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Dr. G. Latuda Questions
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ddnos posted:
Hi Dr. G.

I had a first appt today for a consultation appt re my meds, i.e. Nardil. As you may or may not remember, I've been very slowly lowering the dose because of high adrenaline levels becoming a problem. I'm at 30mgs a day and since changing to that 1 month and 1 weeks ago, it has not been good. So I don't know that I could continue weaning as slowly as I have been and survive it! lol

Anyway, by the end of the appt, she suggested Latuda (starting at 20mg a day) and reducing nardil by another half a pill. So I would still be taking that small dose of nardil along with Latuda and the lithium I'm already taking. I think at first it was her idea to have me continue to reduce nardil by a half pill as slow as I am now, but with the added Latuda to help. I then asked if it would be reasonable to just stay on a low dose of nardil along with latuda. She said that it would be. Of course, none of that is written in stone at this point.

I am diagnosed with BP 2 (depression) - and yes, I know it's completely individual, but at first glance, do you think the above combo of meds is reasonable to try?

Also, re Latuda, I read that the risk of tardive dyskinesia increases with longer duration of taking antipsychotics, and that chronic antipsychotic meds should be reserved for certain patients.....don't want to type it all out.....so that concerns me a bit because I know that meds are a "lifer" for me, and I don't want to take something where the potential for such an effect is in the back of my mind. How common is tadive dyskinesia as a side effect of antipsychotics, in particularly, Latuda?

Thank you for your time!

Debbie
Forgiveness is letting go of the hope that the past could have been any different --Unknown
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Joseph F Goldberg, MD responded:
Dear Debbie, Latuda was recently FDA- approved for the treatment of acute episodes of depression in bipolar I disorder. It hasn't been studied yet for bipolar II disorder or for long-term relapse prevention. There are also 1 year data using it for schizophrenia. Unlike many atypical antipsychotics it appears to be more weight-neutral and also may have a lesser risk for diabetes and high cholesterol. All antipsychotics have some risk for tardive dyskinesia and no specific number is presently known for latuda, though for most atypical antipsychotics the risk is <1%. It is a reasonable choice for treating bipolar depression. Long-term, mood stabilizers like lamotrigine or lithium or Depakote remain more the gold standard mainstays of treatment. Also other traditional antidepressants besides MAOIs are probably much less likely to destabilize mood in someone with bipolar II than I disorder, especially if no recent hypomania episodes have occurred. Dr G
 
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ddnos replied to Joseph F Goldberg, MD's response:
Thank you, Dr. G, though I still don't know what the heck to do. lol Part of me wants to just forget about weaning off Nardil and just deal with the high adrenaline levels because it has (alone with lithium) worked well for me (overall). Also, I don't know if I can deal with this SLOW weaning off, but I know that it's worse if I do so any faster. I just saw this particular doctor only once, and so haven't developed a trust with her yet, so I'm not really comfortable with much of what she says and the fact that she seemed to bend too easily with what I said. I don't want her to "dictate" to me what to do, but at the same time, I want to feel confident that she knows what she's talking about. I can't know that with just one visit. I wonder if maybe there's an anti-depressant that I could take WHILE I'm weaning off Nardil so as to lessen the physical and mental/emotional discomfort of weaning? I don't think there are any anti-depressants that don't interact with MAOI's, is there? I sometimes hate medications!

Thank you

Debbie
Forgiveness is letting go of the hope that the past could have been any different --Unknown
 
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Joseph F Goldberg, MD replied to ddnos's response:
Dear Debbie,

The "antidepressants" that seem to work best in bipolar depression are compounds that aren't technically antidepressants (eg, Mirapex, Nuvigil, riluzole, Lamictal, Latuda, N-acetylcysteine, Seroquel)...any of which is compatible with an MAOI.

Dr. G.
 
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ddnos replied to Joseph F Goldberg, MD's response:
Ok, thank you Dr. G. The only one on the list that is an absolute NOT for me is Lamictal - that stuff about killed me! Oh, and isn't Nuvigil similar to Provigil or the generic thereof? Normally, I don't take Provigil very often, but I've noticed that while weaning off Nardil I've been starting to take Provigil more regular, mainly, so that I can stay awake - it has also helped my mood. Hmmmmm

Again, thank you so much for taking the time to answer my questions, as well as other folks questions/concerns! I/we appreciate it!

Have a great weekend!

Debbie
Forgiveness is letting go of the hope that the past could have been any different --Unknown
 
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Joseph F Goldberg, MD replied to ddnos's response:
Dear Debbie,

Nuvigil (armodafinil) is a variation of Provigil (modafinil, which is now generic). While there has been some encouraging preliminary research on its value and good tolerability in bipolar depression, the most recent placebo-controlled study of its use for that purpose was negative and it appears the manufacturer will therefore not be going forward to seek a formal indication from the FDA (i.e., a designation that would greatly help leverage insurance companies to pay for this relatively expensive medicine, that probably has noteworthy value in depressions involving sluggishness and excessive sleepiness).

Dr. G.


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