Psycho-Babble Medication Thread 100817

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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

 

What Zyprexa is excellent for!

Posted by Tye on April 1, 2002, at 22:19:59

In reply to Re: zyprexa for atypical depression? » SLS, posted by SLS on April 1, 2002, at 20:32:50

Hey,

I still am not convinced zyprexa is an acceptable agent for unipolar or atypical depression as a sole or augmenting agent. What I think zyprexa is good for is:

1. Inducing obesity, potentially diabetes
2. Extra-pyramidal symptoms, potentially TD

So with the aftermentioned risks, why consider zyprexa. This post has been extremely informative and enlightening. Thanks everyone.

Your Friend,

Tye

P.S. Scott, could you please summarize your last three posts? I had difficulty following them. Thanks.

 

Re: What Zyprexa is excellent for! » Tye

Posted by SLS on April 1, 2002, at 23:39:48

In reply to What Zyprexa is excellent for!, posted by Tye on April 1, 2002, at 22:19:59

Hi Tye.

> I still am not convinced zyprexa is an acceptable agent for unipolar or atypical depression as a sole or augmenting agent. What I think zyprexa is good for is:
>
> 1. Inducing obesity, potentially diabetes
> 2. Extra-pyramidal symptoms, potentially TD

You forgot poverty.

> So with the aftermentioned risks, why consider zyprexa. This post has been extremely informative and enlightening. Thanks everyone.
>
> Your Friend,
>
> Tye
>
> P.S. Scott, could you please summarize your last three posts? I had difficulty following them.


I had difficulty writing them! (Obviously).

Some people with severe unipolar depression are refractory to all of the drug treatments they have tried over the course of many years which have excluded Zyprexa and the other neuroleptics. Some of these people go on to achieve remission for the first time in their adult lives when one of these drugs are added. In my opinion, the risk of someone developing EPS and tardive dyskinesia when taking Zyprexa at dosages of 5.0mg or less is low enough to warrant its consideration in some cases.


- Scott

 

Re: What Zyprexa is excellent for - Old School

Posted by Denise528 on April 2, 2002, at 6:03:37

In reply to Re: What Zyprexa is excellent for! » Tye, posted by SLS on April 1, 2002, at 23:39:48

Hello,

I really wish that you wouldn't be so quick to condem Zyprexa because of your own experiences with it. I took SSRIs for about 10 years (5 years prothiaden and 5 years Paxil/Zooloft) and they worked wonderfully well for all that time, I never developed a tolerance for the Seroxat and it never pooped out on me. However, this time round the SSRIs have not worked at all, they have done absolute zip for alleviating my depression and I have been climbing the walls with them, having constant thoughts of suicide. The only drug which has helped me has been zyprexa and I am so grateful that it has been there. Admitedly I am not happy about taking it but it beats the alternative. Sometimes I just take one 10mg and it keeps me going for 5 days.

I am concerned about Tardive Dyskinesia but am more concerned that one day the Zyprexa will stop working as have the SSRIs.

This time round my own experience with SSRIs has been awful but I know that they can work brilliantly when they do work so would never slate them or try to ward other people off them. Although I have been diagnosed as having a mood disorder I feel that I have dysthymia as I had all the traits of a dysthymic from 17 to 23 so I am proof that Zyprexa can help somebody with unipolar depression.

Also, can somebody please explain to me the difference between antagonising a receptor and agonising one?

Thanks.....Denise

 

Re: zyprexa for atypical depression?

Posted by Coyote on April 2, 2002, at 6:48:13

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

Not Zyprexa but Risperdal. It broke a bad downward spiral that SSRI's and mood stabilizers could not stop.

 

Re: What Zyprexa is excellent for - Old School » Denise528

Posted by SLS on April 2, 2002, at 7:59:30

In reply to Re: What Zyprexa is excellent for - Old School, posted by Denise528 on April 2, 2002, at 6:03:37

> Also, can somebody please explain to me the difference between antagonising a receptor and agonising one?
>
> Thanks.....Denise


Hi Denise.

When speaking of neurotransmission, the words "agonize" and "antagonize" refer to the effect that a drug (molecule) has when it attaches itstelf to a receptor.

AGONIZE = attach to and stimulate a receptor; cause is to perform its function

ANTAGONIZE = attach to and block/inhibit a receptor; prevent it from performing its function

---------------------------------

DA = dopamine

DA2 or D2 = dopamine receptor (type-2)

Zyprexa = DA2 antagonist
Mirapex = DA2, DA3 agonist

Generally, the neuroleptic type of antipsychotic antagonize dopamine receptors and reduce the excitability and firing rate of neurons.


- Scott

 

Re: What Zyprexa is excellent for - Old School

Posted by Denise528 on April 2, 2002, at 9:08:02

In reply to Re: What Zyprexa is excellent for - Old School » Denise528, posted by SLS on April 2, 2002, at 7:59:30

Thanks Scott,

Thanks for the explanation, it's clear to me now. However, do SSRIs perform Antagonistic or Agonistic actions or are reuptake inhibitors different?

Denise

 

Re: What Zyprexa is excellent for - Old School » Denise528

Posted by SLS on April 2, 2002, at 10:53:29

In reply to Re: What Zyprexa is excellent for - Old School, posted by Denise528 on April 2, 2002, at 9:08:02

> Thanks Scott,
>
> Thanks for the explanation, it's clear to me now. However, do SSRIs perform Antagonistic or Agonistic actions or are reuptake inhibitors different?
>
> Denise


In the most generic sense, an agonist promotes, and an antagonist inhibits, the event being referred to.

I have seen some authors of medical literature refer to a reuptake-inhibitor as an "indirect" agonist of postsynaptic receptors. These drugs do not attach directly to receptors, and are thus not considered to be receptor ligands. That a serotonin reuptake inhibitor drug like Prozac increases the amount of serotonin in the synaptic cleft (the gap between the pre- and post- synaptic neurons), it causes an increase in the rate of stimulation of the attendant serotonin receptors, as long as these receptors are not also antagonized (blocked) by the same drug. The drug therefore is an agonist of serotonergic receptor stimulation. I do not like this usage of the words "agonist" and "antagonist". They are usually reserved for receptor ligands.

LIGAND: An ion, a molecule, or a molecular group that binds to another chemical entity to form a larger complex. (The American Heritage® Dictionary)

DA (dopamine) antagonists: Zyprexa, Risperdal, Haldol, Thorazine - neuroleptic antipsychotics

DA agonists: Mirapex, Parlodel, Permax, Requip... - anti-parkinsons drugs


-------------------------------------


5-HT = serotonin

Among other things, Serzone does the following:

1. inhibits 5-HT reuptake
2. antagonizes 5-HT2 receptors

The net effect is that Serzone promotes an increase in the stimulation of 5-HT1 and 5-HT3 receptors, but a decrease in the stimulation of 5-HT2 receptors.

That's enough thinking for today. My brain hurts.

:-)


- Scott


 

Re: What Zyprexa is excellent for - Old School

Posted by Denise528 on April 2, 2002, at 11:53:44

In reply to Re: What Zyprexa is excellent for - Old School » Denise528, posted by SLS on April 2, 2002, at 10:53:29

> > Thanks Scott,
> >
> > Thanks for the explanation, it's clear to me now. However, do SSRIs perform Antagonistic or Agonistic actions or are reuptake inhibitors different?
> >
> > Denise
>
>
> In the most generic sense, an agonist promotes, and an antagonist inhibits, the event being referred to.
>
> I have seen some authors of medical literature refer to a reuptake-inhibitor as an "indirect" agonist of postsynaptic receptors. These drugs do not attach directly to receptors, and are thus not considered to be receptor ligands. That a serotonin reuptake inhibitor drug like Prozac increases the amount of serotonin in the synaptic cleft (the gap between the pre- and post- synaptic neurons), it causes an increase in the rate of stimulation of the attendant serotonin receptors, as long as these receptors are not also antagonized (blocked) by the same drug. The drug therefore is an agonist of serotonergic receptor stimulation. I do not like this usage of the words "agonist" and "antagonist". They are usually reserved for receptor ligands.
>
> LIGAND: An ion, a molecule, or a molecular group that binds to another chemical entity to form a larger complex. (The American Heritage® Dictionary)
>
> DA (dopamine) antagonists: Zyprexa, Risperdal, Haldol, Thorazine - neuroleptic antipsychotics
>
> DA agonists: Mirapex, Parlodel, Permax, Requip... - anti-parkinsons drugs
>
>
> -------------------------------------
>
>
> 5-HT = serotonin
>
> Among other things, Serzone does the following:
>
> 1. inhibits 5-HT reuptake
> 2. antagonizes 5-HT2 receptors
>
> The net effect is that Serzone promotes an increase in the stimulation of 5-HT1 and 5-HT3 receptors, but a decrease in the stimulation of 5-HT2 receptors.
>
> That's enough thinking for today. My brain hurts.
>
> :-)
>
>
> - Scott

Scott,

Thanks for such a concise explanation.

Denise

 

Zyprexa progress report

Posted by KB on April 2, 2002, at 20:55:56

In reply to Re: What Zyprexa is excellent for - Old School, posted by Denise528 on April 2, 2002, at 11:53:44

After taking 2.5 mg of Zyprexa since thursday, I
am feeling better - less confused, clumsy, overwhelmed and the pressured feeling of constantly being on a treadmill of tasks has lessened, plus my concentration has improved.

On the down side, I am quite sleepy - after the first dose I fell into such a deep sleep that a fried who called during the night thought I was drunk because I was slurring my words and didn't remember our conversation the next day. On friday I had trouble waking up, felt groggy all day, and fell asleep as soon as I got home from work. Since then it's been a little better, but I'm still having trouble waking up, falling asleep on the subway, and taking long (3 hour) naps after work.

This is a 2-week experiment, so we'll see how I feel by then.

 

Re: Zyprexa progress report » KB

Posted by ChrisK on April 3, 2002, at 4:44:30

In reply to Zyprexa progress report, posted by KB on April 2, 2002, at 20:55:56

KB,

I'm glad that the Zyprexa is working out for you so far. I hope that you don't give up on it just because of the sedation. It took me several months before I adjusted to the sedation. In the mean time try taking it at dinner time. You may end up asleep for the night by 9PM but you should have a good night sleep and feel better in the morning.

I know a lot of people will start a new med on Friday so that they can battle the initial side effects over a weekend rather than fighting to work at the same time.

The only other warning is to watch your weight. It will creep up in a hurry. For me it came in the form of carb cravings. That too shall pass but it is more in terms of months than weeks or days.

I've taken 7.5 mg/day of Zyprexa for over 3 years now and I can tell you that I will probably never go off of it. I notice within two days if I miss a couple of doses. My thoughts become cluttered and dark again and I start to feel agitated.

Best of luck with the rest of the experiment. Regardless of what some people here may say, there are just as many who have seen the benefits.

Chris

 

antipsychotic drugs

Posted by Elizabeth on April 4, 2002, at 4:41:47

In reply to Zyprexa progress report, posted by KB on April 2, 2002, at 20:55:56

Hi. Boy this is a controversial topic -- dopamine antagonists for depression, that is.

It is true that some people become more depressed on antipsychotic drugs. This is a risk, so if you're considering taking them, you should proceed with caution, especially if you're already depressed.

Paradoxically, though, some people with depression (esp. agitated depression) find that low or modest doses of Zyprexa and other atypical APs (dunno about the older DA antagonists) relieve suicidal obsessions. They also sometimes improve other depressive symptoms, perhaps because of a connection to the "negative symptoms" of schizophrenia (which bear some resemblance to some of the symptoms of depression). They can improve mental clarity and help with "brain fog." They can also be helpful for people who have symptoms associated with the amorphous entity known as "borderline personality disorder," notably the extreme mood shifts (such as "anger attacks") which can sometimes lead to dissociative episodes and/or self-injury or other self-destructive impulses. This general stabilizing effect can be put to good use in bipolar disorders as well, of course. Their stabilizing and calming effect may reduce the hyperreactivity and obsessive thoughts/replays often seen in PTSD, and the "negative symptoms" here may be alleviated as well (loss of interest in life, affective blunting, inability to feel close to other people). Finally, some people with OCD benefit from these drugs, in low doses. So as we can see, they have many positive effects that make them worth a try in a lot of situations. This is a benefit of the atypicals in particular: their improved side effect profiles make it worthwhile to try them (especially in low doses) for nonpsychotic conditions. Notice that when APs are used in nonpsychotic conditions, they're usually symptom-directed: they relieve particular symptoms, they don't treat the disorder as a whole (as they often do in psychotic disorders, or as ADs often do in depression, e.g.).

I do think that pdocs are too quick to whip out the antipsychotics if someone doesn't respond completely to an antidepressant. I think there are better strategies that they should probably try first in most cases, strategies that are very unlikely to make things worse. I believe that some of the reasons for this are the fear of using "addictive" drugs (e.g., stimulants), ignorance about the many alternatives (older or newer ADs, augmentation, AD combinations), and excessive concern about occult bipolar disorders (this also leads to overuse of anticonvulsants, IMO).

Another mistake that some pdocs make is assuming that antipsychotic drugs will help with anxiety. This might be in part because antipsychotics are typically sedating and can be calming for people suffering from agitation; the desire to avoid benzodiazepines undoubtedly plays a role as well. I've even heard of doctors trying to force patients to discontinue benzodiazepines, insisting that an antipsychotic will relieve the withdrawal symptoms (it won't) and treat the anxiety disorder (it probably won't do that either). This is cruel and potentially dangerous. In general it's not appropriate to use antipsychotics for your average anxiety disorder, except for some cases of OCD and perhaps severe PTSD. APs are not effective in panic disorder, social or specific phobias, or generalized anxiety.

I might as well throw in my own experience with APs, though it's generally a negative one. I wasn't helped by the addition of antipsychotics to antidepressants (I tried Zyprexa up to 10 mg/day, Seroquel up to 100 mg/day, don't recall the doses of Risperdal or Mellaril, and amoxapine up to 75 mg/day [serum level was probably high though]). IMO, if you have a difficult-to-treat depression, atypical APs are probably worth a try as augmentors even if you don't have any psychotic features. [There actually was, at one time, some speculation between my doctors that I might be having "mood-congruent delusions," but although I'd been agitated, they decided that I most likely wasn't delusional. I'm still not really clear on what constitutes a depressive delusion -- I mean, we've all had some really dark and irrational thoughts while depressed, right? -- so I don't really have an opinion as to what was happening with me back then.

I didn't have any dramatic bad reactions to Zyprexa or Seroquel -- no increased suicidal thoughts or anything like that -- but I did feel sluggish and generally crappy ("malaise" is the technical term for this state, I think) when I tried these two drugs. The only drug of any type that I'd say made me more depressed in any serious way was Risperdal: I took it at bedtime, had a night of horrifying vivid dreams/RBD episodes/frequent awakenings, and woke up feeling agitated and suicidal (this was while I was on one of the MAOIs, too, so most of these problems had been fairly well under control until I took the risperidone). The other DA-blockers I've taken were amoxapine and a very low dose of thioridazine (Mellaril). Neither of these caused any mood problems, although all the TCAs I've taken (amoxapine, desipramine, nortriptyline) seem to have brought on vivid dreams, even when used along with MAOIs (amoxapine + Parnate, nortriptyline + Marplan), which are supposed to suppress REM sleep pretty thoroughly. TCAs have some similarities, both chemical and pharmacological, to phenothiazine antipsychotics -- dunno if that's relevant or what, tho'.

Anyway, the moral of the story is that everybody's different. Don't make a decision about whether to try something based on what happened to somebody else. Take the risks into account (and be prepared to deal with the possible bad effects), but don't be paralyzed into total inaction by them. APs can cause problems for some people, but for many they turn out to be extremely helpful. Unfortunately, it's very hard to predict how any particular person will react to them.

-elizabeth

P.S. A note about extrapyramidal symptoms and their prevention and treatment: I really do think that the atypical APs have made a tremendous difference in terms of side effects and tolerability. I've heard (from reliable sources) that psych hospitals used to be filled with people with all sorts of movement disorders (e.g., "the Thorazine shuffle"). A couple years ago I was visiting someone I knew from group therapy who was hospitalized in the psychotic disorders unit at McLean. I met some of the other patients there, and one of the residents. I didn't see anyone with any visible case of EPS, although the resident said that just about all the patients on that unit were on some sort of antipsychotic drug. There are still a lot of problems in the treatments available for psychiatric illness, but I am impressed with the progress that has been made.

 

Re: antipsychotic drugs (nice write-up) (nm) » Elizabeth

Posted by JohnX2 on April 4, 2002, at 10:26:17

In reply to antipsychotic drugs, posted by Elizabeth on April 4, 2002, at 4:41:47

 

Re: antipsychotic drugs » Elizabeth

Posted by JohnX2 on April 4, 2002, at 10:30:07

In reply to antipsychotic drugs, posted by Elizabeth on April 4, 2002, at 4:41:47

>I've even heard of doctors trying to force patients to discontinue benzodiazepines, insisting that an antipsychotic will relieve the withdrawal symptoms (it won't)

While I was not forced to taper Klonopin, I truly believe that Zyprexa augmentation relieved rebound anxiety and insomnia during the tapering process.

John

 

Re: antipsychotic drugs

Posted by crepuscular on April 4, 2002, at 11:39:55

In reply to antipsychotic drugs, posted by Elizabeth on April 4, 2002, at 4:41:47

100% agreement here Elizabeth. Seroquel has worked for me in the mood cycling department like nothing else. i was both afraid and skeptical, even theoretically opposed, but my pdoc was on to something. it also means I can take modest levels of antidepressants now...

 

Re: zyprexa +zoloft

Posted by Seweryn on June 5, 2002, at 14:20:46

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

I am taking zyprexa 5 mg and zoloft 100 mg and it is quite well althogh I am feeling strange- I have no suicide ruminations and have no tired syndrome. I am well on it now and I wonder how other people go on it? Combination of Prozac and Zyprexa ???

 

xxx for just 70 USD

Posted by Seweryn on July 29, 2002, at 10:43:48

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

I can resell xxx for just 70 USD.

I guarantee honesty and speed delivery at very low price.
if you pay 200 USD for such set please do not hesitate to contact me

 

Zyprexa - life saver and small wonder- Corrected

Posted by totoslim on December 14, 2002, at 11:44:42

In reply to Zyprexa - life saver and small wonder, posted by totoslim on December 14, 2002, at 11:41:51

This drug saved many lifes so mine as well.
However it is very expensive for some people who got no insurance.

Visit this site!!!

xxx

 

Re: medication without a prescription » totoslim

Posted by Dr. Bob on December 14, 2002, at 13:19:52

In reply to Zyprexa - life saver and small wonder- Corrected, posted by totoslim on December 14, 2002, at 11:44:42

> Visit this site!!!
>
> xxx

Please don't use this site to exchange information on how to import into the US prescription medication without a prescription:

http://www.dr-bob.org/babble/faq.html#illegal

Thanks,

Bob

PS: Follow-ups regarding posting policies should be redirected to Psycho-Babble Administration.


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