify therapy is more effective and less sedating than 300mg. Seroquel XR.The use of Symbyax would be faster than a possible Seroquel XR failed attempt; especially due to similarities between the two, I can hedge my bets on the Symbyax or AD alone or AD + Abilify being more effective than Seroquel XR first-line; additionally, Symbrayx allows for less sedation and effects similar to Seroquel XR and on-label SSRI treatment for anxiety with prior positive response to Zoloft; which may reduce the need for clonazepam treatment.
Therefore, the properties of 3mg. Zyprexa are similar to the effects of Seroquel XR target dose, but a low dose of 3mg. Zyprexa might achieve these same effects with less sedation.(and not time released, although it does have a longer half-life)
1.The addition of Zyprexa 3mg. which has similar antidepressant properties as Seroquel XR to a proven antidepressant should reduce any side effects of mania.
2.Zyprexa might be less sedating that Seroquel XR 300mg and the 3mg. Zyprexa also carries a lower risk for TD. I would rather take low-dose olanzapine and Prozac over Seroquel.
3.The Seroquel-esque and anti-manic effects of Zyprexa augmented with a proven antidepressant should be more effective than Seroquel XR alone for Bipolar Depression.
4.Prozac is on-label for anxiety and may reduce the need for Klonopin.
The antidepressant effects are likely derived from effects at 5HT2c, 5HT1a agonism, and NRI effects.Olanzapine shares 5HT2C blocking properties with quetiapine. It is missing NRI and the partial 5HT1a agonism since it is a full agonist as one study points out; furthermore, the addition of fluoxetine adds the NRI effects of norquietapine via:
Study:
Fluoxetine, but not other selective serotonin uptake inhibitors, increases norepinephrine and dopamine extracellular levels in prefrontal cortex.Quietapine Affinities on Left; Olanazapine on the right. (I do realize it is missing the norquietapine metabolite)
D142831
D262611
5-HT1A1040?
5-HT2A 38 4
α1B 14.646.4
α2 6171290
H1 4.417
M1 108626
NET >10000>10000Zyprexa is less sedating than Seroquel due to (slightly) less H1 activity.
Olanzapine is full agonist at D2, HT-1A, and 5-HT2C. Although the affinity of quetiapine is lower than olanzapine for the 5-HT2C receptors in general, previous literature is quite consistent that quetiapine has similar structural properties to olanzapine and clozapine. A dose of 3mg. olanzapine would be around 40% of D2 receptor occupation with nearly all of the 5-HT2 occupation. It would take a dose of ~150mg. Seroquel to reach the same level of occupation. At 6mg., olanzapine would reach the antipsychotic threshold, thus possibly making amphetamine less effective for ADHD; however, this is not true for 3mg. olanzapine.Study:
Experience has shown olanzapine (Zyprexa) to be very effective against agitation and anxiety in patients with bipolar disorder.Study:
Prozac worked 76% of the time to reduce depression clinically below placebo for Bipolar patients who did not discontinue treatment.Study:
Fluoxetine monotherapy produced minimal improvement on various scales that rate severity of depression. The benefits of olanzapine
monotherapy were modest. Olanzapine plus fluoxetine produced significantly greater
improvement than either monotherapy on one measure and significantly greater improvement than olanzapine monotherapy on the other measures after 1 week. There were no significant differences between treatment groups on extrapyramidal
measures nor significant adverse drug interactions. CONCLUSIONS: Olanzapine plus
fluoxetine demonstrated superior efficacy for treating resistant depression compared
to either agent alone.Study:
Therefore, the large, sustained increase of [DA](ex), [NE](ex), and [5-HT](ex) in PFC after
olanzapine-fluoxetine treatment was unique and may contribute to the profound
antidepressive effect of the olanzapine and fluoxetine therapy in TRD.Study:
The uniqueness of the Prozac-Olanzapine combination is better than the combination of SSRI/SNRI + Abilify in the treatment of patients with TRD.Study:
"[Symbyax]-treated patients had significantly greater improvement than lamotrigine-treated patients in change from baseline across the 7-week treatment period on the Clinical Global Impressions-Severity of Illness scale ..."
In conclusion, fluoxetine may be a safe and effective antidepressant monotherapy for the short-term treatment of BP II depression with a relatively low manic switch rate. Fluoxetine may also be effective in relapse-prevention therapy in patients with BP II disorder.Article:
Fluoxetine appears superior to lithium in preventing recurrence of major depressive episodes in patients with bipolar type II, according to new research.Study:
Patients taking lithium were at risk of suffering a relapse much sooner than those on fluoxetine (Prozac), according to a study published online April 1st in the American Journal of Psychiatry. Moreover, the researchers found no significant difference in hypomanic symptoms between the two drugs.
Posted by LouisianaSportsman on May 12, 2012, at 21:30:22
In reply to Re: Suggestions for meds augmentation? (BP2, GAD, MDD), posted by LouisianaSportsman on May 12, 2012, at 19:03:06
I am thinking about starting Abilify, most likely at 5mg. I've read some good things about it and it seems like it's less prone to weight/sedation. I'm just scared about increased anxiety that some people seem to have experienced.
If it works, awesome.
If I get some benefit, it'd be a good way to start augmenting with additional medication.
5mg. would not be antipsychotic, right? I don't want to mess up the effectiveness of my Adderall.
Can the PDOC write #90 5mg. Abilify? I can see what it does at 5mg. I can half it and try a mere 2.5mg. and I can double it or triple it too.
Posted by papillon2 on May 13, 2012, at 0:18:47
In reply to Re: Suggestions for meds augmentation? (BP2, GAD, MDD) » bleauberry, posted by SLS on May 12, 2012, at 13:47:18
I would definitely have Dialetical Behavioural Therapy.
In terms of medication, low dose Lithium could help with rumination and also boost your anti-depressant. Side effects from Lithium are largely dose dependent.
You may find that you don't get any weight gain with Seroquel. You'll only know if you try. You can always stop it if it becomes an issue.
Posted by LouisianaSportsman on May 13, 2012, at 11:33:40
In reply to Re: Suggestions for meds augmentation? (BP2, GAD, MDD), posted by papillon2 on May 13, 2012, at 0:18:47
What anti-depressant are you referring to, papillon2?
Also, low-dose Lithium... it doesn't have to be in the "therapeutic range", right?
Posted by papillon2 on May 13, 2012, at 17:42:48
In reply to Re: Suggestions for meds augmentation? (BP2, GAD, MDD), posted by LouisianaSportsman on May 13, 2012, at 11:33:40
> What anti-depressant are you referring to, papillon2?
I didn't mention any medication officially classed as an anti-depressant.
Dialectical Behaviour Therapy is a practical form of psychotherapy. It greatly helps in teaching you how to cope with unpleasant emotions and thoughts. DBT hasn't cured me of my depression, but it has made it easier to live with.
> Also, low-dose Lithium... it doesn't have to be in the "therapeutic range", right?
It would be in the therapeutic range for augmenting an anti-depressent (in your case Zoloft) in the treatment of major depression, rather than the therapeutic range for someone with bipolar disorder in which it used strictly as a mood stabilizer. The therapeutic range for major depression is a lot lower than that for bipolar disorder.
Posted by LouisianaSportsman on May 13, 2012, at 19:33:39
In reply to Re: Suggestions for meds augmentation? (BP2, GAD, MDD), posted by papillon2 on May 13, 2012, at 17:42:48
I am not taking sertraline. I know my initial post was long and had the word Zoloft in it so I can't blame you for not noticing. I do know about the methods of DBT. Thanks for that advice, but I am more curious about which medication to try next.
My parents really are pushing for an AD since they have responded so well to them. I'm not as sure. I'll go get a panel done to see if my B12 levels have gone low again. Since I'll be going in for blood tests; I'll have them monitor my overall health. Perhaps add Inderal or verapamil(my BP fluctuates from good to bad and these might help anxiety a bit). My diet is very good.
My girlfriend said she has noticed some mood problems, but I don't notice.
Next visit to PDOC: Keep clonazepam at 0.5mg. BID. Raise Lamictal to 300mg QD, Adderall to 15mg. TID and:
Add Abilify and give it a shot. I read this paper: http://www.nature.com/npp/journal/v30/n11/pdf/1300803a.pdf
It seems as if I need to double my dose of amphetamine to get the same effect if I'm taking 20mg. Abilify. So we might have to continue to escalate the amphetamine dose if successful with Abilify. But amphetamine can still work, it appears.
I am also thinking about going to a Suboxone (buprenorphine) doctor.
This is the end of the thread.
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