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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Jesus is Savior on June 16, 2007, at 11:59:38
I may have to go off Zyprexa (even though it works great for my anxiety) because it is causing huge spikes in my blood sugar. Would Geodon be as effective against GAD as zyprexa? Or is geodon going to cause glucose levels to increase also? Remember i have developed tolerance to benzos, so they are not an option.
-MJ
Posted by Phillipa on June 16, 2007, at 12:30:37
In reply to Zyprexa or Geodon?, posted by Jesus is Savior on June 16, 2007, at 11:59:38
I asked my endo about it the other day and he said he knew of no option. Oh great. Love Phillipa
Posted by med_empowered on June 16, 2007, at 13:23:52
In reply to Re: Zyprexa or Geodon? » Jesus is Savior, posted by Phillipa on June 16, 2007, at 12:30:37
generally speaking, if you can avoid an antipsychotic...you should. GAD is a disorder that usually doesn't require antipsychotics. My suggestion would be to go on a benzo or maybe an antidepressant, BuSpar, hydroxyzine, lyrica...anything but an antipsychotic. Even the atypicals can cause tardive dyskinesia and the other long-term problems (tardive dystonia, tardive akathisia, tardive dysphrenia, tardive dementia).....although the atypicals seem better in terms of EPS and probably TD, there are other problems to consider.
Besides, there are other meds that can get the job done without all the risks (and expense) of the atypicals. Benzos are the classic meds--the general rule is they can vanquish any level of anxiety; you just have to get the dose high enough and avoid some pitfalls (disnihibtion, sedation, paradoxical reactions). They're cheap and safe.
Posted by Colleen D. on June 16, 2007, at 15:10:14
In reply to Re: Zyprexa or Geodon?, posted by med_empowered on June 16, 2007, at 13:23:52
When I asked my doc about increasing the dosage amount of my Klonopin for anxiety or changing to another faster-acting benzo, she suggested I try Geodon. Perhaps with my mental health history (about the volume of War and Peace in less than 7 years) she realizes I have other issues, like my sometimes thinking I hear things, and that influenced her decision for her to prescribe Geodon. The warnings you mentioned scare me a little, but I'm still searching for the combination of diet, exercise, meds, etc...to help me get through this single parenting three kids, one with special needs. At 40mg 2x a day, is Geodon really that risky for all the irreversible things you mentioned?
Thanks,
Colleenp.s. - I always follow your posts since you seem to be a well-informed individual...thanks for all you have shared with the group!
> generally speaking, if you can avoid an antipsychotic...you should. GAD is a disorder that usually doesn't require antipsychotics. My suggestion would be to go on a benzo or maybe an antidepressant, BuSpar, hydroxyzine, lyrica...anything but an antipsychotic. Even the atypicals can cause tardive dyskinesia and the other long-term problems (tardive dystonia, tardive akathisia, tardive dysphrenia, tardive dementia).....although the atypicals seem better in terms of EPS and probably TD, there are other problems to consider.
> Besides, there are other meds that can get the job done without all the risks (and expense) of the atypicals. Benzos are the classic meds--the general rule is they can vanquish any level of anxiety; you just have to get the dose high enough and avoid some pitfalls (disnihibtion, sedation, paradoxical reactions). They're cheap and safe.
>
Posted by Colleen D. on June 16, 2007, at 15:14:21
In reply to Re: Zyprexa or Geodon?, posted by Colleen D. on June 16, 2007, at 15:10:14
Posted by Quintal on June 16, 2007, at 18:22:36
In reply to Zyprexa or Geodon?, posted by Jesus is Savior on June 16, 2007, at 11:59:38
Geodon seems to be one of the more activating atypicals (maybe because of the noradrenaline reuptake inhibition) so it probably won't be as effective for anxiety as Zyprexa. According to the available data Geodon has less impact on insulin sensitivity than Zyprexa so it would probably be more manageable for your diabetes though. Seroquel seems to be in a similar league as Zyprexa in terms of insulin sensitivity. It's true what med_empowered says about avoiding antipsychotics because of these side effects, and as you're seeing the effects first hand you know they're not just scare stories invented by the anti-psyciatry brigade. Zyprexa will very likely be raising your blood triglyceride levels like it is your glucose levels, which is an additional concern for someone who has diabetes because you're at higher risk of heart disease etc to start with. It really would be better to find another class of medication if you could.
Q
Posted by med_empowered on June 16, 2007, at 18:44:58
In reply to Re: Zyprexa or Geodon? » Jesus is Savior, posted by Quintal on June 16, 2007, at 18:22:36
Geodon isn't so bad for blood sugars/metabolic issues as zyprexa or seroquel but...the risk isn't zero. More importantly: antipsychotics are rough drugs. The new ones are (probably) safer short- and long-term, in terms of EPS, TD, etc., but they are definitely not risk free. Worse still, your risk of TD goes UP if you have affective (mood) symptoms; thus the depressed, manic, or moody person taking an antipsychotic for whatever reasons is at a higher risk of TD than the average patient with schizophrenia. Why this is the case...no one knows. Plus, being female raises your risks, too.
Geodon may "work," but its not really fixing anything; its lowering dopamine and serotonin levels, and Geodon also has some built-in neurepinephrine reuptake inhibition, so it has some antidepressant action that sometimes leads to increased anxiety, agitation, and drug-induced mania.
I understand how intense anxiety can lead to (semi)psychotic states; however, keep in mind that people who are psychotic--floridly, intensely psychotic--often hate these meds, and some of them do fine off of these meds. Antipsychotics, especially long-term, don't really offer much to anyone, except drug companies (for $$$) and people who need patients to be docile (this is why they are so incredibly popular in old folks' homes, prisons, and mental hospitals, even when the patient could be treated with many other, safer drugs).
I would advise you to seriously consider using another class of medication. More benzos, propranolol, herbs,talk-therapy, self-help, etc. Some patients do OK taking antipsychotics as-needed, usually for agitation or breakthrough quasi-psychotic states--that might be an option, but even then I think a benzo could probably do the job for less money and far fewer risks.
You seem stressed, but still functioning, so some sort of therapy could probably help you out tremendously, if that's an option. I think you should avoid antipsychotics if at all possible--they are not safe drugs and are best avoided.Good luck!
Posted by Phillipa on June 16, 2007, at 19:25:53
In reply to Re: Zyprexa or Geodon?, posted by med_empowered on June 16, 2007, at 18:44:58
Med what if you're building up a tolerance to benzos what do you take then? Doc won't give higher doses. Thanks Love Jnn
Posted by med_empowered on June 17, 2007, at 18:00:42
In reply to Re: Zyprexa or Geodon? » med_empowered, posted by Phillipa on June 16, 2007, at 19:25:53
I think it really depends...how high is your dose? Some docs give 4, 6, 8mgs/day of Klonopin (and sometimes xanax), so it may just be your doc. I personally think that if you've been on benzos for a long time, you're not abusing them or involved in other substance abuse, and you're still having anxiety, a dosage increase (to a point) shouldn't be a big deal, unless higher doses cause problems (cognitive impairment, rage reactions, disinhibtion, that kind of thing) for you.
Antipsychotics might "work," but they work more by inducing apathy and numbing overall consciousness and emotions, rather than by sedating or allowing for relaxation, which is what benzos, miltown, and the barbiturates do. "Addiction" aside, benzos are much safer and cheaper than antipsychotics, and I think most antidpressants.
What's causing the stress? If its situational stuff, try addressing it, maybe enlisting the aid of a therapist/counsellor if that helps. Are you taking any other medications that cause anxiety? Tolernace to the benzos might be part of the anxiety problem if you're going through mini-withdrawals (common with xanax) or if your panic attacks are worse now than before the benzos. I think in those cases you're supposed to taper or go on a higher dose.
Anyway...it kind of sucks, but maybe BuSpar? I imagine that WITH a benzo it might be helpful; alone, it isn't so great. Antidepressants help some people...I read a case study where a patient with treatment-resistant panic attacks got better on Surmontil (an old tricyclic) after other antidepressants had failed.Good luck.
Posted by Colleen D. on June 17, 2007, at 20:34:29
In reply to Re: Zyprexa or Geodon?, posted by med_empowered on June 17, 2007, at 18:00:42
> I think it really depends...how high is your dose? Some docs give 4, 6, 8mgs/day of Klonopin (and sometimes xanax), so it may just be your doc. I personally think that if you've been on benzos for a long time, you're not abusing them or involved in other substance abuse, and you're still having anxiety, a dosage increase (to a point) shouldn't be a big deal, unless higher doses cause problems (cognitive impairment, rage reactions, disinhibtion, that kind of thing) for you.
The Klonopin, I think, is responsible for my daytime drowsiness, mild cognitive impairment, rage reactions, disinhibtion...especially if I have even one drink on the weekend, on my one day off from parenting.
>Antipsychotics might "work," but they work more by inducing apathy and numbing overall consciousness and emotions, rather than by sedating or allowing for relaxation, which is what benzos, miltown, and the barbiturates do. "Addiction" aside, benzos are much safer and cheaper than antipsychotics, and I think most antidpressants.I actually asked for Xanax in place of the Klonopin, so I could take PRN and eliminate the drowsiness. I take Klonopin .5mg at bedtime and when I wake rather than the 3x per divided dosing that's recommended.
>What's causing the stress? If its situational stuff, try addressing it, maybe enlisting the aid of a therapist/counsellor if that helps. Are you taking any other medications that cause anxiety? Tolernace to the benzos might be part of the anxiety problem if you're going through mini-withdrawals (common with xanax) or if your panic attacks are worse now than before the benzos. I think in those cases you're supposed to taper or go on a higher dose.
It IS situational stress and physical exhaustion from caring for the three of them on my own. My son has low vision and is autistic and his self-stim behaviors are over-stimulating me. I petitioned the agency for respite care since the only support I have is my mom, and my ex has the kids one day a week. No sibs to help on occasion. The agency determined that because there are other children in the home I don't qaulify for any of the respite programs. I lost my dream job (position eliminated) in Feb. and now am unemployed drawing UE until mid-July. I just purchased a home last fall because of the great job I HAD.
>Anyway...it kind of sucks, but maybe BuSpar? I imagine that WITH a benzo it might be helpful; alone, it isn't so great. Antidepressants help some people...I read a case study where a patient with treatment-resistant panic attacks got better on Surmontil (an old tricyclic) after other antidepressants had failed.
>
> Good luck.My current cocktail is Zoloft 100mg, Klonopin up to 1.5mg , doxepin 25 to 50mg for sleep, and now the Geodon, 40mg 2x per day. Zoloft is wonderful for my OCD and MDD...
Thanks for responding! Sometimes it's so hard to sort through all the stuff I find in internet searches when I get prescribed yet another trial of X drug. May I ask if you are live in the US? I know drugs are prescribed differently in different countries.
:-) Colleen
Posted by Phillipa on June 17, 2007, at 21:39:35
In reply to Re: Zyprexa or Geodon?, posted by med_empowered on June 17, 2007, at 18:00:42
Med sorry I haven't written in a while but I take 20mg of valium,.5 of xanax, and 3mg of lunesta at night. When life was going fine I was med free. When no stress I do much better and don't require anything higher. And no when the pdocs have told me to take a higher dose I've said no. Don't drink, do any drugs and never have. I've been taking the luvox supposed to keep going up on it but at l00mg I don't feel well. Last summer at 25mg I felt better. I'm seeing a PHD google therapists Charlotte NC and second page you will see who I see Jane Marcus. Let me know via e-mail if you would what you think of her and what I should do. And I read on crazymeds that it's really bad with caffeine the luvox that is . And I found iced green tea and like it. My only depression is from being so scared when home or going out and ad's can't fix this. Love Jan
Posted by med_empowered on June 17, 2007, at 23:39:52
In reply to Re: Zyprexa or Geodon? » med_empowered, posted by Phillipa on June 17, 2007, at 21:39:35
docs are weird about valium. 20 mgs isn't a lot. 40mgs/day was a pretty standard starting dose in the 70s for anxiety..then it got the "Mother's Little Helper" rep, and now docs will rx lots of Klonopin (keep in mind that 2mgsK=40mgsValium) and even xanax (although that's falling out of favor) and ativan, but they won't raise valium doses high enough. oh well.
Maybe switch to xanax? Klonopin is the "it" benzo at the moment but...maybe if you switch to an older doc, they'll have the wisdom to rx something that works, not just what's hip at the moment.
Good luck!
Posted by tgo on June 18, 2007, at 16:51:17
In reply to Re: Zyprexa or Geodon?, posted by med_empowered on June 16, 2007, at 18:44:58
Med-empowered,
After reading your posts about atypicals, I am concerned about being on Geodon. I am on it as a mood stabilizer for moodiness and tiredness and it is working well for me. Do you think I should switch to an anticonvulsant such as trileptal for long-term mood maintenance. I am scared of irreversible side effects now after reading some of the above posts!
Posted by Zyprexa on June 18, 2007, at 22:17:19
In reply to Re: Zyprexa or Geodon? » med_empowered, posted by tgo on June 18, 2007, at 16:51:17
I have no errevesable side effects from either of those 2 in heading. Have been taking zyprexa for almost 10 years. Geodon I took for 2 years, got blurry vision that went away when I stoped it. I say if its working with acceptable side effects keep taking it.
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