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Dr. Bob is Robert Hsiung, MD,
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Posted by bipolarspectrum on August 13, 2005, at 2:37:45
Hi,
I'm taking zyprexa and it really sedates me.. So I'm looking for a new atypical antipsychotic.. is seroquel good for depression? Is seroquel as bad zyprexa for sedation??
bps
Posted by blueberry on August 14, 2005, at 10:50:45
In reply to is SEROQUEL better than ZYPREXA for depression?, posted by bipolarspectrum on August 13, 2005, at 2:37:45
There is no way to tell whether seroquel or zyprexa would be better for depression. We all respond so individually. In either case, they seem to work a lot better than on their own when combined with a small dose ssri, most especially prozac. I do know that zyprexa helps my depression quite a bit, in combo with 10mg prozac, but that seroquel actually created depression for me.
Seroquel sedation is generally stronger than zyprexa sedation. In either case, the sedation does ease off over time. I've taken 5mg zyprexa for a long time. At first it was quite sedating. Now it helps me get to sleep (about 4 hours after dosing), and provides excellent sleep, but it has zero sedation during the day.
Changing the dosing time can help. If you take it too close to bedtime, then there can be a lot of sedation carryover into the next day. I have found that taking zyprexa at 5:00pm is the best for me. It helps me relax in the evening, and then I'm ready for bed about 4 hours later.
Hope this helps a little.
Posted by med_empowered on August 14, 2005, at 21:03:30
In reply to is SEROQUEL better than ZYPREXA for depression?, posted by bipolarspectrum on August 13, 2005, at 2:37:45
Hey! Your mileage will vary but...seroquel is usually pretty sedating. Its used as a sleep aid, and its the antipsychotic/mood-stabilizer of choice for those with insomnia. But...some people seem to do well on it, and they adjust to the sedation. Seroquel is usually dosed 2X daily, but 3X daily might be useful to reduce daytime sedation. Atypicals can help depression, but they can also cause problems--akathisia, EPS, worsened depression--so careful dosing and med combination is absolutely essential. Zyprexa has been the leader in treating bipolar disorder/BP depression/severe depression, but there are a number of studies out now (supported by the manufacturer, I think) that show that Seroquel can be effective for both the manic and depressive ends of bipolar (and control psychosis and insomnia) as monotherapy. If this holds true in real-life, Seroquel could be the first medication to be truly effective bipolar monotherapy. On the other hand, you do have other options. I don't like antipsychotics, but I did respond well to low-dose (5-7.5mgs) Abilify, in combo with Celexa...at higher doses, I just felt apathetic and stupid. But...Abilify is pretty much weight neutral, doesn't *seem* to cause as much metabolic weirdness as the other atypicals (time will tell though), is usually non-sedating (sometimes even activating...you might want to take it in the morning), and seems to have a very good side-effect profile. On the other hand...its mechanism of action (both reducing and bumping up dopamine and serotonin levels) is unique, so no one really knows how its going to play out long-term. The other option would be Geodon. Geodon is sedating, mostly at first, but some people do stop taking it b/c of sedation. Its a 2X daily medication, like seroquel. It tends to be more or less weight neutral and has a very good side-effect profile in terms of EPS; even in overdose, tremor, akathisia, etc. usually aren't major problems (EPS is usually dose-dependent, so those who overdose on neuroleptics show *incredible* EPS...with Geodon, this seems to be much less of a problem). I believe Geodon still has the metabolic-weirdness factor that many of others have, and it seems to push some people *into* mania--this seems to happen at the lower doses, so you may want to aim for a mid-to-high-range dose if you opt to take Geodon and titrate as quickly as possible. Geodon also causes cardiovascular weirdness kind of like that seen with Mellaril, an old antipsychotic (only it seems to be milder). Mellaril was recently re-packaged with a warning regarding the cardiovascular stuff; it may be connected to some of the "sudden deaths" seen in neuroleptic-treated schizophrenics...no one knows how often this happened, since it really wasn't studied that well (Mellaril was introduced around 1962, and the warning was only recently required, if that gives you any idea of how long it can take for side effects like this to be studied and understood...and for action to be taken). Whatever you do, keep in mind that although tardive dyskinesia is much less common with the atypicals (the rate seems to be .5-1%/year baseline, compared to 3%/year baseline for the old drugs; the elderly, especially older women, have a higher risk...people with disorders such as bipolar or severe depression or "moody schizophrenia" may be at a higher risk of tardive dyskinesia than those with more "pure" schizophrenia). The development of diabetes type II is an issue with all atypicals, although Zyprexa seems to be the biggest offender and Abilify seems to be less damaging in this regard. Weight gain is an issue with most of the atypicals except for abilify and geodon--you may gain a pound or two on these, but the gain is insignificant enough for the drugs to be considered "weight neutral". I didn't mention Risperdal in this post, and that's b/c Risperdal is harsher than the other atypicals, particurarly at higher doses, and it causes hormonal weirdness and things of that nature. I also didn't mention clozapine, because clozapine is usually reserved as a last-ditch effort for resistant schizophrenia or resistant bipolar disorder
Good luck!
Posted by bipolarspectrum on August 15, 2005, at 2:42:01
In reply to Re: is SEROQUEL better than ZYPREXA for depression?, posted by blueberry on August 14, 2005, at 10:50:45
Hey,
Thanx for the replies.. I'm currently on Zyprexa and find it very sedating.. I'm not sure its helping much with my bipolar depression either.. Yeah, I'm very excited about the Seroquel trials because it seems that Seroquel could be effective for bipolar depression... Are tips for ways of reducing zyprexa sedation? I've tried alertec and tried splitting up the dosing..
Posted by med_empowered on August 15, 2005, at 10:09:51
In reply to Re: is SEROQUEL better than ZYPREXA for depression?, posted by bipolarspectrum on August 15, 2005, at 2:42:01
hey! If you opt for zyprexa, there are a few thing you could do about sedation...if you're not suffering from schizophrenia, psychotic depression, or a pscyhotic phase of bipolar, your doc might be willing to try something like Provigil as morning add-on...it could, theoretically, counteract some of the sedation w/o making you feel wired or upping the risk of psychosis too much (back when thorazine was introduced, it was often mixed with Ritalin or Dexedrine to counter-act sedation). You might want to start lower than you are now; 5mgs/day is a usual starting dose (the symbyax starting doses are ofen somewhat higher). I think there's a 2.5mg tablet; if its not available to you, you can purchase a pill cutter/splicer at your local pharmacy and cut the pill more or less in half and then dose upwards until you feel adequate relief and can also handle any accompanying sedation. One poster here recommended taking the zyprexa around 5PM, rather than just before bedtime...it apparently works to calm you down and lull you to sleep w/o much sedation in the day this way. Adding a stimulating anti-depressant might be useful, but the outcomes of this kind of combo would be largely unknown...Pamelor, Wellbutrin, and Cymbalta/Effexor might be good meds to try for this kind of thing. Symbyax might also be a good idea, since the Prozac component is often somewhat "stimulating". I dont know what zyprexa/prozac combos are available, but I think the starting dose is 6zyprexa/20prozac...I would imagine that there are formulations that are more zyprexa- or prozac- heavy, depending on your needs. Good luck!
Posted by ed_uk on August 15, 2005, at 10:46:14
In reply to Re: is SEROQUEL better than ZYPREXA for depression, posted by med_empowered on August 15, 2005, at 10:09:51
Hi Med!
>I think there's a 2.5mg tablet....
There certainly is :-)
>Symbyax
In the US it comes as olanzapine/fluoxetine 6/25, 6/50, 12/25 and 12/50.
~Ed
Posted by SLS on August 15, 2005, at 18:34:47
In reply to is SEROQUEL better than ZYPREXA for depression?, posted by bipolarspectrum on August 13, 2005, at 2:37:45
The most recent literature includes descriptions of Seroquel as possessing significant antidepressant properties.
http://www.psycheducation.org/depression/meds/quetiapine.htm
- Scott
1: Am J Psychiatry. 2005 Jul;162(7):1351-60. Related Articles, Links
A randomized, double-blind, placebo-controlled trial of quetiapine in the treatment of bipolar I or II depression.Calabrese JR, Keck PE Jr, Macfadden W, Minkwitz M, Ketter TA, Weisler RH, Cutler AJ, McCoy R, Wilson E, Mullen J.
University Hospitals of Cleveland and Case University School of Medicine, 11400 Euclid Ave., Suite 200, Cleveland, OH 44106, USA. joseph.calabrese@uhhs.com
OBJECTIVE: There is a major unmet need for effective options in the treatment of bipolar depression. METHOD: Five hundred forty-two outpatients with bipolar I (N=360) or II (N=182) disorder experiencing a major depressive episode (DSM-IV) were randomly assigned to 8 weeks of quetiapine (600 or 300 mg/day) or placebo. The primary efficacy measure was mean change from baseline to week 8 in the Montgomery-Asberg Depression Rating Scale total score. Additional efficacy assessments included the Hamilton Depression Rating Scale, Clinical Global Impression of severity and improvement, Hamilton Anxiety Rating Scale, Pittsburgh Sleep Quality Index, and Quality of Life Enjoyment and Satisfaction Questionnaire. RESULTS: Quetiapine at either dose demonstrated statistically significant improvement in Montgomery-Asberg Depression Rating Scale total scores compared with placebo from week 1 onward. The proportions of patients meeting response criteria (> or =50% Montgomery-Asberg Depression Rating Scale score improvement) at the final assessment in the groups taking 600 and 300 mg/day of quetiapine were 58.2% and 57.6%, respectively, versus 36.1% for placebo. The proportions of patients meeting remission criteria (Montgomery-Asberg Depression Rating Scale < or =12) were 52.9% in the groups taking 600 and 300 mg/day of quetiapine versus 28.4% for placebo. Quetiapine at 600 and 300 mg/day significantly improved 9 of 10 and 8 of 10 Montgomery-Asberg Depression Rating Scale items, respectively, compared to placebo, including the core symptoms of depression. Treatment-emergent mania rates were low and similar for the quetiapine and placebo groups (3.2% and 3.9%, respectively). CONCLUSIONS: Quetiapine monotherapy is efficacious and well tolerated for the treatment of bipolar depression.
PMID: 15994719 [PubMed - in process]
Posted by bipolarspectrum on August 17, 2005, at 3:03:39
In reply to Re: is SEROQUEL better than ZYPREXA for depression, posted by med_empowered on August 15, 2005, at 10:09:51
Hello,
Thanx for the replies... That study regarding seroquel is what i was referring too earlier.. I was wondering if anyone else has felt the antidepressant effects of seroquel... Zyprexa knocks me out and doesnt help much with my depression.. I'm wondering if Seroquel would be different?
bps
Posted by fatigued on August 18, 2005, at 8:28:22
In reply to Re: is SEROQUEL better than ZYPREXA for depression, posted by bipolarspectrum on August 17, 2005, at 3:03:39
I hope not to dissappoint, but like previous poster, seroquel above 50 mg caused worsening depression for me. I still use it carefully for insomnia and it is wonderful for that. No sedation hangover. For BP2, I am also taking 40 celexa and ramping up on lamictal to 200mg. Celexa has decreased length and severity of depression, but I am hoping lamictal will settle frequent hypomania, Good luck!
Roger
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