Finding an AP for my sza (Latuda causing mania?)

Medications
1

Hey guys, I have sza bipolar type and I’m having a lot of trouble finding a cocktail for me. Atm I’m on 900mg Lithium, 60mg Latuda, 300mg x3 Gabapentin, and 30mg Buspar.

This sounds ridiculous, but I think Latuda is making me manic. Hear me out. So the Latuda is new, I just got it from my last hospital visit last week. Ever since then, I can’t sleep, I’m picking at my face like crazy (I have body dysmoprhia and now my whole face is bleeding T_T), I’m fapping 5x a day, like I’m definitely at least hypomanic. Now at first I just thought that the Latuda wasn’t stopping the mania like the Zyprexa was. But now I’m thinking: I’m on Lithium. Y’know, the gold standard for bipolar mania. Shouldn’t that be enough to stop the mania? Like theoretically if I were to only be on Lithium I might still be psychotic, but my mania should at least go away. Therefore I think the Latuda is inducing it.

So I think I need a new AP. So far I’ve been on the following:

Abilify - Made me manic, but it was only 2.5mg so might re-try
Seroquel - Made me sleep all day, muscle aches
Risperdal - Awful anxiety and panic attacks, high prolactin
Zyprexa - Pretty good, but high prolactin and little sedating

It’s hard juggling the desire for something to either help or leave my anxiety alone, and something that doesn’t put me to sleep. I like my energy levels, without it my negative symptoms are worse and I feel depressed. But I also have social anxiety. I’m interested in Vraylar, Abilify (10mg or more this time), and maybe Geodon. But I’ve heard that Vraylar is very stimulating. But I’m interested in it for helping with psychosis, mania, and negative symptoms. Is it good for depression as well?

I hear that for Geodon it’s sedating and you have to take it twice a day, so most likely I would be too tired. But I’ve also heard that it helps with negative symptoms, or at least better than most of the other APs besides Vraylar.

Don’t know much about Fanapt, Rexulti, or Saphris, thoughts on them?

1 Like
2

not sure, but recently switched from risperdal consta depot to invega sustenna depot and i feel much better.

3

Latuda to me causes mania. I’m on latuda 60mg at night. How to you tolerate so many meds at once?

1 Like
4

I mean take others but they’re not aps or antideps

5

Oh I forgot about Invega! That’s one to consider as well, just a little worried about prolactin. But hey never know until you try

1 Like
6

Glad I’m not alone! Oh and the Gabapentin and Buspar are just anxiety meds, I probably don’t even need the Buspar cuz I don’t think it does anything

7

i never had problems with prolactin, but for some reason it hits some other people.

1 Like
8

Im the opposite, Latuda puts me to sleep at night within 45 minutes. Got me on a good sleep schedule that’s for sure.

3 Likes
9

Buspar gave me bizarre dreams. Radioactivity. I’d wake up cos it was so scary.

I really hope you find something that works for you.

10

rexulti is quite similar to abilify and i would say like vraylar and abilify its probably more likely to be stimulating though it could still be sedating to some(they are all unique among antipsychotics as they are partial dopamine agonists). saphris and fanapt are probably the two least used second gen antipsychotics, per their wikipedia articles;
saphris: only weak evidence for treating positive symptoms and shows comparatively small effectiveness in mania than other antipsychotics but, theoretically due to its affect on serotonergic, adrenergic, and histaminergic receptors it should have the best effect on negative symptoms of schizophrenia and schizoaffective disorder among the antipsychotics and it seems to have antidepressant effects too. it has less likelihood of causing weight gain but a higher likelihood of causing eps than other second gen antipsychotics. its most common side effect is sedation. its only available as a sublingual tablet afaik.

fanapt: seems pretty run of the mill and not super special amongst second gen antipsychotics, an antagonist to both dopamine and serotonin receptors. honestly nothing particularly interesting in this article about it. supposedly about as effective as latuda in treating schizophrenia. @Anna i believe was on it at some point? she may be able to give you more info about how it affected her.

rexulti is a successor to abilify and acts in ways similar to it, antagonizing some dopamine receptors while being an agonist at others, and antagonizing some serotonin receptors, while being an agonist at others. it has more blocking and less stimulating effects than abilify, which theoretically should lower the risk for agitation and restlessness compared to abilify. personally, it worked about as well as abilify for me, but gave me horrible nausea so i couldnt stay on it.

abilify, because of it both having blocking and stimulating effects, can be either activating or sedating. some report low doses activate while higher doses sedate, others report the opposite. im on 15 mg and its somewhat sedating imo. geodon is interesting because its more weight neutral as far as ap’s go and can actually make you lose weight, a google search tells me this is because it has no affinity for muscarinic receptors.

other antipsychotics available to you (assuming youre in the us) are invega (the active metabolite of risperdal, so i imagine it would probably have similar effects) and clozaril which is the most effective antipsychotic but obviously, because of its myriad of serious side effects, isnt used first line or even second line. there are other second gen antipsychotics that arent used in the us (like dogmatil and solian) but are used in either europe or japan. theres also typical antipsychotics, of which the most used by far nowadays is haldol. it is effective and i believe has less tendency towards metabolic effects than second gens but has a pretty high rate of eps. there are others that are used less frequently like prolixin and thorazine (the first antipsychotic). theres also a drug called resperine that works a lil differently, but its almost entirely abandoned as an ap and i dont think any doctor would prescribe it for that anymore. it has a lot of side effects n can cause a dangerous drop in blood pressure even at low doses. i even read about a psychiatrist working with a violent patient who had not responded to other meds, and got approval and everything from their higher up to prescribe resperine and even then they couldnt (i cant remember why, but someone shut it down and didnt allow it no matter what). thats more of a fun fact i havent gotten to share that i wanted to share, though.

also edited to add that ive heard gabapentin can actually trigger mania. given the onset of it i would say its probably the latuda causing it but who knows, maybe the gabapentin is adding to the manic effect.

1 Like
11

Fanapt was fine, no side effects except it made me gain weight rapidly. I gained 5 lbs in 2 weeks which to me was saying it was probably going to be like Risperidone where I gained 10 lbs a month. So.

I didn’t end up making it up to a dose high enough to manage my symptoms because I got scared of the weight gain so I can’t speak for its effectiveness. I’ve started taking 1.5 mg of vraylar and it seems to give me no side effects, but that’s also a low starting dose. Tomorrow I go up to 3 mg which I think is the lowest therapeutic.

12

Wow thank you for the rundown of everything, this is great! Rexulti actually sounds very interesting to me, perhaps a middle ground between the stimulating and sedating APs.

The Gabapentin was increased at the same time as the Latuda was added, I used to be on 100mg x3 daily now up to 300mg x3 daily. I didn’t even consider that as a possibility, imo it sounds more likely that the Gabapentin is causing the mania. I mean Latuda is supposed to also help with mania, right?

13

Hi I just wanted to add that Latuda is causing me mania too!!!..it seems like no one cares…I try so hard to contain it in public settings, but it sometimes comes out in a fit of passive aggressive talk. Thank you for pointing that out! It helped me a lot.

You are strong because my father just told me about the effects of gabapentin he takes for neuropathy and he seemed hopeless and very sad about it. He has to take it twice daily on different time schedules an it heavily sedates him

I hope you can try something other than Latuda!!! Sorry if I didn’t help at all…voices are judging me that I’m insensitive and nothing I say should be said

1 Like
14

I really appreciated hearing from you, it’s nice to see that I’m not the only one dealing with mania on Latuda! I saw my pdoc today, she increased it to 80mg so we’ll see if it helps. Didn’t think about the gabapentin sedating me, I’ll keep an eye on that. Atm I’m definitely very energetic.

2 Likes
15

Be careful, Gabapentin can cause mania.

1 Like
16

I’m starting to worry about that, I just saw my pdoc today and she increased the Latuda to 80mg, but if that doesn’t help I’ll try stopping the Gabapentin. I only use it for anxiety, anyway

1 Like
17

Latuda caused mania like symptoms in me that I previously had not really experienced with the exception of brief periods of euphoria during certain weather events. When I went back on Invega and added loxapine those symptoms went away.

18

Gabapentin stopped me sleeping and eating and caused serious side effects, made me really loopy and manic
Sure it’s not that?

1 Like
19

I looked on webmd.com and a rare severe reaction to latuda was described as excessive cheerfulness and activity. That’s definitely what i had. I didn’t technically see the word mania on that site in regard to that drug.

1 Like
20

First of all I just wanna say thank you for your post. You kinda just inspired me to look into other medications for my SzA… I honestly was not aware that there was any other medication than Invega (paliperidone)… Wasn’t that the case at one time? I think it’s great that you’re putting so much effort into finding an AP that works for you. The diligence you are putting into this search will pay off, I’m sure. Don’t give up!! Medication is a confusing thing, it takes doctors decades to fully understand it all, and even then they’re still learning. Keep searching, keep inspiring!

2 Likes