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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 grapebubblegum on February 16, 2001, at 11:42:17
Nutshell history - My father was a longtime sufferer of bipolar disorder and was hospitalized several times and took, among others, lithium, tegretol, zoloft and clonazepam. Just yesterday my five-year-old son was diagnosed with bipolar disorder and was given a prescription for Zyprexa. But I am really asking a question about myself here.
I have been on and off Zoloft for years and it seems to control my panic disorder pretty well and keep depression under control, also. I never thought I had depression and can only see it now in hindsight; I always thought depression meant "sad" but to me, it has been more like oversensitive, easily angered/hurt, unable to let even small disagreements go, and feeling inappropriately guilty or responsible for things.
I am now taking a whopping 200 mg. of Zoloft per day and I am discouraged to find that because of a very stressful life situation I am trying to get out of but can't immediately, I am having breakthrough panic attacks. So far they have been short and treatable with clonazepam (in fact, since my Dr. upped my Zoloft dose from 100 to 200 mg. per day I think I have required less Klonopin to derail a panic attack, and I only get the attacks on the order of once or twice a month, anyway, so I never take Klonopin on an ongoing basis.) But the combination of my situation plus the return of panic attacks that have previously been under control for years has been making me feel at times that I may wind up in a hospital which I am trying to avoid because I am in a bitter custody battle and my spouse would try to use that against me.
Since my child was diagnosed I talked to my own psychiatrist who said she wants me to report how my son does on that medication and she may consider whether it would be a good medication for me. My question is: Does anyone know whether Zyprexa would help or aggravate panic attacks? I want to avoid them at all costs because they can be debilitating, i.e. immobilized and unable to speak in a hospital E.R. Luckily I have been able to handle all recent attacks at home with klonopin and sleep, but in the past I have been in the E.R. overnight (never admitted to hospital, though.) I have to admit that the sexual side effects of Zoloft are undesirable and I would consider trying something that doesn't cause such effects. Also, I know klonopin is not a long-term answer for me since at times I have been given so much klonopin that I could barely stand up or walk or see or speak and I was still panicking inside. The panic attack persisted until physical exhaustion and medicinal sedation put me to sleep.
I am kind of discouraged that the mammoth Zoloft dose plus mind-numbing doses of klonopin still barely keeps me out of the hospital and I am open to anyone's suggestions on what else might help. I am very prone to sedating effects of medications and am not typically a "nervous" or anxious person... it's like I don't perceive any anxiety till it knocks me over in a total attack. I don't think I'm a very depressed person in terms of feeling "sad" as much as being overly sensitive and overly "paranoid" about the disapproval or rejection of others, and easily overwhelmed by stress and unable to get work done for fear of not being able to do it right... that sort of thing.
Thanks for anyone's input, particularly on my Dr.'s idea about considering Zyprexa.
Posted by SalArmy4me on February 19, 2001, at 5:55:39
In reply to Panic disorder meds - this Z or that Z?, posted by grapebubblegum on February 16, 2001, at 11:42:17
I don't really know what Zyprexa does for panic, but I do know its benefits for any treatment-resistant patient: it will calm you down all day; it has no anticholinergic effects; it has no sexual side-effects; it will help you sleep.
I took 5 mg for 3 months and it had a very calming effect on me. I did not experience weight gain or drowsiness on it.
Posted by SLS on February 19, 2001, at 8:13:42
In reply to Zyprexa is good, with or without Zoloft., posted by SalArmy4me on February 19, 2001, at 5:55:39
Hi SalArmy4me.
What dosage of Zyprexa did you use? Do you think that 2.5mg would be enough to augment antidepressants?
Thanks.
- Scott
Posted by grapebubblegum on February 19, 2001, at 10:57:20
In reply to Re: Zyprexa is good, with or without Zoloft., posted by SLS on February 19, 2001, at 8:13:42
Thank you! I thought no one would ever answer. Zoloft is really interfering with my sleep so I think I'll talk to my Dr. some more about possibly switching.
> Hi SalArmy4me.
>
> What dosage of Zyprexa did you use? Do you think that 2.5mg would be enough to augment antidepressants?
>
> Thanks.
>
>
> - Scott
Posted by JahL on February 19, 2001, at 14:01:31
In reply to Re: Zyprexa is good, with or without Zoloft., posted by grapebubblegum on February 19, 2001, at 10:57:20
> Thank you! I thought no one would ever answer. Zoloft is really interfering with my sleep so I think I'll talk to my Dr. some more about possibly switching.
> > Hi SalArmy4me.
> >
> > What dosage of Zyprexa did you use? Do you think that 2.5mg would be enough to augment antidepressants?
> >
> > Thanks.
> >
> >
> > - ScottHi.
As Scott's post intimates, Zyprexa may be of most benefit to you if *added* to the Zoloft. A couple of recent studies have reported synergistic effects btwn the SSRIs & the atypicals (of which Zyprexa is one).
Potentially this combination could allow for a lower dose of Zoloft and/or improved response (you said yourself yr syptoms are only 'controlled'; you should expect more).
Also, you talk of a bipolar family history and I think I'm right in saying Zyprexa has just received FDA approval for this indication (manic phase).
I took 5mg/day of Zyprexa briefly and found it took the edge off my depression & was quite calming. The only real drawback was increased appetite...
Just a coupla thoughts,
Jah.
Posted by SalArmy4me on February 19, 2001, at 14:52:43
In reply to Re: Zyprexa is good, with or without Zoloft., posted by SLS on February 19, 2001, at 8:13:42
Here is the abstract of the actual study done on the combination of olanzapine and fluoxetine to create a stronger antidepressant effect (I myself took 5 mg):
OBJECTIVE: Treatment-resistant depression is a significant public health concern; drug switching or augmentation often produce limited results. The authors hypothesized that fluoxetine could be augmented with olanzapine to successfully treat resistant depression. METHOD: An 8-week double-blind study was conducted with 28 patients who were diagnosed with recurrent, nonbipolar, treatment-resistant depression without psychotic features. Subjects were randomly assigned to one of three groups: olanzapine plus placebo, fluoxetine plus placebo, or olanzapine plus fluoxetine. RESULTS: Fluoxetine monotherapy produced minimal improvement on various scales that rate severity of depression. The benefits of olanzapine monotherapy were modest. Olanzapine plus fluoxetine produced significantly greater improvement than either monotherapy on one measure and significantly greater improvement than olanzapine monotherapy on the other measures after 1 week. There were no significant differences between treatment groups on extrapyramidal measures nor significant adverse drug interactions. CONCLUSIONS: Olanzapine plus fluoxetine demonstrated superior efficacy for treating resistant depression compared to either agent alone.
Posted by JahL on February 19, 2001, at 16:42:32
In reply to Re: Zyprexa is good, with or without Zoloft., posted by SLS on February 19, 2001, at 8:13:42
> Hi SalArmy4me.
>
> What dosage of Zyprexa did you use? Do you think that 2.5mg would be enough to augment antidepressants?
>
> Thanks.
>
>
> - ScottI have the full text of the study Salarmy's talking about. It reads:
"For patients receiving Olanzapine,the initial dose was 5mg/day, titrated weekly within a range of 5-20mg/day on the basis of response & tolerability."Fluoxetine was titrated upwards from 20mg/day to a max. of 60mg.
Jah.
Posted by SLS on February 20, 2001, at 11:02:05
In reply to Re: Zyprexa is good, with or without Zoloft. » SLS, posted by JahL on February 19, 2001, at 16:42:32
> > What dosage of Zyprexa did you use? Do you think that 2.5mg would be enough to augment antidepressants?
> I have the full text of the study Salarmy's talking about. It reads:
> "For patients receiving Olanzapine,the initial dose was 5mg/day, titrated weekly within a range of 5-20mg/day on the basis of response & tolerability."
>
> Fluoxetine was titrated upwards from 20mg/day to a max. of 60mg.Thanks Jah - BIG TIME.
Sincerely,
Scott
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