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Conflicted About Abilify


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#1 opalking

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Posted 06 April 2013 - 03:03 PM

I have tried many SSRIs, SNRIs, AEs, AP, etc over the years for my depression and migraines.  I currently take 60mg of Cymbalta which doesn't do much for my mood but was a cure for long term urethral pain, so I have to stay on it.  I started Abilify 2mg about 9 months ago and didn't feel like it did much for my depression.  I have gained 12lbs (10% of my body weight) since then and am sleeping a LOT.  I have tried to go off of it twice and within days became severely depressed with suicidal ideations.  I stayed off a couple weeks and didn't get better, so I restarted it.

 

My pdoc has prescribed me Provigil to try but my insurance company denied it since it is off-label for depression.  I am currently appealing it but it could take months.

 

I feel pretty crappy on Abilify and hate the weight gain and sleepiness but without it, I am so much worse (worse than I remember being before I started it).  Even though 2mg is a low dosage, should I be weaning off when I try to get off it?  Could that help how I feel when getting off?  Is it withdrawal or could it be my actual new baseline without it?

 

Has anyone else heard of insurance problems with Provigil?  

 

Thanks for your advice!


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Past meds: Celexa, Effexor, Zoloft, Wellbutrin, Prozac, Lamictal, Seroquel, Lyrica, Depakote, Namenda, Abilify





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#2 VAL

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Posted 06 April 2013 - 03:35 PM

Abilify has a long half life and doesn't need a slow taper. If it were me (keeping in mind I'm no medical professional), I'd just go off it because if I'm remembering correctly, my last dose of Abilify before I went off (also for weight gain but after three glorious years on it) was 7.5. I had no withdrawal symptoms at all. So, if you have symptoms, it's probably your baseline because 2mg is almost as low as you can go.


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Current Meds: Lamictal 325mg, Wellbutrin XL 450mg, Neurontin 900mg, Klonopin 1.5mg, Saphris 10mg, Trazodone up to 200mg, Prozosin 2mg, Zyprexa 5mg PRN and Inderal 20mg PRN
Past Meds: Siniquan, Elavil, Imipramine, Zoloft, Seroquel, Abilify, Nardil, Emsam, Rozerem and Ambien
Current Non-psych: Soma 350mg PRN, Norco 10mg/325 PRN, Percocet 10mg/325 PRN, Advair, Nasonex, Ventolin PRN, Allegra, Avalide, Dexilant, Levothroxine, Pravachol


#3 opalking

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Posted 06 April 2013 - 04:15 PM

Thanks for that.  Well, until I can get on Provigil or something else, I think I have to stay on the Abilify then.  Since I get so bad when I try to get off of it.

 

Part of the problem is that I feel like I have to stay on the Cymbalta.  I suffered for 5 years with horrible urethral pain and tried everything to fix it before stumbling upon the Cymbalta cure.  But being on the Cymbalta means that I can't move on to try an MAOI, right?  Or even add on another SSRI/SNRI/TCA because of the risk of serotonin syndrome, correct?  Anyway, other than the Provigil, I feel like I'm running out of options.  I'm even willing to look into ECT but I'm not sure if they would consider me a candidate at this point.  But I feel miserable and am unable to work or do much of anything.


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Past meds: Celexa, Effexor, Zoloft, Wellbutrin, Prozac, Lamictal, Seroquel, Lyrica, Depakote, Namenda, Abilify


#4 SmokeInTheWind

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Posted 06 April 2013 - 04:27 PM

I am tapering off abilify. I have been on the drug for 3 years. I have gained 40 pounds, and have developed metabolic syndrome, which we are attributing to abilify. I tried going from 20 to 15 mg, and 2 days later I was a crying mess. My pdoc said my brain really likes this drug. I went right up to 20 mg and the symptoms disappeared in a day. Abilify has a half life of 75 hours, so a sensitive individual can get symptoms fairly quickly. I am currently at about 14 mg. I am tapering by taking a pinch off a tablet for 3-4 weeks, then a pinch and a scratch for another 3-4 weeks, etc. it is a very slow taper. I have not had any symptoms return at this taper. Good luck with your taper.
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#5 SmokeInTheWind

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Posted 06 April 2013 - 04:37 PM

Opalking, I am taking cymbalta and Wellbutrin together. ( And other meds. ) They are metabolized by the same pathway, so you need to be aware of that when adjusting dosages, and may lower seizure threshold further.
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#6 Anyone

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Posted 06 April 2013 - 06:16 PM

Thanks for that.  Well, until I can get on Provigil or something else, I think I have to stay on the Abilify then.  Since I get so bad when I try to get off of it.

 

Part of the problem is that I feel like I have to stay on the Cymbalta.  I suffered for 5 years with horrible urethral pain and tried everything to fix it before stumbling upon the Cymbalta cure.  But being on the Cymbalta means that I can't move on to try an MAOI, right?  Or even add on another SSRI/SNRI/TCA because of the risk of serotonin syndrome, correct?  Anyway, other than the Provigil, I feel like I'm running out of options.  I'm even willing to look into ECT but I'm not sure if they would consider me a candidate at this point.  But I feel miserable and am unable to work or do much of anything.

 

It is possible to safely add another SSRI/SNRI-type AD to Cymbalta.  I know that from personal experience, as I'm on the same Cymbalta dosage you are and am also on the max dose of Nefazadone (which is kind of an SNRI, but blocks certain receptors).  I have been for years, through at least two pdocs, none of whom was concerned about the combo.  Before I was on Cymbalta, I was on Zoloft, with Nefazadone-- and no pdoc was even concerned about that combo, either.

 

One reason may be that Nefazadone has fairly weak SRI action, and its biggest effect is blocking the 5-HT2A receptor, blocking the bastard stepchild of serotonin receptors.  I've read it theorized that overstimulation of that receptor is part of what causes serotonin syndrome.  So, Nefazadone's pharmacology may make it a safe add-on as far as serotonin syndrome is concerned.  Again, it has been for me for years.


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#7 VAL

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Posted 06 April 2013 - 10:47 PM

Opalking,

 

But being on the Cymbalta means that I can't move on to try an MAOI, right?  Or even add on another SSRI/SNRI/TCA because of the risk of serotonin syndrome, correct?

 

Absolutely true that Cymbalta and MAOI's can't be combined but the others could possibly be combined...depends upon the doctor as serotonin syndrome really doesn't happen that easily so some doctors would combine Cymbalta with other medications that inhibit the reuptake of serotonin. Doctors are different about how they react to certain things like a risk that might be real or one that is real only in theory. There is also Trazodone whose mechanism of action I don't understand but it's something like...antagonizes some serotonin stuff and inhibits reuptake of other serotonin stuff. The TCA's have some variability as to how strongly they work on serotonin. What was your experience like on Wellbutrin? Combining it with Cymbalta will add more Norepinephrine action which might be what your brain likes and so if it had any positive impact, you could try the combination.

 

I'm sorry to say that getting provigil approved by your insurance company for depression may be very difficult and I know there are some here who have tried and failed because it is apparently, very expensive and it's an off label use.

 

In the AAP class, have you tried Saphris or Latuda? If not, you might check out those sections of the forum to see how others rate them. I have found Saphris very effective for my depression and though I'm morbidly obese, I have lost weight while on it though with a radical diet...but, I didn't gain weight even without dieting. Latuda is described by many as being even more weight friendly and some have lost weight on it. If sleep is an issue, Saphris knocked me out cold in the beginning but I never once had a groggy or hungover feeling the next day... always woke very refreshed.


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Current Meds: Lamictal 325mg, Wellbutrin XL 450mg, Neurontin 900mg, Klonopin 1.5mg, Saphris 10mg, Trazodone up to 200mg, Prozosin 2mg, Zyprexa 5mg PRN and Inderal 20mg PRN
Past Meds: Siniquan, Elavil, Imipramine, Zoloft, Seroquel, Abilify, Nardil, Emsam, Rozerem and Ambien
Current Non-psych: Soma 350mg PRN, Norco 10mg/325 PRN, Percocet 10mg/325 PRN, Advair, Nasonex, Ventolin PRN, Allegra, Avalide, Dexilant, Levothroxine, Pravachol


#8 dymphna

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Posted 07 April 2013 - 01:04 AM

I have tried many SSRIs, SNRIs, AEs, AP, etc over the years for my depression and migraines.  I currently take 60mg of Cymbalta which doesn't do much for my mood but was a cure for long term urethral pain, so I have to stay on it.  I started Abilify 2mg about 9 months ago and didn't feel like it did much for my depression.  I have gained 12lbs (10% of my body weight) since then and am sleeping a LOT.  I have tried to go off of it twice and within days became severely depressed with suicidal ideations.  I stayed off a couple weeks and didn't get better, so I restarted it.
 
My pdoc has prescribed me Provigil to try but my insurance company denied it since it is off-label for depression.  I am currently appealing it but it could take months.
 
I feel pretty crappy on Abilify and hate the weight gain and sleepiness but without it, I am so much worse (worse than I remember being before I started it).  Even though 2mg is a low dosage, should I be weaning off when I try to get off it?  Could that help how I feel when getting off?  Is it withdrawal or could it be my actual new baseline without it?
 
Has anyone else heard of insurance problems with Provigil?  
 
Thanks for your advice!

Diagnoses:Depression
Current Meds:Cymbalta 60mg, Abilify 2mg, Topamax 200mg

Past meds: Celexa, Effexor, Zoloft, Wellbutrin, Lamictal, Seroquel, Lyrica, Depakote, Namenda

I notice that you haven't tried Risperdal.

IME, Abilify is a very personal drug (much more so than others) in that how it behaves is completely erratically. In some people, it lifts them up, in others, it knocks them flat. Then, if they take it, stop taking it for awhile, and start taking it again, they may have a completely different reaction to their initial one. It is truly a weird drug.

Risperdal, despite being seen as the mother of all mania squashers, is often a valuable component for mood stabilization cocktails. When a person does not "run extremely manic", it may be used in very small doses that don't lend themselves to weight gain. It also isn't a "I have teh dumbs" med.

All of that said, don't overlook the old APs; recent research has found that small doses of the original APs give as much if not better relief than higher doses of AAPs with no higher risk of adverse side effects. It turns out that the reason the AAPs where initially touted for "all of the benefits none of the risk" was simply due to the fact that AAPs hadn't been investigated or on the market long enough to see the long term effects.

As a final thing to consider: even though you may have tried different meds throughout the years, it is likely that you did not try each of them in isolation. Every med reacts differently within a cocktail: you may have taken drug X with drug Y and drug Z and it didn't work. But taking drug X plus drug Y plus drug Q might.

This may occur even within the dosing of a cocktail. e.g. Taking 100 mg of X drug plus 50mg of Y drug plus 2 mg of Z drug together may not work, but taking 100 mg of X drug plus 75mg of Y drug plus 1mg of Z drug may work.

For whatever reason, many docs tend to simply go up on doses when something isn't working, rather than adjusting the doses of the entire cocktail or simply switching out one component instead of adding another drug to counteract the side effects of something that isn't working for the patient. Also, they tend to change a bunch of things at once - this precludes finding the culprit drug.

It all comes down to advocating for yourself. If you started feeling like ass when Abilify was added, address that, and only that. Once you start adding things into the equation, you're going to get lost as to what is cause and what is effect.


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#9 tw0nk

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Posted 07 April 2013 - 04:40 AM

But being on the Cymbalta means that I can't move on to try an MAOI, right?

 

I have IBS and AD's seem to help with the pain.  I recall that Nardil helped with my IBS pain (although it increased constipation).  Replacing Cymbalta with an MAOI might deliver relief from both depression and the urethral pain.  Just a suggestion and unfortunately not guaranteed to work.  

 

 

 

My pdoc has prescribed me Provigil to try but my insurance company denied it since it is off-label for depression.  I am currently appealing it but it could take months.

 

I'm in the same boat - denied.  I got the price reduced from $1,000 to $700 by showing a needymeds "card" (print off from here http://www.needymeds.org/).  Then I ordered modalert from India which arrived after a couple of weeks, for about $60.  I've tried it twice but unfortunately I'm so all over the place at the moment (i.e. doing sh1t) I can't really say if or how it differs from Cephalon's "original".  

 

FYI as I've posted elsewhere on the site Provigil had a remarkable, near-instant positive effect on my depression.  As always though - YMMV.

 

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#10 notfred

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Posted 07 April 2013 - 07:18 AM

I am tapering off abilify. I have been on the drug for 3 years. I have gained 40 pounds, and have developed metabolic syndrome, which we are attributing to abilify. I tried going from 20 to 15 mg, and 2 days later I was a crying mess. My pdoc said my brain really likes this drug. I went right up to 20 mg and the symptoms disappeared in a day. Abilify has a half life of 75 hours, so a sensitive individual can get symptoms fairly quickly. I am currently at about 14 mg. I am tapering by taking a pinch off a tablet for 3-4 weeks, then a pinch and a scratch for another 3-4 weeks, etc. it is a very slow taper. I have not had any symptoms return at this taper. Good luck with your taper.

 

Easier said than done but loose the weight and the metabolic syndrome will go away.


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Dx: Major Depressive Disorder, Attention Deficit Disorder PI, Refractory Insomnia, CSA, Temporal Lobe Epilepsy, Dyspraxia, Tremor
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#11 opalking

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Posted 07 April 2013 - 08:29 AM

The last two times I tried Wellbutrin, it increased my migraines a lot.  

 

I think right now, if the Provigil doesn't get approved, I'm leaning toward swapping out the Abilify to try Latuda.  It's double the copay for me but worth a shot.  I have found that I can't do without the Abilify and yet I don't feel very good on it either and am really sick of the weight gain.  I'll let you know when I find out something more.


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Past meds: Celexa, Effexor, Zoloft, Wellbutrin, Prozac, Lamictal, Seroquel, Lyrica, Depakote, Namenda, Abilify



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