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
poster:Athene
thread:1071382
URL: http://www.dr-bob.org/babble/20140914/msgs/1071382.html