Thank you for the welcome everyone, happy to be here.

WindWalker

Hi,TBI,

Thanks.

I do not have a formal meditation practice but I try to have some moments here and there in the day when I think about the present instead of worrying about the future.

Mari

Thanks WindWalker and Mari,

Maybe that is it, I am reducing the Lamictal (under doc orders) and introducing the Latuda gradually? But then all of this mood swinging starred before the new Meds. I don't know. I seem to feel. A little better, more flat less manic, less depressed. I have to keep doing things. The Lamictal makes me tired. I go to bed at 8 and wake up at 0500. I am not very hungry but I bought a vitamix and I am surprised at how that is making me feel about food. I get super satiated from a breakfast smoothie. Who knows.

I am just trying to be ok.

Thanks guys,
Tbi/PTSD

Hi, Tbi/Ptsd,

It is good to hear that the med changes are helping you.

The vitamixes are great machines but I have not gotten one. I have an o.k. blender. Smoothies in the morning are wonderful.
Keep trying to be o.k. That is what we do here -- keep trying and keep hoping.

Mari

hi tbi,
just trying to be ok with you too.
bizi

Hi TBI/PTSD,

I hope the Latuda is helping you and that you are feeling better by now. The state you described sounds totally yucky! I have had depression with high anxiety and it is positively awful.

As for your meds...

Gradual reduction of Lamictal with introduction of Latuda will be fine, as long as your prescribing doctor is aware of your complete medical situation. My main concern reading the first post was with seizures, since Lamictal protects against seizures while Latuda would lower seizure threshold (i.e., both med changes increase seizure vulnerability). However, a gradual change really should not be problematic unless you have a seizure disorder.

You initially had some questions about the Latuda itself. I don't know what your doc told you about it. I had to look it up - looks very interesting. It is an atypical (i.e. "new generation") antipsychotic, used to treat positive symptoms of schizophrenia and depression in bipolar disorder.

While most antipsychotics treat manic symptoms, I did not see anything about this with Latuda. It should help some, since it tends to be sedating. Generally speaking, it might be less effective than other antipsychotics for mania, due to its unique pharmacodynamics; alternatively, it may not yet have been fully evaluated for treatment of mania.

It is a very new drug, and still in phase 3 clinical trials for general maintenance treatment of bipolar disorder in conjunction with lithium or divalproex. (See http://clinicaltrials.gov/ct2/show/results/NCT01358357.) Primary results are expected 2015. Secondary data expected from this trial will include the amount of time to a manic episode... this could open doors for other trials.

---------------------

You sound as though you are taking really good care of yourself, with the smoothies and all to help nourish yourself despite the loss of appetite. Keep on keeping on.

waves

I have tried Risperidone, Seroquil, lithium, ambilify, and some others, I can't remember. My doc has been with me since the beginning of this new phase of my life and he is wonderful. He is a Forensic Psychiatrist and probably the most brilliant man I have ever met. The best thing about him is that he really listens to me.
I thought all was well w the Latuda but yesterday I was very anxious and verrrrrryyyy angry. Friday will be a week on 20mg of Latuda at which time I will increase to 40 mg.

I really appreciate you taking the time to reply.

Hi TBI/PTSD Try not to worry about the anxiety,and anger at this time. In my experience of over forty years of mental health challenges,these emotions can happen over a period of time no matter what type of medication your on,or changing.

It can really be confusing,and frightening. I know. I'm so sorry. Hang in there,and you will find out in time. If you feel a need,by all means call your doctor. BF

Hi again TBI/PTSD,

Your doctor sounds wonderful! It is so important to have someone who listens!

Wow, you have tried quite a few different drugs. I sure hope this one works out for you. I've tried several too - the antipsychotic (AP) that worked best for me was Zyprexa, but I couldn't handle that because of the weight gain. My current mood stabilizer is Depakote but that works mostly to prevent mania.

Hopefully the anger and anxiety from yesterday are just a bump in the road. In case you are wondering, it is highly unlikely that the Latuda caused those sx. It's likely that that you are still not quite leveled out. From your post, the Latuda does seem to have helped a little, so far. That is good.

Some APs are only effective on activation sx in higher dosage ranges. If that is the case with Latuda, there is lots of room for improvement here, as long as you tolerate it well. Let's keep our fingers crossed.

I wish you well with this new med!

waves

Just a note about a FOOD-DRUG interaction:

It is advisable to avoid grapefruit juice and grapefruit while on Latuda. Grapefruit juice will raise the blood-levels of the drug (via CYP3A4 inhibition). Now, I don't honestly know whether the interaction would bring Latuda to toxic levels (depends on drug toxicity), but an increase in adverse reactions might still be problematic. A simple example might be excessive sedation.

Your doc may have already told you about this interaction, but I figured I'd mention it, since I didn't see it in the prescribing information. The enzyme pathway responsible for this interaction is very clearly disclosed with some of the drug-drug interactions.

If you want to consume grapefruit juice while on this drug, please consult your doctor. He will be aware of the drug's toxicity, adverse effects etc, in relation to your dosage, so he can advise whether there would be a significant problem for you, or not.

IMHO, it would never be a good idea to consume grapefruit while you are increasing or decreasing Latuda. It will throw a wrench into the gradual level change one is performing at these times.

waves

P.S. St. John's Wort and other herbs can also interact with Latuda, via the CYP3A4 enzyme pathway. Some herbs increase drug concentration, others reduce it. (In the latter case, therapeutic response will also be reduced.) It is important to consult your doctor before taking any herbal "supplement" with Latuda.