Abilify, Depakote, Risperdal Question

[roothytoothy]

I need to clarify this with my doctor, but in the mean time, I was wondering:  I currently take Depakote, Risperdal and Cogentin (the latter to control the tremor from the Risperdal) and my doctor mentioned I could probably try Abilify instead.  This regimen keeps my moods very stable (although a little bit unmotivated and depressed all the time) but I am concerned about what I feel is mental confusion, although it is hard to blame that on a particular drug, other health factors, advancing age, eating habits or something else.  

I have Schizoaffective disorder, but for many years before that was my diagnosis, I was simply categorized as bipolar.  I do have some psychotic thoughts when not on meds, so I can understand why I am being given the Risperdal.  

I guess my basic question is, if my doctor switched me to Abilify, what would the Abilify be replacing - the Depakote, or the Risperdal, or both? Also, could I take the Abilify at night or is it likely to interrupt my sleep? I am overweight with borderline high cholesterol and drink a lot of sugary sodas.  While not diabetic, I am always afraid I will some day soon be diagnosed with that.  Is Abilify better or worse than other similar meds when it comes to weight gain, cholesterol and diabestes?

[persephonedemeter]

Sorry, my mistake. Prolactin, not progesterone, in my post regarding cessation of menstrual cycles.

[persephonedemeter]

LOL, I'm very wordy. I used to be more succinct in my writing, but now, I can write volumes. I'm not sure it's a good thing, but it doesn't seem like the people who receive them mind so much. It's funny, because I'm not really very chatty when I talk. Thenk you for your kind feedback. I try to hold a candle to people who I've come across who I admire greatly, who held on and struggled with a sense of humor, a smile on their face, never lose their humanity and keep on trying with faith and hope that there's something better just down the road. it takes just getting there or at least to try. There were times I lost sight of that, especially when I can't think or I'm in the middle of psychosis, and that is when I depend on the goodness of others to come and support me. It was the surprise gift that going hrouh bipola disorder gave me. That i found out that their were actually people out there who cared bout whether I made it or not, and could see past my condition and know the person that I am is still here. I'm not naive to know that all sorts of people are out there. I've met absolutely brutal people in the helping fields, and criminals who were touched by another person's plight and stopped to help and show their humanity.

Getting to your question about tremors, I often wondered why my psychiatrist let some tremors go and what he figured out to be tardive dyskinesia. It is hard to answer your question online, because I can't see your movements or how your mouth is moving. On my "reflex answer," I  would call that TD. my doctor called my restless feet, which he noticed I couldn't stop doing when I sat in front of him and the way I moved my arms when I gestured, and I'm usually not a very gesturing person when I talk, TD.  Not a single person I worked with in my job, because I was  working at the time I was on Abilify said anything about my feetwork or my gesturing, or my hand tremors. A woman in a coffeehouse I always walked to in the morning after work,  call me a "retard" because of my movements, and now I remember I did have a drooling problem at the time. I usually don't get bothered by slurs of any kind, but that  one upset me and made me run put pf the cafe because I started crying. I was a bot emotionally labile at the time and  sensitive. I used to laugh comments like that  or if it's  said to another person, I wpuld make a stand against it because essentially, I don't think so much about people who say such hateful things for no good reason, and to me, it's a bully's behavior. I don't particular enjoy watching someone get leaned on like that. I could hear the barista giving that woman an earful and refusing to serve her though, but I was overwrought already and felt too vulnerable. I had enough sense not to get into conflicts  and distance myself when I'm handicapped by being upset.  

What I know now  is that since being off those other drugs:lithium, seroquel, risperdal, geodon, abilify, thorazine, etc. etc. I have no tremors any more. Not even when I get really upset about something or I'm under a lot of pressure. What a relief!

I would just ask your doctor what is appropriate for you, whether it's cogentin or Inderal, and read up on it. It's always best to go on meds being informed. Someone commented on a forum posting that medicine is an art as well as a science, and that is very true. I went on medications and refused others not only based on what I knew about myself, the info and research i did, and hpw I saw it affect others, and what my doctor said about it or why he's proposing the medication for me. There were times I went with his gut feeling and there were times I said, let's take the risk and see what happens. i also have my own strong stance on treatment, but that can change with how the course is going, how I feel about things, and what I'm willing to go through. For example, I won't go through ECT, which was offered to me early on, and the reason why I refused was because I was unwilling to be under the roof of my family and be taken care of while having 6 months of short term memory impairment. I just wouldn't go through that. Even when my best friend offered to be my 6 month caretaker I said a defiant "No way, Jose." Not even if everone on earth said it would be a one time deal and a guaranteed cure.

It sounds like  you are doing well. Your thinking  and your anxiety and questions are very good to me. Mental clarity, motivation/interest, concentration, and stamina  all come back when the stability takes hold fpr awhile.I found out it's a gradual process. My doctor had told me a long tme ago that concentration is usuallty the last to come back, btw.  I am noticing that I obvious can write and think for longer periods, and I can read and watch movies for longer periods of time. I can cook now and bake. Before, I couldn't cook or bake unless it only involved 3 ingredients and one cooking method.

My period  of stability was short before, only lasting for 3 or 4 months for years, This is the longest I've been stable...since January up to now. although back in january, I didn't really know I was getting stable, My psychiatrist pointed ot out when he reviewed his notes with me after 2 1/2 months. I feel wonderfully centered and getting mentally stronger as the months go by, and I did notice I am more even keeled and I am problem solving and dealing with things with clarity and I can anticipate  results better from different actions. I know  it spunds funny, but  it feels real and right, because my mind just feels more relaxed and flexible. I didn't recognize the wellness because it's  been so long since I felt like this. It's so much better than mania, and frankly, my mind is much more creative with this solid freedom it feels. i can see the limitations of mania now and how the euphoria fools me. I finish things, and what I finish is strong, stable, thorough and effective. when I am fully recovered and my psychiatrist gives me the thumbs up, I will be making a big leap forward, have the thrill of chasing a lifetime goal. Right now, I push myself a little, pace myself and I won't take on something that might overwhelm me. I learned to recognize I'm getting well but not well enough. I ask my doctor, can I go full throttle now and start working? No, he said, not yet.

Whatever I succeed or not when I pursue my life goals and ambitions,  well that's the question worth pursuing, but I personally enjoy the effort and the work towards a goal, more than the goal itself, which is sweet but anticlimatic. I always did enjoy the pursuit, mpre than the actual achievement. However, when i get older and get slower and more restricted, I intend to enjoy the world around me and in me with a sense of satisfaction, that my life is good and I have no regrets, I want to end with my life a dramatic comedy, not a tragedy, with a great, big smile on my face.

I wish this for you with all that is good in this world. To all of us. I did not think this was possible, but here it is. Stay on  the course to wellness, and I wish you all the happiness and stability you deserve. Keep on askng questions.

[roothytoothy]

Thank you both;  your comments are very helpful and I'm thinking I should respond more, but right now it's a little much to take in and respond to.  However, I do have one quick, basic question: I wrote that I have tremors, but I'm not positive I know the difference between tremors, TD and the other things you can get from these meds.  I read the info on crazymeds a while back (and I plan to visit the site again and pose some questions) and I think I have tremors.  My hands always shake when I get nervous, but what I have now if I don't take the cogentin is hands that shake pretty much all the time, and my teeth often move back and forth a little.  The hand shakes are probably worse than what people get when they drink too much coffee, but not so bad that I can't drink a glass or water or whatever with it slopping out of the glass.  Does that sound like tremors?  Does it sound like I should ask my doctor about taking a low dose of Inderal instead of the cogentin?  

Persephone, it sounds like you are doing a great job with your illness - and anonmymouse, you too. I'm doing reasonably well, but I just seem to lack the mental clarity, and the motivation/interest in life that I had before.

[persephonedemeter]

Sorry, just re-red my post. I was multi tasking and on a deadline when I wrote it, and that's why I didn't attempt to proofread. Now I know better than to try that again.

I need to clarify. Same thing  as you, My risperdal was being replaced with the abilify. My lithium stayed. With my risperdal, The cogentin went also. Abilify didn't really do much fpr me. I don't remember exactly what time of day I took it, I let my dr. decide because at time time, Abilify was brand new. i was one of the first people on it for bipolar disorder.

As it turned out, I ended up being on low dose Risperdal. I still had occasional fine tremors, but I had other antipsychotics as well, one after another, before we stayed on Seroquel and Lithium. Riseperdal, Seroquel, Lithium were the basic 3 that stayed on. My hand tremors were fine tremors and they would just happen a few times, short and spontaneous and usually when I was stressed out or upset about something, and would go away after a few minutes. As I said, I couldn't tell if it was lithium, risperdal, seorquel or whatever. I've been on so many meds and combos that I lost track.

i never went back to Cogentin again, btw, even when I went back to low dose risperdal with the other meds. I didn't take Inderal because I would have orthostatic hypotension  caused by some meds, and there were a couple of times I got nauseated, dizzy and past out. Pretty scary at one time since I was travelling and in a hotel room trying to dress up to get to the airport to go home.  I just had to stay down and get up very slowly to a sitting position then to standing on my feet to correct that situation. Then, I just drank 4 glasses of water to help prevent that from happening again.

i had periods of low motivation and fatigue but they were usually short lived unless I had breakthrough and stayed in depression. I'm on only 1 psych med now, although I will take a rare .5 mg klonopin half an hour before a very stressful event I have to deal with, as my doctor knows that's how I take it now. I have problems sleeping at times because I had a job where I worked long hours and I preferred night shift, and a lifestyle that didn't include much sleep for a very long time. So, My sleeping situation was complicated by that and the bipolar disorder. Needless to say, I had to alter my lifestyle dramatically to achieve mental health. Frankly, I rreally love my life now, because ot may not be as exciting, but I still have quality, still making accomplishments, and I just love the "quietness" of it.

As I mentoned in my other comments to other posts--no constant thoughts weighing in my head, NO hallucinations (which I didn't  think was possible because I usually had a rare bit of either auditory or visual when I was stable before) and I may procrastinate every once in awhile, but that's usually because I know it's because the task is not something i enjoy doing. So far, I managed to keep deadlines.

i'm not young either, and mental confusion is something I only experienced with the hypotension episodes, lithium toxicity, fevers or whatever, but I really depend on others, like my doctor to point it out to me and take the appropriate measures to deal with it. If I'm at home, I just lie down. That's my usual response when I try to keep myself safe. Someone usually alerts somebody else or comes over when I require being checked on. I'm lucky, I guess, that my friends and family got together with my psychiatrist and myself to figure out different plans and scenarios on how do deal with thongs reasonably without compromising my fierce hold on independence without stepping over the line. It was my psychiatrist who suggested such a meeting by the way, not me. I did take the lead in coordinating it since I'm experienced in coordinatinfg events with 2 of my friends, also well experienced, helping me. I developed the basic plans to make sure I had my say and had them written down and handed out for everyone to tweak and fine tune it to something reasonable and acceptable for all. Then, copies of the algorithm or procedure was printed and given to everyone as a teference. It vame in handy many times, especially when I was uncooperative and psychotic. It also helped my psychiatrist a lot by having my resources written down fpr him to call if needed.

[Anonymouse88]

Risperdal and abilify are both atypical antipsychotics, and so if you're switching out meds instead of just adding on, it would replace the risperdal.  It's approved for monotherapy for both bipolar and schizophrenia, so it's possible you could go off the depakote as well, but that's up to your doctor.  It's good to cut down on sugary sodas in general, but depakote and risperdal both come with a risk of weight gain, and all of the atypicals have some increased risk of diabetes.  Abilify seems to be less of a risk for weight gain and increased blood sugar, but it's still a possibility.  I think (but I'm not positive) that risperdal is the worst of the atypical antipsychotics for tardive dyskinesia, and is the worst in terms of potentially causing high prolactin, as persephonedemeter said.  It's possible that a switch would allow you to stop the cogentin as well.  I know some people take inderal for tremors that aren't dystonic reactions, and some like it better than cogentin.

Some people find abilify to be activating and take it in the morning, but you'll have to figure it out for yourself since everyone's different.  I recommend the crazymeds.us forums if you want to ask lots of people who have been on these drugs what their experiences were.  I'm sure you can find someone who was/is on the same combo of meds there.

As always, talk to your doctor about these things.  You have a right to have them explain the risks and benefits in terms that you can understand.

[persephonedemeter]

It is likely it will replace the risperdal, but the most accurate way to find out is just to go ahead and call you doctor up and ask him what is he planning with your med regiment. Is he going to replace the risperdal, wean you down to a lower level? Is the Depakote staying? I usually preface it with I forgot to ask you when I saw you..... I will do that occasionally, because I do forget to ask. when my meds were constantly changing, being tweaked or whatever, My sychiatrist would tell me what  he was planning to do or I would ask him.

I was on your med combo at  one time except for the Depakote. I was on Lithium instead. I don't know your gender, but Risperdal can increase progesterone levels and stop menstrual cycles. It was a great drug for me though, but at one tome, my progesterone levels were over 1000, too high, and my dose which was the highest dose, had to be notched down. Abilify can cause weight gain, but it wasn't much pf an issue for me. What it did do was give me tremors and restless feet, that was pretty constant, and that was why my doctpr took me off of it, because he feared it was giving me tardive dyskinesia, which can become permanent. You're already on Cogentin for that with your tremors.

The cogentin/risperdal combo is  not really a long term combo that doctprs lfeel comfortable for their patients to be on.

Personally, I would knock down the sugary drinks. It doesn't help with weight gain or diabetes, with or without the psych meds. I know, it's hard, because I had to do that because My blood sugars did climb into the abnormal range for a long time. I also have high cholesterol that broke the borderline level and I had to take lipitor. I didn't really sweat over weight gain, because I was too depressed to care, but I did care about the blood sugar and cholesterol levels because I didn't think diabetes and strokes or heart attacks were desirable consequences for me. Neither did my doctprs. My psychiatrist worried about the weight gain more than I did, when I said I gained 5 or 10 lbs, and tthen, he would say, that's not good and he would prescribe something to help me combat ot, take me off the drug or lower it, and put me on another; even when I insisted I can manage the weight, but he knew more than I did. He's been a psychiatrist for decades and pretty expert,

Risperdal was great for me, but it did cause me problems with extremely highrogesterone levels when I was on the highest dosage. On the lowest dose, my menstrual cycles stopped completely. On the highest dose, I was lactating. I have no idea what it does to men, if you ate male. I did have fine to mildly coarse hand tremors that was occasiona, but it's hard to pinpoint which drug caused it because a lot of the drugs in the combo can cause that.

He took me off the Abilify when I developed constant restless feet and my hand trenors were also become continuous and more noticeable. He didn't want to risk me having tardive dyskinesia permanently. Not only would that prevent me from doing my job properly, but it's not exactly a date magnet.  Plus, I have stairs in my house and I like to drive.

I didn't have mental confusipn and Idon't have schizoaffective disorder with my bipolar disorder. I know there are others here, who are more knowledgeable about that. I like to just keep conversations to my own experience.

The only real way to get what you need to know about what ypur doctor is replacing is just to call him up and ask him/her directly. I do that a few times, and my doctor didn't mind it at all. It only takes 2 minutes to answer. I usually leave the questipns I have on his answering machine, and he calls me back fairly quickly, usually at the end of his office hours, and answers it.  Knowing what actually is going on is better than fretting about it and wondering. It also demonstrates you are involved with your care andp thinking about it. I usually write down my questions because when my mind is cluttered with thoughts, it's hard for me to remembr to actually say them. I keep it to about 1 to 3 of the questipns thqt can't wait for the next sessipn.  He'd rather not worry about me. The goal besides getting you better is for you to be able to manage  on your own with the spoert you need, and be as independent as sqfely possible.

Sorry about typos.