Dr Hege - Affordable Medications for Psychiatric Diagnoses

You’ve gone through the sometimes difficult process of being diagnosed with Adult ADHD, bipolar disorder, anxiety or depression. Now you have to figure out how to pay for the medication. Whether or not you have insurance to help with costs—you may find some of these tips helpful.

Generics are Affordable Medication

Choosing a generic over a brand medication is a great way to save money. Generic Adderall immediate release costs 90% less than brand Adderall XR. All of the antidepressants except Lexapro and Cymbalta are generic now.

The only atypical antipsychotic, dopamine blocking, mood stabilizer that is generic is Risperdal. The other most frequently prescribed mood stabilizers also have generics. They are lithium, valproic acid (Depakote), oxcarbezine (Trileptal), Keppra (levetiracetam), and carbamazepine (Tegretol). At this time, Zonegran(zonisamide) has no generic available.

A lot of prescription sleeping pills have generics including Ambien. All of the benzodiazepines are now generic, including the extended release Xanax (alprazolam ER).

However, often the newer, brand-only medications offer superior effectiveness and/or fewer side effects than the older generics. Consult your doctor or pharmacist about generic versus brand medications.

Where to Buy Affordable Medications

Patients tell me that the cheapest places to buy their psychiatric medicines are at Costco or Sam's Club. The biggest savings are in generic medication. (The spread between different stores’ prices on brand medications is not nearly as great as for generic medications.)

Patients report paying $.75 to $1.25 per pill at retail pharmacies for generic, short-acting Adderall. At Costco, they pay about $. 40 per pill. The pharmacies in Kroger and Target match prices. When you get a lower price at Costco or Sam’s Club, keep the receipt and present it at the most convenient, price-matching participating pharmacy when you fill your prescriptions the next time and ask for a matching price. An option is to go online at the Costco website and check out their price for your medication. Print it out for evidence to take to your price matching pharmacy. However, that list is not comprehensive and you may have to go to the store to get a price. Some patients have been able to call Costco to get a price, while others have been told they have to come in to the store to get a quote on their medication price.

By the way, you don't need a membership card to go to the pharmacy at Costco or Sam's Club. It is illegal for membership stores to require membership fees to access their pharmacies.

Other Tips for Affordable Medication

Another great way to save money is pill splitting. Most tablets can be split. A pill splitter costs $3-$5 and can be purchased in most pharmacies. Pill splitters are even available for $1 at the dollar stores.

The most dramatic cost savings are for patients who are on Abilify. If prescribed 2 mg per day, it is possible to split a 20 mg tablet into eighths, which is approximately 2.5 mg per day. Since Abilify has such a long half-life, the blood levels swing only a small amount from high to low each day. Patients are unlikely to experience any side effects if they get 1 mg one day and 4 mg another day.

A 30 day supply of the 2 mg size may cost around $400. By cutting the 2 milligram tablets into eighths, it only requires 4 tablets per month. At $13 per tablet, this is only $52 per month.

Other pills I frequently have patients cut are Lamictal 200 mg, Seroquel 400 mg, Trileptal 600 mg, gabapentin 600 mg, Adderall and Ritalin (both in the immediate release form), Provigil 200 mg, and Suboxone 8 mg.

You should discuss pill splitting with your doctor before you do it to make sure it is safe and will still be effective for your particular medication.

Call 770-458-0007 today to schedule an appointment for an evaluation to see if you are getting the most affordable and effective medications for your psychiatric diagnoses, such as Adult ADHD, depression, anxiety or bipolar disorder.

Darvin Hege, M.D.
http://www.eveningpsychiatrist.com/

Mirapex – A New Medicine for Depression

Mirapex is a little used and powerful antidepressant option for bipolar depression and treatment resistant depression.

Typically prescribed for the treatment of Parkinson’s—a disease characterized by deficient dopamine production in the motor centers of the brain—Mirapex is a dopamine agonist. Mirapex helps Parkinson’s patients by raising their dopamine levels.

Likewise, depression involves a state of relative deficiency of serotonin, norepinephrine, and/or dopamine in the mood centers of the brain. Studies show Mirapex increases dopamine in the mood centers of the brain. Increased dopamine tends to reduce depression symptoms of low energy, low motivation, low pleasure, and slowed thinking and movement.

How can I get New Medicine for Depression?
Although I learned about Mirapex’s usefulness in treating depression in 2003, very few psychiatrists prescribe this new medicine for depression.

I have prescribed Mirapex for bipolar depression and treatment-resistant depression for over 200 patients in the last 2.5 years. Many of these patients have found this new medicine for depression to be very effective.

If you’d like to explore this option for treatment of bipolar disorder or depression, call my office today at 770-458-0007 to schedule an appointment.

Effective New Medicine for Depression
I've worked with several treatment-resistant patients who failed to respond adequately or had adverse reactions to as many as 30 previous medicines. Of course, Mirapex is not for everyone. A significant group of patients have not responded or had side effects that required us to stop the medicine. Careful monitoring is required whenever medications are prescribed.

Patients that have responded to this new medicine for depression have been quite grateful for the relief of their symptoms. They also report the lack of weight gain and sexual side effects that plague the typical antidepressants and mood stabilizers. After Lamictal, Mirapex is the medicine I most often prescribe for bipolar depression.

Learn More about New Medicine for Depression
There have been three controlled clinical trials and a review article that provide growing evidence for the safety and efficacy of Mirapex for treatment of bipolar depression and treatment-resistant depressions.

Mirapex has a large effect size of 0.6-1.1. This means it is a lot more helpful than placebo in bipolar depression and treatment- resistant depression. However, it has not been approved by the FDA for these conditions. It is approved for Parkinson's disease and restless legs syndrome.
Mirapex is well tolerated by most patients, although some patients report side effects such as nausea, tiredness, sedation, headache, or insomnia. Less frequent side effects are abnormal muscle movements, restlessness, sleep attacks, faintness when standing.

Rare, more serious adverse reactions include hallucinations, hypersexuality, excess spending, or compulsive eating. So far, mania, hypomania, and psychosis have occurred at lower frequencies for Mirapex than for traditional antidepressants.

You can read an abstract of the review article at: http://www.ncbi.nlm.nih.gov/sites/entrez

Type this article title into the search window:
Pramipexole in Psychiatry: a Systematic Review of the Literature.

You may also purchase the full text of the original article for $15.

Find out whether Mirapex would be helpful for you. Call 770-458-0007 today to make an appointment.

Darvin Hege, M.D.
www.eveningpsychiatrist.com