Bipolar 2 here. I was on Vraylar for almost a year until my insurance recently stopped paying for it. It was the best med I've been on and I've tried over 20. I hadn't felt so good in years. Hoping Latuda will do it for me now I guess.
There is some unpredictability when it comes to which medication is right for each individual. Even genetic testing does not tell us which medication would be ideal. Latuda is good for bipolar depression and mixed depression, I use it often because the price has come down a lot. It would be nice to use all these newer medications but many people who watch the content fail to realize $1500 a month is a lot for the average person, hell it would be a lot for me as well. Hope this helps
Thanks for talking to us like you respect our intelligence. You're willing to get into science, whereas most channels about this drug sound like they're reading directly from the pamphlets that come with the drug.
So excited about this med. Read the research and has the same potency as clozapine but without the need of titration. Gonna be amazing to get it here in Europe
Love the optimism, i still think we need more data before replacing the good old clozapine which has substantial data supporting it’s efficacy. I am excited about D3 as a potential target for future medication design. If you haven’t subscribed to the channel please do and spread the word about what we are doing. If you haven’t seen it yet we have daily posts on Instagram to educate and combat stigma in mental health
Wow, a psychiatrist I can intuitively trust... thank you, nobody I've ever been in to see talks pharmacology with their patients, even if they were medical students. Much appreciated. When I tried aripiprazole in 2011, I had the "activation" that was like beyond anxiety and restlessness and half the ward experienced it. Most would have to sit down, stand up, sit down, stand up, sit down, stand up over and over again or pace like robots. It's like the feeling of electricity about to pour out of your limbs or something. Super bizarre. Wish that didn't happen.
Sounds a lot like akathisia, which is very common with these medications. The meds we have to work with could be better, but I still like to work with the tools we have and accept the limitations of pharmacology. I appreciate the comment, spread the word about what we are doing here and please subscribe if you haven't yet
@@ShrinksInSneakers Same with my son while on ablify, and now he has anger outburst and crying spells which he never had before at times? He never hear voices or see things, he was mainly depressed which cause him to have really bad ocd and not able to focus and take care of his hygiene. He was diagnosed with adjustment disorder because it started after he graduated from high school, , but now his doctor says he is schophrania which I don't think he is, I think he is bipolar/ depressed, plus his cholesterol went wayyy over 200 so we have to discontinue, i asked his DR could we just try zoloft because at one point he stopped taking ablify and he became isolated again, not eating drinking or sleeping so I'm confused, I think he is misdiagnosed the only reason his doctor change his status is because i told him my son started having laughing spells for no reason at times and the incident where he discontinued the ablify and stop eating drinking and sleeping for 3 or 4 days to the point he became delusional and a little non responsive so I waive my hand in front of his face and asked did he know where he was at and he responded saying I'm with GOD, once i gave him some electrolytes he came back to his senses. What do you think?
Did you start having anger outburst and destroying things at times or having crying spells plus high cholesterol? This is what this medicine is doing to my son
@@speedy20201 Sounds like in my lay person opinion that Aripiprazole maybe too much of a partial D2 agonist for your son. I work at a psychiatric facility that shall not be named where frequently it appears there is an activation from too much D2 signaling and something with less of signaling may work better. However antagonists (little signaling D2 receptor) have a propensity toward the wide umbrella of extrapyramidal side effects so it could be quite likely that the good doctor is on the money. I would like his thoughts on the source of the symptoms you describe (i.e. too much agonist or too little).
Bipolar depression can be difficult to treat. There are several medications that have good evidence caripraszine being one of the newer options. In my practice I've had success with Latuda. I hope it all works out for you
Was just given this. Not depressed not sad just irritated a lot and shit gets on my nerves and told my doc the clonazapaz work fine but he’s telling me it’s just a band aide but he gave me ability and it made. My mind run out of control.
1) What combination work better with vraylar. 2) How it reacts with person with bipolar and tonsillectomy. As people with tonsillectomy suffer from IVs result in malabsorption leading to weak mind. 3 ) how people with depression in gluten and chronic fatigue reacts to vraylar.
I have not seen much data on the combination of Vraylar with other medications. I personally do not use combinations unless the mono therapy has failed. That would be my starting point Tonsillectomy has no effect on medication metabolism or absorption (gastric bypass surgery for example would alter absorption) I have not seen any data on gluten sensitivity or chronic fatigue, these are not FDA approvals for this medication Hope this helps, if you haven't subscribed to the channel please do and spread the word about what we are doing here
Great video, very informative. I have lithium-damaged kidneys, CKD Stage 3b, tubes permanently damaged ad cysts at the receptor sites in the kidney. Went insomniac on lamictal, depakote and tegretol above 300mg. My doctor thinks vraylar is last best hope to get off lithium. Very little research on continuing vs discontinuing lithu\ium with CKD, very little research on lithium, bipolar & CKD. Am bipolar 1, 40 years with it. Have you had any success with vraylar-only therapy for bp1? Any other ideas for bp1 patients with CKD? Side effects of vraylar give me pause but I will try it. Thanks for your helpful work.
There are a lot of options for bipolar I disorder that can be explored besides Vraylar but it will depend on what the target of treatment is, if it's depression Quetiapine, lurasidone, lumateperone, cariprazine, olanzapine fluoxetine combination. I would also consider lamotrigine to be in this group. If we are talking about mania there is Depakote, ziprasidone, risperidone, olanzapine, asenapine. As you can see there are a lot of potential options here. The decision about which one to use will depend on many factors. Most of these medications were covered here on the channel in prior videos. Hope this helps, if you haven't subscribed please do and help us spread the word
I started Vraylar today. 1.5mg AM. Mostly because I cannot take quetiapine AM (working and quetiapine do not mix). My Dr says I am OK ( euthymic), it is just a change because of the Quetiapine AM problem. ( I cannot buy Quetiiapine XR here.) So far, so good! Let´s see what happens in the next days. The problem is the price....(and aripiprazole does not seem to do all the tricks to use it as a substitute of Quetiapine).
You're amazing. I'm learning so much. I was misdiagnosed for years as just having regular depression. I now know I have Cyclothymia (I guess this is supposed to be the mildest version of bipolar - sort of like "bipolar 3"??). My new doc has me on Vraylar. It's only been a week, and I feel like a new person. My only concern is he left me on Trintellix and Wellbutrin, which was what I was on by my regular doctor when we thought we were just treating depression. I've been told this combination won't hurt, but is it even needed? If I truly don't have regular depression, why keep me on those two meds? Thanks!
outstanding video; thank you. I wonder how the Akathisia levels with Vraylar. compare to those of Abilify. I found (for add on for treatment resistant depression) that Abilify can be a little too activating, but Rexulti too sedating. (I also have severe OCD and tend to be sensitive to meds.). I wonder if Vraylar, now that is was just approved for add-on for depression, could give me that anti-depressant spark without the sedating qualities of Rexulti and Seroquel and the activating qualities of Abilify. Thanks again for such a useful, informative resource for the community!
Im uniplolar. I was given this for MDD (now FDA approved) I had Akathisia and it didn’t go away for days due to long half life like you explained. It was the most horrible feeling ever.. I get agitated and angry on all the atypicals I have tried. I also have Anhedonia. Why do you think they keep trying to give these types of medications to me? Especially with the dopamine blocking? I had TD on Luvox. So I’m susceptible on just an SSRI. just don’t understand the reasoning. Can you explain why these mechanisms of action would be good for MDD with no mania or psychosis?
I have a question about taking spravato nasally I’ve taken 4 treatments now my Dr suggested vraylor to help me with my anxiety being unpredictable and my social anxiety and embarrassing not taking care of my hygiene I’m just curious your feelings (knowledge) about taking both? Thank you for your compassion and explaining to lay people.. it’s a blessing
I have an entire video on Vraylor and I can say it has no benefit in the treatment of anxiety disorders. I'm not aware of any major interactions between the two medications but it sounds like maybe the diagnosis has to be cleared up a little because the indications for these medications are very different.
Doc i have a question. I'm taking cariprazine but I'm feeling like I'm not getting enough dopamine, I used to have a natural joy, drive, motivation to cook, go for walks and listen to music, to sing and dance, conversate with people, had such an interest in life...but since olanzapine I developed social anxiety, social withdrawal, no joy in anything and a flat, zapped emotional state...these were all the negative symptoms of low dopamine levels....my question is what percentage of dopamine stimulation does cariprazine give? Is it like 50% or 40%? and will it be enough to snap me out of depression, social anxiety and suicidal ideation, I really really felt depressed on olanzpine, give me some good news doc because if it blocks dopamine but also acts as a partial agonist, will it be enough dopamine, does it really stimulate dopamine enough? Can you also say which medication of all the atypical antipyschotics gives the most dopamine agonism, thanks 😊
I would not think of any psychiatric condition as being a neurotransmitter deficiency. All antipsychotics are designed to work as dopamine blocking agents even the partial agonists like Cariprazine. I would think of these medications more like dopamine modulators. In states of excess dopamine such as schizophrenia they act to block D2 receptors. In cases of dopamine dysregulation such as depression they may act as agonists. This is all theoretical and may not play out clinically. For cariprazine D2 receptor occupancy is 45% and for D3 it's 76% indicating that it selectively binds to D3 receptors. Hope this helps a little it's far more complicated than I can cover in a single comment here.
Great video! I love your channel. You said that you would prescribe a high dose of Cariprazine faster for the management of acute schizophrenia, wouldn't you rather use a stronger Dopamine blocker instead at these states? (Like the second-generation Dopamine antagonists, maybe because of their calming antihistaminic properties too) Or that partial agonists are of similar efficacy/ carry specific benefits in acute schizophrenia?
It's a good question, you always need to balance the need to reduce symptoms rapidly with the long term goals of getting patients to stay on medication. The answer is it depends on the patients goals. If the symptoms are causing significant dysfunction in daily life and the person needs to get back to work or care for their family rapid relief of symptoms may be needed. My general approach is to use medications that are slightly less effective but have a better side effect profile than say olanzapine. The reason behind this is that I want my patient to stay on the medication and not discontinue it due to side effects. This is usually my approach with first episode its a gentle way to introduce someone to medication. In sum you will get better and quicker results with something like olanzapine but the side effects will be worse making discontinuation more likely. I hope this helps a little but each patient is an n=1 so it's hard to provide a general answer here
I am concerned. I have been taking Bupropion xl 300 mg for 2 years- I have been prescribed Vraylar now- in addition to this… I also take hydroxyzine for anxiety …Do you have any info on how they work together? Thanks!
I believe this maybe helpful with Bipolar mood disorder however my Psychiatrist isn't treating my generalize Anxiety Disorder I'm concerned I have Two disorders I take Lamiical for Years and She New to my case and wants to change all Medications I also take Topomax What is a good Choice for GAD w Vylar
I Don't have Acute Mania but Bipolar I have High General Anxiety Disorder My Doctor says that this a choice I still take Lamiical two fifty per day and topomax Twice daily Hundred she gave me One . five ever other day very confusing She was going to give me Proponal Twice a Day lowest dosage and I have been waiting two days is this safe and helpful for anxiety as well
What is an ideal all around bipolar maintenance dosage to go with? I don’t get manic often but my dr wants me on a ap with my lithium…Or does 1.5 give any benefit to preventing mania and more so just an anti depressant dose?
My son who has schizophrenia, stopped taking caplyta (didn't work, made him worse) just started 3 mg of Vrylar, been on it two days. He commented to me that he feels "doped up, and not himself, and has anxiety." Could that happen after two days? Will the side affects eventually go away? Another question, is it okay to give the medication with vitamins at the same time (B-12, B-complex, omega 3, probiotic 60 billion and vitamin D gummies)? I also started giving him Ashawanda before bed, is that okay? What is your recommendation for anxiety?
I wemt from suicidal ideation to not being able to cry in the course of hours. I can't cry or get upset it's like a wall is blocking my emotions. This is just in hours so yes 3 days he can feel like that. Idk if I can keep on like this I see my drbin 2 days.
Hi Doc. Will this med work good for someone that has had early on set schizophrenia with high cognitive impairment? Will it help to recover brain cells in function and help make new neural pathways?
Here is my take for anyone dealing with first break psychosis. All medications will work, and the doses will usually be lower than those used for untreated chronic schizophrenia. All dopamine blocking medications will work and in lower doses. When selecting the medication the side effect profile and long term metallic risks are most important to think about. Cariprazine has a good side effect profile and some pro cognitive benefits as you pointed out so it would be a good option. To preserve as much brain function as possible the critical component is remaining in treatment and minimizing the number of psychotic episodes. Omega-3 fatty acids 1000 mg per day may also be of some benefit. Hope this helps, if you haven't subscribed to the channel please do and spread the word about what we are doing here.
I've covered a lot of medications used to treat depression in detail. If you look through the playlist you will find almost everything. In a recent study that was published looking at Cariprazine for adjunctive treatment for depression it was predictably average. 1.5 mg worked but 3 mg did not with an effect size of 0.22 and marginal to no difference in response and remission. Sometimes new isn't always better. Hope this helps check out the other videos
Hi doc I recently started vraylar and recently developed insomnia and delayed periods cause of excess prolactin secretion. Are these common side effects of this medication?
There is not definitive data but it has been suggested that it may help with cognitive dysfunction associated with schizophrenia. I would not use it just for that reason but it's an area that requires more attention and investigation. I hope this helps, if you haven’t already, please like and subscribe to the channel and spread the word about what we are doing here. We also have daily Instagram content it may be of interest.
I convinced my psychiatrist to put me on cariprazine as a substitute for olanzapine (1.25 mg for my depression along with 150 valproic acid, 10 mg Paroxetine, 12,5 doxepine) because I have insuline resistance. Mind you, I was doing great on that medication ( also taking supplements like magnesium, vitamin D, potassium, Ashwaganda) and I managed to lose 10 kg through diet and exercise. But I thought cariprazine would be better for my metabolic syndrome. I took 1.5 mg the other night, woke up at 4 am feeling restless, needed to move, my leg muscles stiff, had a shit day because of the lack of sleep and depressive thoughts, didn't have the energy to do much. Is this just adjusting to cariprazine or is it safe to say this drug is not for me and should go back to dear old olanzapine?
Every decision is a balance between benefits and risks. If someone is doing well on a medication, I will usually try to find a way to continue that medication and work with the side effect. Changing medications when someone is stable can be tricky and there is an art to the process. I would talk with your doctor about the concerns. Hope this helps, if you haven't subscribed to the channel please do and spread the word about what we are doing here.
It appears to work similarly to aripiprazole. It's the drug that kept my depression under control but I wanted to jump out of my skin. I drank the smallest dose
Does the very long half life of cariprazine make it problematic in treating acute mania? Because with a half life of over a week, it should take over 5 weeks to reach steady state, so I wonder if it would take too long to treat a manic episode.
The same can be said for aripiprazole which also shares a long half life of 96 hours and is approved for acute mania. My clinical opinion is mood stabilizers like depakote and lithium are better options and if there is a psychotic component or need for additional stabilization adding a dopamine blocking medication makes sense. I could also see this being a good option for bipolar depression where antidepressants are mood destablizing. There has been a significant trend towards using more dopamine blocking mediations than mood stabilizing medications in bipolar disorder and I think this is a mistake. Hope this helps, if you haven't subscribed please do and spread the word about what we are doing here,
I am very confused. I take several meds for anxiety: buspirone, fluvoxamine, .25 ativan as needed. I’m also on metoprolol, asthma inhaler, some supplements including fish oil for high cholesterol and triglycerides. Was switched from celexa to fluvoxamine about 8 months ago. Having a few really rough months with sick parents etc so anxiety is bad. Dr just have me two weeks of vraylar to try. I’m very concerned about starting this because of possible side effects and already having some health conditions that this medicine can make worse. Told dr and he still wants me to take. I thot this med wasn’t good for anxiety? Plz help. I don’t want my health to worsen with adding another med. dr said he would take me off buspirone if I do well on vraylar. Would really appreciate your inout
Hi Doc, I was just prescribed this for my mania which isn't going away with taking depakote. Is it ok to take it with depakote to get my mania under control?
Whenever someone is having a poor response to depakote I get a blood level. In acute mania I target a blood level of 90-120. I would talk with your doctor about the concerns but blood levels are important with this medication. Hope this helps if you haven't subscribed to the channel please do
@@AP-nx6xo thankyou. I’m from Canada and apparently vraylar was accepted in April. Shocked My dr actually never even heard of it. He says he won’t give me anything other than serequal so think time to find a new dr. I can’t live like this anymore
@@karmaline hello …I live in Canada as well and my psychiatrist just started me on Vraylar. It so new that alot of drs have not heard of it. It’s worth it. My dr said they are getting excellent results from it. I really hope your dr will look into it. The therapeutic dose is 1.5 mg…. All the best to you !
@@AP-nx6xo Will do. First got find a new psychiatrist. Not sure if same as were your from but here in Van nearly impossible to find one. Then ridiculous waiting list! I see only thing vraylar lacks is on the maintenance phase. Guessing gotta add something like lamictal or latuda or something? I’m already on lithium. Maybe that’s enough? Thankyou
@@karmaline hello I’m in Alberta. I know a few people on lamictal with good success I’ve heard of Latuda Don’t give up. Try and discuss with your psychiatrist other options besides seroquel if you don’t like the 12 hr sleeps. I’ve been there I hope he is receptive and is willing to work with you .. I have an excellent psychiatrist Wishing you the best!
I have to recommend against opening capsules or snorting any medication. Personally I don't see the appeal of abusing these types of medications although its been known to happen
