Medications Personally Tried by Our Founder - Personal Experience
My Medication Experience
While making content for The Anxious Resistance I am often asked about medications that I am taking or have taken. When I review medications I put in a personal experience with it if I have one. My goal here is to put into chronological order the medications that I have tried, the effect they had, and my experience.
- I was prescribed this by my pediatrician as a rescue medication. It was quite effective at helping me calm down. I found that it made me fatigued when I took it, but it was the best option I had. I tried not to take this medication very often because of its psychologically and physically addictive properties. Over the course of my mental health journey, I didn’t take more than 60 pills of Xanax.
2. Trazodone
- I was also prescribed this by my pediatrician. It was the only thing that would help me sleep. It would really put me out. This can be a good medication for sleep. After about 6 years of taking this medication, I tapered off of it.
- After about 3 weeks on this medication it made me incredibly suicidal. It was an experience that was horrifying and difficult to look back on. All I could think about for several weeks was death, and what might happen afterward. I was really low, in a way that I never could have without these chemical changes going on in my mind. After a week or so off of the medication I was no longer having suicidal thoughts. I was back to the same anxiety that I had previously. My reaction was severe enough that my prescriber no longer wanted to try medication.
- While on a mission for the Church of Jesus Christ of Latter-Day Saints I had a relapse of intense anxiety. I found a prescriber who wanted to try Wellbutrin. After about a week on the medication I started having joint pain as well as pins and needles sensations all over my body. I tried to tolerate this as long as possible. It became too much to endure while trying to function normally. I quit the medication with my prescribers instructions.
- My Primary Care Provider from my mission thought that this medication might be a good option for relief from my anxiety. After taking this medication many times I found that it did not help, nor did I have any side effects from it.
- After a time I moved to Oklahoma where I served the remainder of my mission for the Church of Jesus Christ of Latter-Day Saints. There I found a Primary Care Physician able to take my insurance and prescribe antidepressants. Pristiq was one that I had chosen because a friend of mine had taken it and had success. After several months of taking Pristiq there was no change in my condition. I did not have side effects and I did not have improvement.
- Effexor was the first medication that I tried with my post-mission prescriber. Within a week I was having itchy, pinchy feelings all over my body. Along with this I started having some suicidal ideation that was not tied to events in my life. My doctor wanted me to be inpatient at the hospital until the effects of the medication wore off. I convinced him that I wasn’t going to do anything and that I knew it was the medication making me feel that way. I went home and was supervised by my mother who is a psychiatric RN. After a few days the effects wore off.
- My doctor prescribed me this to help with the Suicidal Ideation caused by the Effexor. Olanzapine is one of the very few medications actually approved by the FDA for suicidal ideation. I only took a few doses until the Effexor wore off. The side effects I had from it included tiredness and an increase in appetite. I found that it helped with the suicidal thoughts.
- After trying a serotonin reuptake inhibitor again and reacting poorly, my doctor decided to try something a little more off-the-beaten-path. He prescribed Lamictal (Lamotrigine). We slowly titrated up the dose from 25mg to 50mg, then to 75mg, and finally 100mg. This happened over the course of several months. Each time the dosage increased I had aches in my muscles and joints. The longer I spent on the medication the more the side effects abated. When I first started the medication, I had some minor blurriness in my vision. It was definitely out of the ordinary and I attributed it to the medication. I thought I had felt some miniscule relief in depression from Lamictal and thought the medication was worth staying on, for a time.
- I tried a wide dosage range of gabapentin from 200 mg three times a day up to 800 mg three times a day. Again, this was over the course of months. I felt absolutely no relief from depression or anxiety taking gabapentin. I did not have any side effects either. I was frustrated because this medication took a long time to try, and I got absolutely nothing from it.
- I tried Buspar and since it has a very narrow dosage range, it was a short-lived attempt. I felt no different on Buspirone. No side effects, no relief, nothing.
12. Tenex/Intuniv (Guanfacine)
- This is a medication that I recommended I try to my doctor. I had a lot of side effects but it was the first thing that gave me relief from my anxiety besides Xanax (Alprazolam). Alprazolam was ruled out early in my treatment since it was not a long term solution. Benzodiazepine side effects and addiction are a serious problem. I did have dry mouth, a decreased appetite, constipation and episodes of sweating on guanfacine. I also had Orthostatic Hypotension which is feeling dizzy when standing quickly. That’s because this medication lowers blood pressure. I stayed on Guanfacine for about a year and half until I found better options.
- Chemically Lyrica (Pregabalin) is very similar to gabapentin. However, I wanted to give this medication a try. I had some reservations because it is a schedule V controlled substance and I didn’t want to get addicted. I wanted long-term solutions to my anxiety and depression. Lyrica didn’t work out though, like Gabapentin, I received no relief.
- Being on Seroquel (Quetiapine) was a harrowing experience. I was not myself on this medication. I am still in awe at how MESSED UP these medications can make you. First of all, I had a voracious appetite on Seroquel. I was only on Seroquel for a couple of weeks but gained at least 10 pounds. Agitation was the most severe side effect. I was constantly angry. I would punch things in my car. I completely destroyed an office chair that I had. The anger was uncontrollable. I remember thinking that I would have punched out a cop for no reason. This was a miserable couple of weeks for me. I was also incredibly tired. Which was a saving grace. I could sleep to avoid being angry and constantly eating.
15. Maprotiline
- Maprotiline was another medication that I suggested to my Doctor. At this point I had really gotten into my research about how antidepressants worked. Maprotiline appealed to me because it has significant action on the norepinephrine reuptake transporter. Specifically, it blocks that transporter. I had already failed Serotonin Reuptake Inhibitors (SSRIs) and Dopamine Reuptake Inhibitors (Wellbutrin) which left one other major neurotransmitter, Norepinephrine. Maprotiline felt like an obvious next option. It was another class of antidepressant and worked on norepinephrine. After only a few days of being on Maprotiline I had some serious side effects. I had some severe heart palpitations and felt hyperactive. Maprotiline proved to be a short-lived treatment.
- At this point in my mental health journey I was having difficulty sleeping. I gave Ambien a try. It didn’t help with my sleep at all and made me tired all day long. I only took two doses of Ambien.
- My experience taking Lunesta was exactly the same as Ambien. There was no real help with insomnia and it made me tired throughout the day.
- I chose Paxil as my next treatment because it is very specific with its serotonin actions. It has a very high affinity for the serotonin transporter. I reacted fairly well to Paxil compared to other SSRI and SNRI medications. At first, I felt a bit depressed on Paxil but then my mood began to lift. I felt tired on paxil but slowly my mood began to lift. The tiredness got bad enough that I felt I needed to quit Paxil. The fact that it did not make me suicidal as Effexor and Lexapro had was a good sign.
- My doctor chose Prozac (Fluoxetine) as our next option. He (my doctor) was hopeful that an SSRI would work although I was skeptical. We started the dosage low at 10mg and slowly titrated up 10mg at a time. Each time the dosage was raised I had muscle and joint aches for about a month. After a month, they would go away. It was a long and arduous process of raising the dose but each time we did I felt relief for my anxiety. We tried raising the dose to 50mg but I found that at this dosage the muscle aches would not go away. Prozac was the FIRST medication that gave me any real relief from my anxiety and depression. As you can see, this is #18 on the list.
20. Vistaril/ Atarax (Hydroxyzine)
- There were times when the Prozac didn’t give me enough relief from my anxiety. After a difficult breakup and some big changes in my life I sought some more relief from medications. My doctor (who was new as my previous doctor had retired) suggested that I give hydroxyzine a try. I found that it was very effective at taking away my anxiety. I started taking it every day. I felt like the effects from one dose lasted me all day. I actually found that I was pretty sensitive to hydroxyzine and found I needed less and less. After things settled in my life I found that the tiredness caused by the medication was too bothersome and I stopped taking it every day. I still use this medication to help me sleep and for the occasional breakthrough anxiety.
- After years of having success with my combination of Prozac and Hydroxyzine I had a small relapse. After graduating from college and finishing nursing school I found myself in the midst of a quarter life crisis. I found myself having difficulty with both anxiety and depression. I sought something I could add to my current combination of medications and my doctor (Psychiatric Nurse Practitioner) suggested Abilify (Aripiprazole) which is an approved add-on medication for depression. I found that after only several doses at 2 mg that I found relief. After a time I noted some fatigue from the medicine and cut the dose in half to 1 mg. I have been on Abilify for several months and have not experienced any other side effects from it.
Well, that’s it. My entire list of 21 prescription medications, taken over the course of nearly 10 years. This list does not include various vitamins and supplements that I tried over that length of time. Many may feel discouraged because of the lack of success with medications. I sure was! Many times I thought the attempts were hopeless. As long as there were options, I was willing to try though. As you can see, eventually I found the right combination of medications. You can too! Keep trying and don’t give up!
All the best,
Birk Gundersen, RN, BSN and Founder of The Anxious Resistance
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Unveiling Caplyta: A Groundbreaking Solution for Schizophrenia
Caplyta (lumateperone) is a prescription medication that belongs to a class of drugs called atypical antipsychotics. It is approved by the FDA for the treatment of schizophrenia and bipolar depression in adults. In this article, we will review what Caplyta is, how it works, what evidence supports its use, what side effects it may cause, and what are its pros and cons.
What it is
Caplyta is a once-daily capsule that contains two active ingredients: lumateperone and samidorphan. Lumateperone is the main ingredient that acts on various brain receptors to reduce the symptoms of schizophrenia and bipolar depression. Samidorphan is an opioid blocker that helps prevent weight gain, a common side effect of other antipsychotics.
History
Caplyta was developed by Intra-Cellular Therapies, a biopharmaceutical company that licensed lumateperone from Bristol-Myers Squibb. The company conducted several clinical trials to test the safety and efficacy of Caplyta for schizophrenia and bipolar depression. The FDA approved Caplyta for schizophrenia in December 2019 and for bipolar depression in December 2021.
Mechanism of Action
Caplyta works by modulating the activity of certain brain chemicals, such as dopamine, serotonin, and glutamate. These chemicals are involved in regulating mood, cognition, and behavior. Caplyta acts as an antagonist (blocker) of some dopamine and serotonin receptors, such as D2, D4, 5-HT2A, and 5-HT7. It also acts as a partial agonist (activator) of some serotonin receptors, such as 5-HT1A. Additionally, Caplyta inhibits the reuptake (recycling) of serotonin by blocking the serotonin transporter (SERT). By doing so, Caplyta reduces the excess dopamine activity that may cause psychosis and increases the serotonin activity that may improve mood and cognition.
Evidence for use
The FDA approval of Caplyta for schizophrenia was based on three randomized, double-blind, placebo-controlled trials that involved a total of 1,268 adults with schizophrenia. The trials lasted for four to six weeks and compared Caplyta 42 mg once daily with placebo or risperidone 4 mg once daily. The primary outcome measure was the change in the Positive and Negative Syndrome Scale (PANSS), which assesses the severity of psychotic symptoms. The results showed that Caplyta significantly reduced the PANSS score compared with placebo in all three trials. Caplyta was also comparable to risperidone in reducing psychotic symptoms.
The FDA approval of Caplyta for bipolar depression was based on two randomized, double-blind, placebo-controlled trials that involved a total of 1,050 adults with bipolar I or II disorder and a current major depressive episode. The trials lasted for six weeks and compared Caplyta 42 mg once daily with placebo as monotherapy or as adjunctive therapy with lithium or valproate. The primary outcome measure was the change in the Montgomery-Åsberg Depression Rating Scale (MADRS), which assesses the severity of depressive symptoms. The results showed that Caplyta significantly reduced the MADRS score compared with placebo in both trials as monotherapy and as adjunctive therapy.
Side Effects/ Adverse reactions / Contradictions
Caplyta may cause some side effects that are common to other antipsychotics, such as sleepiness, dry mouth, constipation, indigestion, increased appetite, weight gain, headache, dizziness, fatigue, shakiness, back pain, speech problems, memory problems, and pins and needles feeling in the hands and feet. However, these side effects are generally mild to moderate and may improve over time.
Caplyta may also cause some serious side effects that require immediate medical attention, such as stroke, opioid withdrawal or overdose (if taken with opioids), neuroleptic malignant syndrome (a life-threatening reaction characterized by fever, muscle stiffness, confusion, sweating), serious skin reaction (rash, fever,
swollen lymph nodes), severe allergic reactions (swelling of the face,
tongue or throat; difficulty breathing; hives), extremely high blood sugar levels (more hunger or thirst; more frequent urination), seizures.
Caplyta is not approved for the treatment of people with dementia-related psychosis because it may increase the risk of death in this population. Caplyta is also not recommended for people who have heart problems or a stroke history; who use or abuse street drugs; who have kidney problems; who have diabetes or high cholesterol; who have low white blood cell count; who have problems swallowing; who have seizures; who have problems with urination or prostate; who have breast cancer; who are pregnant or breastfeeding; or who are allergic to any of the ingredients in Caplyta.
Positives or Pros
Caplyta has some advantages over other antipsychotics, such as:
- It has a lower risk of causing movement disorders, such as tardive dyskinesia (involuntary movements of the face, tongue, or limbs), akathisia (restlessness), and parkinsonism (tremor, stiffness, slowness).
- It has a lower risk of causing metabolic changes, such as weight gain, high blood sugar, and high cholesterol. This is partly due to the addition of samidorphan, which blocks the weight-promoting effects of lumateperone.
- It has a lower risk of causing hormonal changes, such as elevated prolactin levels, which may cause breast enlargement, milk production, menstrual irregularities, and sexual dysfunction.
- It has a lower risk of causing cardiac changes, such as QT prolongation (an abnormal heart rhythm that may lead to sudden death).
- It has a simple dosing regimen of one capsule once daily, without the need for titration (gradual dose adjustment) or food restrictions.
Negatives or Cons
Caplyta also has some disadvantages compared with other antipsychotics, such as:
- It is not available as a generic and it is very expensive. The average retail price of Caplyta is about $1,740 for a 30-day supply. However, there are some savings programs and coupons that may help lower the cost.
- It has a low bioavailability of 4.4%, which means that only a small fraction of the drug reaches the bloodstream after oral administration. This may affect its effectiveness and consistency.
- It has multiple drug interactions that may affect its metabolism and clearance. For example, it may interact with opioids, antidepressants, anticonvulsants, antibiotics, antifungals, antivirals, grapefruit juice, and herbal supplements. Therefore, it is important to inform your doctor and pharmacist about all the medications and supplements you are taking before starting Caplyta.
Conclusion
Caplyta is a new option for the treatment of schizophrenia and bipolar depression in adults. It has a unique mechanism of action that modulates various brain chemicals to reduce psychotic and depressive symptoms. It has shown efficacy and safety in clinical trials and has some benefits over other antipsychotics in terms of lower risk of movement disorders, metabolic changes, hormonal changes, and cardiac changes. However, it also has some drawbacks in terms of high cost, low bioavailability, and multiple drug interactions. Therefore, it is important to weigh the pros and cons of Caplyta with your doctor before deciding whether it is right for you.
Sources
¹: [Caplyta: Uses, Dosage & Side Effects - Drugs.com](https://www.drugs.com/caplyta.html)
²: [Lumateperone - Wikipedia](https://en.wikipedia.org/wiki/Lumateperone)
³: [FDA approves new drug for schizophrenia - FDA](https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-schizophrenia)
⁴: [FDA Approves Caplyta (lumateperone) for the Treatment of Schizophrenia in Adults - Intra-Cellular Therapies](https://ir.intracellulartherapies.com/news-releases/news-release-details/fda-approves-caplytar-lumateperone-treatment-schizophrenia-adults)
⁵: [Caplyta (Lumateperone Capsules): Uses, Dosage & Side Effects - RxList](https://www.rxlist.com/caplyta-drug.htm)
: [FDA Approves Caplyta® (lumateperone) for the Treatment of Depressive Episodes Associated with Bipolar I or II Disorder in Adults - Intra-Cellular Therapies](https://ir.intracellulartherapies.com/news-releases/news-release-details/fda-approves-caplytar-lumateperone-treatment-depressive-episodes)
Sources:
(1) For Adults with Bipolar Depression - CAPLYTA® (lumateperone). https://www.caplyta.com/.
(2) Lumateperone - Wikipedia. https://en.wikipedia.org/wiki/Lumateperone.
(3) Caplyta: Uses, Dosage, Side Effects & Warnings - Drugs.com. https://www.drugs.com/caplyta.html.
(4) Caplyta (lumateperone): Uses, Side Effects, Dosage & Reviews - GoodRx. https://www.goodrx.com/caplyta/what-is.
(5) Caplyta (Lumateperone Capsules): Uses, Dosage, Side Effects ... - RxList. https://www.rxlist.com/caplyta-drug.htm.
By Birk Gundersen RN, BSN.
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