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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by jonhed on December 4, 2016, at 10:12:59
Hey guys, i need your expertise now!
I have been on methadone 70mg now for 1 month, and clean from non prescription drugs for 9 weeks today.
My Pdoc wants me to take an antipsychotic with the methadone cause i have demonstrated some paranoid behavior in the last months.
You all know that i have had Oculogyric Crisis with almost every AP/AAP i have eaten.
And i know it is hard to believe, but i have had bad luck with medications, high and low dose.The exception is olanzapine, but the weight gain? i can't stand it.. I run and climb 4-5 days a week and this week i have gained 3 kilos, it is not going to work.. And i'm just at 2.5mg now!
I have been thinking of Amisulpride, which seems to be a miracle medicine for some people, but produce more eps than aripiprazol (which was the worst of them all for me), and i'm scared that i'm going to develop Oculogyric Crisis from Amisulpride to, cause i was suicidal last time i had it (4 month in a row, i was so embarrassed and my doctor didn't notice anything. anyway, he was reported to the government for the bad behavior.)
I feel very calm in my mind with the low dose of olanzapine, but have started to develop some anxiety that i haven't had in a long time before starting olanzapine, and amisulpride seems to be very good for depression, anxiety and so on + calming on the mind and paranoia.
I was thinking about taking 50mg a day, and not higher than that.
Do you guys think that 50mg should produce any eps?
And, do you think that 70mg of methadone maybe can counter the eps in some way?
Have someone tried cyproheptadine or mianserine/mirtazapine for akathisia and eps?
If someone have an idea for medications to counter eps, you are welcome to write it here :-)
I was thinking - pregabalin, gabapentin, B6, baclofen.
(except the anticholinergict, i get psychotic from them.)
Thanks! / J
Posted by Lamdage22 on December 4, 2016, at 10:19:37
In reply to Questions about antipsychotics - ., posted by jonhed on December 4, 2016, at 10:12:59
clozapine seems to come without eps i think. I am making the switch i think because i really dont want to get tardive dyskinesia .
Its a weight gain med, too, but you could try to counter it with metformin.
idk if clozapine is save with your methadone though.
Posted by Lamdage22 on December 4, 2016, at 10:28:57
In reply to Questions about antipsychotics - ., posted by jonhed on December 4, 2016, at 10:12:59
I think Zyprexa and Clozapine should feel pretty similar. Hope this helps.
Posted by jonhed on December 4, 2016, at 10:29:29
In reply to Re: Questions about antipsychotics - ., posted by Lamdage22 on December 4, 2016, at 10:19:37
Oh, believe me, clozapine have been on my mind for a long long time, but i'm dead scared of the side effects..
I was thinking about trying amisuloride first, and if it poops out - clozapine!
Have you been on clozapine before?
Seems like the perfect medication for like everything... if it doesn't had the blood side effect.
Posted by jonhed on December 4, 2016, at 10:31:31
In reply to Re: Questions about antipsychotics - ., posted by jonhed on December 4, 2016, at 10:29:29
Both reboxetine and vertisan (betahistine) reduces olanzapine weight gain with 50-60%!
I wonder if it is the same thing with clozapine?
Posted by Lamdage22 on December 4, 2016, at 10:54:24
In reply to Re: Questions about antipsychotics - ., posted by jonhed on December 4, 2016, at 10:29:29
> Oh, believe me, clozapine have been on my mind for a long long time, but i'm dead scared of the side effects..
>
> I was thinking about trying amisuloride first, and if it poops out - clozapine!
>
> Have you been on clozapine before?
>
> Seems like the perfect medication for like everything... if it doesn't had the blood side effect.I was on like 150mg Clozapine along other APs, but didnt follow through. The blood side effect is rare and i think not deadly if you get a blood test every month. If you get it you will notice and react.
I rather take other risks aside from being disfigured forever by tardive dyskinesia. Its just my preference.
Posted by Lamdage22 on December 4, 2016, at 10:57:53
In reply to Re: Questions about antipsychotics - ., posted by jonhed on December 4, 2016, at 10:31:31
> Both reboxetine and vertisan (betahistine) reduces olanzapine weight gain with 50-60%!
Thanks for sharing. I will google that when i am home.
> I wonder if it is the same thing with clozapine?
I think so.
Posted by jonhed on December 4, 2016, at 11:42:10
In reply to Re: Questions about antipsychotics - ., posted by Lamdage22 on December 4, 2016, at 10:54:24
I'm with you! Said that to my psychologist last week.
I was planning to ask my pdoc about it next week, and if it's not deadly if treated right (Blood side effect), i will definitely start clozapine and try to manage the weight gain :-)
As i'm not suffering from schizophrenia or schizoaffective, maybe i can be on a fairly low dose to, and that should reduce the side effect to!
I was just curious about the stimulating and antidepressant effect from amisulpride, but you're right, i rather not make my already bad movement disorder worse by treating the paranoia with something that easily could lead to tardive dystonia or dyskinesia, or even worse, tardive Oculogyric dystonia..
Thanks for the input, you have made me reconsider clozapine.
Posted by SLS on December 4, 2016, at 15:36:28
In reply to Questions about antipsychotics - ., posted by jonhed on December 4, 2016, at 10:12:59
> Hey guys, i need your expertise now!
>
> I have been on methadone 70mg now for 1 month, and clean from non prescription drugs for 9 weeks today.
>
> My Pdoc wants me to take an antipsychotic with the methadone cause i have demonstrated some paranoid behavior in the last months.I am certainly no expert, but I do have a liking for Saphris (asenapine). It is an antipsychotic that is touted as being good for paranoia, and also has antidepressant properties. It can help clear up brain fog and does not promote weight gain. Of course, one cannot generalize to everyone the behavior of these drugs. I don't know if one can predict what kind of EPS you might experience with Saphris. Not too many people take Saphris, but I have not yet heard of movement side effects. Oculogyric crisis sounds horrific. I hope you don't get it again.
- Scott
Posted by baseball55 on December 4, 2016, at 19:59:50
In reply to Re: Questions about antipsychotics - ., posted by jonhed on December 4, 2016, at 10:29:29
My nephew took clozapine for a couple of months and it was the only drug that completely relieved his symptoms, both positive and negative. But he did develop the blood problem and had to go off it. He was so disappointed.
> Oh, believe me, clozapine have been on my mind for a long long time, but i'm dead scared of the side effects..
>
> I was thinking about trying amisuloride first, and if it poops out - clozapine!
>
> Have you been on clozapine before?
>
> Seems like the perfect medication for like everything... if it doesn't had the blood side effect.
Posted by SLS on December 4, 2016, at 22:13:32
In reply to Re: Questions about antipsychotics - ., posted by baseball55 on December 4, 2016, at 19:59:50
> My nephew took clozapine for a couple of months and it was the only drug that completely relieved his symptoms, both positive and negative. But he did develop the blood problem and had to go off it. He was so disappointed.
I don't know. I wonder if he might try building a treatment around Zyprexa (olanzapine). Zyprexa is often considered to be the next best thing to Clozaril (clozapine). Both are weight-gainers, with Clozaril being somewhat worse than Zyprexa. Perhaps Zyprexa should be initiated up to 10-20 mg/day. Then, evaluate which symptoms persist and add drugs that are known to improve those symptoms. If negative symptoms are to be addressed, adding Abilify (aripiprazole) or Saphris (asenapine) are worth considering.
Is anxiety a major component of your nephew's condition?
Is there any cycling of symptom clusters involved?
If your nephew suffers from schizoaffective disorder, he might do better to combine Zyprexa with an antidepressant like Lexapro (escitalopram), Effexor (venlafazine), or Nardil (phenelzine).
There may be more alternative treatments than you were unaware of. I would not be so quick to consider Clozaril to be the only treatment to produce robust therapeutic results.
- Scott
Posted by Lamdage22 on December 5, 2016, at 3:08:07
In reply to Re: Questions about antipsychotics - . » baseball55, posted by SLS on December 4, 2016, at 22:13:32
jonhed, i have researched clozapine a little, it looks like you have to get weekly bloodtests for the first 18 weeks and then monthly.
It is kind of a bummer but i think i will do it anyway.
Posted by Christ_empowered on December 5, 2016, at 15:46:48
In reply to Re: Questions about antipsychotics - ., posted by baseball55 on December 4, 2016, at 19:59:50
I dunno. Maybe a low to moderate dose of Abilify? It can get the job done with not as many adverse effects, for some people.
It is interesting how abilify can be added to other AP/AAP drugs, like with risperidone (to reduce prolactin levels), with clozapine, etc. etc.
Hope things work out for you.
Posted by baseball55 on December 5, 2016, at 19:17:49
In reply to Re: Questions about antipsychotics - . » baseball55, posted by SLS on December 4, 2016, at 22:13:32
He has schizophrenia, quite severe. and though he is aware that the hallucinations are hallucinations, they terrify him. I believe he is now on zyprexa. Anxiety is not a problem
> I don't know. I wonder if he might try building a treatment around Zyprexa (olanzapine). Zyprexa is often considered to be the next best thing to Clozaril (clozapine). Both are weight-gainers, with Clozaril being somewhat worse than Zyprexa. Perhaps Zyprexa should be initiated up to 10-20 mg/day. Then, evaluate which symptoms persist and add drugs that are known to improve those symptoms. If negative symptoms are to be addressed, adding Abilify (aripiprazole) or Saphris (asenapine) are worth considering.
>
> Is anxiety a major component of your nephew's condition?
>
> Is there any cycling of symptom clusters involved?
>
> If your nephew suffers from schizoaffective disorder, he might do better to combine Zyprexa with an antidepressant like Lexapro (escitalopram), Effexor (venlafazine), or Nardil (phenelzine).
>
> There may be more alternative treatments than you were unaware of. I would not be so quick to consider Clozaril to be the only treatment to produce robust therapeutic results.
>
>
> - Scott
>
Posted by Lamdage22 on December 6, 2016, at 11:10:50
In reply to Re: Questions about antipsychotics - ., posted by jonhed on December 4, 2016, at 11:42:10
jonhed, i dont recommend any of the drugs you are considering. Please ignore what i said
25%ish get OCD from Clozapine.
Posted by jonhed on December 6, 2016, at 12:43:10
In reply to Re: Questions about antipsychotics - ., posted by Christ_empowered on December 5, 2016, at 15:46:48
> I dunno. Maybe a low to moderate dose of Abilify? It can get the job done with not as many adverse effects, for some people.
>
> It is interesting how abilify can be added to other AP/AAP drugs, like with risperidone (to reduce prolactin levels), with clozapine, etc. etc.
>
> Hope things work out for you.
If this was written for me, i have to say that even 2.5mg of aripiprazole did cause one hell of akathisia for me, sadly.
But many has been helped from abilify, i know that to!
Posted by jonhed on December 6, 2016, at 12:48:04
In reply to Re: Questions about antipsychotics - . » jonhed, posted by SLS on December 4, 2016, at 15:36:28
Yeah, i have thought about that to but sadly asenapine isn't available in Sweden..
I think i will try Clozapine anyway, i do think that the weekly blood tests are worth it for the cause of being free of paranoia.
Cause Clozapine is the only AAP/AP that i can take in high doses, due to nearly no EPS :-)
(and i want to have a fairly normal dose of an antipsychotic cause my symptoms have been pretty bad lately.)Maybe, if my Pdoc allows it, i will go for the olanzapine/betahistine combination and see if that can reduce my weight gain!!
Posted by jonhed on December 6, 2016, at 12:52:23
In reply to Re: Questions about antipsychotics - ., posted by Lamdage22 on December 6, 2016, at 11:10:50
> jonhed, i dont recommend any of the drugs you are considering. Please ignore what i said
>
> 25%ish get OCD from Clozapine.Yes, i have heard that to but i'm willing to try it out anyway. I don't have so many options due to my hypersensitivity to antipsychotics..
I can't wait to start the treatment cause it has been a couple of paranoid month now and i'm sick of it!
The methadone are doing what it suppose to, but i need something more to counteract the worst things.
Methadone has helped me to be able to go around in stores and shop when it's crowded, but hasn't made me sleep without counting my heartbeats for 2-3 hours per night.
Zyprexa has though, so it is a shame that i can't titrate up to 10-15mg..
Posted by Lamdage22 on December 7, 2016, at 8:33:11
In reply to Re: Questions about antipsychotics - ., posted by jonhed on December 6, 2016, at 12:52:23
good luck. i just dont want to be responsible for you feeling bad.
This is the end of the thread.
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