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Adding an antipsychotic, as a partial responder


Guest anatta

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Guest anatta

Although citalopram seems to work well (most days I don't think I meet the ICD/DSM criteria for OCD) I still get bad spells lasting half an hour to a week (though the last time one lasted that long I was on a lower dose, and I haven't been on my current dose long enough to know whether they will sometimes still last that long) which interfere with my job performance and/or cause enough distress to make me wish I were dead. So it's not complete remission yet. I'm on 30mg and the maximum dose is 40mg. The reason I'm thinking about asking about adding aripiprazole (Abilify) is that unlike SSRIs, and unlike most other antipsychotics, it doesn't usually make ADHD worse, in fact it's sometimes used to treat it. That's because it's a partial dopamine agonist. Because I have a very disabling (when untreated) case of ADHD Primarily Inattentive Type, I don't want to reduce my dopamine or norepinephrine levels further. Citalopram already does that, indirectly, and I've had to increase my methylphenidate dose to the maximum to combat the reduction in dopamine it causes.

So although I imagine my doctor will want to try increasing the cit dose to the maximum before adding an antipsychotic, I'm wondering if that doesn't help sufficiently or it makes my ADHD worse, how willing will most NHS doctors be to try adding an antipsychotic? I really don't want to try another SSRI because the citalopram works well with no bothersome side effects apart from the need to increase methylphenidate, it's just that it still allows breakthrough flair ups. Do doctors usually only prescribe them to complete non-responders, as those are the people the studies have been conducted on? I'm a partial responder, so will I have a hard time persuading a doctor in this country to go that route?

Edited by anatta
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Guest Otloz

I have a mild case of ADD on top of OCD. SSRI-medicines were awful for me; made me really teary and suicidal.

I've been on quetiapine (ketipinor) for some time now and it has helped me massively. I'm on nothing else at the moment. Antipsychotics are definitely worth giving a try.

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Like any meds - it's worth giving it a try. However, I had very bad problems whilst taking an anti-psychotic. It caused me to be very agitated - both physically and mentally - it was very distressing.

So - yes - give it a go but do be aware that there can be side-effects - again - true of any meds.

Take care

whitebeam

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Guest anatta

Took 40mg last night (I was told I could opt for 40mg or try out 30mg first, anyway) and it's the first dose that's made me less focused and more tired the next day (though oddly, that didn't happen when I accidentally took 60mg). Normally the tiredness is limited to the night I take it. If this is how 40mg is going to affect me, it's unacceptable - I need to be fully switched on at work. And if this is how I feel with methylphenidate, I probably wouldn't get out of bed at all on the weekend, when I don't take it. I've decided I'll try again tonight in case this was a coincidence, and I should have a relatively undemanding day at work tomorrow. My telephone appointment is tomorrow. I'll tell her what I've said here, and that I also hope it might reduce my autistic stimming behaviours, which cause several problems and citalopram doesn't help (some SSRIs do, apparently, but not citalopram).

Has anyone else tried azipiprazole augmentation and how easy a sell was it to your doctor?

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Guest Otloz

I suppose the tiredness is an effect of all anti-psychotics. This is my experience at least. On the other hand, that's fine for me, because my brain is working over-time most of the time. When I take the drugs, the obsessions just sort of die out. I just can't ruminate.

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Guest anatta

I have a mild case of ADD on top of OCD. SSRI-medicines were awful for me; made me really teary and suicidal.

I've been on quetiapine (ketipinor) for some time now and it has helped me massively. I'm on nothing else at the moment. Antipsychotics are definitely worth giving a try.

That's interesting, thanks. Does it have any impact on your ADD? I don't need it to make it the ADD better - it's dealt with nicely the methylphenidate - but I do need it not to make it worse.

Citalopram made me feel worse emotionally too, at first, but only for about a week.

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Guest alicebird

I have been on Quetiapine for about 5 years or so now, on and off. I am definitely better on it than not. Although I still get my bad patches it does help me sleep better and keeps me calmer during the good times. I take it with clomipramine and they work well together.

I did try Aripiprazole. It didn't make me drowsy like Quetiapine so I could take it any time of day but it didn't really help at all.

I have also tried extended release Quetiapine (Seroquel XL). It was ok- it made me less drowsy which some people might prefer. It is meant to spread the effects out further throughout the day.

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Guest anatta

I suppose the tiredness is an effect of all anti-psychotics. This is my experience at least. On the other hand, that's fine for me, because my brain is working over-time most of the time. When I take the drugs, the obsessions sort of die out. I just can't ruminate.

I was talking about the citalopram, I haven't tried the antipsychotic yet. The one you're on, quetiapine, is at least in theory far more likely to worsen ADHD than aripiprazole, which studies and clinical practice suggest actually improves it, because it antagonises both D1 and D2 receptors. It's also a much stronger antihistamine, which probably causes most of the tiredness you experience on it. Aripiprazole can cause tiredness too, but I'm hoping it won't be as bad as 40mg citalopram seems to be, and it shouldn't reduce my drive and focus as citalopram does.

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Guest anatta

I have been on Quetiapine for about 5 years or so now, on and off. I am definitely better on it than not. Although I still get my bad patches it does help me sleep better and keeps me calmer during the good times. I take it with clomipramine and they work well together.

I did try Aripiprazole. It didn't make me drowsy like Quetiapine so I could take it any time of day but it didn't really help at all.

I have also tried extended release Quetiapine (Seroquel XL). It was ok- it made me less drowsy which some people might prefer. It is meant to spread the effects out further throughout the day.

Were you taking an SRI at the time? There is some evidence that quetiapine works for anxiety on its own, but most antipsychotics only help if added to an SRI. I would be taking aripiprazole with citalopram, so hopefully it would make a difference.

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Guest anatta

Like any meds - it's worth giving it a try. However, I had very bad problems whilst taking an anti-psychotic. It caused me to be very agitated - both physically and mentally - it was very distressing.

So - yes - give it a go but do be aware that there can be side-effects - again - true of any meds.

Take care

whitebeam

The risk of permanent tardive dyskinesia is my biggest concern about them. But augmentation therapy usually involves a low dose, and I tend not to get long-lasting bad side effects from any kind of drug. I understand the risks and am happy to take them at this point.

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Guest alicebird

Yes I was on duloxetine when I first started quetiapine I think duloxetine is an SNRI which is quite similar as far as I know. I have never taken an anti psychotic just on it's own. Clomipramine is a Tricyclic I think but again it can be used with an anti psychotic to sort of bump up the effectiveness. I think they work together very well.As far as I know they have not been found to be effective on their own. I would discuss with your doctor your ideas, it is good to have a want to be in control of your own care. They may not agree with what you want but if they do disagree I always ask them why, and usually they have a good reason.

I have had some shaking of the hands and stuff but that's only after a long period on it and to be honest I have no evidence that it is the anti psychotic causing it. I am a shaky anxious sort of person in general so I think it could be a psychosomatic thing. The thing my doctor worries about is high blood sugar. A lot of the anti psychotic drugs carry a risk of high blood sugar and diabetes but it's easier if you're already a healthy weight and maintain it I think. If you're happy with the risks and your doctor is too I don't see why trying it out can do any harm. It's yours and your doctors decision.

Sorry for babbling a bit.

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Guest anatta

I have to persevere with 40mg of citalopram for two weeks, and if it doesn't make enough of a difference or it still makes me unfocused (it's not making me tired in the day anymore, but still a lot less focused and productive) my doctor agrees aripiprazole would be a good idea. I'm very lucky that she always investigates suggestions I make. I never get that "just do as I say and stop asking questions" vibe from her. :original:

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