![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Collete on September 28, 2001, at 9:32:28
As suggested here, I tapered off my 2.5 mg dose of Zyprexa with no real side effects except for the return of irritablity, when I finally stopped taking it completely. Zyprexa was a wonder drug for me (combined with 20mg Prozac) but I had to stop because the appetite stimulation was more than I could overcome. I have never experienced anything like that...even when I was pregnant! I still have the appetite (off it for 4 days now) but my pdoc says that will stop soon.
As expected, he said he had another med to try and I piped in with "Geodon", which was correct. He said to take 20 mg in the AM and then another 20 at about 3:00, but I could try taking the second one earlier or even just take 40 in the AM. (This, so that it doesn't keep me up all night.) I just took my first 20mg and will keep you posted. It's hard not to wish for the immediate effect that I had with Zyprexa, but I am trying to be realistic. Collette
Posted by SLS on September 28, 2001, at 11:47:02
In reply to Started Geodon, off Zyprexa, posted by Collete on September 28, 2001, at 9:32:28
> As suggested here, I tapered off my 2.5 mg dose of Zyprexa with no real side effects except for the return of irritablity, when I finally stopped taking it completely. Zyprexa was a wonder drug for me (combined with 20mg Prozac) but I had to stop because the appetite stimulation was more than I could overcome. I have never experienced anything like that...even when I was pregnant! I still have the appetite (off it for 4 days now) but my pdoc says that will stop soon.
> As expected, he said he had another med to try and I piped in with "Geodon", which was correct. He said to take 20 mg in the AM and then another 20 at about 3:00, but I could try taking the second one earlier or even just take 40 in the AM. (This, so that it doesn't keep me up all night.) I just took my first 20mg and will keep you posted. It's hard not to wish for the immediate effect that I had with Zyprexa, but I am trying to be realistic. Collette
Hi Collette.Good luck with the Geodon. I've been on 40mg/day for about a week in an attempt to treat a difficult bipolar depression. I take 20mg in morning and evening. I find it to be a lot "cleaner" than Zyprexa as far as side effects are concerned. It has not increased my appetite at all, and didn't affect my speech like Zyprexa did. It doesn't make me sleepy, but it doesn't cause me insomnia either. Many people do complain about insomnia, and some about becoming "hyper". I think it is helping a bit, but I don't think I'll see much benefit unless I change my antidepressant combination first. I've been taking Effexor, nortriptyline, and Lamictal. I'm thinking about switching from Effexor to Nardil.
Again, good luck.
- Scott
Posted by Roo on September 28, 2001, at 14:29:59
In reply to Re: Started Geodon, off Zyprexa, posted by SLS on September 28, 2001, at 11:47:02
Scott--
How do you like Lamictal? I just started it. Got
the rash last time I tried it, but we're starting
very low and slow this time.
Posted by chloe on September 28, 2001, at 18:35:50
In reply to Started Geodon, off Zyprexa, posted by Collete on September 28, 2001, at 9:32:28
Hi Collette,
I am glad you got off the Zyprexa ok.
In terms of Geodon, I hope it works well for you.
When I took it, I could not believe how different it was from Zyprexa. For me, Geodon had a profound AD effect and well as clearing up my distorted thinking. My sleep was not very good, but I felt so *positive* I didn't mind being out of bed more.
Unfortunately I had to stop it due to TD symptoms. But if not for that awful side effect, it would definitely have been a keeper!
Keep us posted
Chloe
Posted by Collete on September 28, 2001, at 21:01:48
In reply to Re: Started Geodon, off Zyprexa » Collete, posted by chloe on September 28, 2001, at 18:35:50
> Hi Collette,
> I am glad you got off the Zyprexa ok.
> In terms of Geodon, I hope it works well for you.
> When I took it, I could not believe how different it was from Zyprexa. For me, Geodon had a profound AD effect and well as clearing up my distorted thinking. My sleep was not very good, but I felt so *positive* I didn't mind being out of bed more.
> Unfortunately I had to stop it due to TD symptoms. But if not for that awful side effect, it would definitely have been a keeper!
> Keep us posted
> ChloeOh Chloe, that is hopeful to hear. I still can NOT stop eating everything in sight and am even smeaking bags of potato chips into the house. I can't beleive this is me, but I am still so hungry! I have only been totally off the Zyprexa four days and am having a hard time getting myself together. I sure hope the Geodon kicks in SOON! In what way was it different? I just loved how I felt with Zyprexa. Thanks, Collette
Posted by SLS on September 28, 2001, at 22:06:39
In reply to Re: Started Geodon, off Zyprexa--scott, posted by Roo on September 28, 2001, at 14:29:59
> Scott--
>
> How do you like Lamictal? I just started it. Got
> the rash last time I tried it, but we're starting
> very low and slow this time.
Hi Roo.I have yet to hear of someone who cannot avoid the rash-reaction by titrating Lamictal slowly in accordance with the manufacturer's recommendations.
Lamictal has produced a mild antidepressant effect for me that has been stable at 300mg/day. For many people, it is a very "clean" drug as it tends not to produce any side effects. You might notice a bit of trouble with memory early on, but it is not nearly as disruptive to cognition as the other anticonvulsant mood-stabilizers. I see that it is now used to treat both bipolar and unipolar depression. I think Lamictal is well worthwhile to explore fully. The average effective dosage seems to be around 200mg, with a range of between 100mg - 300mg.
Good luck.
- Scott
Posted by Zo on September 29, 2001, at 2:44:37
In reply to Re: Started Geodon, off Zyprexa--scott » Roo, posted by SLS on September 28, 2001, at 22:06:39
Why are you thinking of making the move from Effexor?
Zo
Posted by Zo on September 29, 2001, at 3:00:40
In reply to Re: Started Geodon, off Zyprexa--scott » SLS, posted by Zo on September 29, 2001, at 2:44:37
And while I'm at it, who the hell are you and what makes you so smart?
Zo
Posted by Emme on September 30, 2001, at 8:20:58
In reply to Re: Started Geodon, off Zyprexa--scott » Roo, posted by SLS on September 28, 2001, at 22:06:39
> Hi Roo.
>
> I have yet to hear of someone who cannot avoid the rash-reaction by titrating Lamictal slowly in accordance with the manufacturer's recommendations.
>Scott,
Now you have. Me. It was a small, harmelss rash, though. I liked it otherwise and think it is a good drug. We haven't decided yet about a rechallenge.Emme
Posted by SLS on September 30, 2001, at 8:49:44
In reply to Re: Started Geodon, off Zyprexa--scott » SLS, posted by Emme on September 30, 2001, at 8:20:58
>
> > Hi Roo.
> >
> > I have yet to hear of someone who cannot avoid the rash-reaction by titrating Lamictal slowly in accordance with the manufacturer's recommendations.
> >
>
> Scott,
> Now you have. Me. It was a small, harmelss rash, though. I liked it otherwise and think it is a good drug. We haven't decided yet about a rechallenge.
>
> Emme
Dear Emme,I'm sorry that it was you who had to spoil my record!
For me, I noticed that my eyes itched - sort of like an allergy - whenever I raised the dosage. It usually lasted for a day or two. I'm hoping that your reaction is similarly brief.
When titrating Lamictal in the absence of another anticonvulsant mood stabilizer, the increases must be more gradual than the schedule prescribed by the manufacturer and PDR. I had success with the following:
25mg x 2 weeks
50mg x 2 weeks
75mg x 1 week
100mg x 1 weekI guess you'll have to go slower than that. How exactly did you increase the dosage? I am currently taking 300mg. I think 100mg - 200mg is where most people end up. Do you have bipolar disorder? If not, how would you describe the features of your depression?
Thanks.
- Scott
Posted by Emme on October 3, 2001, at 8:24:35
In reply to Re: Started Geodon, off Zyprexa--scott » Emme, posted by SLS on September 30, 2001, at 8:49:44
Hi Scott,
Yes, sorry to spoil your record. Glad you've been able to tolerate the lamictal well. I see so many positive posts about it. I increased the Lamictal by 12.5 mg/week. I got the rash while I was at 75 mg - just when good things were starting to happen. I've been trying other ACs for the time being. Currently I'm on Gabitril.
Am I bipolar? My doctor certainly thinks so. It's been hard for me to believe the diagnosis because I've never really been clearly hypomanic and definitely never manic. My depression has been different at different times, sometimes accompanied by lots of anxiety, sometimes by awful fatigue, and the symptoms of depression with lots of anxiety are pretty similar to the features of a mixed state. There have been times when I definitely seemed to be cycling up and down on the time scale of a week or two, except that the "highs" never really popped up into hypomanic. My doctor says that loss of efficacy with various antidepressants is another indication. So she thinks that although no one symptom is conclusive by itself, taken together they suggest a bipolar spectrum disorder. I know the BPII diagnosis gets thrown around a lot these days. But I also trust that my doctor has a good clinical sense, and so I am willing to try the bipolar treatments. I assume you have been diagnosed bipolar also? How do you describe your mood disorder?
Emme
> Dear Emme,
>
> I'm sorry that it was you who had to spoil my record!
>
> For me, I noticed that my eyes itched - sort of like an allergy - whenever I raised the dosage. It usually lasted for a day or two. I'm hoping that your reaction is similarly brief.
>
> When titrating Lamictal in the absence of another anticonvulsant mood stabilizer, the increases must be more gradual than the schedule prescribed by the manufacturer and PDR. I had success with the following:
>
> 25mg x 2 weeks
> 50mg x 2 weeks
> 75mg x 1 week
> 100mg x 1 week
>
> I guess you'll have to go slower than that. How exactly did you increase the dosage? I am currently taking 300mg. I think 100mg - 200mg is where most people end up. Do you have bipolar disorder? If not, how would you describe the features of your depression?
>
> Thanks.
>
>
> - Scott
Posted by SLS on October 3, 2001, at 13:12:04
In reply to Re: Started Geodon, off Zyprexa--scott » SLS, posted by Emme on October 3, 2001, at 8:24:35
Hi Emme.
> Yes, sorry to spoil your record. Glad you've been able to tolerate the lamictal well. I see so many positive posts about it. I increased the Lamictal by 12.5 mg/week. I got the rash while I was at 75 mg - just when good things were starting to happen.
I am so frustrated for you. What dosage did you start with? You aren't taking Depakote, are you? What did the rash look like?
> I've been trying other ACs for the time being. Currently I'm on Gabitril.
I'll be very interested to see how things turn out for you. Gabitril is on my list of things to try.
> Am I bipolar? My doctor certainly thinks so. It's been hard for me to believe the diagnosis because I've never really been clearly hypomanic and definitely never manic. My depression has been different at different times, sometimes accompanied by lots of anxiety, sometimes by awful fatigue, and the symptoms of depression with lots of anxiety are pretty similar to the features of a mixed state. There have been times when I definitely seemed to be cycling up and down on the time scale of a week or two, except that the "highs" never really popped up into hypomanic. My doctor says that loss of efficacy with various antidepressants is another indication. So she thinks that although no one symptom is conclusive by itself, taken together they suggest a bipolar spectrum disorder. I know the BPII diagnosis gets thrown around a lot these days. But I also trust that my doctor has a good clinical sense, and so I am willing to try the bipolar treatments.
> I assume you have been diagnosed bipolar also? How do you describe your mood disorder?
I have bipolar disorder, but it doesn't fit well into either bipolar I or bipolar II. I have been in a constant state of depression for over 20 years. It probably started around age 10, but became severe rather suddenly at age 17. I have little or no physical or mental energy, am slow-thinking, have poor concentration and memory, have no motivation to do get up out of a chair, and I experience no enjoyment (anhedonia). This state has been uninterrupted except for one 6 month period resulting from a combination of antidepressants (Parnate + desipramine), and several 3-day "blips" during various antidepressant trials.
I think the identity of the bipolar spectrum is still evolving. I really don't feel competent to comment on your doctor's diagnosis, but it seems very reasonable to me. Your history sounds very similar to mine. The only thing missing is a few drug-induced manic episodes.
My depressive state has changed over time. In the beginning, it included some pretty heavy-duty social anxiety - actually, social phobia. I would literally become physically immobilized with anxiety at parties in high school. I experienced depressed mood with negative thoughts. Everything seemed dark and gloomy. For two years, I displayed a regular weekly cycle, but my mood (I hate using that word) during the upper phase of the cycle barely reached normalcy. I was never hypomanic or manic. I was able to ace my college courses for the first two years. Although I had difficulty reading more than a few pages at a time, I really didn't pay much attention to it. I thought I was just lazy. Fortunately, reading something once was enough. I used to look forward to taking exams. They were fun. I loved physics and biology especially. Didn't care much for calculus though. The class schedule interfered with my sex-life. Anyway by the beginning of my junior year, I couldn't read or remember a damned thing. Organic chemistry did me in. Eventually, the nature of my depression became more anergic and vegetative and less melancholic with much reduced anxiety. This trend is not so unusual as one ages, but it is remarkable that this occurred so early with me. This phenomenon of a changing presentation of depression is such that very often, elderly folks are misdiagnosed as having an organic (I don't like this word either) dementia. The term "pseudodementia" has sometimes been used to describe this.
Oh, but I babble...
- Scott
Posted by Emme on October 5, 2001, at 21:47:42
In reply to Re: Started Geodon, off Zyprexa--scott » Emme, posted by SLS on October 3, 2001, at 13:12:04
Hi Scott,
> I am so frustrated for you. What dosage did you start with? You aren't taking Depakote, are you? What did the rash look like?I started at 12.5 mg for the first two weeks, and then up by 12.5 mg approximately every week. No depakote. The rash was small, just a red, splotchy discoloration with no textural changes - the skin felt totally smooth. It was on my midriff, so it wasn't a sunburn, and there was no other obvious cause.
> I'll be very interested to see how things turn out for you. Gabitril is on my list of things to try.At the moment I'm not feeling optimistic about it. At least not for me. It's doesn't seem too heavy on side effects. But I am still pretty depressed at 12 mg. Kinda miserable actually. I'll see my doctor next week. Back to strategizing. You might want to keep it on your list though. As I said, it doesn't seem too bad in side effects. At first I thought it was a little activating, now I'm a little bit tired, so it's hard to figure out what it's doing to my energy, if anything. But otherwise, it seems on the benign side. So give it a shot and see if it has beneficial effects for you.
> I have bipolar disorder, but it doesn't fit well into either bipolar I or bipolar II. I have been in a constant state of depression for over 20 years. It probably started around age 10, but became severe rather suddenly at age 17. I have little or no physical or mental energy, am slow-thinking, have poor concentration and memory, have no motivation to do get up out of a chair, and I experience no enjoyment (anhedonia). This state has been uninterrupted except for one 6 month period resulting from a combination of antidepressants (Parnate + desipramine), and several 3-day "blips" during various antidepressant trials.
You are quite a survivor to have endured 20 years of depression. Everyone on this board seems very feisty. So many folks have suffered so long and are so tenacious about fighting their illness. I think the lack of physical or mental energy is especially hard for me. Not being able to get things done worsens my sense of lost time and failure, and feeds back into the depression. But I am very sensitive to meds, so finding drugs that keep my anxiety at bay without sapping my energy is tough. I think I was pretty lucky in some ways though. Although there were signs of anxiety and depression going as far back as high school, and which have certainly interfered with my life, I was able to function well for a long time. I didn't get really sick until 1998. I feel very battered by the last few years in particular. But I also know that with less luck, I could have been much sicker much earlier. (Am I making sense?)
> I think the identity of the bipolar spectrum is still evolving.I guess it would be strange if the science of psychiatry weren't continually evolving, just like any other science.
> Oh, but I babble...Well, it is called "Psycho Babble"!
Emme
Posted by SLS on October 5, 2001, at 23:32:29
In reply to Re: Started Geodon, off Zyprexa--scott » SLS, posted by Emme on October 5, 2001, at 21:47:42
Dear Emme,
Just curious.
Was your doctor convinced that this skin anomaly was indeed the appearance of the dangerous skin reaction? I don’t know enough about it to be able to evaluate your description. If I were in your sneakers, I would be determined to try again, if you feel you have failed enough previous drug trials to justify it. You might ask your doctor to consult with someone that perhaps has had more experience seeing patients through the start-up period of Lamictal. He might be better able to assess whether the appearance of your skin discoloration is an absolute contraindication to continued treatment, or whether there are strategies to help establish a therapeutic dosage. If I have time, I’ll see if I can come up with anything more specific.
You might want to check out the work of Robert M. Post of the NIMH. I consider him among the top experts for treating refractory bipolar disorders – bipolar depression and rapid-cyclicity, particularly. For rapid cyclers, he advocates the use of at least two mood stabilizers; usually lithium combined with Tegretol (or perhaps Trileptal, its sister drug), Depakote, or Lamictal. He has also had some success with the combination of Lamictal and Neurontin.
If anything comes to mind – and stays there :-) - I’ll let you know.
Take care.
- Scott
Posted by Emme on October 10, 2001, at 9:01:04
In reply to Re: Started Geodon, off Zyprexa--scott » Emme, posted by SLS on October 5, 2001, at 23:32:29
Hi Scott,
Sorry for the long delay in response. I'm feeling too cruddy to even concentrate enough to post. But I really appreciate your input.
> Was your doctor convinced that this skin anomaly was indeed the appearance of the dangerous skin reaction?She had me go immediately to a dermatologist who said it was a harmelss rash, but definitely a drug reaction. My doctor pulled me from the lamictal because she felt that a harmelss onset didn't guarantee a harmless outcome.
> If I were in your sneakers, I would be determined to try again, if you feel you have failed enough previous drug trials to justify it. You might ask your doctor to consult with someone that perhaps has had more experience seeing patients through the start-up period of Lamictal. He might be better able to assess whether the appearance of your skin discoloration is an absolute contraindication to continued treatment, or whether there are strategies to help establish a therapeutic dosage. If I have time, I’ll see if I can come up with anything more specific.
Some form of rechallenge hasn't been ruled out. She's placed calls to experts to get their input. I think she's had a lot of patients on it, but I'm not sure she's had to really consider a rechallenge before. But we're getting to the point that it's a consideration.
> You might want to check out the work of Robert M. Post of the NIMH. I consider him among the top experts for treating refractory bipolar disorders – bipolar depression and rapid-cyclicity, particularly. For rapid cyclers, he advocates the use of at least two mood stabilizers; usually lithium combined with Tegretol (or perhaps Trileptal, its sister drug), Depakote, or Lamictal. He has also had some success with the combination of Lamictal and Neurontin.Okay, thanks. I will keep these things in mind.
> If anything comes to mind – and stays there :-) - I’ll let you know.
This is scary, but I've been glancing at the posts and I know you're trying something new, but I just can't remember what it is. (I'll look again when I get back to the screen with current posts.) But I wanted to say good luck and I hope it works for you. Sorry I'm so brain dead.
Emme
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.