![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by SalArmy4me on March 29, 2001, at 4:47:38
Risperdal, Seroquel, and Geodon do the same thing, so how is that supposed to help someone? Don't we need dopamine in our brains?
Posted by loosmrbls on March 29, 2001, at 7:24:43
In reply to If Zyprexa BLOCKS dopamine, what good is it?, posted by SalArmy4me on March 29, 2001, at 4:47:38
Zyprexa, and the other medications you mentioned, arte used mainly for schizophrenia, or other mental illnesses where psychosis develops (like true mania or psychotic depression). Zyprexa has also been shown to have mood-stabilizing effects.
In schizophrenia and other psychotic illnesses (like true mania) there is TOO MUCH dopamine, so these drugs are designed to bring it back down to normal levels.
So the question would be, why is someone on Zyprexa. For some people, it is a great drug.
Posted by Chaston on March 29, 2001, at 7:40:46
In reply to Re: If Zyprexa BLOCKS dopamine, what good is it?, posted by loosmrbls on March 29, 2001, at 7:24:43
I have heard that the new class of neuroleptics (originally thought of as anti-psychotic agents), which includes Zyprexa, is now being used quite often in bipolar mood disorders. Maybe different meds in this class work on somewhat different sets of dopamine receptors than older anti-psychotics.
Doesn't Zyprexa also help with anxiety and depression for some people?
Does it tend to make people real knocked out at first, but then they adjust?> Zyprexa, and the other medications you mentioned, arte used mainly for schizophrenia, or other mental illnesses where psychosis develops (like true mania or psychotic depression). Zyprexa has also been shown to have mood-stabilizing effects.
>
> In schizophrenia and other psychotic illnesses (like true mania) there is TOO MUCH dopamine, so these drugs are designed to bring it back down to normal levels.
>
> So the question would be, why is someone on Zyprexa. For some people, it is a great drug.
Posted by Eric on March 29, 2001, at 9:05:33
In reply to If Zyprexa BLOCKS dopamine, what good is it?, posted by SalArmy4me on March 29, 2001, at 4:47:38
> Risperdal, Seroquel, and Geodon do the same thing, so how is that supposed to help someone? Don't we need dopamine in our brains?
What I recently read on here is that lower doses of atypical anti-psychotics increase dopamine levels. Whereas the higher levels that are used for true schizophrenia or manic behavior slow dopamine levels down. If I am incorrect about this, please someone more knowledgeable about anti-psychotics correct me.Low dose neuroleptics increases dopamine levels. High dose neuroleptics decrease dopamine levels? Is this correct?
Eric
Posted by loosmrbls on March 29, 2001, at 12:13:42
In reply to Re: If Zyprexa BLOCKS dopamine, what good is it?, posted by Eric on March 29, 2001, at 9:05:33
I believe all the antipsychotics block dopamine by acting as receptor antagonists -- that is, they don't lower the amount of dopamine, but they "jam up" the receptors so that the extra dopamine can't bind to it's receptors and cause an effect. I'm not sure about the low-dose causing an increase in dopamine.
Zyprexa was approved to be used in acute mania and short-term mood stabilization, but not as maintenance therapy like lithium or depakote.
Posted by stjames on March 29, 2001, at 23:58:31
In reply to If Zyprexa BLOCKS dopamine, what good is it?, posted by SalArmy4me on March 29, 2001, at 4:47:38
> Risperdal, Seroquel, and Geodon do the same thing, so how is that supposed to help someone? Don't we need dopamine in our brains?
James here....
The antipsychotics also have AD effects. Adjust one NT and you adjust many other NT's and systems.
The analogues more, less and block are just that,
analogues. They may help some understand psycopharmacology but neurology is not a tit for
tat system.james
Posted by Chaston on March 30, 2001, at 7:42:02
In reply to Re: If Zyprexa BLOCKS dopamine, what good is it?, posted by stjames on March 29, 2001, at 23:58:31
> > Risperdal, Seroquel, and Geodon do the same thing, so how is that supposed to help someone? Don't we need dopamine in our brains?
>
> James here....
>
> The antipsychotics also have AD effects. Adjust one NT and you adjust many other NT's and systems.
> The analogues more, less and block are just that,
> analogues. They may help some understand psycopharmacology but neurology is not a tit for
> tat system.
>
> jamesYeah, I think you're right. "More gas makes the car go faster," but only if it is mixed with the right amount of air, has enough compression and spark, the gearing and tires are right, etc--it's a complex system.
Posted by stjames on March 30, 2001, at 12:54:54
In reply to Re: If Zyprexa BLOCKS dopamine, what good is it? » stjames, posted by Chaston on March 30, 2001, at 7:42:02
> Yeah, I think you're right. "More gas makes the car go faster," but only if it is mixed with the right amount of air, has enough compression and spark, the gearing and tires are right, etc--it's a complex system.
James here.....
Good analogy ! (spelled right this time)
James
Posted by Eric on March 30, 2001, at 13:17:21
In reply to Re: If Zyprexa BLOCKS dopamine, what good is it?, posted by stjames on March 29, 2001, at 23:58:31
....
>
> The antipsychotics also have AD effects.
VERY mild AD effects if you ask me. My impression of anti-psychotics is that they activate the antidepressants better. Ive tried neuroleptics just by themselves before out of curiosity and they gave me a mediocre antidepressant effect all by themselves.Ive found anti-psychotics by themselves to be very poor antidepressants. They just dont adequately make me feel "alive" enough. However it is very true that many times throwing in some Zyprexa or Seroquel will make your antidepressants totally activate. THEN you will begin feeling like your old self again!
Eric
Posted by SalArmy4me on March 30, 2001, at 20:19:47
In reply to If Zyprexa BLOCKS dopamine, what good is it?, posted by SalArmy4me on March 29, 2001, at 4:47:38
{Background: I actually took Zyprexa and then Seroquel for a couple months as a sleep-aid. I don't have mania, schizophrenia, or psychosis. I didn't notice a change in my mood or anxiety, even at larger than therapeutic doses. I just wonder what could have possibly happened to my mood on atypical neuroleptics.}
> Risperdal, Seroquel, and Geodon do the same thing, so how is that supposed to help someone? Don't we need dopamine in our brains?
Posted by Sunnely on March 30, 2001, at 23:56:34
In reply to Re: If Zyprexa BLOCKS dopamine, what good is it?, posted by Eric on March 29, 2001, at 9:05:33
The biochemical profile of atypical antipsychotic drugs would suggest the possibility of both anti-manic and antidepressant effects. Dopamine 2 receptor (D2) blockade, as occurs with typical antipsychotic drugs, is associated with anti-manic effects. Serotonin receptor 2 (5HT2) blockade, as occurs with some standard antidepressants (trazodone or Desyrel, nefazodone or Serzone, mirtazapine or Remeron), is associated with antidepressants effects; this occurs by increasing neurotransmission of available serotonin along unblocked serotonin 1 receptors (5HT1), a postulated antidepressant mechanism.
Ziprasidone (Geodon) has a strong potential for antidepressant effect due to the following receptor affinities: 1) potent serotonin 1A receptor agonist (enhancer), 2) potent serotonin 1D receptor antagonist (blocker), and 3) moderate serotonin (5HT) and norepinephrine (NE) reuptake inhibitor, similar to imipramine (Tofranil).
======================
> > Risperdal, Seroquel, and Geodon do the same thing, so how is that supposed to help someone? Don't we need dopamine in our brains?
>
>
> What I recently read on here is that lower doses of atypical anti-psychotics increase dopamine levels. Whereas the higher levels that are used for true schizophrenia or manic behavior slow dopamine levels down. If I am incorrect about this, please someone more knowledgeable about anti-psychotics correct me.
>
> Low dose neuroleptics increases dopamine levels. High dose neuroleptics decrease dopamine levels? Is this correct?
>
> Eric
Posted by SLS on March 31, 2001, at 10:33:51
In reply to Re: If Zyprexa BLOCKS dopamine, what good is it? » Eric, posted by Sunnely on March 30, 2001, at 23:56:34
> Ziprasidone (Geodon) has a strong potential for antidepressant effect due to the following receptor affinities: 1) potent serotonin 1A receptor agonist (enhancer), 2) potent serotonin 1D receptor antagonist (blocker), and 3) moderate serotonin (5HT) and norepinephrine (NE) reuptake inhibitor, similar to imipramine (Tofranil).
Dear Sunnely,Are the magnitudes of reuptake inhibition for NE and 5-HT by Geodon comparable to imipramine (IC50)?
Hmmm.
I was thinking of adding Geodon to my current regimen that includes Parnate 80mg and nortriptyline 100mg. I have taken a combination of Parnate 120mg and imipramine 300mg in the past. My concern here is that Geodon will increase the potential for untoward effects, although I have not yet experienced any with my current combination.
I will say this, though, while taking Parnate 120mg, I took the teeniest, tiniest little nibble of a tablet of Effexor. I wanted to test the potential for serotonin syndrome. I was desperate. I chose Effexor because if something nasty happened, its short half-life would quickly terminate the trial. How smart I was to choose Effexor. How stupid I was to try Effexor. Major serotonin syndrome. I became incoherent and babbled nonsense. My body temperature rose, but did not exceed 100 degrees F. I couldn't get myself to move when I tried to get out of bed. I am not sure if this was because of some sort of vertigo or because of any hypertonia. I think it was vertigo. I had to know.
Thanks for any feedback regarding Geodon.
Two more last questions. What do you think of using Moban in the role of augmentor for depression? What is its potential for EPS and TD?
- Scott
Posted by Sunnely on April 1, 2001, at 23:11:22
In reply to Re: If Zyprexa BLOCKS dopamine, what good is it? » Sunnely, posted by SLS on March 31, 2001, at 10:33:51
Hi Scott,
I believe imipramine's reuptake inhibition of NE and 5HT is much stronger than Geodon, although I don't have the exact figures on these.
Re: Moban as an "augmenter" for antidepressant - Unless you have a diagnosis of major depression with psychotic features or schizoaffective disorder, depressed type or schizophrenia with concurrent depression, I will shy away from Moban and the other older antipsychotic drugs. In treatment-resistant or partial-responders depression, the older antipsychotics are not only poor "augmenters" of antidepressants but may even worsen depression. All of them have minimal or devoid of serotonergic effect and are more potent D2 antagonists than any of the existing atypical antipsychotics. As a consequence, they may tend to worsen depression.
Re: Moban and EPS, TD - Virtually all of the older antipsychotic drugs have been reported to cause EPS and TD. In general, the following people are the highest risk for developing TD: 1) older people, especially women; 2) those with neurological conditions; 3) those who are developmentally disabled (e.g., mental retardation); 4) those with diagnosis of affective disorder (e.g., depression, bipolar disorder); 5) those who experience acute EPS; 6) those who have been taking high dosage of antipsychotics for a long time. According to Kane et. al. study (1984 and 1988), the incidence of TD increases as the length of antipsychotic treatment increases. For the first several years, this appears to be a linear progression. The following is the incidence of TD: 5% after 1 year; 10% after 2 years; 15% after 3 years; 19% after 4 years; and 26% after 6 years.
Among the atypical antipsychotics, people on risperidone may be at higher risk in developing future TD compared to other atypical antipsychotics (e.g., clozapine, olanzapine, quetiapine, and ziprasidone).
On the positive note, among the antipsychotics (old and new), Moban, Loxitane, and Geodon appear to be the least to cause weight gain.
+++++++++++++++++++++++++++++++++++++
> Are the magnitudes of reuptake inhibition for NE and 5-HT by Geodon comparable to imipramine (IC50)?
>
> Hmmm.
>
> I was thinking of adding Geodon to my current regimen that includes Parnate 80mg and nortriptyline 100mg. I have taken a combination of Parnate 120mg and imipramine 300mg in the past. My concern here is that Geodon will increase the potential for untoward effects, although I have not yet experienced any with my current combination.
>
> I will say this, though, while taking Parnate 120mg, I took the teeniest, tiniest little nibble of a tablet of Effexor. I wanted to test the potential for serotonin syndrome. I was desperate. I chose Effexor because if something nasty happened, its short half-life would quickly terminate the trial. How smart I was to choose Effexor. How stupid I was to try Effexor. Major serotonin syndrome. I became incoherent and babbled nonsense. My body temperature rose, but did not exceed 100 degrees F. I couldn't get myself to move when I tried to get out of bed. I am not sure if this was because of some sort of vertigo or because of any hypertonia. I think it was vertigo. I had to know.
>
> Thanks for any feedback regarding Geodon.
>
> Two more last questions. What do you think of using Moban in the role of augmentor for depression? What is its potential for EPS and TD?
>
>
> - Scott
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.