When you switch meds: hospital or not?

I’m considering switching to brexpiprazole from abilify. Have you any opinion as to whether med changes like this should be done in hospital or at home?

In my opinion (and it’s just my opinion), if the med you switch to is not a good fit, you might end up in the hospital as a consequence. I’ve done many med changes without resorting to having to go inpatient. In the early days of my treatment, I was so gone that I was in the hospital regardless of meds. You might want to remember that it’s going to be about another month before Brex hits the pharmacies. Can you wait that long for an unproven med? To me that would be the crux of the issue.

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For that vast majority, it’s safe to switch meds that are cross-tolerant without hospitalization. Most of the typicals and atypicals can be switched that way most of the time IF complex polypharmacy is NOT involved.

But if the pt is on several meds with substantial likelihood of interaction (e.g.: an anti-P or two, an anti-D, and/or a mood leveler or – very significantly – any benzodiazpeines, painkillers or sleep aids), the statistical chances of an easy switch-over are decreased. SO… if you’re on several psych meds, I’d suggest either hospitalization or very close monitoring by family members or others who are close by for about two weeks.

Above based on published peer-reviewed literature as well as direct observation.

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Yeah, I’m on benzodiazpeines , but just prn.

Seroquel had gone generic by the time I tried it and it nearly killed me, so as far as I’m concerned, it’s all Russian roulette anyway.

At the “FDA-approved” (supposedly) “therapuetic” dose levels, I agree. But I also think a lot of the sz pts I have seen are over-medicated and/or over-dosed. That said, if they have been OM’d / OD’d for years, it’s likely that their nervous systems are habituated to and dependent upon those high-dose / complex-formulated “cocktails.”

Such pts have to be withdrawn very slowly and very carefully, as well as exposed to the better CBTs and MBCTs to see if they can “substitute” with the “smarting up” they get in therapy for the “dumbing down” the meds do.

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coming down of meds causes psychosis

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Depends for many on how it’s done. But for many other sz pts, I agree: It’s not a real good idea.

Hey, maybe I’ll give that a go! Come off meds! Read books instead.

Nobel prize on its way.

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If the cross titration process is done correctly, it can be done at home.

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I think the obvious answer is that it is usually not good to make med changes unless it is approved by your doctor. Tinkering with your meds on your own is usually not a good idea but there can be exceptions. Notmoses is correct, it is not necessary to go into the hospital to change your meds or the dosage. I know this from my own personal experience and from being on these forums for 6 years. It may be necessary sometimes to go in the hospital if you get a bad reaction from making a med change or it may be necessary for a doctor to monitor you more closely or frequently if you make a med change. But do you need to go into a hospital every time you make a med change? The answer is definitely :no".

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i’ve never had any problems with med changes. It takes me months to relapse.

I was able to do that, as are many others. BUT… some will not be. One size will not fit all here, but can be explored.

That’s what the unusual beliefs section is for, so take it there.

That would make me laugh if it wasn’t so tragic. A relapse is a relapse. You don’t think you have a problem with med changes when it makes you relapse in 60 days? 60 days is nothing. If I knew I would relapse in as little as 60 days if I adjusted my meds I would never do it.