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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by 4WD on June 29, 2005, at 21:47:58
I have found that if I take Zyprexa 2.5-5mg on say, Sunday night, I will have a very bad day on Monday, very tired, blah, etc. But then for the next 3-4 days I feel decent. Less anxiety, less depression. By the end of the week, though, I slip back into feeling *very* bad. I can't take Zyprexa every day - it wakes up my bulimia.
So- my question is: By taking Zyprexa like this, am I setting myself up to feel worse when it wears off than if I hadn't taken it at all?
I discovered this by accident when I took 5mg of Zyprexa one night when I hadn't slept more than a few hours per night for a couple of weeks and was desperate to get some sleep. I figured it would help with my early awakening.
I guess I'm afraid that by taking it off and on I am just joggling things up in my brain and it will never settle down and "normalize." I am too depressed right now to think coherently about this issue.
Marsha
Posted by SLS on June 29, 2005, at 22:44:06
In reply to zyprexa once or twice a week? good or bad?, posted by 4WD on June 29, 2005, at 21:47:58
> I have found that if I take Zyprexa 2.5-5mg on say, Sunday night, I will have a very bad day on Monday, very tired, blah, etc. But then for the next 3-4 days I feel decent. Less anxiety, less depression. By the end of the week, though, I slip back into feeling *very* bad. I can't take Zyprexa every day - it wakes up my bulimia.
>
> So- my question is: By taking Zyprexa like this, am I setting myself up to feel worse when it wears off than if I hadn't taken it at all?
>
> I discovered this by accident when I took 5mg of Zyprexa one night when I hadn't slept more than a few hours per night for a couple of weeks and was desperate to get some sleep. I figured it would help with my early awakening.
>
> I guess I'm afraid that by taking it off and on I am just joggling things up in my brain and it will never settle down and "normalize." I am too depressed right now to think coherently about this issue.There are quite a few poeple who take Zyprexa as a PRN. I really don't like the idea of pulsing (intermittent exposure) something that is acting as an antidepressant, though. You might instead consider Abilify, a drug that has demonstrated itself to be weight-neutral. However, you must go into a trial of Abilify with the understanding that it might produce anxiety, restlessness, and insomnia over the first one or two weeks. However, the reward of making it through the startup side effects is a drug that offers both antidepressant and anti-anxiety effects. I find it to be a clean drug devoid of cognitive or sedative side effects.
- Scott
Posted by Denise1966 on June 30, 2005, at 9:54:14
In reply to zyprexa once or twice a week? good or bad?, posted by 4WD on June 29, 2005, at 21:47:58
Hi Marsha,
I've often taken Zyprexa like this. It has really helped me in the past. If I take 10mg now and again in the early evening and then sleep it off then the next day I feel normal, motivated even strangely enough and the affect seems to last for a couple of days. My head feels clear and my thoughts lucid.
I don't think there is any harm in taking the drug sporadically.
Denise
Posted by ed_uk on June 30, 2005, at 10:49:08
In reply to Re: zyprexa once or twice a week? good or bad?, posted by Denise1966 on June 30, 2005, at 9:54:14
Hi,
>If I take 10mg...
Have you tried low doses? eg. 2.5mg/day.
~Ed
Posted by med_empowered on June 30, 2005, at 19:13:42
In reply to Re: zyprexa once or twice a week? good or bad? » Denise1966, posted by ed_uk on June 30, 2005, at 10:49:08
Hey! Like one poster said, atypical antipsychotics are being increasingly used "PRN" for some problems, especially for those with bipolar or borderline personality disorder. I think you gotta do whats best for you...theoretically, since you're dealing with a D2 antagonist, you might be setting yourself up for a "dopamine rebound" kind of like people get after coming off long-term antipsychotic treatment. With the old antipsychotics, this could be really bad, but no one really knows much about atypicals sooo...the jury's out on that one. One poster I noticed recommend trying low-dose Zyprexa daily, and another recommended abilify. Personally, I'd go for the Abilify--whether you're doing it daily or PRN--because Abilify seems to be weight neutral and less risky in terms of diabetes development than Zyprexa. Subjectively, it also seems to be better--less sedation, less cognitive impairment, etc. 10mgs is the usual starting dose for psychotic disorders, but improvement in non-psychotic disorders can be seen at lower doses...personally, I wouldnt dip below 5, though.
Posted by 4WD on June 30, 2005, at 21:53:37
In reply to Re: zyprexa once or twice a week? good or bad? » Denise1966, posted by ed_uk on June 30, 2005, at 10:49:08
> Hi,
>
> >If I take 10mg...
>
> Have you tried low doses? eg. 2.5mg/day.
>
> ~EdYeah, but if I take it every day, I become bulimic again.
Something about Zyprexa is weird. When I take it I feel better. But I also develop very strong cravings for drugs (especially hydrocodone which I used to abuse) and for huge quantities of food. Since I can't eat large amounts without purging, it's hard to deal with.
I don't understand why it makes me crave drugs. Something about the dopamine blocking?
Marsha
Posted by 4WD on June 30, 2005, at 21:55:15
In reply to Re: zyprexa once or twice a week? good or bad? » 4WD, posted by SLS on June 29, 2005, at 22:44:06
> > I have found that if I take Zyprexa 2.5-5mg on say, Sunday night, I will have a very bad day on Monday, very tired, blah, etc. But then for the next 3-4 days I feel decent. Less anxiety, less depression. By the end of the week, though, I slip back into feeling *very* bad. I can't take Zyprexa every day - it wakes up my bulimia.
> >
> > So- my question is: By taking Zyprexa like this, am I setting myself up to feel worse when it wears off than if I hadn't taken it at all?
> >
> > I discovered this by accident when I took 5mg of Zyprexa one night when I hadn't slept more than a few hours per night for a couple of weeks and was desperate to get some sleep. I figured it would help with my early awakening.
> >
> > I guess I'm afraid that by taking it off and on I am just joggling things up in my brain and it will never settle down and "normalize." I am too depressed right now to think coherently about this issue.
>
> There are quite a few poeple who take Zyprexa as a PRN. I really don't like the idea of pulsing (intermittent exposure) something that is acting as an antidepressant, though. You might instead consider Abilify, a drug that has demonstrated itself to be weight-neutral. However, you must go into a trial of Abilify with the understanding that it might produce anxiety, restlessness, and insomnia over the first one or two weeks. However, the reward of making it through the startup side effects is a drug that offers both antidepressant and anti-anxiety effects. I find it to be a clean drug devoid of cognitive or sedative side effects.
>
>
> - Scott
>
Abilify is the one atypical I haven't tried. How is it different from Geodon, Seroquel, Risperdal?Marsha
Posted by 4WD on June 30, 2005, at 21:57:11
In reply to Re: zyprexa once or twice a week? good or bad?, posted by Denise1966 on June 30, 2005, at 9:54:14
> Hi Marsha,
>
> I've often taken Zyprexa like this. It has really helped me in the past. If I take 10mg now and again in the early evening and then sleep it off then the next day I feel normal, motivated even strangely enough and the affect seems to last for a couple of days. My head feels clear and my thoughts lucid.
>
> I don't think there is any harm in taking the drug sporadically.
>
>
>
> DeniseDoesn't the intense hunger thing affect you? I find that even by taking 5mg I am wanting to eat everything in sight for the next couple of days.
There's no doubt it can help a lot quick. Why do you take it sporadically instead of every day?
Marsha
Posted by 4WD on June 30, 2005, at 21:59:43
In reply to Re: zyprexa once or twice a week? good or bad?, posted by med_empowered on June 30, 2005, at 19:13:42
> Hey! Like one poster said, atypical antipsychotics are being increasingly used "PRN" for some problems, especially for those with bipolar or borderline personality disorder. I think you gotta do whats best for you...theoretically, since you're dealing with a D2 antagonist, you might be setting yourself up for a "dopamine rebound" kind of like people get after coming off long-term antipsychotic treatment. With the old antipsychotics, this could be really bad, but no one really knows much about atypicals sooo...the jury's out on that one. One poster I noticed recommend trying low-dose Zyprexa daily, and another recommended abilify. Personally, I'd go for the Abilify--whether you're doing it daily or PRN--because Abilify seems to be weight neutral and less risky in terms of diabetes development than Zyprexa. Subjectively, it also seems to be better--less sedation, less cognitive impairment, etc. 10mgs is the usual starting dose for psychotic disorders, but improvement in non-psychotic disorders can be seen at lower doses...personally, I wouldnt dip below 5, though.
Is Abilify qualitatively different from the other atypicals? While Zyprexa definitely helps, the food & other cravings it causes are very hard to cope with. And Geodon, Seroquel and Risperdal weren't helpful. How is Abilify different?Marsha
Posted by med_empowered on June 30, 2005, at 22:51:39
In reply to Re: zyprexa once or twice a week? good or bad? » med_empowered, posted by 4WD on June 30, 2005, at 21:59:43
Abilify is the newest atypical so far on the US market, and it *may* be a whole new kind of antipsychotic/mood-stabilizer (I think we should hedge our bets on it being any sort of breakthrough for 5 years or so...see how things develop). Atypicals in general do a relatively weak D2 antagonism (70%or so, compared to 80-90% with old antipsychotics)...the also do some selective serotonin blocking, and some of them hit up numerous other receptors. The reduced dopamine blockade combined with the mild serotonin blockade (which, interestingly enough, causes an increase in dopamine activity) seems to lead to fewer side effects (EPS, tardive dyskinesia, etc.), improved tolerability, better effects on "negative symptoms" and so on. Now, Abilify may be different because it appears to not only work as a dopamine/serotonin antagonist, but also as a weak, selective agonist. This means that Abilify may be able to reduce dopamine/serotonin in parts of the brain that are hyperactive in that respect, and slightly elevate serotonin/dopamine in areas of the brain that are deficient or sub-optimal. This would make Abilify a true mood-stabilizer, because both neurotransmitters would be kept at ideal levels within the brain. Abilify does have the potential to cause tardive dyskinesia like other antipsychotics, and it has been linked to a few cases of neuroleptic malignancy syndrome, just like all other antipsychotics. It can cause your usual EPS symptoms--I developed tremors, for instance, that had to be treated with an increase in Klonopin and a couple tabs of Propranolol daily. It can also cause akathisia (inner restlessness/turmoil, accompanied by uncontrallable movement). But...Abilify is pretty much weight neutral (the long-term studies show minor increases in some groups of people; patients who crossover from long-term Zyprexa treatment usually LOSE weight). As for diabetes...Abilify does seem, like all the other atypicals, to cause some sort of metabolic weirdness in some people, but it doesn't appear to be as big a problem as it is with, say, Zyprexa, which is the reigning champ of Diabetes Inducing Atypicals. Personally, I found Abilify at low doses to be pretty pleasant for my psychotic depression/severe anxiety (part of a bipolar disorder). What's great about Abilify (for most people) is that its non-sedating for the vast majority of people. I took my dose all at once, in the morning, and didn't have any problems at all. Now, sometimes, the sedation that accompanies antipsychotics is desirable. Personally, I think that SEDATIVES are for sedation and ANTIPSYCHOTICS are best used for psychosis or severe mood disorders. The only problem with Abilify's non-sedating profile is that, for some people, it tends to be activating; there are reports of people developing mania and/or some characteristics of hypomania (especially increased anxiety) while doing Abilify treatment. Like all the other atypicals, there is interest in using Abilify as an "add-on" drug for depression, especially when it is severe or accompanied by anxiety, agitation, or psychotic features. There has also been some considerable study into using Abilify for PTSD; it works well, apparently. PRN use of Abilify doesnt seem as popular as PRN Zyprexa, in part because Zyprexa can sedate a patient while Abilify is usually non-sedating; as I said, I think using an antipsychotic for sedation is a misuse of medication. A friend of mine is borderline, and she takes Abilify PRN when she feels the need to cut herself...10mgs, along with 1mg Klonopin usually does the trick (the combo is better than either drug alone, apparently), although I seem to recall her going up to 30mgs during a severe episode. Abilify has a half-life of 75hours I believe. Good luck!
Posted by FredPotter on June 30, 2005, at 23:03:44
In reply to Re: zyprexa once or twice a week? good or bad?, posted by med_empowered on June 30, 2005, at 19:13:42
I'm getting a good response on 2.5 mg a day but with tired eyes and weight gain, without necessarily eating more
Posted by ed_uk on July 1, 2005, at 10:52:21
In reply to Abilify, posted by med_empowered on June 30, 2005, at 22:51:39
Hi Med,
I replied to your post on the psychology board - not sure if you saw it.
Kind regards
~Ed
Posted by ed_uk on July 1, 2005, at 10:53:36
In reply to Re: zyprexa once or twice a week? » ed_uk, posted by 4WD on June 30, 2005, at 21:53:37
Hi Marsha,
>>Have you tried low doses? eg. 2.5mg/day.
>Yeah, but if I take it every day, I become bulimic again.Sorry - I meant that for Denise.
~Ed
Posted by 4WD on July 1, 2005, at 21:06:08
In reply to Abilify, posted by med_empowered on June 30, 2005, at 22:51:39
> Abilify is the newest atypical so far on the US market, and it *may* be a whole new kind of antipsychotic/mood-stabilizer (I think we should hedge our bets on it being any sort of breakthrough for 5 years or so...see how things develop). Atypicals in general do a relatively weak D2 antagonism (70%or so, compared to 80-90% with old antipsychotics)...the also do some selective serotonin blocking, and some of them hit up numerous other receptors. The reduced dopamine blockade combined with the mild serotonin blockade (which, interestingly enough, causes an increase in dopamine activity) seems to lead to fewer side effects (EPS, tardive dyskinesia, etc.), improved tolerability, better effects on "negative symptoms" and so on. Now, Abilify may be different because it appears to not only work as a dopamine/serotonin antagonist, but also as a weak, selective agonist. This means that Abilify may be able to reduce dopamine/serotonin in parts of the brain that are hyperactive in that respect, and slightly elevate serotonin/dopamine in areas of the brain that are deficient or sub-optimal. This would make Abilify a true mood-stabilizer, because both neurotransmitters would be kept at ideal levels within the brain. Abilify does have the potential to cause tardive dyskinesia like other antipsychotics, and it has been linked to a few cases of neuroleptic malignancy syndrome, just like all other antipsychotics. It can cause your usual EPS symptoms--I developed tremors, for instance, that had to be treated with an increase in Klonopin and a couple tabs of Propranolol daily. It can also cause akathisia (inner restlessness/turmoil, accompanied by uncontrallable movement). But...Abilify is pretty much weight neutral (the long-term studies show minor increases in some groups of people; patients who crossover from long-term Zyprexa treatment usually LOSE weight). As for diabetes...Abilify does seem, like all the other atypicals, to cause some sort of metabolic weirdness in some people, but it doesn't appear to be as big a problem as it is with, say, Zyprexa, which is the reigning champ of Diabetes Inducing Atypicals. Personally, I found Abilify at low doses to be pretty pleasant for my psychotic depression/severe anxiety (part of a bipolar disorder). What's great about Abilify (for most people) is that its non-sedating for the vast majority of people. I took my dose all at once, in the morning, and didn't have any problems at all. Now, sometimes, the sedation that accompanies antipsychotics is desirable. Personally, I think that SEDATIVES are for sedation and ANTIPSYCHOTICS are best used for psychosis or severe mood disorders. The only problem with Abilify's non-sedating profile is that, for some people, it tends to be activating; there are reports of people developing mania and/or some characteristics of hypomania (especially increased anxiety) while doing Abilify treatment. Like all the other atypicals, there is interest in using Abilify as an "add-on" drug for depression, especially when it is severe or accompanied by anxiety, agitation, or psychotic features. There has also been some considerable study into using Abilify for PTSD; it works well, apparently. PRN use of Abilify doesnt seem as popular as PRN Zyprexa, in part because Zyprexa can sedate a patient while Abilify is usually non-sedating; as I said, I think using an antipsychotic for sedation is a misuse of medication. A friend of mine is borderline, and she takes Abilify PRN when she feels the need to cut herself...10mgs, along with 1mg Klonopin usually does the trick (the combo is better than either drug alone, apparently), although I seem to recall her going up to 30mgs during a severe episode. Abilify has a half-life of 75hours I believe. Good luck!
Wow. Thank you. That's exactly what I wanted to know. I'm kind of ticked off at my pdoc now. He put me through trials of Zyprexa, Seroquel, Geodon and Risperdal (and wanted me to try Navane) but he's never once mentioned Abilify. I'm going to ask him about it at my next appointment. Now I'll be well informed. Probably more so than him.Thanks again.
Marsha
Posted by 4WD on July 1, 2005, at 21:43:52
In reply to Abilify, posted by med_empowered on June 30, 2005, at 22:51:39
Can you tell me what the different dopamine receptors affect - D1, D2 & D3? I mean, is one responsible for motivation, one for energy, etc.?
Marsha
This is the end of the thread.
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