Safer Alternatives To SNRI Cymbalta/Duloxetine And Anti-psychotic Abilify/Aripiprazole

caspar

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does anyone have suggestions on how to go about getting off these drugs?

my partner has been taking them for about 3 years now, and we are worried about the damage they are doing.
she often has a myriad of issues that may or may not be side effects of the meds, but overall we are convinced if there is a better alternative, we should try it. I also assume it will take long term tapering and some combination of diet, exercise, and supplements and/or less damaging meds.

searched through the forum and read some suggestions for pregnenolone and progesterone, but Im pretty confused as to their functions and how they may help.

also read about cyproheptadine, and tianeptine, but again, some specialized knowledge would help me understand better.

grateful for any help.
 

Hans

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Because everyone's neurotransmitter profile is different, it would be difficult to say what would be a good alternative. For example, your partner could have high cortisol and adrenaline, but low neural noradrenaline and dopamine or the opposite.
What are some symptoms of your partner before going on the meds?
 
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caspar

caspar

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its hard to say, shes been on one drug after another since her teens (now 28), some of them being zoloft, prozac, lexapro + seroquel (about in that order from memory). she says there were no tests save for questionnaires when getting on them and switching. they did take bloodwork for seroquel to check cholesterol, but its been some years.

since Ive known her, shes had bloodwork done about 6 months ago and was diagnosed anemic, and given iron infusions.
she just had recent bloodwork done this week, here is what stood out (but can provide other data from what they gave us):
IRON, TOTAL: 93 (Reference Range: 40-190 mcg/dL)
IRON BINDING CAPACITY: 225 (Reference Range: 250-450 mcg/dL (calc)) which seemed low
% SATURATION: 41 (Reference Range: 16-45 % (calc))
FERRITIN: 112 (Reference Range: 16-154 ng/mL)

VITAMIN D,25-OH,TOTAL,IA: 22 (Reference Range: 30-100 ng/mL)

the main things that stood out were the low iron binding capacity, and low vit D. we've both been taking some vit D supplements (2000 IU) a day for the past couple weeks, but could get outside more.
 
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caspar

caspar

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my current concern is an episode she had earlier this week in which she had a sudden (what we have deduced) migraine with extreme light sensitivity (putting head under blanket) that I hadnt seen before, and aphasia, which freaked me out. she snapped out of it fairly quickly, but was still weak and confused for about an hour. the extremity of the attack was worrying (checked for stroke symptoms, but seemed not to have them, but wouldnt rule out TIA entirely), and am now investigating what has caused not only that, but the almost daily symptoms of: fatigue, anhedonia, headaches, body aches, and resulting depression of it all.

she was diagnosed with fibromyalgia also young as well. if all of this is interrelated someway to some degree (anemia, fibromyalgia, anxiety-panic-depression spectrum), Id like to get to the bottom of what we can do. we are thinking now we should try and get more tests done. perhaps more specific bloodwork or imaging, but Im unfamiliar with most all medical territory. this is all new for me, which is good that Im learning.

are there any specific tests or specialists we should focus on? neurologist or hematologist come to mind, but any corrections and/or suggestions are welcome.

(thanks again @Hans)
 
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aguineapig

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Anti psychotics probably act more via 5-HT2A blocking than the much fetishised Dopamine blocking. A high potency 2A antagonist could possibly replace the abilify.

As an anecdote, abilify is sometimes used in "treatment resistant" OCD where the patient does not respond to ssri. They usually use quite low doses, sometimes so low that the only receptor it'd be significantly blocking would be 5-HT2A. I started taking 1mg cypro for 2A blockade in combination with buspirone for dopamine and Noradrenaline boost and my obsessional OCD has essentially stopped. I have essentially no side effects although I hope to not require it forever.
 
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caspar

caspar

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Whoops! forgot to put the dosages:
5mg Abilify/Aripiprazole and 60mg of Cymbalta/Duloxetine
(daily)
 

Hans

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the main things that stood out were the low iron binding capacity, and low vit D. we've both been taking some vit D supplements (2000 IU) a day for the past couple weeks, but could get outside more.
Maybe up the vitamin D dose to 10K IU per day just to get levels up.

fatigue, anhedonia, headaches, body aches, and resulting depression of it all
Fatigue and body aches - excess acetylcholine and parasympathetic nervous system activation. Most like elevated free serotonin as well, due to elevated parasympathetic nervous system. An anti-cholinergic would be great here and a serotonin reuptake promotor, such as tianeptine.
Anhedonia - low dopamine and elevated serotonin
Depression - is it major depression? Is she relative resilient against stress and not anxious? People with major depression almost always have elevated noradrenaline. The noradrenaline is suppressing the mesolimbic dopamine release, so an alpha1-adrenergic receptor antagonist would disinhibit the dopamine release.
If she isn't resilient to stress, then noradrenaline is most likely low and serotonin high. GABA might then also be low. In this case, a 5-HT2A antagonism will be helpful to increase noradrenaline and GABA is needed to inhibit the serotonin.
It would be beneficial to test thyroid, DHEA-S, progesterone, estrogen, prolactin and cortisol.
 
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caspar

caspar

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she gets stressed and anxious quite often, so perhaps
noradrenaline is most likely low and serotonin high
is more of the case.

what type of specialist do you think would be most helpful to see in this regard, an endocrinologist?
 

Hans

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she gets stressed and anxious quite often, so perhaps is more of the case.

what type of specialist do you think would be most helpful to see in this regard, an endocrinologist?
Sorry for the late reply. I'm not sure who would to a good job. It all depends on the doctor and how enlightened he is and open-minded to alternative options.
 

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