Posted by JohnX on October 17, 2001, at 10:23:13
In reply to Re: zyprexa dose, posted by Cam W. on October 17, 2001, at 2:33:22
> John - I have always found Serzone™ (nefazodone) to be a weird drug. It seems either really work well as an antidepressant, or not at all. I think that the serotonin-2 (5-HT2) blocking ability of the drug has a lot to do with it's ability to really screw-up some people. It's adverse actions in some people may have to do with the relative concentrations and locations of 5-HT2 receptors in these people.
>
> Perhaps the "fogginess" that you experienced had something to do with Serzone's action in the reticular activating system (RAS); the part of the brain responsible for the sleep/wake mechanisms of the body. The RAS contains the raphe nuclei, which is the part of the brain with the densest concentration of serotonin receptors, so this might be the reason why Serzone works so well in improving "sleep architecture" (ie. Serzone supposedly "normalizes" the different stages of sleep). Perhaps the blocking of certain serotonin receptor subtypes in this area buggering up your sleep/wake cycle and the fogginess might be due to your brain being stuck in one of the stages of sleep, while you are awake (caveat - this is just me thinking out loud, and is a total guess on my part).
>
> Serzone is a very potent inhibitor of CYP-3A3 and CYP-3A4 (which are closely linked), but it also inhibits, to a lesser extent, CYP-2D6 and CYP-1A2. Therefore it has the potential to increase plasma concentration of an incredibly wide range of medications, including caffeine. As for affecting herbs, the only one that I can think of affecting, off of the top of my head, is St.John's Wort.
>
> The incidence of contracting tardive dyskinesia (TD) from Zyprexa™ (olanzapine) is very low, probably due to it's "tweaking" of the dopamine-2 (D2) receptor (rather than binding irreversibly to it, like the traditional antipsychotics do). Risperdal™ (risperidone), at higher doses ( >6mg/day) causes EPS, because it seems to bind tighter (although still less than most traditonals) to D2 receptors, and doses over 6mg/day seems to saturate D2 receptors in the basal ganglia more so than other atypicals
>
> Also, I think that quite a few of the cases of TD reported to be caused by Zyprexa were, in actuality, the "unmasking" of TD caused by past traditional antipsychotic use. In some cases, traditional antipsychotics and anticholinergics (like Cogentin™ - benztropine) seem to hide the TD. Once these suseptible people switch to Zyprexa, the TD emerges. Again, I have no proof of this, other than what I have seen clinically. I was looking after one gentleman who had some mild signs of TD while taking Orap™ (pimozide) and Artane™ (trihexyphendyl). and when he was switched to Zyprexa, the TD came out with a vengence (ie. his tongue started flicking in and out of his mouth rapidly, all day, every day, while awake. In itself, Zyprexa seems not to cause TD very often at all.
>
> Again, this post is full of guesses and musings, but no real, proven hard facts. - Cam
Cam,This is a long post, but I really hope I can
get some feedback from you on your thoughts.
I *really* appreciate your insight.So here it goes:
I have found an interesting property of the zyprexa,
which is it "passes" both what I call "The Wellbutrin challenge"
and the "Lamictal challenge". The challenge is
to see if adminsitering the med at certain
levels hits the "snag". The "snag" is
pain in my head (jaw tension + tension headaches
and pressure in head) and numbs my emotions.Basically, I found that 4 anti-depressants
were therapeutic for me but all run into
the "snag" after a short while after
the depression relief.These were the meds, they all were taking
by themselves:
-St. John's Wort (at 1800 MG day)I actually felt best on this believe it or
not, and the effect lasted the longist without
manic symptoms.But, eventually I hit the "snag"
commentary:I think the NIMH test used 900 MG
which is too low for major depression.
Probably secretly funded by the pharmaceutical
companies to get bad results. Conspiracy Theory.- Wellbutrin. I tried this 3 times. It drove me
severly manic on 1st try, hypomanic on 2nd
try, and nada on the third try. The med would
wear off and hit the "snag"- Zoloft: immediate numbed my emotions, after one week
drove me hypomanic (my emotions returned briefly)
which wore off and it the "snag".- Lamictal. This one is weird. When I started
it at a low dose (~20 mg), I got a brief
relief of the pain and depression, that wore
of but I didn't hit the "snag". I increased
the dose to 150-225 mg, and it lifted my
major depression without hitting the snag.
I still had residual dysthymia at that dose.
When I bump Lamictal to 300 mg. I hit the
"snag". Strange....eventually the snag became a permanent
part of my life (after Zoloft) even without meds.
I don't have the emotional numbing when not on meds, just
the head pain. Klonopin releaves the "snag",
as well as Serzone,really high dose of
dyphenhyramine, and a moderate dose of cough
medicine xxx-dm. The dyphenhydramine and
dxm were found by accident. Adderall also
releives the pain when it works (I grow tolerant
really fast).
So after this I stayed at lower dose of Lamictal
and experimented with add ons.- Wellbutrin add on.I found that taking even 100 mg
Wellbutrin would severely exacerbate the "snag"
immediately with emotional numbing.
- St. John's wort. Same as Wellbutrin.
- Lamictal at 300 mg. Same as above.So my "challenge" is to see if any of the
three above add ones to Lamictal, or increasing
Lamictal dose *doesnt* hit the snag.
Well, guess what, I tried the
challenge with Wellbutrin and Lamictal and
I don't hit the snag while taking Zyprexa.I have a hypothesis to what is happening, but
it is lenghy do discuss.So my question is:
Should I bump the Lamictal dose to 300 mg and
leave the zyprexa alone, which is moderately helping
at 5 mg? I ask this because I am paranoid
about TD and I'm getting exacerbated
twitches on my face (not the snag, just benign
twitches).I have a list of other meds that dont hit
the "snag" but don't relieve the depression either.My theory on the "snag" is that I have a
hypo-dopaminergic state stemming
from the mesocortical track to the prefrontal
cortex where the facial mucles are and use
dopamine to tame acetylcholine.
A hypo-dopaminergic state into the frontal cortex
may explain the severe emotional numbing.
Almost like a negative psychosis.Thanks for any insight, I really appreciate it.
John
poster:JohnX
thread:81232
URL: http://www.dr-bob.org/babble/20011015/msgs/81478.html