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About browri

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  • Birthday 05/14/1991

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  1. It doesn't compare. Think of it like volume on a stereo. Medications like alprazolam, clonazepam, or lorazepam turn down the volume in the moment but the volume progressively turns back up as it clears your system and it becomes harder and harder to turn down the volume with benzos (i.e. tolerance). Valproate turns down the volume overall and makes anxious situations less intense for me. So situations that would normally make me really anxious and require me to take my 0.5mg alprazolam are simply less intense and 50% of the time I don't need to take the Xanax and I can tough it out. Thinking of it another way, you can look at your anxiety baseline. Valproate can reduce your anxiety baseline by increasing the brain's GABA supply thus negating the need or reducing the need for PRN benzos. With a lower baseline, your anxiety doesn't reach the levels required to take a benzo. Nevertheless, lately I have been taking my alprazolam more than I would like. I'm in a kind of agitated/anxious period of my mood so I started taking 0.5mg clonazepam qhs until I see my pdoc on Monday. I'm going to ask him to swap out the valproate for carbamazepine. I feel like the valproate has provided good mood control, but I've gained a fair bit of weight, and I think it's negatively contributing to my depression. My last valproate level was 58mcg/mL and the one before that was 68 back in October. However, when I tried to go to 1500mg on valproate, I started to become depressed after a few days. So I think I'm at my limit with this medication. Carbamazepine does also seem to have an effect on GABA supplies in the brain similarly to valproate. I know that valproate increases GABA synthesis from glutamate and prevents GABA's breakdown back to glutamate. I believe carbamazepine only does one of these things. Carbamazepine is also, as far as I know, not a monoamine oxidase A inducer, which should make it less depressogenic. I used to take oxcarbazepine and I found it to be "soothing" after I took it. I was on 300mg tid (900mg daily) and after I took it I would feel this warm, "cozy" feeling come over me. I miss that, and in retrospect, we really should have tried carbamazepine before going directly to valproate. Here's to hoping my pdoc is on-board with letting me try it.
  2. Valproate definitely reduces my anxiety and helps me sleep. It increases the GABA supply in the brain. So it's easy to see why.
  3. As far as I know, all serotonin reuptake inhibitors are contraindicated with monoamine oxidase inhibitors, particularly those that inhibit predominantly MAO-A. MAO-B is slightly less problematic. I do believe I've heard of "heroic" prescribing where pdocs will combine an SSRI or tricyclic specifically with reversible monoamine oxidase inhibitors or low doses of MAOI's that focus on MAO-B. Selegiline in higher doses also inhibits MAO-A. So low doses of selegiline and vortioxetine should be relatively "safe" (if one could even say that for this particular combo).
  4. How much were you taking before you stopped taking it on 6/15? Trintellix has a really long half-life of about 66 hours. That means it takes about 2 weeks for it to clear your system. So if you were taking 10mg when you quit on 6/15, then it would make sense to start back up on 5mg a week later, because at that point you would have about half the blood level of what you had at 10mg, which would likely be about 5mg. However, you should be safe to go back up to 10mg a week from starting the 5mg. The anxious feelings should go away as you re-adjust. I remember those feelings starting up on Trintellix and after every dose increase. They should subside if they did before.
  5. I would imagine so. Trintellix and Wellbutrin are the two antidepressants that are majorly contraindicated. You should talk to your doctor about this because any medication checker is going to show this interaction for him to see, bit it also means Wellbutrin is going to make the Trintellix startup really rough. Ask your doctor if you can take 5mg for 2 weeks before you go up to 10mg. You may find you can tolerate it more.
  6. My recommendation would be to definitely take Saphris at bed time if your pdoc left it up to you when to take it. If he specifically wants you to take it in the morning, there could be a reason. It has a long enough half-life though that for some people with bipolar disorder, 2.5mg at bedtime is enough. Some need 5mg. But if you're in an acute episode you would move to 10mg at bedtime or 5mg twice a day. EDIT: Reviewing previous post, don't see you indicate that you are bipolar and we're just talking about MDD I believe. With that in mind, it would seem that Rexulti would make more sense as it has far more pre-clinical evidence to indicate it would work for your purposes. Personally, I did feel that Saphris had somewhat of an antidepressant and stimulating effect during the day (was taking all at night, no morning dose). I wasn't taking an antidepressant at the time either so that's saying something. Really only went off it because of the akathisia but it was immensely helpful for sleep as well.
  7. What I can say is that while Abilify and Rexulti are chemically very similar they are so very different in my experience. I started on 1mg of Abilify and titrated up to 7.5mg over the course of 10-15 days and I quit it. I just couldn't tolerate it. Made me too restless and agitated. I know people say things change when you get to 10mg+ but I just couldn't hack it. Rexulti on the other hand has been quite the opposite: calming in the lower doses and has become more activating as I've increased. It's significantly more tolerable though to me. No restlessness to speak of and quite honestly this medication does the exact opposite of making you agitated in the lower doses. I find it very soothing. I think it's helped my depression and my anxiety as well. Situations that would normally make my adrenaline pump like crazy I handle so much more gracefully. It jives well with Trintellix and Vyvanse in my experience but I'm also taking Depakote so take all this of course with a grain of salt. For an AAP, the lower doses of Rexulti feel more like a sedating antidepressant than an antipsychotic. I actually love it and the insurance company will have to pry it from my cold dead hands. Lol. One statistical differences would be that Rexulti is half as likely to cause agitation. So your experience with Abilify is not a good indicator of how you would respond to Rexulti. They found in trials that many people who couldn't tolerate Abilify did really well on Rexulti. The other statistical difference is that Rexulti is more likely to cause weight gain than Abilify. I've gained a bit but I don't have good eating habits and I'm taking Depakote too, like I said, so take that with a grain of salt. All in all I couldn't recommend Rexulti more. I did try Saphris as well which did have a good stabilizing effect but I have a very low akathisia threshold and even at 2.5mg at bedtime I still had bouncey legs during the day while I was sitting at my desk at work. None to speak of on Rexulti though, like I said.
  8. I actually experienced exactly what you described. But in my case the nausea was secondary to the "acidic stomach". The name of the side effect that you're looking for is "dyspepsia". It is also a side effect of Trintellix but less talked about relative to the nausea side effect because the nausea is more common. For me the dyspepsia (i.e. agitated and acidic stomach) did go away after a time. And it was important to me as well because I also had a chronic acid reflux problem going into Trintellix that did get slightly worse as a result, but it did ease up and it's back to "as good as it used to be", which isn't really saying much tbh. If you get to 20mg. Give it 2 weeks before you give up on it. You'll know by the end of the 2 weeks if the side effects have eased up at all. But you really do have to stick it out pretty long because of the long half-life and thus long time to steady-state.
  9. I see. So Trintellix is considered a non-preferred brand or top-tier drug on your prescription formulary. And you don't have the option of filling 90-days at a retail pharmacy (no "opt-out", which is total BS). That says to me though that filling 30-days with the Takeda coupon at a retail pharmacy will end up costing you $240 versus mailing it in and not using the Takeda card at all. Your mail-order pharmacy won't accept savings cards? Mine won't either except for specialty medications, which is also TOTAL BS!!
  10. @poetic_fail The Trintellix savings card was actually in the news recently. I think someone took Takeda to court over the fine print of the savings program, which didn't define a maximum savings benefit anywhere. It only said pay no more than $10/30-day or $30/90-day, even though there was in fact a maximum benefit. The terms have been updated as follows: For a 30-day, you are responsible for the first $10 of your insurance copay, then the savings card will pay $100, and then you are responsible for the difference, which in your case appears to be $70. Therefore, I would assume that your insurance copay is $180/30-day. For a 90-day, you are responsible for the first $30, then the savings card will pay $300, and then you are responsible for the difference. As for the nausea, it is something I noticed a bit in the beginning although it was more like dyspepsia which I managed with famotidine and Tums but it always went away within a week or two after a dose increase. I never vomited from it though. Some people have said they have less nausea if they take it on an empty stomach and some say they have less when they take it with food. What's even weirder is that Trintellix is a 5HT3 antagonist just like Zofran, which should actually REDUCE nausea. So it's been perplexing to the psychiatric community as to why it CAUSES so much nausea. However, the hypothesis is that it is most likely coming from the 5HT1A agonism, which is one of the reasons why Viibryd can have some considerable nausea as well. In my opinion, it is worth getting to 15mg or 20mg and staying there for at least 3 weeks before you decide if you want to give up on it. Trintellix has a 66 hour half-life which means it takes up to 15 days to reach steady state after starting or changing the dose. I had been on the 5mg and 10mg doses for several weeks and once I adjusted to them, I didn't really feel that significantly different. It wasn't until I got to 15mg that I felt like it was actually doing something, but after 3 weeks at 20mg, I realized it was going to be a staple med for me. That being said, I have since established that 20mg and 15mg are more "winter doses" and I dial back the dose going into the spring/summer in favor of increasing my AAP (Rexulti at time of this writing).
  11. Your doctor is likely worried about the combination of sumatriptan/vortioxetine causing serotonin syndrome, which is possible. Would be smart to do as your doctor asks, but good luck splitting those Trintellix tablets. They're shaped like eggs. No idea how pdocs think we're going to split those.
  12. For those who couldn't tolerate Abilify, I would highly recommend Rexulti. Been on it 5 days now and it feels nothing like Abilify. Much more calming yet still stimulating at the same time.
  13. Don't worry too much about it yet. Just try it out and see how you feel. Interesting that they suggested taking 300mg every other day instead of giving you 150mg, but they may be doing something to try and ease the withdrawal. As for Trintellix kicking in, the dosing schedule suggested makes sense to me. Not sure you'll want to stay at 10mg for 21 days, but you never know. We all react to things differently. I've read a lot of horror stories about Rexulti but I'm on Day 2 and it seems pretty great to me lol. Don't hesitate to ask to go up though. I was on each dose for several weeks and 20mg was really the winner.
  14. Hope it works for you, @tamsynx! Be careful though with the Trintellix/Wellbutrin mix. Wellbutrin inhibits CYP2D6 which is one of the primary metabolic pathways for Trintellix. This would greatly increase the Trintellix blood levels. You would have to cut the Trintellix dose by half which would mean the highest it would be safe to go on either together would be Trintellix 10mg / Wellbutrin 150mg. Another thing to keep in mind that the initial effects of Trintellix can be activating and agitating. For me it would last about 3-5 days after starting it or increasing the dose. Because you're taking it with Wellbutrin which inhibits the metabolism of Trintellix and is also activating itself, the effect may be compounded. Based on my experience with Trintellix and Wellbutrin, if it were me and my pdoc approved, this is how I would titrate it: Week 1: Trintellix 5mg, Wellbutrin 150mg Week 2: Trintellix 5-10mg depending on tolerance of activating/agitation and eliminating Wellbutrin depending on severity of withdrawal, if any. Eliminating the Wellbutrin may also ease the startup effects of Trintellix, to be considered. Week 3: Trintellix 15mg, at this point, definitely no Wellbutrin Week 4: Trintellix 20mg Then you really should be on the 20mg for a good 2-3 weeks before you make a final determination on whether or not you're going to stick with it or switch to something else. Trintellix has a really long half-life which means it not only takes a while to build in your system, but because you are not already on a serotonin reuptake inhibitor it will take time for receptors to desensitize. Trintellix's other activities in the brain do speed up this process, but in my experience Trintellix took almost as long as Prozac to see the full positive effects after getting to the right dose. I also cannot emphasize more that my experience has taught me the studies were correct when it comes to dosing. Before you really give up on Trintellix you need to try as hard as possible to get to the 20mg dose and stay there for a few weeks before you give up on it. The activation and agitation to me almost felt like restlessness, but this was only really pronounced when I started on 5mg and after I went up to 10mg. 15mg and 20mg were easier to adjust to. At 5mg and 10mg it felt like a placebo. It would stimulate you for a few days and then nothing. It wasn't until 15mg that I felt like it might be doing something for my depression but I wasn't sure I wanted to keep it until I was on 20mg for 2 weeks. I'm telling you it's really long, no matter what Takeda said about it working in as fast as two weeks. You have to take 10mg for a week and then move to 20mg right away at week 2 for it to actually work that fast, but the activation period was rough enough that titrating that fast wasn't possible for me anyway.
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