What medication or combo. of have really helped you? And What would you like to try!

[metamorphosis]

3 yrs ago I was on a combination of meds actually started to send my SA and GAD into remission. To but it in a nutshell life was going well. A stable job, cycling daily, eating well, energy and great non-medicated sleep+++ and also dating. Which wasn't really a top priority.
I was on-
Lexapro- 5 mg
Lamictal- 200 mg
Klonopin- 2-4 mg
Wellbutrin- 300 xl
and
L-Methylfolate- 15 mg

With that a combination of supplements:
Fish oil
Glutamine pwd
Electrolyte replacement- due to sodium and potassium replenishment from cycling (250-300 miles a week)
Protein shakes
HMB
Pro/prebiotics
NAC
Turmeric + ginger
D-Aspartic Acid
CoQ10
Co-enzyme B-complex
and a good multi

Then a few things happened- I was laid off from my job and had to take a much lower paying one. This of course nullified many of the supplements I was taking. They aren't cheap. I was in a severe cycling crash, that caused knee damage and road rash all the way up the right side of my body. I am lucky that there was no permanent damage to my body but my bike was toast. The frame had cracked in the pileup. So, it took time to purchase a new bike while paying the bills.

They say that bad things happen in threes. Well, my lexapro lost it's therapeutic effects (pooped out) on me after two yrs.And I had developed a tolerance to the clonazepam after taking it for so long. I have kept afloat since then but other combos. have just not produced the same results. My pdoc and I are working on some med combos. I have always believed the least meds the best. After my crash and the months it took to heal, almost a yr. I put on weight and my eating habits slipped. Which, in my book, the interwoven combination of allopathic medicine along with naturopathic medicine makes common, logical sense.

So, to end this I am on the rebound. Looking forward towards the summer months, with biking, hiking and camping, which is some of the best medicine for anxiety disorders. The cardio. I get on the bike equals taking a benzo, the endorphins, the working of the body, the afterglow and runners high. There have been times after a good ride when I will be totally relaxed on the couch and if anyone stops by. I feel no anxiety. It's the great feeling of saying, "Yo, what's up"! You can't beat that. I am also eating healthier again. Though I slip more than I should.

Anyway, my question to all is-
What medication, or combo off has helped you the most?
I also want to go beyond that and ask what other therapies or hobbies or physical fitness has worked for you?
Did you ever find a "sweet spot" ? Where everything seemed to click?
What was the combo.? Was it medication along with diet, exercise/ and or cbt/act therapy.
And finally is there a medication that would would want to try but have not been able to or stopped using?

I would love to hear responses to any of these!

[Equinox]

Sorry to hear your meds stopped working, what else have you tried? Also what are your diagnoses? This in itself will alter what will likely work best. As you mentioned expense is also a factor which may have you leaning towards certain medications. As you know some disorders can be multifaceted and need several medications for a full response. It seems like you've got your supplements and diet in check, have you had your endocrines tested? That's always a good avenue to check when psych issues aren't resolving.

I may as-well link to a psychiatry blog that I follow, his opinions are based off the best responses he sees for the most patients, so it will be more objective than any individuals response.
His best meds overall (for all psych issues):http://test.askdrjones.com/index.php...ons-revisited/
Antidepressants: http://test.askdrjones.com/index.php...tidepressants/
Mood Stabilizers: http://test.askdrjones.com/index.php...d-stabilizers/
Sleep Medications: http://test.askdrjones.com/index.php...st-sleep-meds/
ADHD meds: http://test.askdrjones.com/index.php...st-stimulants/
Anxiety disorders: http://test.askdrjones.com/index.php...nd-depression/

I think the first and foremost important thing is to make sure your getting good quality sleep. Maybe you're one of those people who sleep well naturally, melatonin never hurts, med wise you can try a low dose of lyrica, gabapentin, or trazodone at night, they enhance deep sleep, also known as slow wave sleep or stage 3&4 sleep, this is the restorative sleep phase which also builds the immune system. More about sleep here; http://test.askdrjones.com/wp-conten...Newsletter.pdf

Physical fitness wise what helped the most was something that could be done in a routine that isn't too easy, or boring to skip or avoid. You may dislike group sports due to SA, but something like indoor rock climbing can be good. Anything that works the body hard for 30 mins a day is fine, there's no need to overdo it with 2 hour workouts, my theory in general is that if you overdo anything or make it overcomplicated your going to end up stopping it due to feeling overwhelmed or burnt out.

[metamorphosis]

Thanks for the links, I'll have to check them out. You always have good resources ;D.
I thought you knew my daiagnosis:
Severe SA, GAD with moderate to severe depression at times, also Bi-polar 3 (hypomanic states due to 5HT meds) but that is easily controlled with lamictal.
That about sums it up. I don't need any more mental disorder "tags", as it is.
Some of the meds I started with are now generic in the U.S. (escitalopram, bupropion xl, and clonazepam of course). I also get Abilify through Rx assistance.
I really need to join a cycling club this yr. It is much more easy for me to interact riding a bike with others. Instead of standing or sitting and talking for any length of time for the most part.
How are you doing on your meds?
I don't know if you are still on the same ones? Which, we talked about around a month ago.
Any coming down the pipeline that you are interested in or have hope for?

Ps.- gabapentin works really well for me but it is expensive as f$$k here. So, I apply for Rx assistance for it. It is one of the meds that is very hard to get without insurance. Trazodone makes me feel like crap the next day. I have been using melatonin, valerian, and mag. glycinate pwd. When I have it. As far as exercise once I am on my bike; I try to take it easy. But many times it's gofobroke. My friends and I have a saying-"ride until you drop and ride yourself into the ground." I am a bit more conservative over the past few yrs because it will take a toll on your body. But once you get fit, trim and in "fighting shape", damn it feels good. And the post ride with the relaxing high beats any medication.

[Equinox]

Oh right, I recall you tried parnate but it didn't work out for you, so are you back on the meds you mentioned above at the moment, including abilify?
I think if gabpentin works well for you then it's certainly worth looking into getting it or pregabalin on RX assistance if possible.
Depression wise Effexor XR still takes the top place for me, I've tried many antidepressants but for me that one worked the best (I had to stop it due to it exacerbating my sleep disorder).
For SA I would usually mention a beta blocker like Inderal for situational events but given your endurance cycling that's probably better avoided.
I am on the same meds, but I have a lot of stuff going on (PTSD, chronic fatigue/sleep disorder) which always skews my response to things, I don't think I'm a typical case.

[metamorphosis]

Oh right, I recall you tried parnate but it didn't work out for you, so are you back on the meds you mentioned above at the moment, including abilify?
I think if gabpentin works well for you then it's certainly worth looking into getting it or pregabalin on RX assistance if possible.
Depression wise Effexor XR still takes the top place for me, I've tried many antidepressants but for me that one worked the best (I had to stop it due to it exacerbating my sleep disorder).
For SA I would usually mention a beta blocker like Inderal for situational events but given your endurance cycling that's probably better avoided.
I am on the same meds, but I have a lot of stuff going on (PTSD, chronic fatigue/sleep disorder) which always skews my response to things, I don't think I'm a typical case.

Yeah, Parnate kicked my ass. No sleep, no regeneration of the body and 2-4 hrs. a night was not cutting it. Certain meds. were out of question. Some people use trazodone, as a sleep aid but my pdoc was not comfortable with the combination. We considered low doses of seroquel or another AAP but he wanted the drug to stabilize somewhat in my body before adding anything but lamictal and klonopin. After 2 weeks of this, I was just getting ripped apart physically and mentally. I told him, that if we ever try parnate again. Which is a probability. I will not do it without a decent sleep aid!
Yeah, I will pick pregabalin over gabapentin any day!
As far as Effexor XR goes, I seemed to have a paradoxical reaction. It actually made me more lethargic and increased my appetite greatly.
What dose of Effexor were you on? I presume it was XL?
Are you using any DA or GABAergic medications?
Also, with the insomnia, what meds. have you used?
And to any benefit?
Also, are you doing any cardio. exercise on a regular basis to help with sleep and health?

[metamorphosis]

^^^^^To anybody and/or everybody about the OP: What medication or combo. of have really helped you? And What would you like to try?

[Equinox]

Yeah, I will pick pregabalin over gabapentin any day!
As far as Effexor XR goes, I seemed to have a paradoxical reaction. It actually made me more lethargic and increased my appetite greatly.
What dose of Effexor were you on? I presume it was XL?
Are you using any DA or GABAergic medications?
Also, with the insomnia, what meds. have you used?
And to any benefit?
Also, are you doing any cardio. exercise on a regular basis to help with sleep and health?

To answer your questions..
-I was on 225mg of Effexor XR, brand name capsules with the patented slow release bead technology. Apparently some generic venlafaxine- xr preparations are just tablets..might not work as good, were you on a generic?
-I'm not familiar with patient assistance programs as they are not much of a thing in my country, does it usually only apply to brand name meds which are still under patent (since it seems to be through the brands that produce them)? If so there's a new formula of gapaentin called Horizant..I think.
-Yes, I currently take Dexedrine IR and Klonopin, only low doses of each.
-Alot, let's see...Remeron, Seroquel, Doxepin, Trimipramine, Ambien, Lunesta, Unisom. Benefit? Hmm, mostly with the first 3 but they came at the cost of many side effects (strong antihistaminergics= side effects galore generally). You're taking Ambien right? I guess it stopped working for you? The Z-drugs would be my first choice just due to a lack of side effects, even though they are weaker agents so I guess Lunesta would be my recommendation, maybe with gapentin/lyrica added. You mentioned AAPs, which did you try for sleep? I think I recall you mentioning Saphris?
-Not as much as I used too, I really need to get back into exercising regularly.

[metamorphosis]

To answer your questions..
-I was on 225mg of Effexor XR, brand name capsules with the patented slow release bead technology. Apparently some generic venlafaxine- xr preparations are just tablets..might not work as good, were you on a generic?
-I'm not familiar with patient assistance programs as they are not much of a thing in my country, does it usually only apply to brand name meds which are still under patent (since it seems to be through the brands that produce them)? If so there's a new formula of gapaentin called Horizant..I think.
-Yes, I currently take Dexedrine IR and Klonopin, only low doses of each.
-Alot, let's see...Remeron, Seroquel, Doxepin, Trimipramine, Ambien, Lunesta, Unisom. Benefit? Hmm, mostly with the first 3 but they came at the cost of many side effects (strong antihistaminergics= side effects galore generally). You're taking Ambien right? I guess it stopped working for you? The Z-drugs would be my first choice just due to a lack of side effects, even though they are weaker agents so I guess Lunesta would be my recommendation, maybe with gapentin/lyrica added. You mentioned AAPs, which did you try for sleep? I think I recall you mentioning Saphris?
-Not as much as I used too, I really need to get back into exercising regularly.

-It was generic venlafaxine ER and it was encapsulated with the slow release spansules I didn't get above 75 mg though!
-I am hopefully going to be able to get gabapentin through Rx assistance. As iI am also doing a slow taper off of clonazepam.
-I have tried Doxepin and it's antagonism at H1, and alpha 1 adrenergic receptors made me feel like terrible. That was only at 10mg for sleep. I don't think it is an effective medication for anxiety disorders at least in my case. One of the original TCA's, it is almost a straight up anti-histamine. Remeron= 'Shaun Of The Dead', lol. at least for me, even with it's sedation levels being paradoxical. I have used asenapine a few times. I just try to stay away from the atypicals in general. Except aripiprazole, which I use at the lowest dose, 1 mg a day, to avoid akathisia. I see my podoc on Tue., so I am going to talk to him about eszopiclone. I do want to try it for sleep. Zolpidem is worthless to me for sleep because of it's, what 3-4 hr half life? I have been slacking on getting on my bike also. The weather is still cold here. I have an indoor trainer but it is a very mundane way of exercising.
-Meds. I would like to try are vyvanse, adderall spansules, or dexedrine xr. I have used Dex. IR prn. I believe, if an amphetamine is involved. Than extended release is the only way to go. Even at low doses the instant release amphetamines affect the monoamines to strongly and will cause the downregulation of DA and NE receptors, IMO.
Are you taking anything to prevent tolerance from the Dex., memantine etc.?
You dropped the luvox?
Also, you stopped the Effexor ER. because it was exacerbating your insomnia?
I think you mentioned that it was working well for you but increased your sleep issues.
One med. I just have a gut instinct to try is agomelatine. Though it has a weak affinity for almost every NT except MT1,2 and a 5HT2c antagonist from what I gather? and many people say it does nothing. Of course a good response would be to take a pure SERT (escitalopram) along with melatonin.
Nardil would be a choice, if it didn't have such an ugly side-effect profile.
And Parnate would be excellent if had any effect on the GABA transaminase enzyme. Plus, the use of another med. for sleep issues in my case. All of the other MAOIs don't really have very good anecdotal reports. Plus the price of the patch in the U.S. without insurance is through the roof.
Also, do you feel that you do not need any real 5HT meds?

[Equinox]

Maybe you'd prefer Effexors succesor Pristiq, it's said to be more stimulating, however it's on patent so also likely expensive. Have you tried any other SSRIs apart from Lexapro? What about good ol' fashioned prozac? Being an atypical SSRI it is widely regarded as being more stimulating than the others, seems to have stood the test of time too.

Eszopiclone lasts about 7 hours, so twice as long as Zolpidem. In studies little tolerance builds too the sedating effects of Lunesta compared to benzos and Ambien, Stahl explains this away as it having a different way of binding to gaba receptors in the sense in which it doesn't really down-regulate them like a benzo would with chronic use, I don't know how true it is, but it was the basis of Lunesta becoming the first insomnia treatment to receive official FDA approval for long term use.

Speaking of Agomelatine I've tried that one too. I didn't find it to do much just as others have said. But it's not available in the US anyway right? If you do take melatonin for sleep, a few good tips are to take it about 4 hours before bed..it works more effectively that way rather than taking it directly before bed because the biological process it's triggering takes time to peak, and the second tip is to buy proper melatonin, not the homeopathic formulas (usually distinguished by the presence of '6x' on the label, the homeopathic formulas are too watered down.

I stopped Luvox after 6 weeks because I wasn't receiving much benefit and my chronic headaches seemed to be increasing in frequency whilst on it, though this may have just been coincidence.
As for Effexor, yeah it was definitely giving me insomnia which was leading to hyper-somnolence due to, I suppose poorer sleep quality, as you found with parnate.
I'm not sure if I need 5HT meds. I only responded positively to 2 of them..effexor xr and lexapro, in a way this may make sense as drjones (from the links above) explains that these are the two with the lowest protein binding, which in plain english means that a larger percentage is free to interact with 5HT receptors in the brain compared to the others.

If your looking at a generic long lasting stimulant then your choices are probably going to be dexedrine spansules, generic adderal XR and ritalin LA, all last for approximately 8 hours.
Within the clinical dosage range IR stimulants really don't do much damage or downregulation of da/ne, it's a bit over-hyped. As drjones mentions, stimulants have been scientifically studied and used medicinally for 70 years and are regarded as safe even with chronic use so long as one stays within the dose range, the bigger issue with IR stimulants is the valleys and the peaks, it wears off to quickly, it's really just easier to take a long acting form and avoid those issues, especially when depressions involved, as these types are more likely to feel the 'crash'. I don't take memantine, my tolerance is fine, the bigger issue is that it wears off too quickly, necessitating more frequent dosing, but with long acting stims that shouldn't be an issue.

[metamorphosis]

Well thats my issue with instant release amps. They dump to much DA and NE into the synaptic cleft through their quick release on NET, DAT and VMAT inside the cell body itself. Even at a 7.5mg dose of IR Dex. you're going to have that peak and valley because it acts so quickly as a competitive binder to how the whole neuron and monoamine system usually operates. I don't think the negative effects of IR amp. salts are overhyped. It is much better to get a lower and steady release of the NE/DA from extended release than the quick and complete binding to the NE/DA at the substrate sites in such a short period. Thats one reason why we both have fellow internet mates that cannot control the tolerance issue and go over the deep end. Granted a few of them are not specifically looking for SA remission but a dangerous and ultimately neurotoxic high!

[Equinox]

What is your primary purpose for wanting to try stimulants? I don't take stimulants for SA, they don't improve that much for me at all, I take them for the daytime hypersomnia symptoms of my sleep disorder and for ADHD, before them I could hardly get out of bed or function. As for those chasing a high, their on a pointless endeavour, I don't get any kind of high from it nor is that a desired outcome, and for those who do experience it it's merely a short term side effect that goes away as the therapeutic effects shows up, so not sustainable at all. My dosage has never changed, the only thing that's changed is the dosing schedule, say taking 2.5mg 4x per day rather than 5mg 2x per day. I feel sorry for Narcoleptics who routinely have to take 60mg of Dexedrine a day.

The alternative is of-course the methylphenidates such as ritalin, focalin and concerta, as they are only NDRIs and don't interact with VMAT at all. That said, Ritalin-IR is still reported to have a notable crash, so the longer second generation preparations would still be more ideal IMO.

If you really want a consistent preparation of amphetamine salts then your going to need Vyvanse, the others like Adderal XR are still very very variable as to when they peak, so only vyvanse truly demonstrates findings consistent with what you've mentioned above.

Vyvanse is much more consistent than Adderall XR from day to day and patient to patient. Vyvanse consistently reaches peak blood levels in 3 1/2 to 5 hours at a concentration of 100-175 ng/ml for a 70mg capsule. Adderall XR has 400% variability – it peaks anywhere from 3 to 12 hours at levels of 70-300 ng/ml for a 30mg capsule.

Acidity levels in the stomach and small intestine and levels of gastrointestinal motility significantly impact absorption of Adderall XR but not Vyvanse. Food, especially fat in the stomach or intestine can delay Adderall XR up to 2 1/2 hours but maximum delay of Vyvanse absorption is less than an hour. Since it takes 3 hours to digest a fatty meal, forgetting to take XR before eating can result in significant stretches of time with reduced focus and productivity.

http://test.askdrjones.com/index.php...ment-for-adhd/

[metamorphosis]

Yeah, I was insinuating anything about you. Is vyvanse available in Australia?
I do have ADD and dexedrine in the past has made me focus on singular tasks at hand. I gave Ritalin a go once but the extrapyramidal effects were to much. The methylphenidates are not for me. I see my pdoc Tue. and we will discuss vyvanse. I'm sure he will be willing to give it a go but I will definitely need some assistance program for that.

[Equinox]

That's cool, I just mentioned because I recalled that I hadn't given an explanation as to why I take stimulants.
There's no vyvanse in Australia, the only commercially available amp here is Dexedrine IR.
Can you try dexedrine xr spansules? Maybe they have a more consistent controlled release mechanism than adderall xr, I recall there's an article on medscape which explains in detail how each extended release stimulant works, but I can't seem to find it at the moment, do you happen to have it? It was a really good page.
I'm still trying to figure out how patient assistance programs work in the US, does the brand agree to pay a portion of the price for the tablets?

[metamorphosis]

That's cool, I just mentioned because I recalled that I hadn't given an explanation as to why I take stimulants.
There's no vyvanse in Australia, the only commercially available amp here is Dexedrine IR.
Can you try dexedrine xr spansules? Maybe they have a more consistent controlled release mechanism than adderall xr, I recall there's an article on medscape which explains in detail how each extended release stimulant works, but I can't seem to find it at the moment, do you happen to have it? It was a really good page.
I'm still trying to figure out how patient assistance programs work in the US, does the brand agree to pay a portion of the price for the tablets?

Looking through medscape for that singular paper might take me days unless I know the key words. I know you are pretty organized with your filing system. Well my computers storage space would look like that locker in school where sh*t is falling out everywhere. And I do not want to do a computer restore ;p. I'll go to medscape and the pubmed general database. I would love to be paid for somehow as a researcher.$$$ ;D Umm, the prescription assistance program is paid for by the company usually.

" U.S. citizens; people who make below a certain income; people who either lack prescription drug coverage or those with coverage whose insurer has denied coverage of a particular drug".

Now some companies make it a lot easier, as far as applications and paperwork than others. You always have to have a doc or pdoc fill out and sign their part along with sending in said Rx. Certain pharmaceutical companies do not offer or only certain meds in their formulary. Generics are not usually covered for the obvious reason. Let's see my Klonopin, just received- 30ct at 1mg tabs for 11.38. But Parnate which is definitely a generic runs around $120 because it isn't in demand and probably one company is producing it. I think the stats are around 10,000 in the US use the traditional MAOIs.
Often high scheduled drugs/narcotics will not be covered. The other option is a load of PA. cards available. Some that do knock of a little money and others that are worthless or coupons that can be printed out.
So here in the states it is like a double edged sword. If you have decent insurance or can jump through the hoops for PA. programs good. If you do not qualify or make just over the cutoff line w.o. insurance screwed. But overall, we are afforded more meds and specialised health care. Than when you consider many countries. I wish we would implement some form of socialized healthcare. Either using the U.K. model or Canadian or some other countries. They all tweak it out of the system in their own ways, higher taxes etc. I can go on about the billions we spend on a manufactured war but thats for another forum.
There is a simple but profound saying:"Take care of your side of the street before worrying or bothering about the others"

[Equinox]

We have socialized health care here, I think all western nations bar the US do. How it works here is basically that if a person has a professional diagnosis which matches a disorder that a medication has been approved to treat then it's government subsidized, so for example a person with major depression can get brand name Lexapro for cheap. For more expensive/off label meds those with private health insurance can claim back some of the money they've spent, but I think that's a bit more similar to what you have in the US since not everybody has health insurance here by any means.