This is a first post and sort of “where I am right now” compared to where I’ve been for the past little while and what meds I’m on, what’s working, what isn’t, and potential changes coming up.
The Main Meds
Abilify Maintena – Long Acting Abilify Injection
Abilify Maintena is a monthly (28 days) long acting injection of the antipsychotic abilify (aririprazole). Abilify is an atypical (third generation) antipsychotic and is a dopamine-2 (D2) partial agonist, meaning it lowers or raises dopamine when it is out of balance. It is also a partial agonist at serotonin 5-HT1A receptors and an antagonist at 5-HT2A receptors. This is unique to Abilify and helps balance serotonin and dopamine without the powerful blockade of some atypical and typical antipsychotics. This can also mean it’s more activating, causes insomnia, and can cause anxiety and restlessness (akathisia).
I find it pretty decent – the injection isn’t as painful as the Invega (paliperidone) ones, and I find I’m not as dull or muted as on other antipsychotics. I was on strong, typical or atypical antipsychotics for decades, and I’m sort of “waking up” on Abilify Maintena. It’s sorta hard, to start having all these feelings again, when I was sedated for so long, because I have to be able to cope with them, and learn how to live with the feelings instead of blocking them all out. I switched to Abilify Maintena in June 2025, after 3 years on Invega Sustenna/Trinza. My prolacitin was high, Abilify was added, my prolactin went back down, but not enough, so we decided to switch to the Abilify LAI over Invega. I’ve never really been on Abilify before, except briefly over a decade ago, and it’s really quite something! I do have some breakthrough paranoia and hallucinations, but have insight, and my mood is relatively stable. I am still reaching steady state at this time.
I am on 400mg, IM, q 4 weeks.
Saphris – Adjunct Antipsychotic And Mood Stabilizer
Saphris, a 10mg sublingual formation of the atypical antipsychotic asenapine, is added on for breakthrough symptoms like paranoia, hallucinations and insomnia that aren’t managed otherwise with Abilify Maintena. It tastes terrible.
Saphris is a potent D2 antagonist, which means it rapidly smacks down psychosis and stabilizes mania, it is also an antagonist at 5-HT2A, partial agonist at 5-HT1A and acts on histamine (H1) and alpha-adrenergic receptors.
Effexor XR – 300mg – Dropped from 375mg
Effexor XR, velafaxine extended release, is a well known SSRI/SNRI (selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitor) that acts as a a SSRI at lower doses (under 225mg) and an SNRI at higher doses. At very high doses it has light actions on dopamine. I’m on it for anxiety and depression – I’ve had ECT twice, once in 2008, once in 2022, and it helped get me out of that, so it stays.
I’m on a pretty high dose. It can be activating. I’m on the “norepinephrine is going crazy” dose and it’s like chugging coffee without the fun. I’m finding I have afternoon anxiety, when Effexor is commonly prescribed for anxiety – at lower doses.
Foquest – 85mg – Dropped from 100mg
Foquest is a long acting release version of methylphenidate, most people know as “Ritalin”. It’s old medicine packed into new technology and is a decent stimulant without a “high” or “crash” later in the day. I find it effective, but it can make me pretty paranoid on bad days, and I have dropped down doses before and probably will again.
Elavil – 50mg – PRN, kinda
Elavil (amititriptyline) is a well known tricyclic antidepressant used for just about everything from depression to pain. It’s effective for insomnia, and I’m on it for that in particular. I’ve been on it forever, it has a high anticholinergic load, so I might be switching off it onto something a little “cleaner”.
Propranolol -The beta blocker that got me off benzos after 23 years.
I partly stopped taking benzos as a challenge, and partly out of spite. But propranolol has done magic for my anxiety without sedating me and knocking me out the way benzos did. Oddly, my anxiety baseline without valium is much lower than on it. I’m learning how to cope again, and live without benzos. I’m having weird side effects still, one called “residual disequilibrium”, which can feel like being outside of your body, being rocked back and forth on a boat, and like things are happening a second in time difference from you.
I didn’t know about that when I started tapering benzos, so it was an interesting surprise. It can last months! It’s s steadily going down.
Propranolol has knocked out my physical anxiety and I don’t get the bursts of my heart racing out of my chest and blood pressure climbing (or crashing) and that really helps with the anxiety symptoms.
Stability
I’m kinda on the subthreshold of hypomania, but still have insight. I have some paranoia, the benzo withdrawal, and sensory overload. I’m not sure what exactly is a symptom and what is the Abilify activation, akathisia, and withdrawal, so I’ve been coping and waiting. The next step is replacing Saphris and Elavil with low dose Zyprexa (olanzapine) to knock out the residual paranoia and stabilize my mood. Hopefully that won’t happen.
Lifestyle stuff
I’m doing a few things with my lifestyle to help, some are proven, some aren’t. I
- take fish oils (for my triglycerides, not sure if this helps mood/psychosis)
- knit all the time, I find it relaxing and helps me with creativity, stress and overthinking
- make dice – this helps me creatively, and gives me something to focus on and also sell on my time off work
- only drink one coffee a day
- smoke a couple cigarettes – I’m not withdrawing from benzos and nicotine at the same time!
- exercise a bit – I haven’t got my birthday present (stationary bike) up and running yet
- Do CBT and DBT, I have a couple books and a schedule. It helps reality check the paranoia. It helps me talk back to the hallucinations.
None of this is medical advice, and don’t take it as any!
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