"As little medication as possible" shouldn't be about # of pills

One of the first things my new pdoc said to me when she started pushing for Latuda was that her goal was to have me on as little medication as possible. My previous pdoc, who pushed Abillify, said the same thing although I can’t remember exactly how she worded it.

I know that both Latuda and Abilify work on both dopamine and seratonin at the same time. So my impression is that my pdocs’ impression is that if you combine multiple meds into one med, then it’s less medication.

But I don’t really see it that way. I actually see it as a possible negative because it’s much harder to fine-tune your meds when they come pre-packaged together in one pill. As an example, my previous pdoc let me try Zyrprexa, but then I felt I needed an anti-depressant very badly. Instead of giving me an AD, she changed my prescription to Symbyax which combines Zyprexa and Prozac into one pill. This meant I had to automatically change my Zyprexa dosage (which had been working just fine) from 10mg to 6mg because Symbyax packs it in there at 6 or 12 mg with the Prozac.

So for my pdocs to be equating “less meds” with “less pills” seems like a fallacy that actually makes it harder to get my cocktail just right, by deluding themselves into thinking that if it’s just one pill, then it’s not a cocktail anymore.

My current pdoc is doing this with me with the Latuda, she won’t let me add an anti-depressant that we could actually measure and adjust because Latuda affects seratonin. It means less room for precision.

Interesting point. I always thought it was because handing someone a bunch of different pills is scary. However, it does make it harder to fine tune the medication just right. I guess the pharmaceutical companies just want to make the "magic"pill that cures everything. One day…one day.

I feel this is a foolish endeavor, though. The brain is very complex, and different people who all fall under the same diagnostic label can have different brain chemistry going, hence the need for the ability to fine-tune for each patient.

So why would they be trying to make prepackaged cocktails that can’t be adjusted without adjusting everything at the same time, when different brains are going to need different adjustments to different things?

I am very frustrated with my pdoc right now for thinking I don’t need an AD because I’m on Latuda. I don’t even know how much of Latuda is an AD, or essentially what “dosage” of AD I am getting, and we can’t adjust it, either, without adjusting upwards all of the other ingredients that affect other things like dopamine.

It seems like the only benefit to this approach is having one pill instead of 2-3 pills, but that doesn’t seem to outweigh the cons of the approach.

I agree with you on that. She has no way of telling how things would work out without an AD. If someone knocked me off my zoloft because i was taking Abilify, I would not be cool with that at all. I am a factual person for the most part and would want evidence that Abilifty can do both.Did you ask her what exactly the benefits of doing that were? Are there any?

Well I know that ADs affect seratonin, and so if Abilify affects seratonin, then that is the basic evidence that it can also act as an AD. The problem is that the needs for the AP and the AD are not always going to perfectly correlate the way they come prepackaged in the pills. I feel that my depression/anxiety issues are just as big a deal to my ability to function as my psychosis, and while both need to be treated, it’s not like if the psychosis is cleared up, then the depression is “chill”. Like wth.

And she seems to think that Latuda should be an all-in-one wonder drug but in that approach she is missing the possibility that maybe I need more AD impact than Latuda offers, while perhaps the AP impact Latuda is offering is adequate.

I don’t want to take the Latuda anymore anyway because it makes me so agitated and restless, but this was just something I was thinking about randomly tonight. How both of my recent pdocs seemed to think that one pill is better even if it means sloppier treatment.

I agree with all that you’ve said. Pdocs sometimes get an idea in their head and follow through with it whether it makes any sense or not. Although Abilify and Latuda have Serotonin factors, they’re not the same as an AD. And if something is working for you, you shouldn’t throw it away and switch it to something else in order to “be on as little medication as possible.” There’s nothing wrong with giving your opinion to your pdoc and pushing for your ideas to be given a try. She isn’t God, but she does control what meds you get, so do your best to discuss things with her and not tick her off. :slight_smile:

True. In the end the meds should be what works best for you. I agree that whole duel purpose drugs are not always effective. If I dropped my zoloft, the trich would spike back up again even with the abilify. I just wonder if she has another motive for it. My pdoc and I are on pretty…umm unpleasant terms as it is. However, she could truely believe it would be help for you aswell.

My pdoc and I are still in the getting-to-know-each-other phase, and I actually do generally like her, although I am concerned about her approach. Unfortunately because she sees me as a brand new psychotic patient, she regards me as though I am incapable of drawing logical conclusions and like she needs to heavily guide my perceptions. I am trying to be patient with her because like I said from her perspective I am a new patient with psychosis and she doesn’t know how much insight and organized thinking I’m rocking yet. So I would like to believe she is playing it safe when she does not explain things very well but instead tries to distract and soothe when I express concerns, i.e. I believe she probably means well. But soon we need to get to a point where she realizes that I can contribute to some extent in the decisions.

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Maybe your being patient with her is enabling her to push her controlling side. Maybe you need to stand up more for yourself and substantiate your opinions. Maybe you’d be better off standing up for yourself sooner rather than later…

Well, I’m trying to compromise, and next appointment is when I expect her to reciprocate, so will see how it goes. I didn’t want to be on an activating med, but I tried Latuda anyway. When it made me miserable, she gave me propranolol, and I tried that, too (only worked a couple days). When I asked for an AD and she said no, I decided to just let it rest and see how things go. I need to make sure I am giving things a chance before getting really assertive.

This may seem clumsy or cheeky but what about printing out this thread and showing it to her to get her response to all the questions that have been brought up.

I might ask about these concerns of mine at a different future appointment. I’m already going to be in trouble for stopping the Latuda on my own days before the appointment, instead of calling her to debate it over the phone. And I will probably be anxious and agitated. I won’t really be in a good position or mental state to debate with her, but in the future I would like to ask her about this concern of mine. My goal for this upcoming appointment on Wednesday is just to get her to agree to change my prescription from Latuda to something else.

I’m on a med cocktail and it’s working wonders for me.