please check my reasoning: selecting a med

I am seeing my p-doc tomorrow. He offered Abilify, Tegretol, or Trileptal to replace Geodon because Geodon causes unorgasmia. I have researched all three, both on the Internet and via posting here, and come up with the following ranking:

1. Abilify since it is an AP, like Geodon, and my dx is BP I with psychotic features, so treatment of psychosis is important. But I am very afraid of akathisia and will ask for a med to prevent it right away, without waiting for akathisia to rear its ugly head
2. Tripeltal. The side effect profile seems more benign than that of Tegretol. On this board I got only two responses but both were positive.
3. Tegretol. The nice thing about Tegretol is that it might prevent migraines, which would be a plus.

So this is my ranking and I will let him make the decision.

Sounds reasonable?

It seems they're evenly matched. I'd go with tegretol. In my case I can only take trileptol on your list- reactions to other two. Since you don't know that you'll get the akathesia, trying abilify is still worth a shot too.

Well, not everyone with bp1 gets psychotic symptoms but, from what I understand psychosis with bipolar 1 or 2 is associated with a mood state, mania, depression or mixed and when you get psychosis between mood states it is something else such as schizoaffective disorder so, while that is a concern in a current episode for maintaining an antipsychotic isn't needed.

Of course, that is if medications actually worked to prevent episodes...

And experiences from boards are flawed.

I discussed it with my p-doc friend a while ago and he said that since I had akathisia on Seroquel, I have higher than average chance to develop akathisia on Abilify. When I posted here, 33% percentage of respondents reported akathisia. In the published studies, the figure is 25% - still high. Add to it my predisposition and the number gets pretty big, so I do not have my hopes high. But I will give it a shot.

i would agree about tegretol, I have zero experience with that one. but if it could relieve your migraines that would be good!

i hate abilify, so did my kids. trileptal was ok for daughter but made her very sleepy.

well, I got 33% from the board and the published studies cite 25% - it is not THAT far apart, is it?

All I know is this time around I will be figuring out if stuff works and if stuff is worth its side effects pretty quickly - no more long months or even years on wrong meds for me, thank you.

How do you figure it out quickly when it ages to find/get to an appropriate dosage or adjust?

For example, Wellbutrin would be a go to drug for depression for me but, when I started it it was horrible and weeks later I adjusted even the appetite loss that had me quit it lessened and I stayed on it so long thinking that it might get better or that I needed it.

Or lamictal which takes so long to reach even 200 mg...

And many you cant even expect anything for at least a few weeks.

I think they do: I select 5 (happy medium) in Optimism and "baseline" in Moodtracker almost every day. Get mildly depressed with insufficient sleep and that's about it. I have been tracking only for a few weeks though.

So I saw an on-call p-doc today about insomnia (he ended up giving me his first Amitiptyline prescription in 10 years!). We discussed it. He did not change my main meds because it is a big decision to be made with the regular p-doc, but he gave his opinion. Without thinking of the cost, he ranked them as follows:

-- Abilify
-- Tegretol
-- Trileptal

Based on his experience, Abilify will be as effective as Geodon but without sexual side effects. Basically, try Abilify and pray that it does not cause Akathisia, and if it does, try Tegretol.

Considering the cost, Tegretol, at $4 at Walmart, is the winner.

Glad you made a decision.

Yeah, I am looking for something that works quickly - Prozac started working in a matter of days, not even weeks. I woke up a different person. It was very impressive. And stayed that way.

Right now I am stable, so I guess what I would be looking for is "no change". I sure hope it is possible. I would hate to think that the current combo is unique in its ability to prevent episodes.

Glad the Amitiptyline (Elavil) is helping you sleep!
If I ever have to come off Lamictal or add to it, Tegretol is what I'd try.