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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by g_g_g_unit on November 18, 2011, at 22:40:05
I've been on Zyprexa for about 10 days now (one week at 2.5mg, 3 days at 5mg). So far it's increasing my anxiety and OCD. Are the anxiolytic effects usually delayed, or is this a sign I'm on an inadequate dose?
Posted by Phillipa on November 18, 2011, at 23:28:14
In reply to zyprexa increasing anxiety, posted by g_g_g_unit on November 18, 2011, at 22:40:05
I would think it would be stimulating? Phillipa
Posted by SLS on November 19, 2011, at 1:33:37
In reply to zyprexa increasing anxiety, posted by g_g_g_unit on November 18, 2011, at 22:40:05
> I've been on Zyprexa for about 10 days now (one week at 2.5mg, 3 days at 5mg). So far it's increasing my anxiety and OCD. Are the anxiolytic effects usually delayed, or is this a sign I'm on an inadequate dose?
I wouldn't assume that Zyprexa is always calming. It can trigger mania in some people. I cannot predict the effects that Zyprexa will ultimately have on you, but I would not be shocked if you were to report having a paradoxical reaction to it.
"Ramassubo et al. [2000] speculated that, unlike traditional antipsychotic drugs, atypical neuroleptics may have a paradoxical effect on OCD. They may induce or exacerbate symptoms in a subset of patients..."
Obsessive Compulsive Disorder Research
B. E. Ling
- Scott
Posted by g_g_g_unit on November 19, 2011, at 1:58:17
In reply to Re: zyprexa increasing anxiety » g_g_g_unit, posted by SLS on November 19, 2011, at 1:33:37
Interesting to know Scott. I was aware that APs could exacerbate OCD, especially in lieu of an SSRI, but I wasn't aware that they (or Zyprexa, at least) could trigger mania. I have definitely been feeling more anxious and agitated.
> > I've been on Zyprexa for about 10 days now (one week at 2.5mg, 3 days at 5mg). So far it's increasing my anxiety and OCD. Are the anxiolytic effects usually delayed, or is this a sign I'm on an inadequate dose?
>
> I wouldn't assume that Zyprexa is always calming. It can trigger mania in some people. I cannot predict the effects that Zyprexa will ultimately have on you, but I would not be shocked if you were to report having a paradoxical reaction to it.
>
> "Ramassubo et al. [2000] speculated that, unlike traditional antipsychotic drugs, atypical neuroleptics may have a paradoxical effect on OCD. They may induce or exacerbate symptoms in a subset of patients..."
>
> Obsessive Compulsive Disorder Research
> B. E. Ling
>
>
> - Scott
Posted by g_g_g_unit on November 19, 2011, at 3:38:46
In reply to Re: zyprexa increasing anxiety » SLS, posted by g_g_g_unit on November 19, 2011, at 1:58:17
Scott, your remark about Zyprexa causing mania is interesting .. I have been wrestling with whether I might be on the BP spectrum for a while now. The prof. with BP research interests who I saw recently only asked me whether I'd experienced racing thoughts and a reduced need for sleep during his screening. Since my answer to both was no, he ruled out BP.
However, on Zyprexa I've noticed:
- insomnia
- restlessness/constantly feeling like I'm in a hurry
- a general increase in obsessiveness (I'm completely preoccupied with potential weight gain)
- increased OCD and anxiety
- moments of grandeur (though not constant)
- more impulsive with money (I haven't been on a shopping spree or anything, but I'm less careful with my decisions)
- less self-control and a very flighty attention-span
- thoughts of ending my lifeDoes Zyprexa only trigger mania in BP patients, or are unipolar patients susceptible as well?
Posted by SLS on November 19, 2011, at 5:59:34
In reply to Re: zyprexa triggering mania? » g_g_g_unit, posted by g_g_g_unit on November 19, 2011, at 3:38:46
Hi GG.
> Does Zyprexa only trigger mania in BP patients, or are unipolar patients susceptible as well?
That's a great question for which I have no answer. Well, almost no answer. The research team at the NIH who worked with me diagnosed me as bipolar because I had had several manic reactions to antidepressant drugs. I have never had a spontaneous manic episode.
The insomnia might be important. Do you have a reduced need for sleep? Do you feel energetic, despite not getting more than 3-4 hours of sleep?
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC161651/
- Scott
Posted by g_g_g_unit on November 19, 2011, at 6:58:55
In reply to Re: zyprexa triggering mania? » g_g_g_unit, posted by SLS on November 19, 2011, at 5:59:34
> That's a great question for which I have no answer.Yeah, that's what seems to stump my pdoc. Even though I often have manic-like reactions, I've never experienced an 'organic' mania.
> The insomnia might be important. Do you have a reduced need for sleep? Do you feel energetic, despite not getting more than 3-4 hours of sleep?
>
> http://www.ncbi.nlm.nih.gov/pmc/articles/PMC161651No, I don't notice a reduced need for sleep on Zyprexa. If anything, I'm somewhat physically fatigued during the day and am still sleeping 9-10 hours a night (which is my characteristic amount while depressed).
Posted by floatingbridge on November 19, 2011, at 16:59:20
In reply to Re: zyprexa triggering mania? » SLS, posted by g_g_g_unit on November 19, 2011, at 6:58:55
>
> > That's a great question for which I have no answer.
>
> Yeah, that's what seems to stump my pdoc. Even though I often have manic-like reactions, I've never experienced an 'organic' mania.
>
> > The insomnia might be important. Do you have a reduced need for sleep? Do you feel energetic, despite not getting more than 3-4 hours of sleep?
> >
> > http://www.ncbi.nlm.nih.gov/pmc/articles/PMC161651
>
> No, I don't notice a reduced need for sleep on Zyprexa. If
anything, I'm somewhat physically fatigued during the day and am still sleeping 9-10 hours a night (which is my characteristic amount while depressed).
>
>I do not have a citation at hand, but insomnia accompanied by fatigue and desire to sleep is indicative of some presentations of hypomania according to my readings. But again, I have no citation to back this.
I recall you react with restlessness and/or agitation to a number of medications. Darn it.
Posted by Christ_empowered on November 20, 2011, at 8:09:03
In reply to Re: zyprexa triggering mania? » g_g_g_unit, posted by floatingbridge on November 19, 2011, at 16:59:20
I don't have any references/links for you, but I do recall reading that anxiety can go up on a neuroleptic, even if you don't have full-fledged akathisia. The way the stuff I read put it is that although we think of Parkinson's as a disease with physical manifestation--the stiff movements, for instance--its also accompanied by psychiatric symptoms. Depression, lethargy, and severe anxiety. This is why so many people with Parkinson's take benzodiazepinies.
Now, all neuroleptics induce varying degrees of Parkisons. The atypicals usually induce a milder form, so you see fewer twitches and what not, but they can definitely still induce depression and anxiety. When my Abilify dose was too high, I had a sort of slowed down, lethargic anxiety. In an ideal world, I could ditch the Abilify--and all neuroleptics--and just live. Since I can't, I had to cut the dose in 1/2 to 15 and since then I've felt much, much better.
Have you tried low-dose Abilify? I couldn't tolerate anything except Abilify, which is why I now stick with it through thick and thin (though the thin spots have been rather unpleasant, I must say). With the D2 partial agonism and what not, I would think a really, really low dose (I think they make 2mgs tablets) might be helpful. Abilify is super potent, so even at what seems to be a tiny dose, a pretty large % of your D2 receptors will be occupied.
Other than that...any non-neuroleptic options? Benzos can be good for OCD.
Posted by g_g_g_unit on November 21, 2011, at 7:01:14
In reply to Re: zyprexa triggering mania?, posted by Christ_empowered on November 20, 2011, at 8:09:03
> I don't have any references/links for you, but I do recall reading that anxiety can go up on a neuroleptic, even if you don't have full-fledged akathisia. The way the stuff I read put it is that although we think of Parkinson's as a disease with physical manifestation--the stiff movements, for instance--its also accompanied by psychiatric symptoms. Depression, lethargy, and severe anxiety. This is why so many people with Parkinson's take benzodiazepinies.
Strange. I always figured neuroleptics were practically fail-safe as far as anxiety was concerned, though given all my other bizarre reactions to stuff, I should've expected as much. Anyway, the point you make about Parkinson's is interesting. I think that the mind/body split is somewhat engrained in popular culture, which is why, as you point out, there's a tendency to see Parkinson's a physical affliction - and likewise why I initially balked upon discovering that depression could cause symptoms of physical pain.
>
> Now, all neuroleptics induce varying degrees of Parkisons. The atypicals usually induce a milder form, so you see fewer twitches and what not, but they can definitely still induce depression and anxiety. When my Abilify dose was too high, I had a sort of slowed down, lethargic anxiety. In an ideal world, I could ditch the Abilify--and all neuroleptics--and just live. Since I can't, I had to cut the dose in 1/2 to 15 and since then I've felt much, much better.
>
> Have you tried low-dose Abilify? I couldn't tolerate anything except Abilify, which is why I now stick with it through thick and thin (though the thin spots have been rather unpleasant, I must say). With the D2 partial agonism and what not, I would think a really, really low dose (I think they make 2mgs tablets) might be helpful. Abilify is super potent, so even at what seems to be a tiny dose, a pretty large % of your D2 receptors will be occupied.I haven't tried Abilify, no. Maybe that's next on the list ..
>
> Other than that...any non-neuroleptic options? Benzos can be good for OCD.Hmm. My psychiatrist prescribed Xanax when I first saw him. The starting dose (0.5mg, 3x a day) didn't have much of an observable effect and he gave up after that. I should bring them up again, 'cos I'm just about ready to off myself due to anxiety, but I'm scared he'll refuse given my little stint in the emergency room several weeks ago.
I've been thinking about asking if I could try an MAOI again but I'm not sure if they're any good for anxiety.
Posted by g_g_g_unit on November 21, 2011, at 7:04:51
In reply to Re: zyprexa triggering mania? » g_g_g_unit, posted by floatingbridge on November 19, 2011, at 16:59:20
>> I do not have a citation at hand, but insomnia accompanied by fatigue and desire to sleep is indicative of some presentations of hypomania according to my readings. But again, I have no citation to back this.
>
Weird. The criteria for BP seem endlessly elastic.> I recall you react with restlessness and/or agitation to a number of medications. Darn it.
>
Yeah, t'is mighty strange. I used to avoid all this stuff out of fear, but now I'd given anything just to respond.
Posted by Christ_empowered on November 21, 2011, at 9:48:51
In reply to Re: zyprexa triggering mania? » floatingbridge, posted by g_g_g_unit on November 21, 2011, at 7:04:51
I don't know that its always (or even usually) helpful to focus on diagnosis. The best shrinks I've had used diagnosis as a rough guideline for how to treat me, but focused more on symptom management. In my experience, the only times diagnosis really mattered was when I had useless shrinks who were blinded by it. "Well, I said you're schizophrenic. Therefore, all your problems can be solved by ever-increasing neuroleptic doses" and this gem "This patient has a Personality Disorder the leads to depression and anxiety; therefore, he needs meds to manage those and therapy will be ineffective." Right...
So, I fight for my bipolar diagnosis because a) its less stigmatizing than schizophrenia and b) because shrinks look at it and start using their skills to help me, instead of putting me in a chemical straight jacket like they do when you have "schizophrenia" (or just ignoring you when you have "narcissism").
I guess what I'm saying is that diagnosis shouldn't matter that much in terms of treatment, but if it does its really your prescriber's concern. As the person dealing with it, I think you should just focus on symptom relief and living your life, especially since the "soft" bipolar criteria just keep getting looser and looser.
Posted by ed_uk2010 on November 21, 2011, at 13:55:24
In reply to Re: zyprexa triggering mania? » Christ_empowered, posted by g_g_g_unit on November 21, 2011, at 7:01:14
>I always figured neuroleptics were practically fail-safe as far as anxiety was concerned
Oh no, absolutely not. This is a common misconception. Neuroleptics can be very unpleasant - dysphoric. In particular, high doses of typical neuroleptics such as haloperidol can cause intense physical restlessness and distress. They are not sedating like benzos.
Posted by Phillipa on November 21, 2011, at 18:46:35
In reply to Re: zyprexa triggering mania? » g_g_g_unit, posted by ed_uk2010 on November 21, 2011, at 13:55:24
True or false? Phillipa
http://neuroskeptic.blogspot.com/2010/09/are-antipsychotics-antipsychotics.html
Posted by Phidippus on November 22, 2011, at 18:24:17
In reply to zyprexa increasing anxiety, posted by g_g_g_unit on November 18, 2011, at 22:40:05
Are you on an antidepressant? Taking an antipsychotic that antagonizes 5hta is going to worsen your OCD if you take it alone without an AD. Seratonin levels are low in certain parts of your brain, so you have to take an AD for that. Dopamine levels also tend to be high in certain parts of the brain in OCD patients as well, which is why a AAP is often used to AUGMENT an SSRI, SNRI, TCA, etc. to depress dopamine levels.
What medications are you on?
Eric
Posted by bleauberry on November 23, 2011, at 14:48:56
In reply to zyprexa increasing anxiety, posted by g_g_g_unit on November 18, 2011, at 22:40:05
The anti anxiety effect should have been noticed within about an hour or two of dosing. If not then it probably needs a test at a higher dose.
All meds and natural substances have the potential to do the opposite of intended sometimes. It depends on the person's unique chemistry, biology, and underlying cause of the symptoms. Toward the end of my 8 years on zyprexa I developed bad anxiety which was from waking until mid morning which I later found out was adrenal fatigue low cortisol. Zyprexa completely fixed that anxiety in an hour but when I woke it was back twice as bad.
A common function of antipsychotics is to block adrenergic sites which can cause a stronger release of norepinephrine/epinephrine/adrenaline via interruption of the feedback mechanism by the blocking. That can be a cause of anxiety from antipsychotics sometimes with some people.
Hey, sometimes people get jitters and insomnia from a sleep med or from benadryl. Ritalin can calm some kids down. Ya know?
Anyway, I think at least for the near future no matter what you do...stay at the dose give it more time....or increase the dose....or quit altogether.....or whatever.....I think you need some immediate as needed assistance to weather the anxiety. Personally I would begin with a combination of tincture herbs including lemon balm, skullcap, passion flower, valerian..any 2 or 3 of them after sampling each. They helped me a lot through my zyprexa withdrawal anxiety phase and were easy to walk away from when I didn't need them any more. Or get some xanax, but it's harder to get off if you use it regularly for a while. I just think you should not have to suffer any more during the waiting stage of either titration upward or weaning downward. If the med is going to be given some time to work then it makes sense to at least be as comfortable as possible during that waiting period. IMO.
That said, zyprexa usually does the bulk of what it is going to do pretty quick, like within days to weeks. Sometimes within hours of first day. So if things are not looking good in 4 weeks or so, if it were me, I would have another plan in place.
I personally never ventured higher than 5mg the whole 8 years except a short time sampling 7.5mg. But most people seem to do best in the 10mg range from what I've seen.
> I've been on Zyprexa for about 10 days now (one week at 2.5mg, 3 days at 5mg). So far it's increasing my anxiety and OCD. Are the anxiolytic effects usually delayed, or is this a sign I'm on an inadequate dose?
Posted by g_g_g_unit on November 24, 2011, at 8:12:04
In reply to Re: zyprexa increasing anxiety » g_g_g_unit, posted by Phidippus on November 22, 2011, at 18:24:17
> What medications are you on?
>
> EricI'm also on 15mg of Lexapro.
Posted by Phidippus on November 24, 2011, at 18:23:48
In reply to Re: zyprexa increasing anxiety » Phidippus, posted by g_g_g_unit on November 24, 2011, at 8:12:04
Needs to be higher to treat OCD. 40 mg range.
Eric
Posted by Phillipa on November 24, 2011, at 23:58:28
In reply to Re: zyprexa increasing anxiety » g_g_g_unit, posted by Phidippus on November 24, 2011, at 18:23:48
Really? What if combining with luvox how much of each? Phillipa
Posted by Phidippus on November 30, 2011, at 20:04:30
In reply to Re: zyprexa increasing anxiety » Phidippus, posted by Phillipa on November 24, 2011, at 23:58:28
At least 200 mg of Luvox.
Eric
Posted by Phillipa on November 30, 2011, at 20:11:11
In reply to Re: zyprexa increasing anxiety » Phillipa, posted by Phidippus on November 30, 2011, at 20:04:30
Thanks I once did well on 250mg and dumb doc lowered it. Got to get fasting cortisol tomorrow am. Take lmg of dexamethasone tonight and blood tomorrow. I had the 24 hour urine for cortisol and was high. I'm confused of what could be wrong any idea? Phillipa
Posted by Phidippus on November 30, 2011, at 20:22:37
In reply to Re: zyprexa increasing anxiety » Phidippus, posted by Phillipa on November 30, 2011, at 20:11:11
Lots of things can cause high cortisol, any kind of stress. Cortisol levels tend to be higher in folk with anxiety disorders, but it is also high in some other conditions, such as psychotic major depression. In fact they are testing RU486, a cortisol blocker as a treatment for psychotic major depression.
Eric
Posted by Phillipa on November 30, 2011, at 21:55:39
In reply to Re: zyprexa increasing anxiety » Phillipa, posted by Phidippus on November 30, 2011, at 20:22:37
The RN did mention stress and have ocd and the thyroid hasimotos. Hope it's stress. That would mean no tumor on pituitary or adrenal gland or Cushings. Thanks Phillipa
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