Psycho-Babble Medication Thread 100817

Shown: posts 1 to 25 of 45. This is the beginning of the thread.

 

zyprexa for atypical depression?

Posted by KB on March 28, 2002, at 20:37:47

Has anybody had any experience with Zyprexa for atypical depression? I'm also taking Celexa and Wellbutrin, have never had any psychotic symptoms.

 

Re: zyprexa for atypical depression?

Posted by OldSchool on March 28, 2002, at 21:41:50

In reply to zyprexa for atypical depression?, posted by KB on March 28, 2002, at 20:37:47

> Has anybody had any experience with Zyprexa for atypical depression? I'm also taking Celexa and Wellbutrin, have never had any psychotic symptoms.

Sounds kinda funky to me. Zyprexa is used for psychotic symptoms and mania. Some Pdocs use it for other stuff, like anxiety, agitation, insomnia, etc. which they really shouldnt do. For atypical depression, the most commonly recommended drugs are the older MAOIs. There is also a new experimental drug called Gepirone which is supposed to be marketed for atypical depression. Maybe you could get into an open clinical trial for Gepirone.

If you have no psychotic symptoms I would leave the Zyprexa alone. Is not worth the risk of EPS and other neurological damage.

Old School

 

Zyprexa *never* for depression!

Posted by Tye on March 30, 2002, at 13:35:16

In reply to zyprexa for atypical depression?, posted by KB on March 28, 2002, at 20:37:47

> Has anybody had any experience with Zyprexa for atypical depression? I'm also taking Celexa and Wellbutrin, have never had any psychotic symptoms.

Hey KB,

Theorectically, zyprexa augments SSRIs by increasing norepinephrine and dopamine in the frontal lobes. Of course, the study that supports this was performed on rat brain .... and we are not rats! Also Eli Lilly, the maker or zyprexa and prozac, had a small study showing zyprexa augmented prozac in patients with depression.

In reality, zyprexa is a poor agent for depression. In fact, most patients feel more depressed/more apathy/more sedated on zyprexa. Along with the risks of tardive dyskinesia, zyprexa should probably *never* be prescribed for depression.

Of course if you have bipolar disorder or psychosis, zyprexa can be helpful.

Get better soon!

Tye

 

Re: Zyprexa *never* for depression!

Posted by KB on March 30, 2002, at 17:41:53

In reply to Zyprexa *never* for depression!, posted by Tye on March 30, 2002, at 13:35:16

The Celexa and Wellbutrin got rid of the most extreme of my depression symptoms - the Celexa helped with the extreme tearfulness, reactivity, and suicidal thoughts and the Wellbutrin helped with energy. The reason Zyprexa was suggested was to counteract a sort of dissociated, confused feeling - forgetfulness like leaving the front door open or the oven on all day, getting off at the wrong train stop, etc.

 

Re: Zyprexa *never* for depression! Tye

Posted by JohnX2 on March 31, 2002, at 8:22:54

In reply to Zyprexa *never* for depression!, posted by Tye on March 30, 2002, at 13:35:16

> > Has anybody had any experience with Zyprexa for atypical depression? I'm also taking Celexa and Wellbutrin, have never had any psychotic symptoms.
>
> Hey KB,
>
> Theorectically, zyprexa augments SSRIs by increasing norepinephrine and dopamine in the frontal lobes. Of course, the study that supports this was performed on rat brain .... and we are not rats! Also Eli Lilly, the maker or zyprexa and prozac, had a small study showing zyprexa augmented prozac in patients with depression.
>
> In reality, zyprexa is a poor agent for depression. In fact, most patients feel more depressed/more apathy/more sedated on zyprexa. Along with the risks of tardive dyskinesia, zyprexa should probably *never* be prescribed for depression.
>
> Of course if you have bipolar disorder or psychosis, zyprexa can be helpful.
>
> Get better soon!
>
> Tye

Given a Zyprexa, minus the noradrenergic alpha-1 antagonism (which for some may induce sedation), and the dopamine antagonism (potential for tardive dyskinesia), would you retract your statement? I.e. a clean medicine that blocks the Serotonin 5-ht2a and 5-ht2c receptors, thus relieving a lot of anxiety and side effects from the current generation of antidepressants?

John


 

Re: Zyprexa *never* for depression! JohnX2

Posted by Tye on March 31, 2002, at 8:44:24

In reply to Re: Zyprexa *never* for depression! Tye, posted by JohnX2 on March 31, 2002, at 8:22:54

> Given a Zyprexa, minus the noradrenergic alpha-1 antagonism (which for some may induce sedation), and the dopamine antagonism (potential for tardive dyskinesia), would you retract your statement? I.e. a clean medicine that blocks the Serotonin 5-ht2a and 5-ht2c receptors, thus relieving a lot of anxiety and side effects from the current generation of antidepressants?

Hey John,

Nah, I wouldn't retract my statement. I agree 5-HT2 antagonism reduces anxiety, I am not sure it improves mood directly. Other 5-HT2 antagonist are not antidepressants per say.

Although, this is just my opinion and I could very well be completely wrong! You are very well informed/intelligent, and I enjoy reading all of your posts.

Tye

 

Re: Zyprexa *never* for depression! Tye

Posted by JohnX2 on March 31, 2002, at 9:04:33

In reply to Re: Zyprexa *never* for depression! JohnX2, posted by Tye on March 31, 2002, at 8:44:24

> > Given a Zyprexa, minus the noradrenergic alpha-1 antagonism (which for some may induce sedation), and the dopamine antagonism (potential for tardive dyskinesia), would you retract your statement? I.e. a clean medicine that blocks the Serotonin 5-ht2a and 5-ht2c receptors, thus relieving a lot of anxiety and side effects from the current generation of antidepressants?
>
> Hey John,
>
> Nah, I wouldn't retract my statement. I agree 5-HT2 antagonism reduces anxiety, I am not sure it improves mood directly. Other 5-HT2 antagonist are not antidepressants per say.
>
> Although, this is just my opinion and I could very well be completely wrong! You are very well informed/intelligent, and I enjoy reading all of your posts.
>
> Tye

Hi Tye,

I don't think the medicine alone would be effective for vanilla depression (it would for many other disorders). In fact this has already been shown with medicines like Ketanserin. But the sertonin system has been studied, and there is a greater understanding of what makes the SSRI medicines "suck". Blocking out a few receptors would substantially alleviate side effects like anxiety, sexual dysfunction, insomnia, etc. Many people can not tolerate taking SSRIs for Panic disorder, even though they are effective medicines because initially the SSRIs will increase serotonin conductance on these anxiety causing receptors. So these people go after the benzos instead. Also, non compliance from SSRIs from the side effects is a huge issue.

The atypical APs are potentially useful *adjuncts* (not primary medicines in general) for non-pychotics and manics, mainly for their sertonergic blocking properties. The chemical structures that achieve this most always block dopamine receptors however. I have seen a few clean medicines in the pipeline that might not mangle the dopamine system.

But i also agree that the risk of TD is something to take seriously. But they do work fast, and a quick trial of an AP beats taking the long road of an AD for some issues. Also, I have seen many people with depression, generally comorbid with certain other disorders, do well on APs (as well as have bad experiences) just like every other medicine, so I'm not sure what you base your statement regarding efficacy on.

Regards,
John


 

Re: zyprexa for atypical depression?

Posted by Mark H. on March 31, 2002, at 9:48:11

In reply to zyprexa for atypical depression?, posted by KB on March 28, 2002, at 20:37:47

It works for me, prn.

I *am* bipolar (II), but my depression is both refractive and atypical. I eat and sleep all the time when depressed. I tried more than 25 ADs and adjunctives over a 4 year period before finding the right mix for me.

When my twice-annual cycles became annoyingly agitated a couple of years ago, SLS suggested I try Zyprexa, and my psychiatrist agreed. A ten-day course put me back on track, and I experienced no withdrawal problems on 5mg a day.

Now, I use it infrequently (one or two 2.5mg tablets taken once or twice a month) to "reset" as needed. It's a god-send for me, the perfect fast, short-term intervention. I'm able to stop the problem and recover before the agitation, despair, obsession or rage has a chance to do much psychological damage.

I realize it may not work this well for everyone, but because of its relative safety and fast action, I believe it *may* be worth trying with a broader range of patients, including those with unipolar depression. The enormous "plus" of Zyprexa in those who respond well to it is the potential to use it as needed rather than continuously.

I have not read anywhere that the newer, atypical anti-psychotics (including Zyprexa) cause tardive dyskinesia, nor do I understand why TD is even part of this discussion. Have I missed some new findings? Please let me know, as I don't keep up as well as many of you.

In general, I think we have to be careful about using "always" and "never" when discussing medications, unless there is a documented risk of damaging side effects (as with dangerous drug interactions, for instance). Otherwise, we tend to expose ourselves to the single contradiction that disproves the generality.

I am continuously amazed and grateful for the level of intelligence, concern and care people on this board offer to one another. Thank you all for being here.

With appreciation,

Mark H.

 

Re: zyprexa for atypical depression? Mark H.

Posted by JohnX2 on March 31, 2002, at 10:21:54

In reply to Re: zyprexa for atypical depression?, posted by Mark H. on March 31, 2002, at 9:48:11

> It works for me, prn.
>
> I *am* bipolar (II), but my depression is both refractive and atypical. I eat and sleep all the time when depressed. I tried more than 25 ADs and adjunctives over a 4 year period before finding the right mix for me.
>
> When my twice-annual cycles became annoyingly agitated a couple of years ago, SLS suggested I try Zyprexa, and my psychiatrist agreed. A ten-day course put me back on track, and I experienced no withdrawal problems on 5mg a day.
>
> Now, I use it infrequently (one or two 2.5mg tablets taken once or twice a month) to "reset" as needed. It's a god-send for me, the perfect fast, short-term intervention. I'm able to stop the problem and recover before the agitation, despair, obsession or rage has a chance to do much psychological damage.
>

Agreed, its an easy med to get-in-and-out. So if it helps, great. If not, bail. No painful weeks of hell like an AD. ;)


> I realize it may not work this well for everyone, but because of its relative safety and fast action, I believe it *may* be worth trying with a broader range of patients, including those with unipolar depression. The enormous "plus" of Zyprexa in those who respond well to it is the potential to use it as needed rather than continuously.
>
> I have not read anywhere that the newer, atypical anti-psychotics (including Zyprexa) cause tardive dyskinesia, nor do I understand why TD is even part of this discussion. Have I missed some new findings? Please let me know, as I don't keep up as well as many of you.
>

I took the medicine for about 4 months continually at 5 mg (it was a godsend for my agitation and sleep problems, I am bpii). In January I developed severe Mania which may have been precipitated by tapering off Klonopin. During this time period I raised my Zyprexa dose to 20 mg to help curb the near psychosis and I started to experience twitching and clenching in my left fist. I later tapered off the Zyprexa, but I occasionally get a clenching in my left fist which may or may not be a tardive dystonia which may or may not have been caused by the Zyprexa (exacerbated by the mania and strong dosing). It also could have been exacerbated by the Klonopin taper which was reducing Gaba and deprotecting neurons (maybe some toxic transmission), so who knows.

Regards,
John


> In general, I think we have to be careful about using "always" and "never" when discussing medications, unless there is a documented risk of damaging side effects (as with dangerous drug interactions, for instance). Otherwise, we tend to expose ourselves to the single contradiction that disproves the generality.
>
> I am continuously amazed and grateful for the level of intelligence, concern and care people on this board offer to one another. Thank you all for being here.
>
> With appreciation,
>
> Mark H.

 

Re: zyprexa for atypical depression? JohnX2

Posted by judy1 on March 31, 2002, at 12:09:56

In reply to Re: zyprexa for atypical depression? Mark H., posted by JohnX2 on March 31, 2002, at 10:21:54

John,
I just read your post and was amazed at the similarities with my experience with zyprexa- I also took it at 20mg/day and developed tremor (also on the left side!) which took many months to resolve once I was off. I wasn't tapering klonopin at the time, so that wasn't a factor. Did your symptoms stop once you stopped using zyprexa?- j

 

Re: zyprexa for atypical depression? judy1

Posted by JohnX2 on March 31, 2002, at 12:16:23

In reply to Re: zyprexa for atypical depression? JohnX2, posted by judy1 on March 31, 2002, at 12:09:56

> John,
> I just read your post and was amazed at the similarities with my experience with zyprexa- I also took it at 20mg/day and developed tremor (also on the left side!) which took many months to resolve once I was off. I wasn't tapering klonopin at the time, so that wasn't a factor. Did your symptoms stop once you stopped using zyprexa?- j

Generally I don't have a problem with the clenching (i.e. it is not there most of the day). It seems to get triggered mostly by drinking caffeine. My fist will clench up for a while (muscle spasms, like a writers cramp) and then it will let loose after a while. I have been off of Zyprexa for about a month. So I hope it goes away completely in a while.

Did you do anything special to resolve your issue? Or did it just dissipate over time?

Thanks,
John

 

Re: zyprexa for atypical depression? OldSchool

Posted by SLS on March 31, 2002, at 12:32:50

In reply to Re: zyprexa for atypical depression?, posted by OldSchool on March 28, 2002, at 21:41:50

> > Has anybody had any experience with Zyprexa for atypical depression? I'm also taking Celexa and Wellbutrin, have never had any psychotic symptoms.

> If you have no psychotic symptoms I would leave the Zyprexa alone. Is not worth the risk of EPS and other neurological damage.

Hi OldSchool.

I think the relevant question is:

What is the percentage of neuroleptic-naive people taking Zyprexa at dosages of 5.0mg or less that develop EPS? What about TD?

I don't know.

Lilly is currently testing a preparation that contains a combination of Prozac and Zyprexa. Although I think this is a silly idea, there is a precedence for this sort of thing. Triavil would be an example (amitriptyline + perhenazine).

The marketing ploy is thinly veiled, of course. Lilly wants to milk every last drop of fluoxetine as they can, now that it is off patent and available as a generic. Repackaging it as Sarafem with the indication for PMDD is an attempt to do this. So, too, is the once-a-week version of Prozac. Cam W. made a good comment regarding the idea of having to take one pill only once a week. He proposed that this protocol is counterproductive. One is much more likely to forget to take a pill each Monday than they are to take one every day.

The main reason I think that producing one pill containing both Prozac and Zyprexa is that it precludes the ability to optimize the dosage of either of them. I'm guessing that they will combine 20mg of Prozac with 2.5mg of Zyprexa. Some people don't respond to Prozac until dosages of 60mg are reached. It makes no sense to expose someone to more than 5.0mg of Zyprexa if it is not necessary. How much more difficult is it for a patient to take two pills instead of one? Of course, most of us here have no problem with the idea of polypharmacy. We usually need more than one drug to get us well. I think many doctors still think in terms of treating depression with one drug at a time. This is silly to.

Zyprexa has antidepressant properties, especially when combined with antidepressants. It might even be most successful when combined with Prozac than for any other drug. I don't know. I am sure that Prozac + Zyprexa will get more people well than Prozac alone. It already has.

As with any other treatment decision, one must weigh the risks versus the potential benefits of choosing to take Zyprexa to augment antidepressants. I have tried a whole bunch of things to treat my bipolar depression without success. When I decided to try Zyprexa, I did so with the information available concerning the risks of it producing EPS or TD. I thought the rates of occurrences of these things were low enough to feel comfortable taking it - especially at dosages of 5.0mg and less.


- Scott


 

Re: zyprexa for atypical depression? JohnX2

Posted by judy1 on March 31, 2002, at 12:33:59

In reply to Re: zyprexa for atypical depression? judy1, posted by JohnX2 on March 31, 2002, at 12:16:23

My pdoc did give me something (sorry I'm blanked- but it is commonly used for Parkinsons) and the worst of the tremor stopped but I loathe taking meds to stop side effects of other meds so I allowed time to heal. And it did- slowly... although in very stressful periods (maybe 1-2x month) I will start to shake. I haven't noticed any caffeine affect and it has now been 11 months- take care-j

 

Re: zyprexa for atypical depression?

Posted by OldSchool on March 31, 2002, at 13:28:23

In reply to Re: zyprexa for atypical depression? OldSchool, posted by SLS on March 31, 2002, at 12:32:50

> Zyprexa has antidepressant properties, especially when combined with antidepressants. It might even be most successful when combined with Prozac than for any other drug. I don't know. I am sure that Prozac + Zyprexa will get more people well than Prozac alone. It already has.


Scott you know what Zyprexa plus SSRI did to me? Made me think about suicide more.

>
> As with any other treatment decision, one must weigh the risks versus the potential benefits of choosing to take Zyprexa to augment antidepressants. I have tried a whole bunch of things to treat my bipolar depression without success. When I decided to try Zyprexa, I did so with the information available concerning the risks of it producing EPS or TD. I thought the rates of occurrences of these things were low enough to feel comfortable taking it - especially at dosages of 5.0mg and less.

Again, here are the symptoms I get when I combine atypicals with SSRIs:

1)increased general depression feelings, increased suicidal thoughts
2) decreased appetite
3) worsened sleep
4) decreased libido
5) "numb" tongue feeling
6) muscle "pops and twitches"
7) tight muscle contractions
8) extreme tightness feeling on the back of my head (dystonia?)

Old School

 

Re: John, Judy, Scott, Old School Thank You!

Posted by Mark H. on March 31, 2002, at 13:37:37

In reply to Re: zyprexa for atypical depression?, posted by OldSchool on March 31, 2002, at 13:28:23

Thank you for the additional information! This helps me understand the earlier concerns better.

With appreciation,

Mark H.

 

Re: Zyprexa *never* for depression! JohnX2

Posted by Tye on March 31, 2002, at 14:35:38

In reply to Re: Zyprexa *never* for depression! Tye, posted by JohnX2 on March 31, 2002, at 9:04:33


> > Hey John,
> >
> > Nah, I wouldn't retract my statement. I agree 5-HT2 antagonism reduces anxiety, I am not sure it improves mood directly. Other 5-HT2 antagonist are not antidepressants per say.

> Hi Tye,
>
> I don't think the medicine alone would be effective for vanilla depression (it would for many other disorders). In fact this has already been shown with medicines like Ketanserin. But the sertonin system has been studied, and there is a greater understanding of what makes the SSRI medicines "suck". Blocking out a few receptors would substantially alleviate side effects like anxiety, sexual dysfunction, insomnia, etc. Many people can not tolerate taking SSRIs for Panic disorder, even though they are effective medicines because initially the SSRIs will increase serotonin conductance on these anxiety causing receptors. So these people go after the benzos instead. Also, non compliance from SSRIs from the side effects is a huge issue.
>
> The atypical APs are potentially useful *adjuncts* (not primary medicines in general) for non-pychotics and manics, mainly for their sertonergic blocking properties. The chemical structures that achieve this most always block dopamine receptors however. I have seen a few clean medicines in the pipeline that might not mangle the dopamine system.
>
> But i also agree that the risk of TD is something to take seriously. But they do work fast, and a quick trial of an AP beats taking the long road of an AD for some issues. Also, I have seen many people with depression, generally comorbid with certain other disorders, do well on APs (as well as have bad experiences) just like every other medicine, so I'm not sure what you base your statement regarding efficacy on.
>
> Regards,
> John

Hey John,

If people need the 5HT antagonism for anxiety, why not just add a safer med like serzone or trazodone?

Any thoughts...

Your Friend,

Tye

 

Re: zyprexa for atypical depression? OldSchool

Posted by SLS on March 31, 2002, at 14:51:40

In reply to Re: zyprexa for atypical depression?, posted by OldSchool on March 31, 2002, at 13:28:23

OS,

> > Zyprexa has antidepressant properties, especially when combined with antidepressants. It might even be most successful when combined with Prozac than for any other drug. I don't know. I am sure that Prozac + Zyprexa will get more people well than Prozac alone. It already has.

> Scott you know what Zyprexa plus SSRI did to me? Made me think about suicide more.

That sucks.

The following drugs made me think about suicide more:

amoxapine (Ascendin)
bupropion (Wellbutrin)
idazoxan
mirtazepine (Remeron)
moclobemide (Aurorix, Manerix)
protriptyline (Vivactil)
reboxetine (Edronax)
triiodothyronine (Cytomel)

I hope no one decides not to try one of these drugs based upon my negative experiences with them.

> > As with any other treatment decision, one must weigh the risks versus the potential benefits of choosing to take Zyprexa to augment antidepressants. I have tried a whole bunch of things to treat my bipolar depression without success. When I decided to try Zyprexa, I did so with the information available concerning the risks of it producing EPS or TD. I thought the rates of occurrences of these things were low enough to feel comfortable taking it - especially at dosages of 5.0mg and less.


- Scott

 

Meds triggering suicidal ideation? SLS

Posted by Ritch on March 31, 2002, at 16:29:06

In reply to Re: zyprexa for atypical depression? OldSchool, posted by SLS on March 31, 2002, at 14:51:40

> The following drugs made me think about suicide more:
>
> amoxapine (Ascendin)
> bupropion (Wellbutrin)
> idazoxan
> mirtazepine (Remeron)
> moclobemide (Aurorix, Manerix)
> protriptyline (Vivactil)
> reboxetine (Edronax)
> triiodothyronine (Cytomel)
>
> I hope no one decides not to try one of these drugs based upon my negative experiences with them.


Hi Scott,

Your list of meds that aggravate suicidal ideation is somewhat interesting to me. I noticed they are all principally noradrenergic meds (for the most part). The only time I have any remarkable suicidal ideation is whenever I am in a mixed dysphoric state (hostile and/or anxious/agitated depression). I realize that SSRI's have had a rap for causing that, but I found in my own experience if they chill out my anxiety and I can remain reasonably focused, the ideation is reduced a lot. I had to break down today and try a little chunk of Celexa (2mg), and yeah sure enough here comes that wave of alerting numbness sweeping over me, but everything is just okeedokee now. Add 2.5mg of dexedrine and I feel fine. The dex. is actually making me a little drowsy feeling. My head seems a little hot right above my eyebrows, but I feel ok. It seems that the *trick* for me is to directly boost serotonin and dopamine, but try to avoid "hitting" the NE receptors (at least directly anyways). The worst meds for agitation or dysphoria seems to be stuff like Remeron/Effexor/Wellbutrin, primarily noradrenergic meds like those in your list. I wouldn't worry too much about scaring people away from decent meds, there is enough bad rap to scare them anyhow. Besides you will hear success stories with stuff like Effexor, Remeron from others here anyway. I am just curious why people (even with the same dx) can have such different responses.

Mitch

 

Re: Zyprexa *never* for depression! Tye

Posted by JohnX2 on March 31, 2002, at 20:07:05

In reply to Re: Zyprexa *never* for depression! JohnX2, posted by Tye on March 31, 2002, at 14:35:38

>
> > > Hey John,
> > >
> > > Nah, I wouldn't retract my statement. I agree 5-HT2 antagonism reduces anxiety, I am not sure it improves mood directly. Other 5-HT2 antagonist are not antidepressants per say.
>
> > Hi Tye,
> >
> > I don't think the medicine alone would be effective for vanilla depression (it would for many other disorders). In fact this has already been shown with medicines like Ketanserin. But the sertonin system has been studied, and there is a greater understanding of what makes the SSRI medicines "suck". Blocking out a few receptors would substantially alleviate side effects like anxiety, sexual dysfunction, insomnia, etc. Many people can not tolerate taking SSRIs for Panic disorder, even though they are effective medicines because initially the SSRIs will increase serotonin conductance on these anxiety causing receptors. So these people go after the benzos instead. Also, non compliance from SSRIs from the side effects is a huge issue.
> >
> > The atypical APs are potentially useful *adjuncts* (not primary medicines in general) for non-pychotics and manics, mainly for their sertonergic blocking properties. The chemical structures that achieve this most always block dopamine receptors however. I have seen a few clean medicines in the pipeline that might not mangle the dopamine system.
> >
> > But i also agree that the risk of TD is something to take seriously. But they do work fast, and a quick trial of an AP beats taking the long road of an AD for some issues. Also, I have seen many people with depression, generally comorbid with certain other disorders, do well on APs (as well as have bad experiences) just like every other medicine, so I'm not sure what you base your statement regarding efficacy on.
> >
> > Regards,
> > John
>
> Hey John,
>
> If people need the 5HT antagonism for anxiety, why not just add a safer med like serzone or trazodone?
>
> Any thoughts...
>
> Your Friend,
>
> Tye

Serzone is not an antagonist at the 5-ht2c receptor. In fact, one of its metabolites mCpp is an agonist at that receptor and may cause start up anxiety for some people.

Remeron is another medicine that is a possibility. But Remeron antagonizes the alpha-2 noradrenaline receptor, an action which increases norepinephrine firing in the locus coeruleus, a key stress center of the brain (but generally the 5ht-2 antagonism in Remeron prevents anxiogenic side effects for many).

Sorry, no perfectly clean medicine.

John

 

Re: Zyprexa *never* for depression!

Posted by OldSchool on March 31, 2002, at 20:12:58

In reply to Re: Zyprexa *never* for depression! JohnX2, posted by Tye on March 31, 2002, at 14:35:38

> Hey John,
>
> If people need the 5HT antagonism for anxiety, why not just add a safer med like serzone or trazodone?
>
> Any thoughts...
>
> Your Friend,
>
> Tye


Thats exactly what I say. If you just need 5HT2A receptor antagonism for anxiety, agitation, insomnia or other non direct psychotic/mania stuff, why not just take Remeron, Serzone or Trazadone? As Tye mentioned, all three of these antidepressants antagonise 5HT2A. Remeron in particular does it real real good. Why risk EPS and even TD by going the atypical anti-psychotic route?

Old School

 

Re: zyprexa for atypical depression?

Posted by OldSchool on March 31, 2002, at 20:18:51

In reply to Re: zyprexa for atypical depression? OldSchool, posted by SLS on March 31, 2002, at 14:51:40

> OS,
>
> > > Zyprexa has antidepressant properties, especially when combined with antidepressants. It might even be most successful when combined with Prozac than for any other drug. I don't know. I am sure that Prozac + Zyprexa will get more people well than Prozac alone. It already has.
>
> > Scott you know what Zyprexa plus SSRI did to me? Made me think about suicide more.
>
> That sucks.
>
> The following drugs made me think about suicide more:
>
> amoxapine (Ascendin)
> bupropion (Wellbutrin)
> idazoxan
> mirtazepine (Remeron)
> moclobemide (Aurorix, Manerix)
> protriptyline (Vivactil)
> reboxetine (Edronax)
> triiodothyronine (Cytomel)
>
> I hope no one decides not to try one of these drugs based upon my negative experiences with them.

Scott...you say you are bipolar. Im not bipolar. Its common knowledge that antidepressants oftentimes trigger mania and dysphoric feelings in bipolar people. When I am discussing atypical anti-psychotics on here dude, I am discussing them in reference to UNIPOLAR MAJOR DEPRESSION. Not to Bipolar manic depression or schizophrenia. I made that clear.

I never had an antidepressant that made me think about suicide more. Every one Ive tried made me think about suicide less. However, every atypical Ive taken in conjunction with an antidepressant made me more depressed, as well as caused acute EPS symptoms that were a major pain in the ass.

From now on, whenever you read my posts about atypicals, please remember I am discussing them in regards to UNIPOLAR depression, anxiety, using them for things like insomnia, etc.

Remember...bipolar and unipolar depression are two totally different things.

Old School

 

Re: zyprexa for atypical depression?

Posted by crepuscular on April 1, 2002, at 12:54:15

In reply to zyprexa for atypical depression?, posted by KB on March 28, 2002, at 20:37:47

some people who have "atypical" depression are actually undiagnosed bipolars. if this is the case for you, Zyprexa may work.

for people with bipolar disorder, atypical neuroleptics often *help* with the depressive features as much as mania. my experience with Seroquel has been excellent in this regard. i've also not gained any weight and so, far not a single instance of anything resembling TD/EPS/NMS.

 

Re: zyprexa for atypical depression? OldSchool

Posted by SLS on April 1, 2002, at 13:11:09

In reply to Re: zyprexa for atypical depression?, posted by OldSchool on March 31, 2002, at 20:18:51

Hi OldSchool.


It looks like we have slightly different opinions regarding the use of neuroleptics in mood-illness.


> Scott...you say you are bipolar.

That's what a few doctors have said. Mania has expressed itself only in conjunction with my taking MAO-inhibitors. Some people do not regard this phenomenon as being a defining feature of bipolar disorder. However, because I displayed a striking 11-day ultra rapid cycle (8 days depression followed by 3 days of non-manic euthymia - sometimes called normothymia) for two years prior to drug intervention, I would lean towards bipolarity. Also, that the features of my depression are of the atypical type would be supportive a bipolar depression.

> Im not bipolar. Its common knowledge that antidepressants oftentimes trigger mania and dysphoric feelings in bipolar people.

So? At no time during my dysphoric manic episodes had suicide ever entered my mind. Is suicidality exclusive to manic dysphoria? Of course not.

It is common knowledge that antidepressants can sometimes make unipolar depressives feel worse and think more about suicide. I believe the contention that antidepressants can cause suicide is true. The law suits brought against Eli Lilly regarding Prozac-induced suicide have merit, in my opinion. (I hope Potter and Schmidt aren't reading this). The physicians involved are perhaps more culpable, though.

There are quite a few people on PB describing themselves as unipolar who have reported becoming severely suicidal as a reaction to various drugs. Many had never been suicidal previously. These reactions can be intense, painful, and unique within one's historical experience of depression.

> When I am discussing atypical anti-psychotics on here dude, I am discussing them in reference to UNIPOLAR MAJOR DEPRESSION.

So? Why do you deem bipolar disorder to ineligible or irrelevant in a discussion of drug-induced suicidality? I am confused. OK. Let's talk about unipolar depression.

> I never had an antidepressant that made me think about suicide more.

> However, every atypical <antipsychotic> Ive taken in conjunction with an antidepressant made me more depressed, as well as caused acute EPS symptoms that were a major pain in the ass.


Here is what we know so far:

1. Zyprexa + SSRI = suicidality for OldSchool
2. OldSchool is unipolar.
3. OldSchool has never had an antidepressant make him feel worse.
4. Every atypical neuroleptic antipsychotic that OldSchool has thus far taken in conjunction with an antidepressant has caused him to feel more depressed and has produced EPS.

So far, so good.


These are a few questions that come to mind. I think they might help to put into some perspective (mine, of course ;-)) the use of antipsychotics in unipolar depression.


Question #1: True or False

Statement: Neuroleptic antipsychotics are the only drugs that have caused unipolar depressives to think more about suicide.


Question #2: True or False

Statement: No drug, other than neuroleptic antipsychotics, has ever caused anyone to think more about suicide except for in those people who suffer from mental illness.


Question #3: True or False

Statement: Every unipolar depressive who has taken a neuroleptic antipsychotic has reacted to that drug by thinking more about suicide.


Question #4: What is the percentage of unipolar depressives who react to neuroleptic antipsychotics by thinking more about suicide?


Question #5: What is the rate of response of treatment-resistant unipolar depressives to the addition of a neuroleptic antipsychotic to their treatment regime?


Question #6: What is the rate of response of treatment-resistant unipolar depressives for each drug tried as an adjunct to their treatment regime?


Question #7: True or False

Statement: Every unipolar depressive feels more depressed each time they take an atypical neuroleptic.


Question #8: What is the percentage of unipolar depressives taking appropriately low dosages of atypical neuroleptic antipsychotics that experience EPS?


I don't have statistics to offer for any of these questions.


> From now on, whenever you read my posts about atypicals, please remember I am discussing them in regards to UNIPOLAR depression, anxiety, using them for things like insomnia, etc.

I will.

Is it your opinion that there are no circumstances for which the use of neuroleptics in unipolar depression is justified? If so, which ones?


> Remember...bipolar and unipolar depression are two totally different things.

This is probably true. However, they both suck.

- Scott

 

Re: Zyprexa *never* for depression! OldSchool

Posted by SLS on April 1, 2002, at 13:22:44

In reply to Re: Zyprexa *never* for depression!, posted by OldSchool on March 31, 2002, at 20:12:58

> > If people need the 5HT antagonism for anxiety, why not just add a safer med like serzone or trazodone?
> >
> > Any thoughts...
> >
> > Your Friend,
> >
> > Tye
>
>
> Thats exactly what I say. If you just need 5HT2A receptor antagonism for anxiety, agitation, insomnia or other non direct psychotic/mania stuff, why not just take Remeron, Serzone or Trazadone? As Tye mentioned, all three of these antidepressants antagonise 5HT2A. Remeron in particular does it real real good. Why risk EPS and even TD by going the atypical anti-psychotic route?
>
> Old School

Hi.

I don't think we as a species can yet proclaim an understanding as to how drugs work to alleviate depression - especially on an individual basis.

There may be a modulation of dopaminergic function that is essential to the efficacy of atypical neuroleptics in depression. Consider sulpiride and amisulpride. Both of these neuroleptic antipsychotic drugs are putatively effective in treating depression and dysthymia, and are marketed for those indications around the world. Both antagonize DA D2 receptors. Neither antagonizes 5-HT2 receptors.


- Scott

 

Re: zyprexa for atypical depression? SLS

Posted by SLS on April 1, 2002, at 20:32:50

In reply to Re: zyprexa for atypical depression? OldSchool, posted by SLS on April 1, 2002, at 13:11:09

Sorry about the typos and the redundant questions.

- Scott


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