![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Jeff on April 18, 2001, at 16:01:25
I suffer from depression and a debilitating case of GAD. I have a sister that has recently gotten off Zyprexa, but it alleviated her anxiety symptoms considerabley when she had an episode of major, major depression. For those of you that use Geodon how does it affect your anxiety and what if any problems have you had with it. I am terrified of TD, but think this could bea good fit. All advice would be appreciated. Thanks, Jeff P.S. I currently take 3000mg neurontin, 5 mg valium, and 50 mg luvox
Posted by SalArmy4me on April 18, 2001, at 16:21:23
In reply to Geodon/Ziprasidone Users-Please Advise!, posted by Jeff on April 18, 2001, at 16:01:25
I'm also looking to relieve depression and anxiety with an atypical neuroleptic, so I'm on Seroquel for now. But I can't imagine how I'm going to be able to tolerate large doses of Seroquel without falling asleep, so I too am looking at Geodon seriously now.
> I suffer from depression and a debilitating case of GAD. I have a sister that has recently gotten off Zyprexa, but it alleviated her anxiety symptoms considerabley when she had an episode of major, major depression. For those of you that use Geodon how does it affect your anxiety and what if any problems have you had with it. I am terrified of TD, but think this could bea good fit. All advice would be appreciated. Thanks, Jeff P.S. I currently take 3000mg neurontin, 5 mg valium, and 50 mg luvox
Posted by avoet on April 18, 2001, at 16:50:55
In reply to Geodon/Ziprasidone Users-Please Advise!, posted by Jeff on April 18, 2001, at 16:01:25
> i took geodon/ziprasidone for about 6 days for anxiety and i could not sleep on it at all. i was up for several nights in a row. however, it did seem to help my obsessive thoughts a little bit. it does not cause weight gain, in fact i lost about 3 pounds in the 6 days i was on it. i was disappointed that i had to go off it but you may have better luck with it. it also gave me shakes and made me feel weird. it is a powerful drug. i switched to riperidal which for me has less side effects, but may not be true of others. it does not cause TD. please, please let me know how it works for you okay!
Posted by Sunnely on April 18, 2001, at 19:59:14
In reply to Geodon/Ziprasidone Users-Please Advise!, posted by Jeff on April 18, 2001, at 16:01:25
Hi Jeff,
Ziprasidone (Geodon) is a combined 5-HT2 (serotonin receptor type2) & D2 (dopamine receptor type 2) blocker. This specific chemical structure makes it an effective antipsychotic with minimal side effects (movement disorder), hence an "atypical" antipsychotic.
Ziprasidone has a potential to be an effective antidepressant because of its structural make up. It is an agonist (enhancer) of 5-HT1A (ala buspirone or BuSpar) and a blocker of the serotonin receptor type 1D (5-HT1D). It is also a moderate reuptake inhibitor of serotonin and norepinephrine (similar to some of the tricyclic antidepressants and Effexor). With its 5-HT2 antagonism (like Zyprexa, Risperdal), it may have potential as an "augmenter" to an antidepressant in the treatment of depression. All these receptor affinities makes ziprasidone, theoretically, a potential antidepressant. As a 5-HT1A-enhancer, it may confer anti-anxiety effect (like BuSpar). On the other hand, theoretically, it may also increase the risk of manic switch or rapid cycling in patients with bipolar disorder.
One of the country's noted psychopharmacologists (Peter J. Weiden, MD) own experience prescribing ziprasidone, insomnia is the most common and problematic side effect, at least when switching outpatients from other antipsychotics to ziprasidone. Often patients can't get to sleep or they do not sleep soundly. They become more alert during the day and need fewer total hours of sleep. Among his patients, insomnia seemed to occur about 50% of the time in outpatients who were switched to a starting dose. It usually happens soon after the switch - within a few days to the first week.
He described insomnia as can be quite distressing and seems to increase the overall anxiety level in some patients. He recommended some techniques to manage insomnia from ziprasidone switchover or start:
1. Evaluate for other causes of insomnia, especially caffeine intake. Some cases of ziprasidone-induced insomnia seem to improve once caffeine intake is reduced.
2. Add a benzodiazepine (e.g., lorazepam) for sleep. Patients may need higher doses of lorazepam (e.g., 2-3 mg at bedtime) for the first few weeks. His experience with insomnia from ziprasidone is that it abates in about 3-4 weeks on its own, and the lorazepam can then be tapered and discontinued.
3. Continue to overlap the older antipsychotic for a longer period of time, especially if the prior antipsychotic has a sedative effect for the patient.
4. Give more ziprasidone in the morning and less in the evening. For example, if the daily ziprasidone dose is 80 mg/day, the patient can take 60 mg capsule in the morning and a 20 mg capsule in the evening rather than 40 mg twice a day.
5. Postpone increasing the ziprasidone dose until insomnia resolves.
Dr. Weiden also mentioned that among his own cases, initial nausea occurred in about 20% of outpatients when they were first switched to ziprasidone. He states that nausea tends to occur during the first 2 weeks of treatment and then to subside on its own. The nausea appears to be sensitive to dosing adjustments and responds to a lowering of the dose or giving the ziprasidone with meals. He claims that he had never had to discontinue ziprasidone for this reason, although in several patients the dose had to be lowered.
There is not enough experience to give an exact determination as to ziprasidone's ability to cause tardive dyskinesia (TD). However, like the other atypical antipsychotics, it is expected that the risk of TD from ziprasidone is much lower than the older antipsychotics.
One of ziprasidone's main selling points is its affect on weight. It is described as being "weight neutral." Compared to the other atypical antipsychotics, ziprasidone causes the least weight gain. Ironically, ziprasidone is also a potent blocker of serotonin receptor type 2C (5-HT2C). One of the postulated causes of antipsychotic-induced weight gain is their ability to block 5-HT2C (e.g., Clozaril and Zyprexa). This proves that this hypothesis alone is not enough to explain weight gain from antipsychotics and it is most probably due to a number of mechanisms.
Ziprasidone must be taken with food. Food doubles its absorption and reaches a "bioavailability" of 60%. "Bioavailability" is the amount of drug left to enter the blood circulaltion after it passes through the liver ("first pass"). My understanding is that, if you can tolerate it, a glass of milk with ziprasidone is OK, too.
+++++++++++++++++++++++++++++++++++++> I suffer from depression and a debilitating case of GAD. I have a sister that has recently gotten off Zyprexa, but it alleviated her anxiety symptoms considerabley when she had an episode of major, major depression. For those of you that use Geodon how does it affect your anxiety and what if any problems have you had with it. I am terrified of TD, but think this could bea good fit. All advice would be appreciated. Thanks, Jeff P.S. I currently take 3000mg neurontin, 5 mg valium, and 50 mg luvox
Posted by Jed00 on April 19, 2001, at 2:02:30
In reply to Re: Geodon/Ziprasidone Users-Please Advise! » Jeff, posted by Sunnely on April 18, 2001, at 19:59:14
Sunnely,
Thank you for all the info. Can you tell me what the recommended doseage of Geodon is? I'm taking 20mg twice a day but I think I should increase it for it to be more effective.
Thank you,
Jed
Posted by ChrisK on April 19, 2001, at 4:54:53
In reply to Geodon/Ziprasidone Users-Please Advise!, posted by Jeff on April 18, 2001, at 16:01:25
I just switched from Zyprexa to Geodon this month. For one week I took both the G and Z and then eliminated the Z completely. I am currently taking 40 mg of Geodon twice a day which appears to be a good dose. I didn't notice any problems with the transition except that now my sleep is a little more disturbed. I tend to wake up at about 1AM and stay awake for about 30 minutes before being able to fall back to sleep. I also feel like my short term memory may be worse but I think it is still too early to tell. Both the Z and G seem to help a lot with my anxiety problems.
Chris
> I suffer from depression and a debilitating case of GAD. I have a sister that has recently gotten off Zyprexa, but it alleviated her anxiety symptoms considerabley when she had an episode of major, major depression. For those of you that use Geodon how does it affect your anxiety and what if any problems have you had with it. I am terrified of TD, but think this could bea good fit. All advice would be appreciated. Thanks, Jeff P.S. I currently take 3000mg neurontin, 5 mg valium, and 50 mg luvox
Posted by jimmygold70 on April 19, 2001, at 13:39:44
In reply to Geodon/Ziprasidone Users-Please Advise!, posted by Jeff on April 18, 2001, at 16:01:25
To my best knowledge Geodon is not associated with TD.
However, why don't you take the dose of Luvox up to 200mg ? And concerning Valium, try Xanax instead . Also, when you augment Luvox with an AP, like Geodon, you do that in extremely low doses with no risk for TD.
> I suffer from depression and a debilitating case of GAD. I have a sister that has recently gotten off Zyprexa, but it alleviated her anxiety symptoms considerabley when she had an episode of major, major depression. For those of you that use Geodon how does it affect your anxiety and what if any problems have you had with it. I am terrified of TD, but think this could bea good fit. All advice would be appreciated. Thanks, Jeff P.S. I currently take 3000mg neurontin, 5 mg valium, and 50 mg luvox
Posted by Sunnely on April 19, 2001, at 19:02:58
In reply to Re: Geodon/Ziprasidone Users-Please Advise!, posted by Jed00 on April 19, 2001, at 2:02:30
The following Geodon dose range are considered effective for schizophrenia (from clinial studies):
A) For acute psychotic relapse: 120-160 mg/day in two divided doses.
B) For maintenance treatment (in remission): 40-80 mg/day in two divided treatment.
Ziprasidone has not been studied specifically in the treatment of depression. IMHO, like the other atypical antipsychotics (e.g., Risperdal, Zyprexa), probably lower than the dose range for schizophrenia.
+++++++++++++++++++++++++++++++
> Sunnely,
>
> Thank you for all the info. Can you tell me what the recommended doseage of Geodon is? I'm taking 20mg twice a day but I think I should increase it for it to be more effective.
>
> Thank you,
> Jed
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.