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SB415

Need Help With Ad Augmentation Choice, Lithium/abilify?

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Hi everybody,

I'm working with a new Psych doc and we are deciding on a medication change going forward.

I currently take: Effexor 300MG and Remeron 30MG daily

I have what should be called a treatment resistant, edgy, anxious, case of Major Depression. I've always felt this way. An example of my silly anxiety is when I see someone walking towards me from a block away I become concerned with how I appear to them and lose track of my own train of thought. I feel the same way at home with my roomates in the hallway. It's a very shame based state of anxiety. I test highly on the Borderline Personality and Avoidant Personality disorders scales.

I have taken almost every ssri/snri since 2000 with varying results. I notice improvement but I never really pass the threshold into what I think may be a better baseline experience of contentment and comfort.

I have been suicidal for the past few months with no hope of a future for myself and the rest of humanity. My Uncle, (the head of a psychiatric hospital in Frankfurt), has been recommending augmentation with Lithium. I have a really good history of tolerating meds but it still scares me.

My Pdoc was very cool when I asked her about the Lithium add on and my blood work came back with good results, so there is a green light now if I choose to go forward. I'm sure she would entertain other treatment options as well so I wanted to put it out there for some feedback,

What do you guys think?

Should I go with:

effexor 300mb, remeron 30mg, Lithium low dose?

An SSRI like Lexapro, remeron 30mg, Lithium ld?

I was thinking that since I have been suicidal on the Effexor it might be worth addressing that directly before considering augmentation. I don't know. I'm just tired of trying things that don't work.

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Hi SB415 -- Welcome to Df. :welcomeani:

First of all, Venlafaxine at that high dose should be monitored carefully as in combination can be very dangerous but it sounds like that's actually under control.

I would recommend Aripiprazole as it can be used as a mood stabiliser and antidepressant/antipsychotic together in place of Venlafaxine.

Lithium is the classic mood stabiliser that has a low threshold for side effects with very little room for error, so skipping a dose say, would have detrimental effects where Aripiprazole has more room for this with a greater response.

It is of course, down to you and your psychiatrist and what you both feel is necessary.

Hope this helps.

Tungsten.

Edited by Tungsten Aromatics

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Thanks Tungsten!

It's dawning on me that I have been suicidally depressed for months while on the Venlafaxine at the max dose. I guess one thought is that it simply isn't working. Not sure if attempting to augment something that isn't working makes sense or not.

I have never tried Paxil, which I hear is used for OCD and has some strong anti anxiety qualities.

Not sure yet if I should tear the whole current medication list down and build up anew,

Thanks for the recommendation of Abilify. I'm reading that a lot of people have had great results with it.

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I agree with Tungsten. As you can see in my signature, I take Abilify, and I love it. It has a long half life, which is helpful if you forget to take doses. I'm meticulous about it, but I did forget one night and never noticed a blip. With something like Geodon, I started getting withdrawals if I missed one dose.

Tungsten's pointing out that lithium can be harder to dose is another consideration.

As far as the suicidal thoughts go, sometimes they can happen when an anti-depressant is actually working. It lifts you up past the point where you are too apathetic to be suicidal. It could be that the Effexor is indeed helping, but you need an adjunct med. Just another perspective to consider.

I wish you well with your decision. I know how hard it is to adjust the psych med cocktail.

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I went with the Abilify. The cost is a little higher for me but it seems to be worth it. We are trying 2.5mg a day to see if it agrees with me. Took it a few hours ago and no problems so far.

I feel good about the decision. Thanks guys! I know there is often no miracle pill that will uproot any psychological causes of personality disorders but I am glad to have the extra help while I work on this.

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I've been through two different psych docs due to moving recently. I'm now on the third and have settled in where I live now.

We only discussed augmentation of the current meds at this point. In the long term, it may well turn out that the venlafaxine should be eliminated or replaced but for now it's off the table.

I went through the medication rollercoaster wringer recently so I'm pretty happy to take it slow. At one point I was on strattera, neurontin, venlafaxine, and remeron. I started feeling like I was charged electrically. Best way I can describe it. It was too much.

Looking back I can see that I was possibly more stable on celexa or sertraline. I'll bring this up to my doc in the future.

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I hope the Abilify does well for you!

Celexa is a good drug. I was on it for six years before it pooped out on me. I felt really steady on it, if that makes any sense. Good and steady. Zoloft worked great when I took it in the 90s but not at all when I tried it again last year. I mention this because yours would also be a second attempt. Not trying to discourage you, just giving you a heads up that it might not be effective the second time.

I love Effexor and understand the need for the high dose since I'm also on 300 mg after a med-go-round.

With the Abilify, hopefully a low dose is effective. I am also active on a thread written by someone who was given 10 mg of Abilify and it was too strong for him. In your case, 2.5 or 5 will hopefully be good. I need 20 mg because I have severe psychotic depression, but for just an adjunct, you should be good where you are or slightly higher.

Good luck!

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Thanks Shmooey! I've had some difficult circumstances in the last year so I am especially treatment resistant right now. I'm barely above water right now but ask starting to see that this does not have to be the end of my life. In that light maybe I should be extremely grateful for the venlafaxine and remeron. I could be dead without them!

The only ssri/snri I haven't taken is paxil. I'm saving that one for a rainy day! This is my second run on venlafaxine. That might explain the less than excellent result I am getting.

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Like Shmooney, I am also on 20mg of Aripiprazole after being sectioned last year and put in hospital. My current Dx is severe depressive episodes with psychotic symptoms and take 30mg of Mirtazapine along with Aripiprazole which I find to be particularity effective. I have also had psychosis before being in hospital and went through the med-go-round in hospital and ended up being put on so many meds at one put that I couldn't keep track of it all.

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Quick update on my meds.

i am now on 5MG Aripiprazole in addition to my effexor and remeron. It has been a huge change. I immediately stopped sleeping 12+ hours a night and laying in bed all day in despair. Well, not immediately, it took a few days. I feel so much better. It's the most profound reaction I have ever had to a psych med. It's as is a part of myself that has been gone for a few years is waking up and going "where have I been, what happened?"

I feel restless at times and the days seem very long. I catch myself getting frustrated with the length of the days and having to fill them. But I think it's just a natural reaction to being awake for the first time in quite a while. It's a dramatic shift in perspective for me. Thank you guys so much for the suggestion!

:hugs:

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I don't have it. I take mine at bedtime since I have such a large dose and it makes me tired. When I wake up, I am nervous, but I attribute that to not having Buspar in my system for over 12 hours. It works well for me.

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Currently, I am taking zoloft with lamictal, the reason i started lamictal is because my zoloft stopped working (it worked really well for a year) and my doctor believes it is treatment resistant depression. However, the lamictal has not been my favorite, I just have never been able to fully feel like my happiest self. The past few months have been even worse. I am thinking about asking my doctor about abilify.

If anyone has any experience with zoloft and abilify, I would love to hear about it. also, my depression is unipolar.

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Currently, I am taking zoloft with lamictal, the reason i started lamictal is because my zoloft stopped working (it worked really well for a year) and my doctor believes it is treatment resistant depression. However, the lamictal has not been my favorite, I just have never been able to fully feel like my happiest self. The past few months have been even worse. I am thinking about asking my doctor about abilify.

If anyone has any experience with zoloft and abilify, I would love to hear about it. also, my depression is unipolar.

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Im currently on 150 zoloft and 10 abilify. Im having issues with being groggy and lack of concentration and appetite. Adding abilify did bring ne out of my depressive state however

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