new bipolar depression medication approved by FDA — and into my body it goes

I start a new Crazy Med in the next week or two, depending on when it arrives: Cariprazine, as sold under the brand name Vraylar, to treat bipolar depression.

this is a drug that was only just approved in May 2019 (like, just seven months ago). so there’s limited data out about it. but as always, I’m doing my pre-administration self research. and as follows are my notes.

oh! but first!! I want to point out the ironic hilarity in my spellchecker’s desire to auto-correct “Cariprazine” to “Craziness” (image below) when I was emailing my Mum about it.  XD I’m already a fan of this stuff, lol.

it’s as if you’ve met a potential female mate for the first time and she’s got the smeared lipstick look goin’ on with a name tag reading “Hot Mess”.

anyway, below are the meds I’m currently on are below (for Crazies and brain muckery, not anything else). it’s important to keep track of all this shit.

(name brand)
Dosage & FrequencyReason
0.5 mg, as neededanxiety,
panic attacks
(Wellbutrin XL)
100 mg, once daily;depression
400 mg, twice dailyanxiety
Lithium Carbonate600 mg, twice dailymood stabilizer
Nortriptyline HCL
10 mg, twice dailyfibromyalgia
Pramipexole Dihydrochloride
0.5mg, nightlyrestless leg syndrome
0.50 mg, twice dailybipolar,
yes, that’s 1,200 mg of lithium a day.
are you less surprised now about my constant exhaustion and the complete death of my Creativity?

and again, for my personal reminding, I’m posting below anything I read that was of interest or relevance to me. apologies if my shorthand is unintelligible to others initially; I’ll try to flesh things out once it’s all collected.

  • Purpose & Usage
    • heavy focus on bipolar I (versus II); schizophrenia seems to be in the backseat, too
  • Administration & Consumption
    • advised dosage for depression starts at 1.5 mg daily and settles at 1.5 – 3.0 mg daily
      • for mania, starts at 1.5 mg and settles at 3.0 – 6.0 mg
    • take with or without food
  • Side Effects (for mania & depression): so the normal shit, naturally; plus all this mess…
    • nausea & vomiting
    • dyspepsia (bloated gassiness)
    • restlessness
    • somnolence
    • akathisia (twitchy, full-body RLS; sometimes spazmatic loss of motor control)
    • other extrapyramidal symptoms
      • Parkinsonism (tremors, slower thought processes, slower movements, rigid muscles, difficulty speaking, facial stiffness)
      • tardive dyskinesia (potentially irreversible effects; uncontrollable facial movements, like sucking or chewing, lip-smacking, sticking tongue out, or blinking eyes repeatedly) [so like a gecko?]
      • dystonia (muscles involuntarily contract and contort) [DC’s Ragdoll with a loss of control?]
    • metabolic changes
      • fffff, weight gain D:
      • 3% of folks had >7% weight increase for each mania and depression treatment
      • another viewpoint suggests an average 1.1 lbs of weight gain in the first three weeks for mania. for depression it was 1.5 lbs at 1.5 mg/day within the first 6-8 weeks.
    • okay, y’all, direct quote time from the manufacturer’s distribution sheet:
      • Falls: Antipsychotics, including VRAYLAR, may cause somnolence, postural hypotension, motor and sensory instability, which may lead to falls and, consequently, fractures or other injuries. For patients with diseases, conditions, or medications that could exacerbate these effects, complete fall risk assessments when initiating antipsychotic treatment and recurrently for patients on long-term antipsychotic therapy.”
      • like seriously, though. falls. I mean, that’s just a freakin’ Tuesday for me. XD
    • body temperature dysregulation
    • direction quote number two from official website:
      • Do not become too hot or dehydrated during treatment with VRAYLAR. Do not exercise too much. In hot weather, stay inside in a cool place if possible. Stay out of the sun. Do not wear too much clothing or heavy clothing. Drink plenty of water.
  • Other Random Facts
    • is second-gen (or atypical) anti-psychotic
    • long half-life (Cariprazine 2–4 days; DDCAR 1–3 weeks)
    • side effects may take longer to appear than with other drugs
    • metabolites’ formation and elimination via CYP3A4 (liver-based)
    • looks like it legit can make you more suicidal (hello every anti-psychotic ever), not just the typical level for antidepressants

Things I need to research further include:

  • tardive dyskinesia
  • dystonia
  • Cytochrome P450 3A4
  • ways to counteract weight gain
  • details on potential body temperature dysregulation

An then some potentially useful links:

medication, relationships, and disassociations

oops.  so I’ve managed to not take my morning medications almost every day this week (my most important meds are my morning ones, of course).  also, I’ve forgotten my evening meds numerous times in the last two weeks.  however, I’ve been fairly good about my mid-day meds — naturally, because those are the least important of the three.  ~sighs~

I’ve been totally exhausted lately.  like, before my screwing up the taking of my meds.  that’s actually what led to my forgetting to take them.  over the weekend, I just got really, really tired.  then Monday morning, I sleep in until I absolutely have to wake up for work, and I forget to dope myself up while I rush getting ready.  and it just happens like that every morning for the rest of the week.  today included.

Brian called me while I was on my way to work because he noticed I forgot my meds.  I’d be late if I had turned around though.  and I just also didn’t give a fuck about going back to take them.  “it’s not like they’re doing much good anyway”, half-sleepy me told myself as I steered with one knee, guzzled an energy drink with one hand, and shoved eggs into my mouth with the other hand.  (the second knee was attached to the foot reserved for the gas and brake pedals.  I have to get creative whenever I need each a hand and a foot/knee/leg for the shifting and powering the clutch.)  so I just thanked him, and kept going away from home.

I’ve been frustrated with him for a day or so now.  he did tiny thing A that is a big thing to me, and I noticed I had an emotional response about it.  I did my best not to have an emotional reaction, and I only kinda succeeded.  but then I beat myself up for having emotions at all.  I typically get very angry at myself when and because I’m angry at him.  and of course, during all this, I don’t tell him shit, because I don’t want him to start feeling bad about having peeved me off.  but he inquired this morning, and I was just like, “let’s talk about this when I’m not running late for work, okay?”

second thing I really wanted to discuss here (venting about Brian kinda snuck in here, lol) is my disassociation qualities returning.  I’m getting “that feeling” again wherein I’m not Me.  I’m multiple peoples living in a single body, so take turns sharing the physical cage.  I “see” myself doing and saying things.  I’m over-analyzing my actions in a very particular way — not so much “objective” as it is disjointed and disconnected.

maybe it’s the lack of medication in my system.  maybe it’s the two energy drinks a day I take just to stay awake.  maybe it’s whatever started making me so tired over the weekend.

maybe it’s finally time for a Cycle change, and I’m going to go into a mania soon.  that would be a nice change of pace.  I haven’t had a proper (hypo-)mania in a while.  though I doubt it, given all the additional sleep I’ve been needing.

one thing I’m going to discuss at therapy is how I’m so Tired.  like, when she or my psychiatrist ask me about how this is going or what I feel about that, I just wanna look at them and say, “I don’t know. I’m too Tired to think about an analyze it.”  an me being too tired to analyze something — not a good sign.

I suppose that’s all for now.  I’m just really off kilter.  and because I don’t know the cause, I can’t even pretend to come up with a solution.