View Full Version : Next Choices??


netsavy006
11-07-07, 08:29 PM
Just asking a generalization question.

From your standpoint, here's what I've tried:

Risperdal, Invega, Zyprexa, Abilify

All of which give me side effects. What other choices are there? I know lots, like I know Seroquel could be added to the list, but like Zyprexa will probably make me very tired. Geodon I'm aware of too, but can cause heart problems which is bad considering the risk of heart problems already from a large family history of it.

I don't want anyone to play doctor here, but I'm trying to evaluate my own needs as well as make sure I'm not doing the "wrong" thing.

Matt S.
11-08-07, 10:16 AM
have you ever heard of DBT? or the Skills Training Manual for Borderline Personality Disorder?

I think that mindfulness is a good thing for a lot of people.

On another related topic, I doubt anyone here will have advice to give you from experience because you are switching medications every two weeks.

Have you ever been diagnosed with Borderline Personality disorder? I ask only because I know some borderlines that are on new meds every week and I observe other issues you have and it suggested that to me. Maybe you should ask your doctor about that possibility. It's common and treatable.

netsavy006
11-08-07, 05:28 PM
I'm not wanting to change meds every other week but I'm having tics from the abilify that have not gone away. I've also had tics from zyprexa, invega, and risperdal. I don't think it's a good idea to continue meds when you are geting a negative reaction from them. Am I right?

netsavy006
11-09-07, 02:38 PM
have you ever heard of DBT?...No. What is it?

Matt S.
11-09-07, 04:55 PM
Dialectical behavioral therapy

Dialectical behavioral therapy (DBT) is a psychosocial treatment developed by Marsha M. Linehan (http://en.wikipedia.org/wiki/Marsha_M._Linehan) <SUP class=reference id=_ref-0>[1] (http://en.wikipedia.org/wiki/Dialectical_behavioral_therapy#_note-0)</SUP> specifically to treat individuals with borderline personality disorder (http://en.wikipedia.org/wiki/Borderline_personality_disorder). While DBT was designed for individuals with borderline personality disorder, it is used for patients with other diagnoses as well.

The treatment itself is based largely in behaviorist (http://en.wikipedia.org/wiki/Behaviorism) theory with some cognitive therapy (http://en.wikipedia.org/wiki/Cognitive_therapy) elements as well. Unlike cognitive therapy it incorporates mindfulness (http://en.wikipedia.org/wiki/Mindfulness) practice as a central component of the therapy.

There are two essential parts of the treatment, and without either of these parts the therapy is not considered "DBT adherent."

1. An individual component in which the therapist and client discuss issues that come up during the week, recorded on diary cards and follow a treatment target hierarchy. Self-injurious (http://en.wikipedia.org/wiki/Self-harm) and suicidal (http://en.wikipedia.org/wiki/Suicide) behaviors take first priority, followed by therapy interfering behaviors. Then there are quality of life issues and finally working towards improving one's life generally. During the individual therapy, the therapist and client work towards improving skill use. Often, skills group is discussed and obstacles to acting skillfully are addressed.

2. The group, which ordinarily meets once weekly for about 2-2.5 hours, in which clients learn to use specific skills that are broken down into 4 modules: core mindfulness skills, emotion regulation skills, interpersonal effectiveness skills and distress tolerance skills.




[edit (http://en.wikipedia.org/w/index.php?title=Dialectical_behavioral_therapy&action=edit&section=2)] Biosocial theory (http://en.wikipedia.org/wiki/Biosocial_theory)

"DBT is based on a biosocial theory of personality functioning in which BPD is seen as a biological disorder of emotional regulation. The disorder is characterized by heightened sensitivity to emotion, increased emotional intensity and a slow return to emotional baseline. Characteristic behaviors and emotional experiences associated with BPD theoretically result from the expression of this biological dysfunction in a social environment experienced as invalidating by the borderline patient." <SUP class=reference id=_ref-1>[2] (http://en.wikipedia.org/wiki/Dialectical_behavioral_therapy#_note-1)</SUP>



[edit (http://en.wikipedia.org/w/index.php?title=Dialectical_behavioral_therapy&action=edit&section=3)] Cognitive behavioural therapy





<DL><DD>See also: Cognitive behavioural therapy (http://en.wikipedia.org/wiki/Cognitive_behavioural_therapy) </DD></DL>"One of DBT's several elements is cognitive– behavioural therapy (CBT). DBT espouses the scientific ethos. It makes use of self-monitoring, there is an emphasis on the here and now and much of the therapeutic technique is borrowed from CBT, including the style of open and explicit collaboration between patient and therapist. Furthermore, the treatment has a manual. The ‘bible’ of DBT is Linehan's Cognitive Behavior Treatment of Borderline Personality Disorder (1993a). (She says that her publisher insisted on ‘cognitive behavior treatment’ because they felt that a title including the word dialectical was less likely to sell well, particularly in the USA.) "<SUP class=reference id=_ref-2>[3] (http://en.wikipedia.org/wiki/Dialectical_behavioral_therapy#_note-2)</SUP>





[edit (http://en.wikipedia.org/w/index.php?title=Dialectical_behavioral_therapy&action=edit&section=4)] Zen





<DL><DD>See also: Zen (http://en.wikipedia.org/wiki/Zen) </DD></DL>"DBT utilizes Zen concepts as a basis to encourage patients to be mindful in the current moment, see reality without delusion, and accept reality and themselves without judgment. This skill, which has its roots in Western contemplative and Eastern meditative practices, is called mindfulness (http://en.wikipedia.org/wiki/Mindfulness)." <SUP class=reference id=_ref-3>[4] (http://en.wikipedia.org/wiki/Dialectical_behavioral_therapy#_note-3)</SUP>





[edit (http://en.wikipedia.org/w/index.php?title=Dialectical_behavioral_therapy&action=edit&section=5)] The Dialectic





<DL><DD>See also: Dialectics (http://en.wikipedia.org/wiki/Dialectics) </DD></DL>"As a world view... dialectics anchors the treatment within other perspectives that emphasize: 1. the holistic, systemic and interrelated nature of human functioning and reality as a whole (asking always "what is being left out of our understanding here?"); 2. searching for synthesis and balance, (to replace the rigid, often extreme, and dichotomous responses characteristic of severely dysfunctional individuals); 3. enhancing comfort with ambiguity and change which are viewed as inevitable aspects of life." <SUP class=reference id=_ref-4>[5] (http://en.wikipedia.org/wiki/Dialectical_behavioral_therapy#_note-4)</SUP>





[edit (http://en.wikipedia.org/w/index.php?title=Dialectical_behavioral_therapy&action=edit&section=6)] The four modules

The purpose of the DBT skills in all four skill sets is to help the client get into a state of mind referred to in DBT as wise mind. Wise mind is the middle ground in the dialectic between rational mind and emotional mind. To be too far on the side of rational mind would mean focusing only things such as facts and figures; ignoring and suppressing emotion. To be too far on the side of emotional mind would mean being so blinded by strong emotions that one would not be able to consider the facts.



[edit (http://en.wikipedia.org/w/index.php?title=Dialectical_behavioral_therapy&action=edit&section=7)] Mindfulness

The essential part of all skills taught in skills group are the core mindfulness (http://en.wikipedia.org/wiki/Mindfulness_%28psychology%29) skills.

Observe, describe, and participate are the core mindfulness what skills. They answer the question, "What do I do to practice core mindfulness skills?"
Non-judgmentally, one-mindfully, and effectively are the how skills and answer the question, "How do I practice core mindfulness skills?"
Mindfulness comes from the Buddhist (http://en.wikipedia.org/wiki/Buddhist) tradition and can be read about in more detail in the book The Miracle of Mindfulness by Thich Nhat Hanh (http://en.wikipedia.org/wiki/Nhat_Hanh) (among others).



[edit (http://en.wikipedia.org/w/index.php?title=Dialectical_behavioral_therapy&action=edit&section=8)] Interpersonal effectiveness

Interpersonal response patterns taught in DBT skills training are very similar to those taught in many assertiveness and interpersonal problem-solving classes. They include effective strategies for asking for what one needs, saying no, and coping with interpersonal conflict.

Individuals with borderline personality disorder frequently possess good interpersonal skills in a general sense. The problems arise in the application of these skills to specific situations. An individual may be able to describe effective behavioral sequences when discussing another person encountering a problematic situation, but may be completely incapable of generating or carrying out a similar behavioral sequence when analyzing his/her own situation.

This module focuses on situations where the objective is to change something (e.g., requesting someone to do something) or to resist changes someone else is trying to make (e.g., saying no). The skills taught are intended to maximize the chances that a person’s goals in a specific situation will be met, while at the same time not damaging either the relationship or the person’s self-respect.



[edit (http://en.wikipedia.org/w/index.php?title=Dialectical_behavioral_therapy&action=edit&section=9)] Distress tolerance

Most approaches to mental health treatment focus on changing distressing events and circumstances. They have paid little attention to accepting, finding meaning for, and tolerating distress. This task has generally been tackled by religious and spiritual communities and leaders. Dialectical behavioral therapy emphasizes learning to bear pain skillfully.

Distress tolerance skills constitute a natural development from mindfulness skills. They have to do with the ability to accept, in a non-evaluative and nonjudgmental fashion, both oneself and the current situation. Although the stance advocated here is a nonjudgmental one, this does not mean that it is one of approval: acceptance of reality is not approval of reality.

Distress tolerance behaviors are concerned with tolerating and surviving crises and with accepting life as it is in the moment. Four sets of crisis survival strategies are taught: distracting, self-soothing, improving the moment, and thinking of pros and cons. Acceptance skills include radical acceptance, turning the mind toward acceptance, and willingness versus willfulness.



[edit (http://en.wikipedia.org/w/index.php?title=Dialectical_behavioral_therapy&action=edit&section=10)] Emotion regulation

Individuals with borderline personality disorder and suicidal individuals are frequently emotionally intense and labile (http://en.wikipedia.org/wiki/Labile_affect). They can be angry, intensely frustrated, depressed, or anxious. This suggests that these clients might benefit from help in learning to regulate their emotions. Dialectical behavioral therapy skills for emotion regulation include:

Identifying and labeling emotions
Identifying obstacles to changing emotions
Reducing vulnerability to emotion mind
Increasing positive emotional events
Increasing mindfulness to current emotions
Taking opposite action
Applying distress tolerance techniques
<SUP class=reference id=_ref-5>[6] (http://en.wikipedia.org/wiki/Dialectical_behavioral_therapy#_note-5)</SUP>http://en.wikipedia.org/wiki/Dialectical_behavioral_therapy

It's an accurate Wikipedia article.

netsavy006
11-09-07, 05:02 PM
I had a group meeting (me, mom, therapist, pdoc) and right now, I'm just taking Pexeva. I wish the doc would try Seroquel before we give up.

Matt S.
11-09-07, 05:08 PM
I think you are an adult right? I will shut up I am going to just say that medication should ideally be between you and your doctor, not the mother and the therapist, if someone tried to make me do a group meeting, they would be told to get ******.

netsavy006
11-09-07, 05:27 PM
Well they wanted to have my mothers input since she lives with me and sees how I am and stuff. The therapist made the suggestion to have the group meeting.

I was looking seroquel up in the physision information and it stated that seroquel effects alpha 2 recepters just like clonidine (clonidine did help me but too many side effects) in addition to dopamine of course.

Crazy~Feet
11-09-07, 09:08 PM
All of which give me side effects...Zyprexa will probably make me very tired.
As I have stated to you repeatedly...how do you KNOW if you haven't even tried it? It appears to me that you are seeking Medication Utopia and that you are doing exactly what your doctor thinks you are doing: micromanaging your medications.

I don't blame your doctor one bit for giving up. I think that he has probably been a saint up until now.

Sometimes you have to do a risks vs. benefits evaluation. If your symptoms are making you miserable, you seek relief. It's a very simple process. Tearing down every medication for possible side effects, then magically manifesting them seems very counterproductive. You were convinced you were having some effect from the Abilify, a dystonic reaction, that you simply were NOT having! The only reason I can imagine that you would even think such a thing is that you read about the possibility and leapt to an erroneous conclusion.

I wonder if the doctor said you were too uncomfortable on the medication or if YOU said you were too uncomfortable. I would imagine that when subject to a barrage of continuous complaints, a doctor would discontinue a medication...to save his own ears.

netsavy006
11-09-07, 09:25 PM
Well when I was speaking to the doctor about the side effects I was trully having, he did tell me that it sounds like I'm too uncomfortable on the medication. Zyprexa I did try. It did indeed make me very drowsy. I had 2 cokes that morning and I still was drowsy. Plus, with Zyprexa, I had surges around my heart area, making it feel like I was having a heart attack. the above was a mistake as I've taken Zyprexa not too long ago. I have a fairly recent post in the co-exisiting medications on that.

The only 2 atypicals left that I know I haven't tried are Geodon and Seroquel
The ones I've tried all of which gave me tics (tics being noted by my mom):
Risperdal, Invega, and Abilify. I was really hoping for abilify to work so I could stop this medication circle of trying different medications.

Matt S.
11-10-07, 12:25 PM
that's where DBT skills can help Andy, you learn coping skills that reduce the symptoms you have, I can guess that you are most likely 'very sensitive' from what you describe, yes I will just go with 'sensitive' since it correlates with your current diagnosis, which is always subjective by the way, but yeah, back to my point, look into a DBT program, if you like group meetings and the 'sick' role DBT is right up your alley.

netsavy006
11-10-07, 04:12 PM
That's what I was told. That I was sensitive to medications.

netsavy006
11-11-07, 04:34 PM
Does it make since that an anticonvulsant in combination to an anti-psychotic could help with the twitches. I know they're not convulstions but since they affect that area of the brain maybe... I hate to play doctor but I do see him on Tuesday and I wanted to ask should any of this make since.