antipsychotics in bipolar-ish

i do.not.have classic Bipolar I. "It" started as psychotic depression, I had a lil switch-a-roo, and now...???

im on 15/Abilify (the next Rx is for 10) + 20/Prozac. blah. the anti-seizure meds were mostly a bust. i hate depakote, trileptal caused depression, and lamictal...well, it did less to elevate mood than Prozac has, and it was ridiculously numbing. i wasn't necessarily zonked out, apathetic...it was more subtle, and...yeah. yeah.

so, now, id like to know...for those of you with similar "issues..." how is your abilify (or other neuroleptic) dosed? im -especially- interested in how people who have been diagnosed with the manic flavor of Schizoaffective are dosing the antipsychotic, which one was prescribed, etc.

im oddly tempted by seroquel. lol. but i think abilify might not be as harsh on the body, overall (?). i just...don't know. my psych is forever singing the praises of vraylar, but...id rather not. it scares me...-if- i am to switch, id like something with solid data available.

ok. and...i kinda suspect abilify might have been making -some aspects- of my (frequent) depression worse. does anyone have truly good experience with these drugs, long term, when the low end is the main problem?

I have schizoaffective bipolar type, I take two APs, Abilify and Thorazine and have been doing fantastic on them. I'm more stable than I've been in years. Dosages are 10mg abilify and 200mg thorazine

I don't have schizoaffective disorder. I have bipolar type 1 that leans in the manic depression. I have had my share of psychosis and also depression. For me, Seroquel XR has been my main medication. I do take other bipolar medications, as well, but believe Seroquel XR is the main one for me.

My dose of Seroquel XR is 600 mg. Most all websites state the following for people with bipolar type 1. Average doses as monotherapy or adjunct to Lithium or Depakote are:

* Bipolar depression - 300 mg

* Mania/Maintenance - 400 mg to 800 mg

Obviously people do well on other doses other than "average doses", above or below, or take it only for sleep, usually at lower doses. Plenty of people take it as an adjunct to other meds instead of Lithium or Depakote. In my case, my Seroquel XR might be slightly higher than it otherwise would need to be because of how it interacts with Tegretol. Maybe.

Regular Seroquel has the same averages above, but is often given twice a day instead of once. I find some minor differences between the two in terms of my tolerability. I highly doubt that I would do as well taking the regular Seroquel only once per day. XR is the right choice for me.

Abilify was temporarily helpful for a past depression, but not my mania. I know it was for others. I forget my past dose.

I'm on 20 mg abilify only. The higher dose works well for me so far. I haven't stayed home alone yet though. I'm usually on the low end.

I have bipolar 1 and am doing well on Seroquel at night and Vraylar during the day - Also on Lamictal and Gabapentin. Typically play with small doses to see how things work together - day night split helps identify variables that need tweaking.

thorazine...eeek! it has a bad reputation. but 200mgs isn't a high dose, and apparently it is about as easy to tolerate as risperidone as long as the dosage isn't too high (so says wiki). :-) why those two?

i've considered 2 AP combinations (by which I mean prescribers have brought up the possibility...), but I'm scared I'll die or have twitches. a doctor brought up amoxapine, which is an old tricyclic that does double duty as a tranquilizer, for my intense depression. i declined, because I thought it sounded like the harshest possible Rx, ever. now, I kind of wish I'd at least tried it, maybe (?).

i've been oddly curious about seroquel, probably the xr. it has solid data on it for all phases of bipolar, plus its original indication was for Schizophrenia, so...yes! im just concerned that I'll get diabetes or...cataracts. I dunno.

abilify is a somewhat unusual Rx. low doses can help depression; higher doses = an OK antipsychotic, no more or less effective than most other options (so says the Cochrane Review), but less toxic in some respects than many alternatives. my -big- concern is TD, because (wait for it, wait for it) I -had- facial tics and such after stopping an 'atypical,' way back when...they stuck around till I started taking high/massive doses of antioxidants, b-vitamins, etc.

im a little worried about going down to 10/abilify, but...again: abilify is a somewhat unusual drug. the brain imaging studies show that most people probably don't need high doses, anyway...it takes over those D2 receptors at a high %, even at low(ish) doses. good to know...

anyway, thank you all. :-)

I was on 600mg of seroquel but changed over to the abilify and thorazine due to weight gain and the seroquel not fully controlling my psychosis. Thorazine doesn't generally have the weight problem since it's a typical antipsychotic according to my doctor. and abilify is just generally less associated with weight gain so my doctor chose those. I was a little shocked when my doctor brought up thorazine," I'm like but isn't that ancient?" she said yes it's an old one but it's a very effective medication.

I was terrified of taking thorazine at first but I took it and I have to say, I haven't had any side effects except when I was on 400mg of it but that had to be lowered to 200mg because it was causing too much dizziness and blood pressure issues, at this dose along with the abilify and other meds I'm on I'm doing amazing. I'm not overly sedated, I have energy and motivation and it controls the psychosis probably better than any other meds I've been on.

I think part of the bad reputation associated w/ thorazine is due to it being used at way too high doses back in the day

I have only one idea to add. For me Seroquel has been a nightmare. Tremendous weight gain, absolute no benefits except that it causes me to sleep pretty well. The problem with that so-called "bebefit" is I that am physically addicted to the stuff and cannot sleep without it anymore. I feel like I'll be on a tiny dose forever, unless I don't want to sleep. IMO, a horrid med.

I have bipolar 1 with a history of a ton of psychosis, so, actually not that different from Schizoaffective Bipolar Type in terms of symptoms. To me these are very similar disorders on the same spectrum. Just my take. Anyhow, I was on Abilfy 30 mg/day for years. I don't think I ever had any side effects and my labs were all normal. It definitely helped prevent psychosis in me, no doubt. No weight issues. I can't really comment on its depression effect because I am on lithium, which works well most of the time for my particular depression. I ultimately had to d/c the Abilify because I was developing a movement disorder that was really impairing my quality of life. We decided to go without an antipsychotic. So far, so decent. And the movement disorder has basically gone away completely. Yeah!

I have also been on Risperdal, Invega, Seroquel, Zyprexa, and Symbyax. They all have their pluses and minuses. If I had to choose one to go back on again, since I can't do Abilify, it would probably be Risperdal. Taken at night or by injection, I did pretty well on it. Good luck!!

i've been curious about symbyax, too. zyprexa was a nightmare once the dose was up to semi-therapeutic levels, because I went from calmer, more lucid to foot tapping, unable to engage in convo because of akathisia. ugh. but...i was younger then, on other things, and...honestly, i just like the idea of it, because its an antipsychotic+antidepressant combination that's actually been studied, in depth. so, there's that.

i took 30mgs/abilify for years, too. i think, looking back, i had un(der)-treated depression, and I blamed the abilify. but..now, the Prozac apparently boosts blood levels of Abilify. The combination -is- good to me, overall, its just....my right hand has a fun tremor going, and...not good. not good at all.

honestly, i kind of wonder...if maybe i just get recurrent psychotic depression, with some bad anxiety and mild obsessive stuff 24/7. not that im "special," just...i've responded -so- well to just 20mgs/Prozac, I'm wondering if what ails me is heavier on mood, lighter on psychosis. who knows, right?

My biggest problem was severe mixed episodes, sometimes with psychosis. The only med that has stopped both mixed and psychosis is Geodon. I started it in February and within a week was no longer psychotic and just moderately hypomanic for another two weeks. Since then I’ve been stable. It’s the longest time I’ve been stable since I was a kid. No side effects either. I’ve tried Latuda, Abilify, Seroquel, Largactil, Zyprexa with little to moderate effect but a lot of side effects. Geoden has been a game changer for me.

I have schizoaffective and clozapine has worked like a charm for me. It has given me my life back.

Haldol is my lifesaver

I don't have schizoaffective but I do have severe bipolar. Clozapine has changed my life immensely and I am so glad I ran out of viable med options and went on it. I'm almost at 4 years out of the hospital and I've stayed able to cope through things like my father's death. I'm even able to break out of my shell a bit and go to church and a group through church. Those are huge things for me. I haven't had a severe episode since starting. The one time I started going mixed 4 days of a 25 mg increase kicked its' butt. That never happened with other meds, even heavy sedatives.

I know it's not a first choice but if you need it it is good stuff.

I also have severe bipolar 1 but not schizoaffective. I am managed by two atypical anti-psychotics. Seroquel XR and Saphris have given me a stability that has previously eluded me. I have now been stable for 2.5 months - the longest period of stability I’ve had since diagnosis 5yrs ago.

I relate and empathize. I've tried to feel in my time but ID rather just stick to an ssri or something like that you know but that's me I was never diagnosed with psychotic tendencies glow

im really hoping to up the anti-depressant end and lower the tranquilizer/antipsychotic end of things. nothing against the drugs, people need them, blah blah blah...

I'm starting to think psychotic depression is just...my current residence...and if I can get my mood elevated, maybe I won't need as much antipsychotic. they're all harsh drugs, after all.