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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by theo on October 13, 2005, at 23:05:05
My pdoc is frustrated because I'm not responding to Cymbalta and prescribed Abilify for me today.
She acts as if I'm being none responsive on purpose. Oh well, I'm a little freaked about trying a med from this class and any input would be appreciated. She wants me to start at 2.5mg.
Are there many dangers with this med at low doses? Seems like I've heard some scary stuff about this one.
Posted by med_empowered on October 14, 2005, at 6:00:50
In reply to Questions about Abilify-SLS, Anyone, posted by theo on October 13, 2005, at 23:05:05
Ugh, I hate it when shrinks do that stuff. If they took the time to read the actual data on these meds, they'd know that **lots** of people either a) don't respond or b) don't repsond adequately. Plus, cymbalta isn't proven to be anymore effective than any other medication, so its not as if you're some freak of nature b/c you're not walking around in a constant state of medication-induced euphoria. As for Abilify...its a tricky med, which is true of all the neuroleptics. For me, adding low-dose (5-7.5mgs) Abilify to an antidepressant and Klonopin really did help with intense anxiety and depression...but the results were short-lived, and I didn't like the "numbed" feeling Abilify gave me. Lots of people report start-up anxiety, though. And then there are the contradictory side-effects; some people report more energy and motivation, some people report apathy and fatigue. Some people feel sharper, some people feel stupid. Its worth trying **if** you're comfortable with the idea of taking a neuroleptic (if you're not, don't let your shrink talk you into it; the only really well studied aytpical+antidepressant combo is Symbyax, which is prozac+zyprexa...Abilify is really new, and using it as an augmenting agent isn't all that well studied). You might also want to talk about just how long your doc wants you on the atypical; although it seems like lots of docs lean towards co-prescribing them for the entire course of treatment, I found that just 1-3 weeks of very low-dose atypical augmentation is all that's really needed (for me at least) to get to a point where I can function well again and not feel like $hit. Its kind of like how psychotic depression is treated--short-term neuroleptic+antidepressant, then long term antidepressant+whatever else. All reservations aside--neuroleptic+antidepressant combos, when they're carefully monitored and the doses are well calibrated, work quite well for many people. With Abilify, especially at low-doses, it might be possible to get all the benefits of D2/serotonin blockade, plus the benefits of mild dopamine/serotonin agonism, plus the benefits of cymbalta. Abilify is sometimes called a "dopamine-serotonin stabilizer" b/c it seems to create a sort of new equilibrium in the brain which it constantly adjusts. That said...side-effects could suck. Have you tried other stuff? Adding Buspar might help...even if you don't have anxiety, adding 15mgs+ could boost your antidepressant and help deal with any sexual side effects and improve the overall antidepressant experience. Depending on your situation, you could also try..benzos, stimulants (including provigil), straterra, wellbutrin, remeron, or a tricyclic antidepressant. Personally, speaking as someone who has taken most of the atypicals and remains unimpressed, I'd try the other stuff--which is usually older, cheaper, safer, and has more available data--before adding a neuroleptic. Good luck!
Posted by SLS on October 14, 2005, at 10:40:56
In reply to Questions about Abilify-SLS, Anyone, posted by theo on October 13, 2005, at 23:05:05
> My pdoc is frustrated because I'm not responding to Cymbalta and prescribed Abilify for me today.
I agree with much of what Med_Empowered has to say. I take Abilify 10mg. It helps only slightly with energy and motivation. However, it really does keep the worst of my depression at bay and helps prevent me from becoming suicidal. Zyprexa sort of does the same thing for me, but I find Abilify to be a much cleaner drug as far as cognition and sedation are concerned. You will very likely experience some startup side effects. These might include anxiety and restlessness which appear like an akathisia-like syndrome. It does resolve with most people within a few weeks. For me, it was moderate and lasted about a week. If necessary, you could take a small amount of a benzo during this period.
I guess no one can guarantee you what the pay off will be. You would just have to try it. I have seen atypical neuroleptics act potently as antidepressants in some people, many of whom are probably bipolar or suffer from psychotic depression. That is not to say that you need to have psychotic features for these drugs to work as antidepressants. I don't think there is enough data to indicate a strong association. If it is going to help, you will probably see results within the first one or two weeks at 5.0mg.
I don't know what I would do in your situation. I guess it depends on what other treatments remain untried. Abilify is probably less apt to cause involuntary movements as EPS than the other neuroleptics. It doesn't seem to penetrate the striatum. It is the initial akathisia, anxiety, nausea, and insomnia that causes people to discontinue this drug prematurely. Doctors don't seem to prepare patients well for the experience of startup side effects.
Good luck on making a decision. I don't see that you have much to lose by giving Abilify a short trial.
Try not to read too much into you perceive as your doctor's reaction to your reporting a treatment failure. Any frustration you see on his face is probably directed at the drugs and the illness, not at you personally.
- Scott
Posted by theo on October 15, 2005, at 15:53:29
In reply to Re: Questions about Abilify-SLS, Anyone, posted by med_empowered on October 14, 2005, at 6:00:50
Its worth trying **if** you're comfortable with the idea of taking a neuroleptic (if you're not, don't let your shrink talk you into it;
What do you mean about "being comfortable taking a neuroleptic." Are there some major risks? The tardive dyskinesia warning scares me, but with all the warnings with all meds, it's hard to know which ones to seriously worry about. I don't know about tardive dyskensia, but I do know I'll be taking only 2.5 - 5mg Abilify monotherapy.
I'm on my last dose of Cymabalta tonight, will wait a few days, and then plan on trying the Abilify to get a true read as I'm taking no other meds. This tardive dyskinsea scares me about as much as when I tried Lamictal and the rash issue.
Is the risk high with this med and tardive dyskensia?
Posted by theo on October 15, 2005, at 16:04:43
In reply to Re: Questions about Abilify-SLS, Anyone » theo, posted by SLS on October 14, 2005, at 10:40:56
I will probably try Abilify in a few days, I'm on my final dose of Cymbalta this evening, about 20 pellets. At what dose did you stop Cymbalta? Was withdrawal as horrid as Effexor XR?
I'm on no other meds, so I will be giving Abilify a true test. I'm trying not to look at the side effects so I don't build up to much anxiety, but this "irreversible tardive dyskinesia" is freaking me out a bit. Is this more common with the older antipsychotics? I'll only be taking 2.5mg - 5mg Abilify, but this is building much anxiety in me. This has me about as freaked as when I started Lamictal and worried about the rash.
Posted by med_empowered on October 15, 2005, at 17:52:01
In reply to Re: Questions about Abilify-SLS, Anyone » SLS, posted by theo on October 15, 2005, at 16:04:43
hey! The tardive dyskinesia risk is higher with older meds, especially haldol and thorazine (around 3%/year baseline; higher risks for women, children, and elderly...at 5 years, about 20%; after long-term exposure, over 50%). The only med I've seen any good numbers on for TD is zyprexa, where the risk is estimated to be about .5-1%/year, but no one really knows for sure quite yet. Risperdal is believed by some to be the harshest atypical, and also the one most likely to cause EPS and TD..there have been a couple risperdal lawsuits regarding TD in those cases. Abilify is really new, so we won't know for a while how likely it is to cause TD...interestingly enough, it can be used as a treatment for pre-existing TD; the antagonist/agonist action apparently helps keep involuntary movements at a minimum. The therapeutic dose used to be considered 15mgs (this is for bipolar and schizophrenia), but now 10mgs is believed to be effective, too...your risk should be lower than that of someone taking the full, therapeutic dose (although one must keep in mind that people with mood-disorders are more likely to develop TD than are people with schizophrenia). Good luck!
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