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Old 04-30-2018, 01:53 PM #11
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All of those are possibilities but here is my logic for thinking itís the meds. A partial agonist at d2 is still less than native dopamine so it still blocks dopamine and actually binds more efffectively than any other AP because itís a partial agonist. So itís still dopamine blockade which is how APs all work. The meds for add/adhd function by increasing dopamine, they are basically speed, that suggests that adhd is in part caused by too low of dopamine. This is why I think it could be the meds.
One of the good things about not taking meds for over a year is that you know that whatever's going on is probably not down to meds anymore (well, except for the tardive myoclonus, which I figure is permanent now after 8 years of it) :/ But I remember trying in vain to figure out what was meds and what was 'me' back when I was on meds

Obviously, to preface all of this, what we understand about the brain and dopamine systems and what the meds are actually doing in there is limited. But the theory is that the striatal and frontal dopamine levels are linked by a mesocortical feedback loop. So high striatal dopamine levels in psychosis push down the frontal dopamine levels.

Regular D2 antagonists are theoretically going to push down the striatal dopamine signalling, which should increase frontal dopamine signalling in response. BUT they're 'dirty' in the sense that they don't just act on the mesolimbic pathway areas, so they're probably undermining that in the frontal area by antagonising D2 there too.

But D2 partial agonists, like aripiprazole (and brexpiprazole, and I believe that cariprazine is a partial agonist too?? Neither of those are out in the UK yet though) should theoretically increase the frontal dopamine signalling. They might not decrease the striatal signalling as much as the antagonists do to activate the frontal feedback loop as much, but they should also be working in the frontal lobe to actively increase dopamine signalling too.

Aripiprazole is the only AP with evidence for use in combination with another AP as it can improve negative and cognitive symptoms, whereas all of the other combos just increase side effects with limited/no benefits. So, IMO, aripiprazole shouldn't be causing you as much issues with impulsivity and cognition as the standard D2 antagonists might. I'm honestly leaning towards it being negative and cognitive symptoms. But that's jmo and who really knows what's actually going on in reality: it's all just theories!

Anyway, it occurred to me last night that you must really be struggling if you are considering taking sarcosine and other stuff. I know how concerned you were about supplements before, so I figure that things must be bad if you're willing to try them, and I'm sorry about that

I know that you are even more scared about messing with the aripiprazole, and I don't blame you when it has worked for you so well for so long. But maybe it would be worth trying something else if the supplements don't do everything that you hope? Cognitive and negative symptoms are the hardest to treat though, as you well know, but everyone responds differently to the meds, and only trial and error will show if there's a better option for you out there.

Anyway, I know that it really sucks, and so I just wanted to offer my support

*Willow*
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Old 04-30-2018, 02:09 PM #12
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Default Re: Sitting with hunger....

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One of the good things about not taking meds for over a year is that you know that whatever's going on is probably not down to meds anymore (well, except for the tardive myoclonus, which I figure is permanent now after 8 years of it) :/ But I remember trying in vain to figure out what was meds and what was 'me' back when I was on meds

Obviously, to preface all of this, what we understand about the brain and dopamine systems and what the meds are actually doing in there is limited. But the theory is that the striatal and frontal dopamine levels are linked by a mesocortical feedback loop. So high striatal dopamine levels in psychosis push down the frontal dopamine levels.

Regular D2 antagonists are theoretically going to push down the striatal dopamine signalling, which should increase frontal dopamine signalling in response. BUT they're 'dirty' in the sense that they don't just act on the mesolimbic pathway areas, so they're probably undermining that in the frontal area by antagonising D2 there too.

But D2 partial agonists, like aripiprazole (and brexpiprazole, and I believe that cariprazine is a partial agonist too?? Neither of those are out in the UK yet though) should theoretically increase the frontal dopamine signalling. They might not decrease the striatal signalling as much as the antagonists do to activate the frontal feedback loop as much, but they should also be working in the frontal lobe to actively increase dopamine signalling too.

Aripiprazole is the only AP with evidence for use in combination with another AP as it can improve negative and cognitive symptoms, whereas all of the other combos just increase side effects with limited/no benefits. So, IMO, aripiprazole shouldn't be causing you as much issues with impulsivity and cognition as the standard D2 antagonists might. I'm honestly leaning towards it being negative and cognitive symptoms. But that's jmo and who really knows what's actually going on in reality: it's all just theories!

Anyway, it occurred to me last night that you must really be struggling if you are considering taking sarcosine and other stuff. I know how concerned you were about supplements before, so I figure that things must be bad if you're willing to try them, and I'm sorry about that

I know that you are even more scared about messing with the aripiprazole, and I don't blame you when it has worked for you so well for so long. But maybe it would be worth trying something else if the supplements don't do everything that you hope? Cognitive and negative symptoms are the hardest to treat though, as you well know, but everyone responds differently to the meds, and only trial and error will show if there's a better option for you out there.

Anyway, I know that it really sucks, and so I just wanted to offer my support

*Willow*

Thanks willow.....have you seen the studies where Abilify specifically increases gambling activity and other risky behaviors? Thatís why I was wondering if it was an impulsivity issue. But yes I was feeling really badly last week after failing my first practice test after months of study, but I really improved this week so it might be ok. Normally Iím not studying exactly but while Iím studying I think supplements might help, coffee has already helped.....
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Old 04-30-2018, 02:19 PM #13
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Thanks willow.....have you seen the studies where Abilify specifically increases gambling activity and other risky behaviors? Thatís why I was wondering if it was an impulsivity issue. But yes I was feeling really badly last week after failing my first practice test after months of study, but I really improved this week so it might be ok. Normally Iím not studying exactly but while Iím studying I think supplements might help, coffee has already helped.....
Yeah, I read about that, but IMO the numbers are tiny when you consider how many people have been prescribed it over the years. Perhaps those people have some weird propensity to it, or it's a coincidence, or it clashed with some other med they were taking, or a million other possibilities...

Do you feel like other people would classify you as an impulsive person??

(Not to recommend nicotine addiction at all, but the evidence for its cognitive enhancement is pretty good! lol)

I hope that you're not comparing your current cognitive abilities with your previous abilities. When I do that, it's a recipe for disaster. As much as it sucks, I have to accept that I'm not like that anymore, and you probably aren't either, unfortunately

*Willow*
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Old 04-30-2018, 02:36 PM #14
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Default Re: Sitting with hunger....

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Originally Posted by WeepingWillow23 View Post
Yeah, I read about that, but IMO the numbers are tiny when you consider how many people have been prescribed it over the years. Perhaps those people have some weird propensity to it, or it's a coincidence, or it clashed with some other med they were taking, or a million other possibilities...

Do you feel like other people would classify you as an impulsive person??

(Not to recommend nicotine addiction at all, but the evidence for its cognitive enhancement is pretty good! lol)

I hope that you're not comparing your current cognitive abilities with your previous abilities. When I do that, it's a recipe for disaster. As much as it sucks, I have to accept that I'm not like that anymore, and you probably aren't either, unfortunately

*Willow*
No I donít think Iím generally impulsive just slightly moreso now than historically....in some ways itís like if there were a gallon of impulse control that you get through the day, I feel itís been cut in half, itís not that I have no control but I can only use the control for really important stuff not food etc.

I considered nicotine it supposed to be a 25% increase or so and you can use the patch but still bad for your heart.

Iím not comparing with pre illness so much as initial post illness values....things have gotten worse, at first they were bad and got continually better now they seem worse than when they got better and I havenít had more episodes....why is it I can barely focus while reading.....I know I read better off Abilify itís almost like it stops me from learning.....
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Old 04-30-2018, 06:39 PM #15
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No I donít think Iím generally impulsive just slightly moreso now than historically....in some ways itís like if there were a gallon of impulse control that you get through the day, I feel itís been cut in half, itís not that I have no control but I can only use the control for really important stuff not food etc.
I can't relate if you call it 'impulse control', but if you call it 'mental energy' or 'willpower', then I think I can. I think because I don't consider myself impulsive; maybe that's the sticking point, idk? But in terms of mental energy or whatever to do what needs to be done, I definitely feel like there's less to start with, and that everyday tasks take up way more of it than it used to. So I have to force myself to do things that never used to require a second thought. And socialising with people, even when I'm having a really good time, wipes me out way worse than it ever used to (though I have always been an introvert, just way more so now). Not everything that needs to get done, does get done, but I get by. But in terms of doing things impulsively, no, not at all.

I can't speak to hunger and food though. Pre-meds, I had a perfectly normal appetite. I never worried about weight: I ate what I liked, and I stopped when I was full. The only exception was a special occasion, like a birthday, where I'd squeeze in dessert, even if I was full, but then always felt so uncomfortable afterwards. But I never really fought against my hunger because I never had to: I never had the desire to overeat. Actually, when I was 8yo, I severely restricted my food intake for a few months, so I guess that I fought against hunger then, but I don't remember that it was hard.

Being on mirtazapine, quetiapine, and olanzapine were totally different experiences though. Honestly, the hunger never let up. It wasn't a 'normal' appetite at all! I tried fighting against it, and it was so ridiculously hard, and it felt futile to resist, because even resisting, I was still gaining weight, though maybe not as much. I felt totally out of control with it, and my pdoc at the time telling me to "eat less and do more" when I was sleeping 18 hours a day and eating anything not nailed to the floor...well, I wanted to punch her in her stupid face! She clearly had no understanding of how intensely my brain would scream at me for food. I don't see that as impulsive so much though...maybe others would, idk? But it feels so completely alien to my previous experiences of hunger and controlling food intake that it's hard to compare.

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I considered nicotine it supposed to be a 25% increase or so and you can use the patch but still bad for your heart.
Yeah, much as I'd love the cognitive boost, I wouldn't take it either.

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Originally Posted by Sometimes psychotic View Post
Iím not comparing with pre illness so much as initial post illness values....things have gotten worse, at first they were bad and got continually better now they seem worse than when they got better and I havenít had more episodes....why is it I can barely focus while reading.....I know I read better off Abilify itís almost like it stops me from learning.....
Honestly, values change over time in everyone, but especially after what you went through. It's only natural, IMO. Eleven years ago, I was a complete workaholic. I lived to work. My career as a Dr was the most important thing, and I didn't do much else outside of it, except the extracurricular stuff needed to get ahead in medicine (and very occasionally I had a social life). Now, I wouldn't be that career-focused if you put a gun to my head! I've discovered the value of living in the moment, and appreciating the little things in life. So my values in that regards have very much changed, even though I'd still like to go back to medicine in an ideal world. I'd do it very differently this time around though.

My ability to study has tanked. Recall is really bad. I learn something, like a new word, and the next time I come across it, a few lines further down, I have to look it up again because I've forgotten it. I even forget the meaning of words that I know. As soon as I've read something, it's gone again. Even replying to posts here can be hard because I've forgotten so much of what I used to know, it's hard to learn anything new, and it's hard to form a coherent argument. Repetition was the only thing that helps a little, but it's still not an efficient way to learn given how much effort it costs.

Reading is really difficult too, and I used to read voraciously. It seems to make more sense if I hear it at the same time as I read it (I used to have text to speech software, which really helped, but it stopped working.) Listening to audio books doesn't help as my mind wanders, and straight reading doesn't work either. But the two together at the same time is a bit easier, but still not what it was. I also found watching videos better than reading if I could get around it, which I know is something you're trying now with some success.

The meds really messed with my ability to think. Everything felt like wading through sludge, especially on the more sedating ones. But even off meds for ages, it's not miraculously clear at all. It has gradually gotten worse over the last 11 years and I don't know why. My thinking just isn't what it was, and it really sucks that that's the way it is. I'd give anything to go back to how I used to be cognitively, but I have to accept that this is the way it is. I mean, I get by and most people can't tell, which in some respects, is good because I don't want people thinking that I'm stupid. But in other respects, it feels quite invalidating because it feels like people are basically calling you a liar because they can't tell you're having issues. But then I get that with most things, so I should be better at ignoring it!

Anyway, I don't really have any answers, I'm sorry. I really wish that I did, for both of us. All I can offer is some empathy and a

*Willow*
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