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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by ChrisK on August 30, 2001, at 3:52:56
I've been on Geodon for about 4-5 months now. When I first started it my sleep was disturbed but that seemed to setttle down after a couple of weeks. Well for the last 2 weeks I haven't been able to sleep more than 2 or 3 hours each night. I don't think it has anything to do with the Nortriptyline or Mirapex I take. I take everything in the morning. I'm now going to go back to taking Zyprexa in the evening to see if it helps my sleep at all.
Anyone with any thoughts that Geodon may be the culprit after 4 months?
Posted by SalArmy4me on August 30, 2001, at 14:50:45
In reply to Delayed Geodon Side Effects, posted by ChrisK on August 30, 2001, at 3:52:56
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.
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*In 1880, Commissioner George Scott Railton and 7 young women began work in New York City, helping the poor and combining Gospel preaching with social work.
*By the Early 1900's, many special services emerged, such as women's social work (1884), the first food depot (1888), the first day nursery (1890), and the first Army missionary hospital (1901).
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God bless all of our programs and their leaders.
Posted by Dr. Bob on August 31, 2001, at 20:27:47
In reply to Re: Delayed Geodon Side Effects » ChrisK, posted by SalArmy4me on August 30, 2001, at 14:50:45
> -------------------------------------------------
> *In 1880, Commissioner George Scott Railton and 7 young women began work in New York City, helping the poor and combining Gospel preaching with social work.
> *By the Early 1900's, many special services emerged, such as women's social work (1884), the first food depot (1888), the first day nursery (1890), and the first Army missionary hospital (1901).
> * The Salvation Army operated 3,000 service units for the armed forces, and led in the formation of the USO. Since WWII, the Army has continued its own worldwide religious and charitable programs.
> God bless all of our programs and their leaders.You may have already, but in case you haven't, please see my recent post about tag lines:
http://www.dr-bob.org/babble/admin/20010718/msgs/1854.html
Thanks,
Bob
Posted by SLS on August 31, 2001, at 22:58:31
In reply to Delayed Geodon Side Effects, posted by ChrisK on August 30, 2001, at 3:52:56
Hi Chris.That really sucks.
I don't recall the specifics of your situation, but if you are bipolar, it might be a good idea to evaluate if you are experiencing the onset of a manic or schizoaffective-manic reaction.
From what I can see, a large percentage of people, perhaps the majority, experience insomnia with Geodon at the beginning of treatment.
With me, the features of my illness have at times changed. For most the time I have suffered depression, over-sleeping (hypersomnolence) has been the rule. However, starting about two years ago, my sleep became very choppy to the point of my not sleeping for much more than 4 hours a night. There has not been any major change in my affective state, that is to say, there has been no sign of mania or anxiety.
From reading the posts of people here on PB, it is not rare that someone will see a changes in the way a drug affects them. For instance, quite a few people have seen Effexor produce fatigue and somnolence early in treatment, only to see a flip to activation and insomnia many weeks later. I have seen the opposite pattern as well.
I will probably start taking Geodon tomorrow, adding it to Effexor, nortriptyline, and Lamictal. Two people have seen Effexor + Geodon work very well, one of whom had been previously refractory to treatment. I'm really not expecting too much, though. I don't think I'm getting enough, if any, benefit from having added Effexor 300mg.
Please post as you work through things. I wish you the best.
- Scott
Posted by ChrisK on September 1, 2001, at 3:59:43
In reply to Re: Delayed Geodon Side Effects » ChrisK, posted by SLS on August 31, 2001, at 22:58:31
SLS,
I went back to my 7.5 mg of Zyprexa at night and I'm sleeping 6 hours again within two nights. I see my pdoc next week and will tell him what happened and get his approval to go back to Zyprexa.
Mentally I didn't really see a signifcant difference between the two so I'd rather get some sleep and be fat than be up all night and slightly jittery.
Posted by SLS on September 1, 2001, at 8:31:59
In reply to Re: Delayed Geodon Side Effects » SLS, posted by ChrisK on September 1, 2001, at 3:59:43
> Mentally I didn't really see a signifcant difference between the two so I'd rather get some sleep and be fat than be up all night and slightly jittery.Chris - I think you may be smart enough not to get fat. Disciplined too. Maybe you can innovate some behavioral changes that allow you to maintain your weight. The first time I tried Zyprexa 10mg, I think I gained 10 pounds within a week. However, I ate like a pig. I have since been on Zyprexa 5mg twice for over a week. I didn't gain any weight at all. Of course, this difference might have been related to using a lower dosage of Zyprexa and taking Parnate and desipramine concurrently. My appetite did increase however.
I now manage to restrict my caloric intake by not denying myself food when I am genuinely hungry. The trick is to learn how to recognize hunger as opposed to just having a desire to eat. It is extremely difficult to break a behavioral cycle that first time. However, I have found that the urges disappear very quickly thereafter. Similarly, I seem to lose my desire for sweets after being without them for two to four days. One treat, however, can get you hooked again. I guess it's like cigarettes. I try not to allow the clock determine when to have a ritualized meal. I eat very slowly. I allow my brain to catch-up with my stomach. I put on my plate a minimal amount of food. This is to prevent the tendency to eat more than what really satisfies me just to finish what is on my plate. I never deny myself the option of putting more food on my plate, but it is probably more effective to leave the extra food in the kitchen and not have it sitting there right in front of you. It also forces yo to get up and walk over to get it. It's just too much work. By eating very slowly and walking away from the table for a little while (watching some TV or playing on the computer), I allow my hunger to disappear. One of the tricks I use for eating more slowly is to put down my knife and fork after every bite. I chew slowly, and try to focus on the taste experience. I have found that a great deal of the impetus to continue eating is to satisfy a continuing gustatory desire. I sort of try to mimick the way gorillas eat. They sit down, relax comletely, and leisurely eat one berry or nut at a time. We eat too fast and think about too many other things while we eat.
I can't really address the issue regarding carbohydrate cravings. I have found that substituting an equivilent amount of protein to substitute for starches doesn't reduce the cravings. However, I think some of the tools I mentioned above help to reduce how much carbohydrate I consume to satisfy those cravings.
I'm thinking about writing a diet book: "Listening to Leptin".
:-)
I haven't been listening over the last few months, however. I am so week.
Cam W. feels that the tendency to gain weight on Zyprexa is related to increased appetite and caloric intake rather than a decrease in the rate of metabolism. Zyprexa does produce effects in glucose dynamics, and I don't know how this would affect the disposition of calories.
I don't know. I'm probably being a pollyanna. It wouldn't be the first time.
Oh, well. Just trying to help.
- Scott
Posted by Craig on September 2, 2001, at 2:23:59
In reply to Re: Delayed Geodon Side Effects » SLS, posted by ChrisK on September 1, 2001, at 3:59:43
Chris,
I will start taking Geodon next week. My fear is that if it doesn't work and I have to go back on Zyprexa, I will begin gaining weight like I did the first time around. I am interested in knowing how Round 2 affects your weight, so will you please post again when you notice any change? Thanks.
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> SLS,
>
> I went back to my 7.5 mg of Zyprexa at night and I'm sleeping 6 hours again within two nights. I see my pdoc next week and will tell him what happened and get his approval to go back to Zyprexa.
>
> Mentally I didn't really see a signifcant difference between the two so I'd rather get some sleep and be fat than be up all night and slightly jittery.
This is the end of the thread.
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