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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by ronaldo on October 29, 2006, at 7:55:53
Today I am really in a positive mood - a bit of a rarity for me. It is the end of daylight saving time in the UK today. I don't think that has anything to do with it. The clocks here SPRING forward and FALL back by one hour.
I have been on 5 mg Olanzapine for nearly four years. I tapered down to 0 mg just over a month ago. I blamed it for my flat affect. Insomnia forced me to go back on it at 10 mg two weeks ago. My sleep is improving - I manage to get 6 or more hours every night. My reading tells me that Olanzapine increases dopamine levels with resultant relief of depression. Is this right? My dx is manic depression in remission. So says my ex pdoc. I think my 10 mg Olanzapine is starting to kick in. Is this true? Can it take two weeks to 'bed in'? I like the way I feel on the 10 mg.
My alternative dx is schizo-affective disorder. I only experience the negative symptoms of schizophrenia: social withdrawal, lack of energy, apathy, and reduced ability to express emotion. It is still 'early days' I know but I feel like the 10 mg Olanz. is helping these symptoms.
My current pdoc tried me on 50 mg Seroquel which did not work for me despite trying it for 24 days at various dosages between 6.25 (approx.); 12.5; 25; 50; 75; 100 mg. Perhaps I did not persevere long enough on one particular dosage? I have been off the Seroquel for 15 days. I don't think I will try it again, unless my pdoc can convince me that it takes 2 weeks on a constant dosage to 'bed in' before any benefit becomes apparent. I did not really like the Seroquel. Side effects were a stuffy nose and anxiety when I was withdrawing from it.
My opinion of Olanzapine has undergone a reversal. I now think it is something that can help me. I am now prepared to take it 'for ever'. Can anyone please tell me how it works in the brain and on the synapses? Does it block the receptors? Does it inhibit re-uptake? I would be very grateful for some indicators from you psycho-pharmacological boffins out there... Does anyone out there have an Olanzapine success story to share with me? Or else has anybody got a cautionary tale to tell?
I will be really grateful for anything anybody can share with me.
Thanks
...Alan
Posted by SLS on October 29, 2006, at 8:56:04
In reply to Long term Olanzapine for BP....any comments?, posted by ronaldo on October 29, 2006, at 7:55:53
Therapeutically, olanzapine (Zyprexa) can work miracles with a relatively low risk of EPS and TD. However, it can wreak havoc with glucose dynamics and triglycerides, and cause weight gain. If you monitor these things carefully and don't run into problems, you might not need to search for another drug. I would just mention that aripiprazole (Abilify) offers much of the same therapeutic benefit as olanzapine against negative symptoms and is without these metabolic drawbacks. It sometimes produces anxiety and insomnia as startup side effects during the first few weeks, but these usually disappear. It can be a remarkably clean drug.
- Scott
Posted by ronaldo on October 29, 2006, at 9:32:32
In reply to Re: Long term Olanzapine for BP....any comments?, posted by SLS on October 29, 2006, at 8:56:04
> Therapeutically, olanzapine (Zyprexa) can work miracles with a relatively low risk of EPS and TD. However, it can wreak havoc with glucose dynamics and triglycerides, and cause weight gain. If you monitor these things carefully and don't run into problems, you might not need to search for another drug. I would just mention that aripiprazole (Abilify) offers much of the same therapeutic benefit as olanzapine against negative symptoms and is without these metabolic drawbacks. It sometimes produces anxiety and insomnia as startup side effects during the first few weeks, but these usually disappear. It can be a remarkably clean drug.
>
>
> - ScottThanks for your answer, Scott. While I was on the 5 mg Olanzapine (long term) I had a recent blood test for sugar (hyperglycaemia?) which was negative. I also did not put on any weight while on the 5 mg. I have just weighed myself and I have not put on any weight on the 10 mg. I guess I should consider myself lucky. I will keep a careful watch on my weight and blood sugar. If they should become a problem I will remind my pdoc of Abilify. Thanks for that.
Seroquel was also unsuitable because at the higher dosage - 100 mg - it made me feel 'spaced out' without doing anything for my sleep.
While on the 5 mg Olanzapine I did complain of feeling over-sedated yet since I have been on the 10 mg I have encountered less of this. It seems strange that I should feel sedated at 5 mg and not at 10 mg. Is there a logical explanation for this? Maybe it is too soon to tell? Maybe the feeling of over-sedation was compounded by lack of sleep. I suffered from early awakening (5:00 am) and an inability to get back to sleep on the 5 mg Olanzapine.
Maybe I am feeling so 'bouncy' ('hypomanic') today because I had the best night's sleep for years last night.
...Alan
Posted by Phillipa on October 29, 2006, at 11:00:39
In reply to Re: Long term Olanzapine for BP....any comments? » SLS, posted by ronaldo on October 29, 2006, at 9:32:32
Ronaldo I think that's wonderful that you feel so great today. And I sincerely hope this continues for you. And you got a great answer from Scott. Love Phillipa have a wonderful day.
Posted by med_empowered on October 29, 2006, at 11:20:24
In reply to Re: Long term Olanzapine for BP....any comments? » ronaldo, posted by Phillipa on October 29, 2006, at 11:00:39
zyprexa has lower EPS and TD rates than, say, Haldol, but both can still occur, so do watch for that.
Adding metformin to the zyprexa may help reduce/minimize/reverse metabolic issues that pop up.
Abilify is different from zyprexa (generally not sedating, best taken in the morning, etc.) but it seems to have a low EPS rate and I don't think any cases of TD have been reported yet (although it is entirely possible this drug *will* cause TD, since it can suppress pre-existing cases of TD). Some people hate the first couple weeks; a beta blocker and/or benzo might be a good call for the initial period. Since ABilify can pump up or reduce dopamine levels (after inducing a state of low dopamine), it may be more tolerable than other APs out there.
Olanzapine boosts dopamine when mixed with Prozac (and probably other antidepressants as well)..alone it drops levels of most neurotransmitters. I imagine other APs have similar effects, but...who knows.
Posted by SLS on October 30, 2006, at 7:20:18
In reply to Re: Long term Olanzapine for BP....any comments?, posted by med_empowered on October 29, 2006, at 11:20:24
> Abilify is different from zyprexa (generally not sedating, best taken in the morning, etc.) but it seems to have a low EPS rate and I don't think any cases of TD have been reported yet (although it is entirely possible this drug *will* cause TD, since it can suppress pre-existing cases of TD).
One case has been reported by the folks at Mass. General / Harvard.
1: CNS Spectr. 2006 Jun;11(6):435-9.
Aripiprazole-related tardive dyskinesia.
* Maytal G,
* Ostacher M,
* Stern TA.Psychiatric Consultation Service, Massachusetts General Hospital, Boston, MA 02114, USA. gmaytal@partners.org
The low prevalence of extrapyramidal symptoms associated with atypical antipsychotics has led to their widespread use during the past decade. Aripiprazole, the newest medication in this class, has been associated with extrapyramidal symptoms (eg, akathisia) and with improvement of tardive dyskinesia (TD), but to date it has not been associated with the development of TD. We report a case of TD associated with the use of aripiprazole 15 mg/day for 18 months for refractory depression. Symptoms of TD resolved within several weeks of discontinuation of aripiprazole.
PMID: 16816781 [PubMed - indexed for MEDLINE]
Posted by deniseuk190466 on October 30, 2006, at 14:06:32
In reply to Long term Olanzapine for BP....any comments?, posted by ronaldo on October 29, 2006, at 7:55:53
Hi,
I have taken Zyprexa 10mg on and off over the last five years and it always clears my head and helps me to think straight again. 5mg doesn't seem to have the same affect.
I don't want to have to take it for ever though, not because of weight gain as I don't have a problem with that but because I just don't want to need it.
Denise
This is the end of the thread.
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