What combination of psychiatric drugs has worked to improve your lifestyle? Ask me ?s

[Geaux Tigers!]

klonopin, ambien, paxil, vistaril
i am not sure the paxil and vistaril do anything, as they sure don't help on their own. i accept this full cocktail because it's the smart thing to do.
i am diagnosed with OCD and generalized anxiety. past diagnosis include major depressive disorder and cluster b. i think if i qualify for any cluster now, it's most likely c. i don't trust the diagnosis i got as a teen though.
it's panic/anxiety now, and the OCD which used to manifest itself in externalized rituals has very much internalized


i abuse opiates and alcohol when i do not have meds. i likely need ongoing therapy to keep myself clean from other drugs once i am on my meds, as then it's a matter that therapy can help and not a need to balance my brain chemistry. (back when i was on my meds, environmental factors and emotional ones were the only triggers to want to use anything else, and were easily avoidable with the right measures)


klonopin, ambien, paxil, and vistaril was the prescription i took that changed my life. nothing else worked in 12 years of mental health issues/many, many different meds and dosages and combos
i believe an old psych i had actually gave me some drug that wasn't even a psych med but increased my dopamine directly, in hopes it would work


yr welcome

You had no positive response to Paxil? Why did you continue on the drug? Same thing with the Vistaril. Sounds like the Klonopin is what is really alleviating your symptoms. Would you feel like benzodiazepine maintenance is really the only thing helping you? I would suggest tapering off the Paxil and ditching the Vistaril and going solo on the Klonopin to see how this works. There is no reason to be taking a SSRI if it really didn't help you. I am glad that you're stabilized and don't need anything else.

I'm glad that you have found a combination that has changed your life! Yes, you definitely need to continue with therapy; it is more effective than any drug that I could write.

I am very open to the idea of using buprenorphine as an antidepressant. I think that it would help you.

Do opiates relieve social anxiety/OCD for you as effectively as your prescription drugs?

 

[Geaux Tigers!]

My daily meds are and have been for about 3 years:

4mg Risperidone
250mg Clomipramine
2000mg Sodium Valproate
I also have Temazepam and Quetiapine prescribed to take "as needed", and completed a course of ECT approximately 3 years ago.

I don't really know what my diagnosis is anymore, Bipolar-OCD-Schizophrenia-Depression-Anxiety?

As for illegal/recreational drugs, I have experimented with a number of drugs and was a daily cannabis smoker for around 14 years (on a hiatus of about a year now), and am a sober alcoholic (again, about a year of abstinence) but the only one I use that I would classify as "abusing" at the moment is caffeine in the form of coffee and energy drinks.
Large doses help combat the tiredness that is a common side-effect of all of the above drugs, and I do shift work at odd hours.

As for what has worked for me, my current meds, along with a course of ECT seem to keep things to the point where I can just hold down a job and support my family. Having said this, I am not happy with the trade-off of the side effects and
plan on changing/reducing my meds with consultation with my psychiatrist.

Jean-Paul has some excellent advice there for treating patients.

I find this to be an interesting cocktail, it sounds like you have a skilled psychiatrist. What side effects do you have from these medications? I think the likely cause of most of your side effects would be the risperidone. Have you tried Geodon or another antipsychotic?

I would write you armodafinil (Nuvigil) for your tiredness. I think it would be a crucial drug to add and the first thing I would do if I was your doctor. I think it might help with the side effects of the other medications too.

I’m glad to see that you’re doing OK, but I know things can be better for you. Congratulations on your pseudo-soberness. Jean-Paul is very interesting! I would add Nuvigil and see how it goes and then probably change you to Geodon or another atypical antipsychotic (Saphris), these tend to have less acute side effects.

Thanks for your response. Feel free to follow-up.

 

[Geaux Tigers!]

Mirtazapine and benzodiazepines (zolpidem, alprazolam, nitrazepam) give me sleep and benzodiazepines relieves anxiety (surprise). No SNRI/SSRI I've tried ever helped me in any way so I'm currently weaning off them. I have been diagnosed with major depression (past) and avoidant/mixed personality disorder with social anxiety. I think I've never met true professional in this area, but I don't think medicines are the solution to my problems anyway so i'm done with them, except for the symptomatic meds.



Opiates and occasionally benzodiazepines. Low dose Naltrexone helps me not becoming dependent and avoid withdrawal, keeps my tolerance down too, but i'm still addicted mentally.



Abusers with co-existent mental health issues (which most abuser have in my view) should be treated as whole, not separately.

I wish I knew your past medication history. I understand the benzodiazepines being effective. Are you on an antidepressant dose of mirtazapine (above 15mg.)? I would suggest trying an antidepressant dose of mirtazapine or try doxepin. Have you tried doxepin? Also, I think an atypical antipsychotic like Abilify might help as well. I would write you Abilify first thing. Is the nitrazepam really necessary?
Low dose naltrexone is very interesting to me. I plan on using it with an opiate-dependent patient that did not accept my referral to a Suboxone doctor. It works well for you?

Thanks for your advice as well. Feel free follow up with me.

 

[Geaux Tigers!]

OP, I have some questions. What are your thoughts.

1. I have a problem with the daily prescriptions of amphetamines for ADHD or whatever else.
My opinion is that the serious addiction amphetamines and meth can cause is related to the use of this type of drug for functional purposes.
Attempting to come of a drug like this when its being used to perform better in life and for work is incredibly difficult because you feel you need it to live.
Im sure this often leads to abuse of the more serious amps like meth.
How can doctors justify the risk of daily amp prescriptions. Can the reward truly justify the risks?

2. Daily Benzo prescriptions for Anxiety and sleep
Similar to above but with the serious dependance and physical addiction they can cause, how can medical professionals prescribe these daily since that will should pretty much ensure serious dependance on the drug

3. I have been treated very successfully with Paxil for anxiety and PTSD for 7 years so far caused by serious MDMA abuse (consecutive days, OD level dosages etc) culminating in a week of bad SS and derealization/depersonalization when i stopped this drug forever. I believe physical damage was caused by this abuse.

The anxiety and PTSD (caused by a armed robbery event) would create serious obsessive hyper vigilance behavior which was very difficult to function or to sleep since i would be forced to physically monitor and check up on sounds and my surroundings for danger.

What the paxil did for me was not remove the fear but it removed the obsessive behavior so i would not be forced to check every little sound for danger and it allowed me to eventually get to sleep or shift my focus away from the fear so as to function. This was a drastic change that made it manageable.

Questions:

1. Now 7 years later I have noticed a drastic change for the better where my anxiety and PTSD has gotten much better, almost vanished with no change to my lifestyle, environment or medication. I am wondering if my brain has healed itself and is this possible based on the cause of the damage.
I am wondering if i should try properly taper off my Paxil to see how I am without it or if I "shouldn't fix anything that aint broken"

2. I am using Seroquel for it off label use to sleep at 300mg a night. This works extremely well as it provides a natural anti histamine based sleep.
I dont get any of the side effects either. I use this as its supposedly non addictive, no dependance and no tolerance. I have not needed to increase dosage for 3 years. I am hoping to eventually move over to OTC anti histamines for sleep since I would be used to it from the Seroquel.

I was on Zolpidem before and I abused them and the tolerance was crazy that i ended up in hospital due to suspected OD from family members (I was in fact safe due to tolerance). This is why I am anti prescribed daily use of any addictive medication.

a) What are your thoughts on the above and do you think its fine and safe for short to medium term
b) Are you aware of any other drugs that provide only the strong anti histamine sleep properties of Seroquel without the anti psychotic properties. I cant see how such a large gap in the market could exist, but I cant find anything.
c) Is there anything else you could recommend over Seroquel for this that would be as effective and safer and provide a natural sleep?
d) I often use Seroquel to come off stimulant drugs. Is this safe?

Thanks OP!

First of all, thanks for such an in-depth response. I love discussing things in detail. Let’s tackle your questions one at a time.

How can doctors justify the risk of daily amp prescriptions. Can the reward truly justify the risks?

The reward does justify the risk in most cases. I have seen so many patients come in with ADHD and be treated well for years. There is absolutely nothing wrong with daily amphetamine when not abused and taken as prescribed. It helps a lot of people; yes, it is addicting – however, all psychiatric medications are, essentially, you are asking me to justify my entire practice. I think you’re overestimating how these patients respond without amphetamine. I know patients who can forget their pills and are just fine; perhaps, they suffer mild fatigue. I see nothing wrong with prescribing amphetamines for someone that suffers from ADHD. They need the D4 regulation.

2. Daily Benzo prescriptions for Anxiety and sleep

Once again, you are asking me to defend my medical practice. You will be addicted to benzodiazepines, but there are tapering schedules, etc. There’s a reason it’s called “maintenance”. You have to ask yourself whether the addiction to benzodiazepines will help the patient more than it will harm the patient in the long run. I’m more prone to prescribing them than other doctors because I am aware of their tremendous benefits – remission of many disorders with benzodiazepines without using other psychiatric drugs.

3. I have been treated very successfully with Paxil for anxiety and PTSD for 7 years

Great! I am very glad that Paxil has worked for you.
Questions:

1. Now 7 years later I have noticed a drastic change for the better where my anxiety and PTSD has gotten much better, almost vanished with no change to my lifestyle, environment or medication. I am wondering if my brain has healed itself and is this possible based on the cause of the damage.
I am wondering if i should try properly taper off my Paxil to see how I am without it or if I "shouldn't fix anything that aint broken"

I would suggest tapering off the Paxil only if you’re willing to do concomitant therapy during the tapering process.

a) What are your thoughts on the above and do you think its fine and safe for short to medium term

You’re using quietapine (Seroquel) at the maximum dose before it starts to become an antipsychotic. I think the use of Seroquel is sufficient, but I don’t suggest long-term use of an antipsychotic. I would suggest a TCA, perhaps amitriptyline, instead for sleep. It would give you, of course, the same anti-cholinergic effects.

b) Are you aware of any other drugs that provide only the strong anti histamine sleep properties of Seroquel without the anti psychotic properties. I cant see how such a large gap in the market could exist, but I cant find anything.

There is an entire class of medications called tricyclic antidepressants.

c) Is there anything else you could recommend over Seroquel for this that would be as effective and safer and provide a natural sleep?

Obviously, I would not prescribe a benzodiazepine given your abuse history. I would write amitriptyline. [/quote]

d) I often use Seroquel to come off stimulant drugs. Is this safe?

You’re good on it. What amphetamines are you prescribed? I imagine the doctor gives you the Seroquel due to its antipsychotic properties for amphetamine comedowns. If you want to switch Seroquel to a TCA, trimipramine (Surmontil) is a good option since it is a moderate d2 antagonist too, but not considered to be an antipsychotic.

Feel free to add to our discussion!

 

[Geaux Tigers!]

Vyvanse and adderall daily has done fucking wonders for my addiction problem. I take 70 mg vyvanse in the morning and 10 mg adderall in the later afternoon and I have the longest clean time I have ever had. They don't affect my eating, sleeping, exercise, or sleep. So for people who have problems with these types of meds for ADHD or whatever, they need to realize they really are meant for some people.

However I do agree they are probably over-prescribed.

This is actually typical for a lot of my ADHD patients.

 

[Geaux Tigers!]

Maybe having personal experience makes you better at your job?

For sure!

 

[Geaux Tigers!]

If you want me to review your medications, please include your medication history, your symptoms, and what you desire from your medications.

I will only be able to provide pharmaceutical solutions, of course. Your doctor knows you better than I do, also.

 

[blight12]

Thanks OP. Some more questions below, please feel free to ignore any that are not relevant or not what you requested. I can tend to go a bit overboard. thanks!

Apologies for coming off as judgmental or critical with regards to the first two questions. I dont know much about the topics in depth details and in such causes I always try not to be judgmental.
But in this cause I may have came off as aggressive as I guess it helps me to avoid these risky situations by maintaining an aggressive mental stance towards them which then can manifest . I hope that makes sense. I will look into this topic in more detail based on what you have said. Thanks.

Just to clarify, the use of Seroquel for stimulants was referring to my use of street drugs like coke and meth. Stimulants would be my drug of choice.
I have found they do not impact my anxiety issues in any way and thus became my replacement for MDMA. (Coke for last 6 years, meth last 9 months)

I feel I have done quite well in maintaining their usage over the past 6 years by never escalating beyond weekend usage with the following rules. What are your thoughts on these for managing safe rec drug usage? Would you add any rules or concepts to these?

1. No daily usage of addictive or rec drugs
2. No functional or non-rec usage of recreational drugs
3. No usage of any rec or addictive drug beyond 2 consecutive days (has worked to ensure no dependency is formed)

Why this works well for me is that I no longer get cravings for drugs like I used to so its easy to stick to the above rules for me. For some reason cravings vanished for me around the time i damaged myself with the MDMA, or a little while after, possibly about a year max.

I would like to know if you have ever heard of this happening or how 1 day somehow the whole concept of intense cravings can simply vanish and never reappear again, even for new drugs done in the future.

I feel there is some therapeutic value to be gained from understanding how this happened for myself.
This has resulted in my drug use being managed as deciding it would be pleasant to plan an experience rather then giving in to intense cravings at inappropriate times. Obviously this has made a huge difference in ability to reduce real life negative impacts of rec drug usage.

Lastly, with regards to the damage the MDMA abuse caused. Do you think or know if such damage can possibly repair itself and what do you think is the likely reason my issues have suddenly resolve themselves. I can confirm that the fear and underlying psychological problems are still there, and that its the actual anxiety and physical/mental damage/issues that have seemed to improve. As in the deficits that where causing the overreaction to the psychological issues is what as improved, so it would seem.

Thank again for your time!

 

[Swimmingdancer]

I would like to know if you have ever heard of this happening or how 1 day somehow the whole concept of intense cravings can simply vanish and never reappear again, even for new drugs done in the future.

I know you weren't asking me but FWIW, I know many people who this happened to. It pretty much happened to me (not eliminate cravings but reduce them by 95%) after a head injury. I also saw a documentary about alcoholics who suddenly quit easily after head trauma. I have also had friends who didn't have brain damage or a traumatic experience who suddenly found their cravings disappeared and they said it was like a switch flipped where it became much easier for them to quit drugs. You know the phrase "when you're ready, you're ready". Something in their life or brain changes.

 

[blight12]

I know you weren't asking me but FWIW, I know many people who this happened to. It pretty much happened to me (not eliminate cravings but reduce them by 95%) after a head injury. I also saw a documentary about alcoholics who suddenly quit easily after head trauma. I have also had friends who didn't have brain damage or a traumatic experience who suddenly found their cravings disappeared and they said it was like a switch flipped where it became much easier for them to quit drugs. You know the phrase "when you're ready, you're ready". Something in their life or brain changes.

No worries, I always appreciate your helpful posts.

This is very interesting and exactly like I experienced it. I usually try not to emphasize the "like a switch flipped" element of it because it just sounds to odd to believe, but that's exactly like it happened. I remember that Friday out with friends at the usual pub when i noticed i didn't get the cravings like i did the previous Friday. And they never came back.

I sure hope somebody is researching how to replicate this safely as a treatment. Stopping the cravings made such a massive difference.

 

[cook]

I wish I knew your past medication history. I understand the benzodiazepines being effective. Are you on an antidepressant dose of mirtazapine (above 15mg.)? I would suggest trying an antidepressant dose of mirtazapine or try doxepin. Have you tried doxepin? Also, I think an atypical antipsychotic like Abilify might help as well. I would write you Abilify first thing. Is the nitrazepam really necessary?
Low dose naltrexone is very interesting to me. I plan on using it with an opiate-dependent patient that did not accept my referral to a Suboxone doctor. It works well for you?

I have been using mirtazapine up to 45 mgs, venlafaxine 75-150mg and sertaline. I was suggested to add quetiapine in combination with mirtazapine&venlafaxine, however I could not tolerate it all, except for doses below 50mgs. And I see red when I hear hear the word anti psychotic, especially after my experiences with quetiapine. Have not tried TCA:s, though I seem to tolerate medications well in general so it might be worth trying. Abilify maybe after the generics arrive, the price of it is stellar. But really, i'm more into psychotherapy and other means of coping now and would want to give up all medications if possible..

Naltrexone works well for me, i'm kind of using it to control my otherwise uncontrollable opiate use. But still don't want to quit them for good. No side effects. I have played with it for a while now, and I've noticed that it blocks the euphoria first at low end doses but the analgesic effects still remain somwhat. If I take more than 10mg/day, in the evening, it seems to block pretty much all effects next day. At very low dose, 1-2mg, opiates seem to take effect normally, euphoria included, but I still won't get dependent even when binging. Quitting it completely for a while makes me very sensitive, in fact I almost overdosed that way with regular opiate dose of mine, that is the danger.

I was opiate dependent during naltrexone induction, but manager to titrate the dose from 0.25mgs to 5mg within couple weeks without virtually any precipitated withdrawal while using opiates every day at the same time. Ultimately when the dose was high enough the opiates stopped working properly and it was very easy at that point to quit em. I felt this detoxification method was very succesful and pain free and I would do it again if I got dependent.

 

[wrongdose]

It's really interesting reading these posts. I have a couple of questions for the OP if that's ok.

I see you really like TCAs and that they are first line on your chart, can you tell me why this is your preference? In Aus TCAs are most commonly used for secondary indications now (eg. Pain, insomnia etc) because of the side effect/dosing correlation and their tendency to cause sedation and toxicity. It's SSRI/SNRI 1st line all the way here. Can't think of the last patient who was taking amitryptyline at therapeutic doses. I'm on my tablet ao unfortunately easy typing isn't possible.

In regards to your queries about possible abusers, my personal motivation would be to first do no harm. By that I mean keeping the regime as clean as possible. Toxicity is always a risk with users and many psych drugs are pretty damn toxic or slow to metabolise. I'd also keep in mind that drug abusers 'may' be more at risk of suffering symptoms such as RLS, akasthisia etc and that some psych drugs (seroquel etc) can potentiate this and create a world of hurt. Does this make sense? (screen typing really gripping me!). what do you think? Personal experience of akasthisia has given me a new appreciation of just how much damage one wrong rx can do.

Hope you're having a good night...day

 

[DementiaSavantPlus]

I suppose my diagnosis would be low-grade depression, symptomatic of hypothyroidism.

for me alcohol was the gateway to marijuana, which probably led to hydro/oxycodone.

I have been most addicted to vodka, marijuana, and Adderall.

The most significant drug in my life is gabapentin. I didn't realize that I was depressed until I was introduced to the 180 degree turn that it caused in my personality and emotions. I fall into the very small percentage of people that have an MDMA-like experience: Enhanced physical sensation, highly saturated color perception, complete alteration of taste sense, elevated mood, "drifting" feeling, increased motivation. This went on for about 2 years with no rise above a 900mg per day dosage. The effects are now less pronounced with a current dosage of 1500 mg. It improved my life immensely until my body chemistry completely assimilated its effects.

I got a prescription for dexmethylphenidate 10 mg twice per day from a university doctor. I was then changed to 10mg of IR amphetamine salts twice per day... then 30 mg per day, 40 mg, 60, 80.
I experienced amphetamine psychosis with a paranoia that alienated me from my social circle for about a year. But I also trained myself to focus on creative things, an ability that I retained after discontinuing its use. My abuse of generic Adderall came close to ruining my life.

While I was on Adderall, I was prescribed Effexor as a "cushion" for the amphetamine crash, and could not stand more than a single 37.5 mg dose. I was completely dehumanized for that one day.. I was switched to desipramine for about 2 weeks, while I took a break from Adderall. It had a true antidepressant effect. I think I took up to 80 mg per day, but ignorantly discontinued it when I was convinced that it was interacting negatively with the (reintroduced) Adderall. In other words desipramine by itself did very well. It did, to my knowledge, what an antidepressant is designed to do. When I tried to kick Adderall (the first time), I went on desipramine again, but was turned into a zombie that was completely unmoved by any situation no matter how provocative. This was for about 2 weeks again. I was taking 25 mg per day.

This was the end of my pharmaceutical use, besides the mainstay of gabapentin, which I have been on for 4 years.

Now, I have had a great success with Rhodiola Rosea, 300 mg per day, and DLPA, 500 mg per day. I have stopped drinking and stopped smoking marijuana. I do consume a lot of caffeine, and smoke cigarettes.

Other things I've taken.
L-Tyrosine: edgy energy... irritability unbearable.
Mucuna Pruriens: Very slight feeling, not worth it.
Vyvanse: took for one month, good the first day, paralyzed, stiff feeling after that... felt like Parkinsonian symptoms. held my body in strange postitions, etc... difficult to shift my gaze. could sometimes not read a sentence because I was locked on individual letter forms. terrible. gave up on amp after this.
Yohimbe: worst thing I've ever taken (besides maybe energy drinks mixed with alcohol)... weird muscle pains worse than Adderall... burning headache... panicky, sweaty feeling for the first 2-3 hours, decent stimulation after that, but not nearly worth the garbage that comes with it.
Wellbutrin: weird, felt dehumanized. amp-like anxiety for the first few days. Almost quit smoking. turned into weirdness quickly.
Kratom: very good the first couple of times... tolerance skyrocketed, intense nausea, dopesick feeling, very depressed for about a week after stopping.

so far, Rhodiola has helped me the most out of everything.

 

[Swimmingdancer]

But really, i'm more into psychotherapy and other means of coping now and would want to give up all medications if possible..

This is how I feel too. Now I am only using drugs when I've tried everything non-drug option I can possibly find/think of, and my goal is to only use them for a short period of time. Whenever I've been on a drug long-term it's done more damage than good. So many drugs cause a physical dependence and eventually stop working (if they worked at all in the first place), then when you try to quit you are left worse off than before you even started the drug. I really feel like people should receive honest info about the possibility for physical dependence and lasting adverse physical and mental health effects from any drug they are considering, so they can make an informed decision about what they are getting themselves into. The problem is, many health care practitioners actually are not aware of the lasting side effects of long-term use, or even if they are they say little to nothing about them to the patient. I've heard some Drs rationalize it by saying that the drugs are in the person's best interest and they wouldn't want to take them if they were told the truth about the drugs, but I think that's awful and that the person should be able to decide that for themselves. Most practitioners just don't know though, they believe the small amount of info they are told by the drug reps (which of course if going to be biased) and they don't have time to thoroughly research every drug they prescribe. I have learned the hard way that I have to do the research myself.

I'm not sure now what to say about my diagnoses and the specific drugs I've taken. I'm actually kinda concerned that it could make me personally identifiable to people reading this, in combination with all the other things I've said about myself on these forums.