View Full Version : Abilify (questioning another trial)


netsavy006
03-02-09, 04:34 PM
While I may be having changes with Zyprexa Zydis, I'm feeling very strange this time. It feels like I'm falling into a depression. I can't take antidepressants anymore because they raise my risk of mania or hypomania (I've been on 4; Zoloft, Pexeva (a form of Paxil), Cymbalta, and Lexapro). I've even taken Strattera (if you want to count that as an anti-depressant) and it totally changed my personality. Strattera made me very agitated and irrtable. I was yelling/hollering/screaming at Mom for no reason at all. With Zoloft/Pexeva I had gotten manic and with Cymbalta I was on for less than 2 weeks. It made me confused and daydream a lot. Lexapro worked for the anxiety and depression for 2 years and then I had a manic episode on it. I was having racing thoughts, I was speaking too fast, and I was all over the place according to me and the doctor. So I had to be taken off of it in the hospital. I was placed on Abilify 15mg/day (divided as Abilify 5mg 3x/day). It really helped my symptoms but it caused restlessness, which not even 5mg of Valium 3x/day, nor Artane 2mg 3x/day could help. In the past not even 1mg Cogentin 2x/day was fully helpful, but Cogentin I think was helpful.

I don't know what to explain to the doctor tomorrow when I see her. She's a psychiatrist. We just got off of Abilify recently because of all the restlessness/akathisia and I know that Mom would be unhappy with me wanting to start over with it again. (especially since I've been on it for 5 other times at least). But I like the way I feel when I'm on Abilify despite the anxiety and restlessness. I like the emotional uplifting that it provides me.

Is there a way that I could take Abilify and not get the restlessness/akathisia? Could taking Cogentin 1mg 3x/day be better than Cogentin 1mg 2x/day? I know I'd have to get off the Artane first because they'd probably interact, but just a thought.

I just want to get over this bipolar mood swings. I don't like the mood state that I feel I'm in and I just want to get over the hump. Mom explains it as a withdrawal from all the med changes (which could be true, can't deny it) but I don't like the way I feel.

What can I do?

Thanks,
Andy...

netsavy006
03-03-09, 02:14 PM
Well I saw the psychiatrist today and through some luck (and crying) I was able to give Abilify a final shot. But with one word of caution. I have to manage the side effects on my own. I cannot be rushing to the ER, rushing to use the psychiatric on call service, or especially sign myself in to the hospital. One trip into the hospital, and I'm totally closed of from the building from where I'm getting my treatment. So I'm hoping that with Cogentin, Abilify and it's side effects will be easier to manage. I wish myself full luck as I manage my day to day routine. I'm on Abilify 5mg AM and Cogentin 1mg 2x/day to help manage the restlessness/akathisia side effect...

Song of Mercy
03-03-09, 02:51 PM
I hope with all thats in me that this will work for you. I am on abilify and am grateful not to struggle with side affects. I am able to think more clearly on abilify (nick name...ability.)

I would encourage you to be careful with the introspection. To much and then even small things seem big. I love your contributions to the community. I would also like to encourage you to explore some threads that will give you a chance to share your experience with others...it will encourage them and relieve you from worry.

Reaching out to others is a wonderful remedy for many of the trials and worries of life. I have been keeping an eye on your post and I know you have a world of knowledge to contribute.


Song

KFC in CA
03-03-09, 03:32 PM
You have alternatives. Wellbutrin is safe for many w/bipolar who cannot tolerate SSRIs or SNRIs. Mirapex is used off label and it's like Wellbutrin only milder. There is Geodon which is not known for much akathesia, but it does have a lot of antidepressant boost to it. There is mid-dose Seroquel. There is augmenting your T-3 thyroid hormone. There is Lithium. There is Lithium augmenting Lamictal or an AD. There are options besides Abilify should Abilify not work for you this time, either.

Scarletta
03-03-09, 06:49 PM
I really recommend against the Abilify for all the reasons I've stated before in your other threads. If you do take it, why not start with 2.5 mg a day, and take a max 5 mg a day. I did not have akathisia on 5 mg a day.

But I've also posted lots of other antidepressants for you that are not SSRIs. Why don't you look into those?

netsavy006
03-03-09, 06:58 PM
I really recommend against the Abilify for all the reasons I've stated before in your other threads. If you do take it, why not start with 2.5 mg a day, and take a max 5 mg a day. I did not have akathisia on 5 mg a day.

But I've also posted lots of other antidepressants for you that are not SSRIs. Why don't you look into those?

Because I worry that any (even non-SSRI) antidepressant could send me into a manic state. The doctor doesn't want me on an antidepressant either because of the mania/bipolar cycling risk.

I don't plan on taking more than 5mg/day of Abilify if I don't need to. But if I go off of Zyprexa Zydis 5mg and the Abilify 5mg per day is not enough, what do I do then? I would have to increase the dosage, right?

I'm too scared of the cardiac risks for Geodon, and the doctor doesn't understand that I don't think (or I'm not understanding what she was telling me, she mentioned something about getting to a cardiologist and being checked out first).

I need something that I can take with the anti-depressant properties (in my opinion) and Abilify seems like one of my only options, even if it does carry an akathisia risk.

Scarletta
03-03-09, 07:24 PM
First,what is your main diagnosis? Is it depression? Abilify alone is probably not that great for depression. It's more of an augmentation to another antidepressant. Abilify alone is an antipsychotic approved for bipolar and schizophrenia.

Zyprexa is also an antipsychotic.

If your problem is depression, you have to look into anti-depressants that do not have mania listed as one of their possible side effects. I can look those up for you. But let me know is depression the main problem?

netsavy006
03-03-09, 07:27 PM
At the moment, depression seems to be the main issue. I have bipolar 1 disorder - mixed episodes as my diagnosis. I don't usually get the depression. I usually struggle with the manic side of the illness. So to be feeling the depressive side is very odd for me. If you could find me something that would be especially helpful.

Thanks,
Andy...

Scarletta
03-03-09, 07:34 PM
OK, well I know now that you were diagnosed with bipolar, mixed episodes. You are usually more manic than depressive, but now seem more depressive. OK let me see what I can find.

Scarletta
03-03-09, 09:49 PM
Well what you seem to need is a mood stabilizer that is also effective against depression. Zyprexa is approved by the FDA for acute mania and may also help relieve psychotic depression, but it is mainly for acute manic episodes.

Most mood stabilizers are antimanic agents and anticonvulsants. The only ones that seem to treat both mania and depression are lithium and lamotrigine. Lithium is very effective but has a narrow therapeutic window so your blood levels need to be checked frequently. Lithium also is not an anticonvulsant. It also can be used in combination with another anticonvulsant (or antidepressant).

Other mood stabilizers can stop mania and so make you "normal," it stops the moods from cycling so in that way can keep away depression.

These are:
-valproic acid
-carbamazapine
-Gabapentin — Not FDA approved for bipolar disorder but used for it
-Oxcarbazepine - Not FDA approved for it
-Topiramate - Not FDA approved for it

Antipsychotics for it:
-Seroquel
-Geodon
-Abilify
-Zyprexa
-Risperidone
-Symbyax (combination of Zyprexa and Prozac, specifically approved for depressive episodes in bipolar

Of these, risperidone is used for treatment-resistant depression as well as bipolar, so that could be a good option.

I would recommend Symbyax except you've said you've had mania triggered by Prozac, which is contained within Symbyax.

Any of the antipsychotics can be used to treat bipolar and there are a ton of those, but these are the most common (that I've listed).

Since you're already on Topamax, maybe you should talk to your doctor about combining it with lithium. Lithium plus an anticonvulsant is a common treatment and could be very effective for your symptoms.

Or else consider Risperidone or lamotrigine.


But Zyprexa seems to focus more on the anti-mania aspects and I'm not sure if your doctor would want to keep you on that and combine it with lithium or an anticonvulsant (or if that's even advisable). You may want to switch altogether.

They say that Paxil and Wellbutrin are two antidepressants very unlikely to trigger manic episodes. Combining one of these with lithium might be an idea. Or combining one of these with Zyprexa.

Just some suggestions.

netsavy006
03-03-09, 10:09 PM
Thanks for the list.

Valporic acid (Depakote) I can't take. I've tried it in the past and the blood levels couldn't be stabilized. I was falling into a depression and after about 2 - 3 weeks of starting Depakote I went right back into the hospital.

The inpatient pdoc told me that Tegratol (carbamazapine) might not be a good fit for me, because there is something where the drug auto-motabilizes itself, so the dosage would always be needing adjustment. That would just be too much of a hassle for me.

The inpatient pdoc said he rarely prescribes Lamictal because it takes too long to get to a stable range. I know I'm outpatient now, but I don't know what my current pdoc would say about it.

In regards to the AAPs:

Seroquel 100mg - one dose made my hallucinations much much worse. I was seeing roaches all over the floor and I was seeing Ronald McDonald, the Wendy's girl and other things I don't remember. I know I can never take that one again.

Geodon - To scared of the heart/cardiac risks associated with it.

Abilify and Zyprexa I'm on now

Risperdal - I was on a low dose @ one time (.5mg/day) and 6 weeks into treatment I started getting tics so I had to stop taking it.

Invega (a 'newer' form of Risperdal) - It helped the psychosis I get, but caused other side effects, one of them being akathisia, but Artane was able to control it. Artane doesn't control the akathisia one bit with Abilify. I wish it did.

------

I tried Pexeva (a form of Paxil) in the past, and it sent me into a manic state. That and Klonopin put together sent me straight into a manic episode. I was yelling, screaming, hollering at my mom and then I went to the doctor and I did the same thing to her and then I started crying in front of the doctor and that's when she called 911 and sent me to the hospital. That was when I had my first ever hospitalization. Still prior to my Bipolar 1 Disorder dx...

------

I know you mention of Lithium, but Lithium scares me to death because of Lithium toxicity. I know they do blood work to help prevent it but I've heard from another forum that you have to go off of Topamax to be on Lithium because for one reason or another they don't "agree" with one another. It's not an interaction with the medications, it's that one affects the levels of the other I think. And I don't want to give up Topamax, not after reading about the good it can do.

I know you are trying to be helpful and all I'm doing is being a "bad boy" and refuting your responces but I'm just trying to express how I feel about each treatment presented. I hope this helps.

I'm hoping that Abilify in time will help with the depression, because it did in the past, it kept me stable but it always seemed to require 15mg. We never tried to see if I could stabilize on a lower dose so this will be one interesting ride. And I have Cogentin and Valium to help with the restlessness/akathisia side effect so hopefully that won't happen. I'm very hopeful with Abilify that it will do the job that it did before even @ a lower dosage.

Thanks for your help,
Andy...

KFC in CA
03-03-09, 10:34 PM
I've been on Geodon. It is no.big.deal! There are many other medicines, including a relatively common antibiotic that has a higher risk. Besides, it is only a risk if you have prolonged QT interval. You get a simple, 10 min lay on the bed and do nothing heart test first. No QT problem, not problem.

Geodon is not known for akathesia like Abilify. Personally, I think you are nuts to go back to Abilify when you have other options.

netsavy006
03-03-09, 10:44 PM
I've been on Geodon. It is no.big.deal! There are many other medicines, including a relatively common antibiotic that has a higher risk. Besides, it is only a risk if you have prolonged QT interval. You get a simple, 10 min lay on the bed and do nothing heart test first. No QT problem, not problem.

Geodon is not known for akathesia like Abilify. Personally, I think you are nuts to go back to Abilify when you have other options.

That may be KFC in CA, but you forget about family history. I have a family history of heart problems. My father has heart problems and my maternal grandmother had heart problems, so that kind of puts Geodon out of my favor there. I may be young but I don't want to put my heart at risk where I don't have to...

That doesn't mean I'm not putting my heart at risk with Abilify, I understand...

KFC in CA
03-04-09, 02:48 AM
That may be KFC in CA, but you forget about family history. I have a family history of heart problems. My father has heart problems and my maternal grandmother had heart problems, so that kind of puts Geodon out of my favor there. I may be young but I don't want to put my heart at risk where I don't have to...

That doesn't mean I'm not putting my heart at risk with Abilify, I understand...

Maternal grandmother = heart attack, dropped dead at 50
Maternal uncle = heart valve defects and other problems. Dead at 78 of heart failure.
Mother = heart murmur, palpatations, on heart meds, about to get a pace maker
Me = same heart problems as my mom only they have yet to progress to needing meds.
All = no QT Interval prolongation problem
Therefore...
Geodon = no problem
Teeth cleaning, however = problem. Take antibiotics... no problem.
Guess what else... My whole family tree could be filled w/QT interval problems, but as long as I don't have them, Geodon would not be a problem.

The heart may not be as complex as the brain, but it is a complicated little organ. People can have all different types of heart conditions. If they do not include prolonged QT interval, Geodon carries no greater heart risk than most meds.

Geodon was not a good med for me. I really don't care what med anyone takes.

My only point/irritation is that getting needlessly hung up on a consideration w/o bothering to find out if it even applies is all about creating anxiety and doing nothing productive.

Scarletta
03-04-09, 09:47 AM
It seems like you have an excuse not to try anything! There are only so many options- if you don't want to try them you'll have to live with what's going on now. But every drug has possible risks involved, and you have to weigh them against the quality of life you have now. For example, Lithium. It's been called a "wonder drug" for bipolars- and it's not that hard to monitor your blood levels.

But anyway, you can decide!

cthulhufhtagn
03-05-09, 12:51 AM
I'm also bipolar I, but I definitely think you shouldn't rule out atypical antidepressants when in combination with mood stabilizers/antipsychotics.

my doctor would always start me on the latter before trying me on an antidepressant; when I was younger before I was diagnosed with bipolar I got put on Zoloft and became horrendously manic [like. paranoid, psychotic, no sleep, no eating, wouldn't leave the house to keep my doctor's appointment to discuss the problems I was having, etc...] but I'm currently on Seroquel and Wellbutrin for this and Concerta for ADHD with no issue - the stimulants have a higher risk of inducing mania than atypical antidepressants such as Wellbutrin or others mentioned.

Technophiliac
06-03-09, 04:22 AM
From the wikipedia entro on Akathisia.

"One study showed that vitamin B6 (http://en.wikipedia.org/wiki/Vitamin_B6) is effective for the treatment of neuroleptic-induced akathisia.[9]" (http://en.wikipedia.org/wiki/Akathisia#cite_note-8)

worth a try? Just got prescribed 10mg + ritalin 5mg myself. hopefully it helps with the anxiety. Previously on risperdal + ritalin but felt way too knocked out and had facial/arm tics... hoping this goes better for me. read ages ago that magnesium and vitamin b6 helped ADHD significantly so im gonna try that combination.