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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Athene on September 21, 2014, at 18:02:55
Hello everyone,
I'd like to get your thoughts on switching from Seroquel to something that will let me lose weight, perhaps Geodon. First, a little bit about my situation.
I've been on Seroquel most of the time since 2007. Currently I take 262.5 mg a day, but I have been fine on doses as low as 150 mg. Although the official diagnosis is BP1, I feel that trauma (and the on/off pattern of fight/flight/freeze) describes my problems much better, and am currently finding deep emotional healing through body-based therapy (following the ideas of Peter Levine). At one point I gave up entirely on anything calling itself an "antidepressant", since all they did was make me hyper and give me sleep problems, so I think the fact that I function quite well (working, socializing, etc.) has little to do with "bipolar" treatment and more to do with my own growth. I've just accepted that Seroquel keeps the trauma from overwhelming me, at the cost of blahness.
However, I am having a harder and harder time accepting the Seroquel weight gain. Since 2007, I've gained over 60 lbs - I am a 5'6" female, but I weigh 206 lbs. I have had to buy bigger and bigger clothes, my midsection is particularly bloated, and in addition, I started developing plantar fasciitis in one of my feet from having a standing job for 8 months. I also experience pain in my chest and stomach regularly, and am not sure, but I think I am occasionally short of breath. Also, I have a family history of type II diabetes and heart disease, with a father who was obese and died at 56 from congestive heart failure and diabetes.
I was unsuccessful in weaning off Seroquel in 2012/2013 (all hell broke loose at 87.5 mg), but I hadn't yet found my trauma therapist. Therefore I think that I need to switch to something else, while still working with my therapist.
My pdoc says that at the dose I'm at, Seroquel is not much of a dopamine blocker, so he thinks it keeps me "stable" because of the serotonin antagonism. As atypicals cause weight gain due to their anti-histamine action, I've been investigating drugs with weak dopamine antagonism, strong serotonin antagonism, and low histamine action, which has brought me to Ziprasidone (Geodon). I am considering asking my pdoc to switch me to Ziprasidone, but there are a few concerns holding me back:
(1) I have a few things in my life I can't afford to lose: for example, an upcoming job (starting around Oct 15, so only 3 1/2 weeks from now), a French class, friendships.
(2) I have heard/read that Geodon can be activating at some dosages (being a partial serotonin agonist for certain 5-HT receptors?). I don't want to end up hyperactive or not sleeping, so I prefer non-activating substances.
(3) Several drugs (Risperidone and divalproex sodium) in the past have caused akathisia, which to me felt like extreme panic. I don't want a repeat of that.
(4) There are concerns about Geodon prolonging the Qt interval in the heart. I don't want to die from that.
(5) I am concerned that even with the hype, I wouldn't lose weight on Geodon.
(6) Dosage concerns - I am afraid my doctor would put me on too much Geodon, causing that dopamine blockade flatness. Would 40 or 60 mg be similar to 200-250 mg Seroquel?
(7) Switching concerns: As Geodon has a different receptor binding profile, there are bound to be weird changes. One big thing is adjusting to no anti-histamine action. I don't want to have such severe Seroquel withdrawal that Geodon appears to be ineffective or worse.
If you have any experience with Geodon or thoughts about whether this is a reasonable switch, how to make it easier/smoother, etc., I would appreciate your opinion. Or if you have any other med ideas for me, that would be good too.
I'm seeing my pdoc tomorrow and will be talking with him about this.
Thanks,
Athene---
* 35 y.o. female diagnosed BP1 but feels trauma makes more sense
Rx:
* Seroquel 262.5 mg
* Ativan 1 mg
Posted by Athene on September 21, 2014, at 18:09:48
In reply to Switching from Seroquel to Geodon (weight loss), posted by Athene on September 21, 2014, at 18:04:37
Hi everyone,
I forgot to mention that I have already been on a lot of "mood stabilizers" and "antipsychotics". Lithium made me feel very depressed and started affecting my thyroid, Depakote (divalproex sodium) and Risperidone gave me extreme anxiety/akathisia, Olanzapine made me eat the fridge and gain tons of weight, and Lamictal was way too activating.
Athene
Posted by Phil on September 21, 2014, at 21:10:41
In reply to Switching from Seroquel to Geodon (weight loss), posted by Athene on September 21, 2014, at 18:02:55
Hi Athene..I went from 300xr seroquel for two weeks then 150xr for two more and it was totally painless to drop it.
Now I'm back on it. Can't afford newer stuff. I pay $5 for Quetiapine IR. I'm doing better but I could play tackle in the nfl. weight wise.
Posted by SLS on September 21, 2014, at 21:11:25
In reply to Re: Switching from Seroquel to Geodon (weight loss), posted by Athene on September 21, 2014, at 18:09:48
Hi.
What exactly do you need a drug to do?
What you be like without taking any drugs at all?
In what ways did you feel divalproex helpful?
Perhaps Latuda (lurasidone) is worth taking a look at. It is hard to know what to suggest without knowing more about your illness presentation.
I don't know what you mean by "trauma". Is PTSD a component of your condition?
- Scott
Posted by Athene on September 22, 2014, at 0:29:12
In reply to Re: Switching from Seroquel to Geodon (weight loss) » Athene, posted by SLS on September 21, 2014, at 21:11:25
Hi Scott,
I would rather not be on any drugs, but I was forced onto them by being hospitalized for what was considered mania. It all started in 2002 and then 2004, when I got into extreme states - not sleeping, believing I was on mystical quests, thinking I would be able to stop wearing my glasses and not be near-sighted, talking to strangers about my ideas, talking a lot, wandering, believing I was in touch with the universe, solving the equations that would usher in a new era, etc. The first couple times were joyful and positive, although underneath that was a sadness/worry for the world, but after I was hospitalized for the first time in 2002 (forcibly secluded, held down and injected, drugged up to my eyeballs), my future "extreme" experiences (2005, 2007, several times between 2008 and 2010 that I can't even keep track of) started having more rage and terror, wanting to sleep but being unable to, being socially disruptive, having business ideas instead of mystical ideas, dissociating, feeling like I was about to die, etc. I was never dangerous to anyone, never suicidal or violent, but the Mental Health Act around here let me be hospitalized for "danger of deterioration".
From 2002 until 2007, I was only on drugs in the short times I was hospitalized. The rest of the time, I would feel numb and shut down, confused, blank-minded, and sometimes sad, though at times a good conversation or a certain relationship would lift my spirits for a few hours. I was especially messed up after my first (highly traumatic) hospitalization. Yet I could go to school and work at times. I graduated from a degree program while not on any medication. I also had more personality than after I was medicated.
After being placed on psych drugs permanently (and keeping me on them required them to hold me in the hospital until they broke my will), I didn't go to school anymore or work, for a long time. I tried several combinations of so-called "mood stabilizers"/"antipsychotics" and felt flat and dead all the time. Adding antidepressants never made me feel better, just hyper or unable to sleep. The years between 2007 and 2010 were the worst for number of hospitalizations, probably because I was still trying activating drugs like Wellbutrin and lamotrigine.
Then in 2011, I started taking more charge of my life again, despite feeling zombied out by Seroquel. I held down a professional job (software developer) for 15 or 16 months and volunteered a lot more, on gradually lowering Seroquel doses. But I still felt crappy and zombified.
I had a long stretch out of the hospital between Dec 2010 and July 2013, the longest stretch since being diagnosed in 2002, despite being on fewer psych drugs than in the past. Despite having troubles concentrating and apathy, I did some language courses at the university. I wanted to get off Seroquel then because although it kept me calmish (or zombified, however you look at it), the weight gain was already a big problem. When I tried going off of it gradually in 2012 and 2013, I re-experienced panic, rage, shame, isolation feelings, etc. Eventually I found myself in panic attacks that would last from night until morning, so I couldn't sleep and would hang out with people on the street just to feel safe (ironically, my bed scared me). I was also really worried about not having a career (I never enjoyed software development), so I was trying to make a go at selling at a flea market. At times I felt like a soldier in a war zone, trying to survive while parts of my brain were shutting down. It was not a case of not feeling like I needed sleep - I wanted it desperately, but was terrified. Then my behaviour became chaotic, they called me "manic" again, and I was again dragged to hospital. At other times in the past I have had episodes of stroke-like paralysis, which I now think were psychogenic from being terrified.
I don't have a PTSD diagnosis, but I believe that my problems stem from complex trauma growing up and subsequent attachment problems, which were then exacerbated by psychiatric hospitalization, seclusion, injection, and being put in the ghetto of mentally ill. I was bullied viciously all through elementary school, was very lonely, and at age 10 decided to shut down my feelings and be like Mr. Spock. Eventually I grew more and more lonely, but without anyone to talk to, I was like a desert island. I thought intellect could save me, but eventually the emotional storm came through. At least that's how I see it.
I know what my problems "look like" on the outside, though. I know I "look" like I have "bipolar", but none of the stuff that was supposed to work for "bipolar" actually helped. Lithium and divalproex were terrible, divalproex especially bad (terrible akathisia).
Last Sept (2013), after getting out of the hospital, I found my current therapist, and the work we are doing is the only thing that has really helped. From the very first time I saw her, I felt like someone finally saw me as a person. The work is very body-oriented, very intuitive, nothing at all like the CBT that never helped me. Sometimes I yawn, or sigh, or shake, or find my legs kicking, my mouth trembling, tears coming out. This is what Peter Levine (*Waking The Tiger*) considers to be trauma discharge - getting the body out of freeze, fight or flight. After my body has this discharge, I feel freer emotionally, and can actually experience happiness, connection, contentment, curiousity, relaxation, etc. I never had any of that for years and years. It used to be either on (overactivated/terror/rage) or off (frozen). I just learned to call that "mania" or "depression", but the labels never quite fit internally.
I have never asked to be formally diagnosed as having PTSD, and the doctors seem to want to just keep calling it "bipolar". Plus, the way I see trauma has more to do with the effects on one's physiology than definitions of severe and terrifying experiences, though I've certainly had plenty of those. That's why I just say "trauma", not PTSD.
I would only hope that another psych drug would make me feel about as yucky as I do on Seroquel, but let me lose weight. I don't have high expectations. My last year of therapy has helped me more than any drug ever did. I just don't want to rock the boat and end up in a spiral of freak-out/insomnia and back in the hospital.
Sorry for the length of this post; it's hard to boil down my situation to a few sentences.
Athene
Posted by SLS on September 22, 2014, at 8:41:58
In reply to Re: Switching from Seroquel to Geodon (weight loss), posted by Athene on September 22, 2014, at 0:29:12
Thanks for the explanation. I'm not a doctor, but it sounds like your condition is a bit complex. Chronic trauma early in life may have set you up for presenting with a cluster of psychiatric phenomena that do not fit neatly into a diagnosis of classic bipolar disorder I. As described, your first psychotic episode sounds a lot like bipolar I disorder mania. Depression in bipolar disorder does not always resemble that seen in unipolar major depressive disorder, especially if it occurs as a mixed-state. Bipolar depression is difficult to distinguish from unipolar depression. A few studies indicate that bipolar depression more often resembles atypical unipolar depression, and is less likely to include appetite loss and agitation.
It is possible that a history of chronic trauma early in life - "developmental PTSD" - is what triggered and continues to drive mood instability. This instability is now biological in nature, but may still be modifiable by psychotherapy via neuroplasticity. I guess the most conservative approach would be to mitigate the potential for the emergence of psychosis using medication while addressing psychosocial issues through psychotherapy.
http://en.wikipedia.org/wiki/Complex_post-traumatic_stress_disorder
http://www.positivehumandevelopment.com/developmental-ptsd.html
Latuda (lurasidone) is an antipsychotic that demonstrates antidepressant effects in bipolar depression. It is officially approved by the U.S. FDA to treat schizophrenia and bipolar depression, although it is currently being studied for mania. It is perhaps the least likely neuroleptic antipsychotic to produce weight gain and negative metabolic effects.
Saphris (asenapine) might be worth a look. It is an antipsychotic that has both antimanic and antidepressant properties. I know someone who is doing very will with it. She is able to lose the weight she gained while taking Seroquel. Saphris seems to be very capable of treating psychosis that presents with paranoia.
- Scott
Posted by Phil on September 22, 2014, at 10:49:09
In reply to Re: Switching from Seroquel to Geodon (weight loss), posted by Athene on September 22, 2014, at 0:29:12
I didn't read your entire post but are you in therapy and have you signed off on letting your therapist and doctor exchange info. Doing that has helped me tremendously.
If my doc won't prescribe a drug that I know will help, I bitch to my therapist who sends him a note. The next appt, my doc writes the script.
Posted by Lamdage22 on September 22, 2014, at 14:30:57
In reply to Re: Switching from Seroquel to Geodon (weight loss) » Athene, posted by SLS on September 21, 2014, at 21:11:25
If its just weight gain from Seroquel why you want to change... you could take Metformin like me.
Im not gaining. And im on a very high AP dose.
Posted by Athene on October 3, 2014, at 21:21:06
In reply to Re: Switching from Seroquel to Geodon (weight loss), posted by Lamdage22 on September 22, 2014, at 14:30:57
> If its just weight gain from Seroquel why you want to change... you could take Metformin like me.
>
> Im not gaining. And im on a very high AP dose.Ziprasidone is not working out and I'm going to have to quit it. (It's causing akathisia - restlessness and anxiety.)
I think metformin's my next stop. Anyone else used it to lose weight while taking Seroquel? How much weight did you manage to lose from it?
Thanks,
Athene
Posted by Phil on October 5, 2014, at 13:23:47
In reply to Metformin for Seroquel weight loss?, posted by Athene on October 3, 2014, at 21:21:06
I lost 30 pounds in a short period of time but not too fast. No change in lousy diet(then) no change in not exercising. It fell off and was very motivating. My doctor took me off of it for some reason.
I'm back on it and haven't lost one pound in over a month even though I'm eating better.
Not everyone automatically loses weight but some have dramatic weight loss.
Check out diabetes forums, you will find tons of info.
Beware the 'Metformin Moments'that many people get. Put it this way, you better be close to a bathroom. Very close.
It will also depend on your Seroquel dosage.
It is most definitely worth a shot. Some savvy doctors are using it for just good old fat people. AAP's, diabetes or not.
Posted by Lamdage22 on October 18, 2014, at 15:29:01
In reply to Metformin for Seroquel weight loss?, posted by Athene on October 3, 2014, at 21:21:06
> Ziprasidone is not working out and I'm going to have to quit it. (It's causing akathisia - restlessness and anxiety.)
I had the same reaction. Plus heavy sedation.
> I think metformin's my next stop. Anyone else used it to lose weight while taking Seroquel? How much weight did you manage to lose from it?
>
> Thanks,
> AtheneI have some hairloss due to Metformin, but then again im a man.
And i would choose it over being fat any day of the week.
This is the end of the thread.
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