AP Switching: Aripiprozole to Quetiapine

Is Lamictal in the same class of compounds (antiseizure) that Gabapentin is in? I remember, it seems, that DS' PsyMD had said they (Gabapentin, etc) do not work with well with AS. Maybe I misheard.

There are ALOT of questions I've regarding PDD-NOS. I've not found too many keen on discussion (maybe I haven't asked the right questions at the right time, though)

Maybe you could keep a spot on for them as I manage to post them here and there in the Austism forum, if you're a mind to.

Cheers,

Lamictal was a wonder med for me. Unfortunately I did develop SJS and had to stop taking it. Autistic people with family with autoimmune illness should probably not take this med, and if the patient himself has any autoimmunities, they should absolutely not take Lamictal. They did not know this when I tried it. Too bad. It wasn't like gabapentin or anything like that for me.

If autism coexist with ADD/ADHD, a stimulant might help. Sometimes when they coexist, stimulants still don't help and can create problems. Different for different people.

Some people with autism tolerate neuroleptics quite well, but I seem to really need my dopamine. The only one in this class I tolerated at least a bit was Risperdal. The other ones, Seroquel, Geodon, made me feel like I was in HELL. Maan! It is hard to explain. I feel like the world is sometimes too close to me. Neuroleptics made me feel like I was even way closer to the world, and everything was hyper real. Like every impression, every thought, really got to me. Like I had no protection from anything. The world mentally scorched me.

Luckily I stopped having anger issues after getting on Luvox, sometimes other SSRIs can help as well. But all people don't have that kind of luck. It actually made me have a little more protection from the "world" but the med that helped most with that part was a benzo, and you don't give those to kids. About SSRIs, it is not like if you tried one you tried them all, I have tried several and all of them gave me different reactions.

My anger stemmed from everything being too close and getting to me. It is kind of hard to explain. I couldn't drop negative emotion, it just built up.

If he responds well to Benadryl, you could try the antihistamine path. Antihistamines are brutally sedative to me, even the non sedating ones. But we're all different. Antihistamines in psychiatric treatment are for example Vistaril, prometazine and doxylamine.

Personally SSRI+benzo dealt well with irritability and Ritalin made me less "autistic" even if they claim it makes autistic people more autistic. I was unhappy about being less though, so I just take it on rare occasions.

Corr blind me - you developed Stevens Johnson?!? From what I've seen of photos and all - its absolutely horrid! Look like plane crash victims. Nightmares...

I think I mentioned it already to someone but we had DS tested for an allele of a gene that if present, indicated a much higher risk. As his mum was of Asian descent (also higher risk for SJS), one did not want to have this strand of DNA and take medicines that had a high incidence of triggering it.

No known autoimmune disorder, though there is a penicillin allergy and looks like it'd be wise to have him take allergy shots for environmental triggers as pet dander, pollen, dust and moulde, I'm uncertain if that would increase his risk.


He does. In fact, he was screened early on for severe ADD (war screened for AS as well, but they didnt catch it) and has taken those on and off. Do see def improvement but it wears off and when it does...bad, bad, bad. Also aggravates his on/off transient compulsive tics.

I've much to add here - but they be screaming at me to get off the computer, already.

More later!

Cheers,

Yes, Lamictal is also an anti-seizure med. I took Gabapentin for a few years and it helped me as well. For me Gabapentin was especially helpful because I have sensitive skin and one of the side effects is loss of feeling so it was actually a nice side effect for me. There is concern sometimes because of this though for a fear a child could cut their foot and not realize for example. Lamictal doesn't have the same loss of feeling effects though.

Sure, I'll keep an eye on the autism forum.

Everyone's case isn't as dramatic. I was more close to anaphylaxis than having a lot of skin involvement. The rash I had wasn't severe. They actually missed it at first because it didn't come with the rash first, it developed later. My main symptoms were high fever, very severe headache and body pain and very low blood pressure. I only had a rash on my arms and thighs that actually went away quite quickly and wasn't really bothersome, then I developed blisters in and around my mouth and they didn't stay for that long either.

Still the reaction could have lead to full anaphylaxis and death.

sometimes, a stimulant (upper) plus a tranquilizer/neuroleptic is a good option. I have an acquaintance (not with your son's set of problems, but...still...) who found relief from a broad range of "issues" with seroquel at night and an adderall xr capsule in the morning. the downside is I think there's some indication the TD risk goes up a bit, and if one gets problems from the neuroleptic (akathisia comes to mind), then the amphetamine or Ritalin can make it worse, not better. blah.

sorry about this situation.

For the very brief period of time I took Seroquel it totally wiped out any effect of stimulants. I think it has to do with how fast your body processes the neuroleptic. For some it goes faster.

The good thing with stimulants is that they don't need to be taken on a daily basis to work, one can take them when needed the most and then take breaks from them. Which is probably when they work the best.

dosing is an issue, too. it seems that neuroleptics=higher upper dosage to achieve whatever effects are being sought in treatment. Having said that...

for a while there, shrinks relied on "goof balls"--they were combo pills, part upper and part either sedative (usually a barbiturate) or carefully dosed neuroleptic. The ones w/ the upper and the neuroleptic were effective for weight loss, some forms of depression, etc., but there were also occasional horror stories (TD, addiction, etc.). Anyway...

some things never change. Now, it seems to be an amphetamine for "ADD" and then Klonopin for "anxiety." basically the same thing, just...2 prescriptions to fill, 2 diagnoses to contend with, etc. The Ultimate Goof Ball is a downer, a neuroleptic, and an upper. Not the best idea over the long haul, but...effective for extreme states of misery, no doubt.

Exactly. That's exactly how our son has described it and we've seen how negative emotion builds up and once it gets going he focuses on it to the exclusion of everything else. He cannot be consoled.

Actually, the idea of 'focusing on (idea, thing, person, food, want) exclusively, completely out of perspective is a life-long trait. With the advent of adult-sized rage replacing the irritability of his childhood, we see him likewise fixating on that.

As far as benzos are concerned, him being 16, they aren't going to give those to him, even if it helped.

Ja, the amp salts seem to have the most straightforward, WYSIWYG effect. In, does what it does and then out. They did seem to help with his unbelievably short attention to work but could also ignite his mania/perseverance and up the irritation (as if it weren't already in the red) in the later part of the day, not to mention the tics, which, even when the offending med is dropped, often continue on their own.


Odd thing was the stims seemed to make him far more compliant when they are first working, otherwise his personality is naturally hyper objectionist, hyper oppositionist.

As it turns, the matter is now out of our hands. He had to be admitted yesterday - something that has never happened before.

They're in the process of drawing up medication changes and will submit the to us in the near term. I'm wondering if they will come back with some sort of "goof-ball" combo, as you mentioned. I wouldn't be surprised.

Just hope they can find the right mix.

Thanks to all of you for your responses.

I hope things will be better from now on.

Hope he will get well soon.

I'm also switching from Risperidone to Seroquel from tonight and nervous about that.

Thank you kindly for the well wishes, Vishva.

You're switching from Rispiridone to Seroquel or from Seroquel to Rispiridone?

Cheers,

I've been taking Lexapro and Risperidone. It is now the third day I'm titrating into Seroquel. Still at 50mg. Tomorrow I have to take the 100mg. Lexapro dose is unchanged.

I'm wondering how long it will take for Seroquel to start working. I already feel a little bit of relief, it is hard to explain it.

from Rispiridone to Seroquel

Okay - gotcha. One question, Vishva - is the Rispiradone primarily for the OCD? Do you have compulsive tics that go along with the OCD?

How's the switch going so far? (ja, okay. More than one question, lol)

Seroquel is fairly fast acting, it seemed.

I think the Risperidone was for multiple reasons.
* It helps sleeping
* Intrusive thoughts became more manageable
* It is also as an augmentation for Lexapro

Yes, there were some compulsive actions I couldn't stop. Like, when walking down a street, I feel like I have dropped something and I feel an urge to go back and check the ground, and double check everything in my pockets.

When I'm working on the computer, I have this urge to be a perfectionist in my work, and often were double-checking it is was a single space, or double spaces or actually a tab. I have to check these multiple times. I think I have overcome this recently. I don't remember feeling this way for the past few days.

It is very uncomfortable for me if my cloths are not properly adjusted around my body or touching at a stretched angle. So I also have this urge to fix it often. I think this is more of an Asperger thing than pure OCD.

When I was about 4~5, I had a compulsive hand washing thing. I was given a placebo to convince me that it killed all germs, but that didn't work at that time.

I'm very uncomfortable when touched by a stranger. When walking down a crowded street, I have to be extra careful and vigilant to not get my body in contact with a stranger. If someone accidentally touches me, I get very upset, and it feels itchy where they have touched. And I can't touch that area with any other part of my body. As soon as I get home or office, I thoroughly wash that area. This is something I'm still straggling with.

I have been struggling with this sub-clinical OCD as long as I can remember. I'm used to it. It is tiresome. I have overcome them halfway. Was not focusing on my OCD for a while; just living with it for the moment.

Right now I'm having a very mild headache. I feel so thirsty. Today I was not as drowsy as yesterday or day before. I think the sedation subsides at higher doses.

Last night I went up-to 100mg, and today also staying at 100mg. I'm sticking to the titration plan PDoc gave me. Tomorrow and onward is 200mg target dose.

I want to believe Seroquel will enable me to stop smoking.

Physically I feel like everything is padded, like I don't feel the hard surfaces as it is. It is the sensation of outside word at skin. It is weird and hard to explain. Not bad, neither good, but I'm slightly worried if this persists or get worse.

I also feel that tired feeling you get when on Cymbalta.

Mentally, I already feel so much quietness in my head. My thoughts are clear. I don't feel worried all the time. It is like I have a firm grip of things around me. Emotions are dull, but that is kind a good. I don't feel like a zombie at all . I feel I can enjoy small things around me. I'm not frustrated or angry or agitated. This is good.

The only worry I have now is the metabolic side effects I have to watch out for. PDoc didn't tell me I have to get blood tests regularly. But I will get them done anyways before next visit.

No offence, but..

Neuroleptics is the outdated term. Those are now called first generation anti-psychotics.

Abilify is the only third generation anti-psychotic.

Regarding your OCD, I suppose you've tried Exposure Therapy. It really helped my son when he was being plagued by OCD-like, repetitive worries when he was around 10. In fact, exposure therapy was the only time any sort of 'talk' therapy has worked - but thing was, he was truly tired of it by then and wanted rid of it.



If you have success, let me know for certain as I've tried everything myself to stop (except quitting, of course ) Tried Buproprian for smoking cessation but it just made me very short tempered.



I'd give yourself time to adjust. Even though Seroquel is a faster acting med compared with many of that class, the effects of coming off the Rispiradone may not have had their final say. I don't think any of the AP switches are anywhere near a 1-to-1, even in the best case.

Can't ask it to do any more than that!

No, I haven't tried exposure therapy. I'm scared about the idea of that, specially when it comes to contamination anxiety.

I agree with Wild Coyote, anti epileptics might be better. It's awful that your child has been put on antipsychotics at 16. Seroquel is bad for severe weight gain, craving unhealthy foods, and will make your son very sleepy. 800mg knocked me out for about 10 hours a night (I am female and 5ft 1 though). I put on half my body weight with Seroquel and it made me obese. It can also cause diabetes and heart disease. So I would suggest something other than an antipsychotic. Abilify is not so bad for these things but it is a newer drug so the long term side effects are not really known.
Most atypical antipsychotics have side effects like Seroquel.

Best of luck with it all.

All true, but I hear atypical antipsychotics more often and that picks up Abilify too. I know there's a mechanistic reason for giving Abilify its own class, but for all practical purposes its just another one of the AAP's that may or may not work and may or may not have the same or different side effects as any of the rest.

You should consider it. The term 'Exposure' does seem to have a disquieting ring to it with implications of some hooded and cloaked beastie lumbering behind you at a lido, "Hello, a bit of aquaphobia, I see. Well, hows about a little dip, then? Shall we? heh-heh", lol.


No, its not like that at all! I'd wondered about that myself, but I sat through sessions with my son and watched the process. Its quite safe. The key is getting a therapist whose demeanor meshes well with you and that may take several tries. Not all therapists are created equal. Just remember that the therapy itself has a very good track record. Its the implementation that is key.



Also, it helps to be sick and tired of having the compulsions and intrusive thoughts running your life.


Thanks, Rose. Ja, 16 and we've seen them much, much younger. I do wonder about the long term effects. What will these kids look like years in the future. I shudder when I think of the possible toxicological effects after years of use beginning in early childhood. I shudder.

There's no way of knowing, not even close to doing any meaningful medium term studies. Many, if not most, haven't been around long enough. Its uncharted territory from here out.


Yes, Abilify does seem to be the best out of the bunch. Our child had been on it nigh three years, and I recall overhearing, almost in passing from at least one doctor, they didn't think it a keen idea to keep them on it for too long and we can't help but wonder if at least some of the problems he's been experiencing are possibly due to unknown effects on some portion of the executive function.

But there's just no way of knowing...

I'm sorry if I'm hijacking the thread. If so, let's move this discussion to a separate thread.

I too have had very bad aquaphobia when I was very small. As a child I was even scared to death seeing the depth of a bucket of water. My parents have helped me get over it.