Posted by JohnL on January 16, 2001, at 3:40:06
In reply to Could Zyprexa be making things worse?, posted by ItsJustMe on January 16, 2001, at 1:14:37
> Hi - I currently take 300 mgs of Effexor XR a day. My Dr added 5 mg of Zyprexa once a day to help the Effexor XR. Lately, I seem to be spiraling downward into a deeper and deeper depression. I'm finding it hard to even get out of bed.
>
> Could the Zyprexa be making things worse???Hi there ItsJustMe,
I hate to admit it, but all drugs have the potential to make things worse. It all depends on the underlying root cause of the symptoms. If we accept that depression is related to a chemical imbalance, then it is desired to correct that imbalance. But not overcorrect it, or accidentally modify the balance of something that's not out of balance to begin with.Effexor is increasing serotonin the most, norepinephrine somewhat, and dopamine a little bit. Zyprexa is also increasing serotonin and NE, with unknown mechanisms on dopamine. Is your worsening related to over-increased serotonin? Overload of NE? Too much, too little dopamine? Don't know. Could be any of them. Zyprexa is rather sedating and sometimes being lethargic can seem a lot like being depressed.
I know that with me, if I take too much of a serotonin-increasing med I get more depressed. Same with NE or dopamine. It's like they are maybe a little out of balance, but if I go too far then they're out of balance in the opposite direction. I think my depression, and probably with others as well, is not caused primarily by an out-of-balance chemistry, but rather by existing receptors just not functioning properly. And thus I get better responses from things that 'wake up' or turbocharge existing chemistries, such as stimulants or low dose antipsychotic.
If I were in your shoes I would cut the Zyprexa dose to 2.5mg. 5mg is a pretty hefty dose to start with. I would stay at 2.5mg for about 2 weeks and then make a reassessment. I would either then continue if there was a hint of improvement, or I would discontinue if I was still worse. That's just what I would do.
What if Zyprexa doesn't work out? Then I would look at trying Ritalin and Adderall for one week each as a probing test, just to see if they help. If so, then continue. Sometimes Prozac combines nicely with Effexor. It doesn't make sense on paper, but in reality it has been very successful to a few other people here. There are plenty of other options, but I would start with 1)lowering Zyprexa; 2)sampling stimulants; 3)adding Prozac; 4)cross this bridge at a later time. I think two drugs that could help a whole lot of people are only available through European mailorders. They are Adrafinil and Amisulpride. If you and I were sitting on the porch chatting, I would offer you some of mine and feel very confident that one or both of them would help you feel much better and with few, if any, additional side effects. It's not unusual to be uncomfortable with this option though. Somehow it seems if a doctor prescribes it, then it must be OK. (obviously that's not true as often as we would like)
John
poster:JohnL
thread:51771
URL: http://www.dr-bob.org/babble/20010111/msgs/51772.html