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New Med Combo: Lithium + Prozac + Abilify


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8 replies to this topic

#1 pennylover

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  • Current Meds:Prozac (20 mg), lithium (1200), abilify (2.5), buspar (40), atavan (prn)

Posted 07 May 2012 - 06:08 PM

Hi all,

I was recently able to get a 2nd pdoc opinion for the first time, and he feels that I'm BPII. I've always felt that my depression dx from my primary pdoc leaned fairly fair to the right in the bipolar spectrum, so this is ok. I haven't had any hypomania in ages though, and though I miss it, since the depression has been so bad and unrelenting, it can get pretty nasty for me when things go in that direction. That said, the 2nd pdoc recommended I add abilify to my current regimen of prozac and lithium.

Med background: lithium has helped me more than anything else. That with prozac worked for a long time, till the prozac pooped out. Wellbutrin was too activating, as was effexor. Went off cymbalta recently due to terrible side effects after missing only one dose--went back on prozac to counterract the withdrawl from cymbalta.

I'm wondering if others have experience with this combo? I am so new to abilify--it's an atypical antipsychotic(?!), and how it works in conjunction with the other two, esp. lithium.

In a little over a week of adding abilify, I've noticed my mood improve greatly. I'm a little scared, I haven't felt this good in a LONG time! I'm also in the 6th week of an intensive CBT program--that's helping immensely, too, so it's hard for me to say what's what. I just hope that I'm plain old feeling happiness, and not skating into mania and more darkness.

Thanks,

G
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#2 pennylover

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  • Current Meds:Prozac (20 mg), lithium (1200), abilify (2.5), buspar (40), atavan (prn)

Posted 08 May 2012 - 02:40 AM

downside to abilify: insomnia. It's 2:30 a.m. and I'm wide awake. Fell asleep around 10:30, this is my 2nd time up. My consulting pdoc/2nd opinion recommended I go off trazodone when I started abilify, which I used as a prn for sleep. I didn't really understand why? any ideas? Try something else for sleep?

Thanks,

G
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#3 bipolar librarian

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Posted 08 May 2012 - 05:31 AM

How long have you been on the abilify?

I would be concerned and hesitant to simply add something on top of the abilify for sleep. I tried abilify once in an attempt to find something less sedating and more weight-neutral than seroquel. I promptly started waking up bright-eyed at 4 or 4:30 in the morning. After several years of having to sleep 9-10 hours on the seroquel, this was such a welcome change that it didn't occur to me that it wasn't a good thing. A few weeks of this was followed by one of the more crushing depressions I've ever had. Afterward, looking at my other behaviors, I realized that my early-bird stuff was a pretty severe hypomanic episode for me.

If you're a little scared as to how good you feel, be concerned. Abilify is a great drug for those who tolerate it, but it did a number on me. I had much better luck with seroquel in terms of lifting the depression while keeping my mood stable.
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Dx Bipolar II 11 years ago
Current meds: Lamotrigine 300mg, lithium 300 mg, latuda 40 mg, xanax .25 mg PRN, synthroid 200 mcg, fish oil
Meds used prior to now: Prozac, Buspar, Zoloft, Wellbutrin, mirapex, abilify, seroquel, NAC


#4 pennylover

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  • Current Meds:Prozac (20 mg), lithium (1200), abilify (2.5), buspar (40), atavan (prn)

Posted 08 May 2012 - 07:31 AM

I've been on the abilify for about 2 weeks. Are you saying the sleeplessness could be a sign of hypomania? And that I shouldn't take anything for sleep? In a way, it really beats the 16 hours a day I spend asleep when I'm depressed. . .

did I mention I use atavan as a prn for sleep--it helps me fall asleep, but I'm not staying asleep is the problem.

when you had your episode, where you on any mood stabilizers? I take lithium.

Thanks,
G
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#5 pennylover

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  • Current Meds:Prozac (20 mg), lithium (1200), abilify (2.5), buspar (40), atavan (prn)

Posted 08 May 2012 - 07:35 AM

I've been on the abilify for about 2 weeks. Are you saying the sleeplessness could be a sign of hypomania? And that I shouldn't take anything for sleep? In a way, it really beats the 16 hours a day I spend asleep when I'm depressed. . .

did I mention I use atavan as a prn for sleep--it helps me fall asleep, but I'm not staying asleep is the problem.

when you had your episode, where you on any mood stabilizers? I take lithium.

Thanks,
G
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#6 bipolar librarian

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Posted 08 May 2012 - 11:49 AM

I probably did not phrase part of my message well, as I do NOT want to tell you not to take something for sleep against the advice of your pdoc. Nope, nope, nope, don't want to go there and not what I intended.

My concern was that if the Abilify is causing you any serious problems, beyond just the sleep, you may want to address that with your pdoc first. If Abilify is a bad fit, slapping something on top to induce sleep may simply be a temporary band-aid.

I was on lamotrigine when I took the Abilify. As to whether you could be hypomanic, I can only speak to my own experience -- and I was hypomanic on abilify until the Great Crash (so bad, it deserves title case...). My initial issue was staying asleep, not falling asleep. I was waking up at 4 or 4:30 rarin' to go. At first, it seemed like a great benefit. Oops! Same thought as I hear from you -- after having to sleep 10 hours a night just to cope, the sleeplessness beat the sedation.

I only realized afterward that I'd been into hypomania. I think you need to ask yourself if you have any other indications that you might be hypomanic, and not just sleep-disturbed. Not sleeping and not missing it can be a symptom of hypomania, but there are other signs as well. I'm not telling you you are hypomanic -- just encouraging you to evaluate that as a possibility.
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Dx Bipolar II 11 years ago
Current meds: Lamotrigine 300mg, lithium 300 mg, latuda 40 mg, xanax .25 mg PRN, synthroid 200 mcg, fish oil
Meds used prior to now: Prozac, Buspar, Zoloft, Wellbutrin, mirapex, abilify, seroquel, NAC


#7 pennylover

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Posted 08 May 2012 - 09:43 PM

I met with my 2ndary pdoc today, and he recommended I try klonopin instead of my usual ativan as a prn for sleep, as it has a longer half life. I think that's how he explained it.

As far as other signs of hypomania go, I'm unclear, just concerned. I've been so deeply depressed for so long, it feels strange to feel anything that even approaches happiness. I'm feel good, and am very wary of veering into grandiosity, arrogance, etc. I'm not even sure what to look out for. I like having some self-esteem, how do I know when I'm crossing the line?

I really appreciate your experience and feedback. What are your signs, aside from sleeplessness, that you're slipping into hypomania? I was so happy the other night about something I had accomplished, I called my mother, and she immediately thought I was being manic. It really hurt, and now, if that's how my loved ones see it, I'm fearful. Can't I just be happy?


Thanks again,

G
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#8 ci317

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Posted 09 May 2012 - 07:01 AM

Pennylover,

Good to hear that your cbt is working, didn't work for me but cool to hear it's going well for others. I can relate on the family stuff, they are tough to deal with sometimes. If I was the slightest bit unenergetic my dad would tell me my meds aren't working and I should go talk to a doctor. If I was hypomanic it changed to him saying I should come off meds and that my body has healed itself. Depression is a tough subject to understand from the outside.

You might want to take a look at the prozac, SSRIs can create bad reactions for some with bipolar. I would give melatonin a try. It's OTC and has few side effects. The other possibility is if you aren't satisfied in the long run with your current meds switch over to an antipsychotic. Geodon, Zyprexa, or Seroquel could help with the bipolar and also make you drowsy enough to sleep.
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#9 bipolar librarian

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Posted 09 May 2012 - 08:09 AM

What are your signs, aside from sleeplessness, that you're slipping into hypomania?


For me, my typical is:
Pressured speech
Taking on too many projects
Irritability
Agitation
Impulsivity
Wanting OUT -- of job, marriage, etc
Generally feeling like I'm on that 1st hill of the roller coaster going up the chain and waiting for the drop

I don't typically overspend, even when manic, but I did find myself spending and giving away money more on abilify than on other drugs or even unmedicated. Not so much I got myself in trouble, but definitely more than usual.

My experience is that I don't notice when I get pressured speach but my counselor does. Do you have a good counselor who knows you and has a good sense of when you're going manic or depressive? if your mom thought you were manic, you might want to ask her specifically why.

It's hard to know when you're crossing the line, but over time you develop that capacity to evaluate. I also know that after being down, down, down, ANYTHING good feels better, even if you are crossing that line. Depending on your particular wiring and background, you may not get the full list of symptoms. eg -- you might get pressured speech, but not the grandiosity. It's a good idea to write yourself down a list of YOUR particular red flags of when you are going hypomanic. Mine includes wanting to quit my very good job and divorce my wonderful husband. When I start thinking that way, since it's on my list I can slow down and say whoa, my mind ain't right at the moment, let's calm down, not make any irrevocable decisions and try to get back on track.
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Dx Bipolar II 11 years ago
Current meds: Lamotrigine 300mg, lithium 300 mg, latuda 40 mg, xanax .25 mg PRN, synthroid 200 mcg, fish oil
Meds used prior to now: Prozac, Buspar, Zoloft, Wellbutrin, mirapex, abilify, seroquel, NAC



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