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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Bob on July 23, 2008, at 13:43:44
Is anyone here familiar with the pros and cons of the various atypicals as an augmentation to antidepressants?
Here's what I think I know:
Abilify can be somewhat stimulating and there's evidence (quite anecdotal at this point) of a "dose threshold" beyond which the drug becomes more calming and sedating. This drug caused insomnia and anger for me. It seems to be more weight neutral than some of the others.
Zyprexa is more sedating, and is notorius for weight gain and risk of diabetes. I've heard this is the best drug for anti-suicidality, anti-anxiety, and may even offer some anti-obsessional benefits.
Risperdal I don't know much about. It seems to be somewhat depressogenic and sedating, but I've never taken more than one or two doses before quitting.
Geodon I know very little about also, other than it is probably the most stimulating. I once tried a single dose of the med years ago, and within a half hour had entered into an akathisic panic.
If anyone has other insights, I'd love to hear about them.
Posted by llurpsienoodle on July 23, 2008, at 15:10:00
In reply to AAP's comparison, posted by Bob on July 23, 2008, at 13:43:44
> Is anyone here familiar with the pros and cons of the various atypicals as an augmentation to antidepressants?
Only from my own personal experience...
>
> Here's what I think I know:
>
> Abilify can be somewhat stimulating and there's evidence (quite anecdotal at this point) of a "dose threshold" beyond which the drug becomes more calming and sedating. This drug caused insomnia and anger for me. It seems to be more weight neutral than some of the others.yep, weight neutral here too. I was taking 5, which was somewhat activating. when I increased to 10, it became more sedating, but only for a few hours after I took it. I have used abilify successfully with zoloft and wellbutrin.
>
> Zyprexa is more sedating, and is notorius for weight gain and risk of diabetes. I've heard this is the best drug for anti-suicidality, anti-anxiety, and may even offer some anti-obsessional benefits.
>
I was Rx Zyprexa for suicidal crises, prn (zydis, the freeze dried antipsychotic candy). It basically knocked me out for 10 hours, made me slur my speech for 15 hours, and eat big portions of ridiculously unhealthy food for the next 48 hours. But, hey, still here, huh?
> Risperdal I don't know much about. It seems to be somewhat depressogenic and sedating, but I've never taken more than one or two doses before quitting.never taken this one
>
> Geodon I know very little about also, other than it is probably the most stimulating. I once tried a single dose of the med years ago, and within a half hour had entered into an akathisic panic.Geodon. oh geodon. My pdoc said that ziprasidone would make me zippy. um. not quite.
I started with 60mg, then increased to 120 mg, split dose. It was a difficult drug for me to take because of the extreme sedation. I would take a dose and become stuporous for the next 3 hours. It was necessary to take provigil to counteract the sedation. I went up to 180 mg because I was a mess, then spent a miserable week on 240mg, split into 4 doses. When I wasn't lying down staring at the ceiling, I was sitting in a rocking chair wondering where my consciousness went. Staring off into space. I took geodon with cymbalta (120 mg) and later with zoloft (50mg)You forgot seroquel!
my first antipsychotic. sigh... (nostalgia). 25 mg knocked me out and got rid of the nagging little thoughts that were keeping me awake at night. Eventually I increased to a therapeutic dose of 300mg. It was tough for the first few weeks, but then the sedation was gone (except for the first 3 hours after my nighttime dose) -- sleepygirl and I were seroquel buddies at the time! and my head was CLEAR. unfortunately, couldn't stay on seroquel because of gaining a pound a week. yuck.>
> If anyone has other insights, I'd love to hear about them.me too
thanks,
-Ll
Posted by Phillipa on July 23, 2008, at 17:08:08
In reply to Re: AAP's comparison » Bob, posted by llurpsienoodle on July 23, 2008, at 15:10:00
Li I've wondered about geodon could never find much on the net. It knocked you out? What about a low dose. Phillipa
Posted by Bob on July 23, 2008, at 22:30:59
In reply to Re: AAP's comparison » Bob, posted by llurpsienoodle on July 23, 2008, at 15:10:00
You're right, I forgot about Seroquel!
I've only ever used Seroquel on a PRN basis for panic situations. It worked rather well for that, but the sedation and groginess the next day were enough for me to not want to try it long term. I guess for that reason I'm reluctant to try Zyprexa and Risperdal long term also.
Posted by chiron on July 23, 2008, at 22:48:26
In reply to AAP's comparison, posted by Bob on July 23, 2008, at 13:43:44
My experiences are atypical (My body doesn't like antipsychotics)
Zyrexa for mixed agitation - made me more agitated.
Abilify - combined w/ Adderall = hospital
Geodon - made me extremely crazy & depressed in a couple weeks. Had ect to get out of it
Seroquel - akathisia
Posted by Bob on July 23, 2008, at 23:53:26
In reply to Re: AAP's comparison, posted by chiron on July 23, 2008, at 22:48:26
> My experiences are atypical (My body doesn't like antipsychotics)
>
> Zyrexa for mixed agitation - made me more agitated.
>
> Abilify - combined w/ Adderall = hospital
>
> Geodon - made me extremely crazy & depressed in a couple weeks. Had ect to get out of it
>
> Seroquel - akathisia
>
>Wow. I'm sorry to hear about your experiences with the AAP's. I too have had many experiences with meds that have nearly landed me in the hospital. I truthfully don't know how I've avoided the emergency room so far in my life.
Geodon is apparently quite a med. My doc says it can do some scary things. He doesn't seem to impressed with it.
What happened when you took the Abilify with the Adderall? How much Abilify were you taking? Did it make you suicidal?
Posted by yxibow on July 29, 2008, at 1:58:11
In reply to AAP's comparison, posted by Bob on July 23, 2008, at 13:43:44
> Is anyone here familiar with the pros and cons of the various atypicals as an augmentation to antidepressants?
>
> Here's what I think I know:
>
> Abilify can be somewhat stimulating and there's evidence (quite anecdotal at this point) of a "dose threshold" beyond which the drug becomes more calming and sedating. This drug caused insomnia and anger for me. It seems to be more weight neutral than some of the others.
>
> Zyprexa is more sedating, and is notorius for weight gain and risk of diabetes. I've heard this is the best drug for anti-suicidality, anti-anxiety, and may even offer some anti-obsessional benefits.
>
> Risperdal I don't know much about. It seems to be somewhat depressogenic and sedating, but I've never taken more than one or two doses before quitting.
>
> Geodon I know very little about also, other than it is probably the most stimulating. I once tried a single dose of the med years ago, and within a half hour had entered into an akathisic panic.
>
> If anyone has other insights, I'd love to hear about them.The response varies wildly to them as I've seen in this thread.
Potency can roughly be said to be Risperdal/Invega (at a high enough dose nearly Haldol occupancy), Geodon/Abilify, and Zyprexa/Seroquel.
This will probably show the average, but not necessarily the norm in side effects especially such as akathisia.
But one has to remember that the biochemical makeup of someone with BP I/II is completely different with someone in the Schizophreniform spectrum or various classes of affective disoders.
Personal, and only personal experience:Low dose Risperdal, terrible nightmares, combined with Prozac a mild tic in my right index finger still there years later. I'm very sensitive to APs though.
Abilify I thought would be the cat's pajamas because of its pushme-pullyou activity. Not terribly different from Geodon, akathisia, crawling and holding the carpet.
Zyprexa -- lets not go there --- first round with a low dose, slept like a baby, best antidepressant. Later use, caused some form of tardive dystonia or dystonic reaction which is still here in my legs and arms (stiffness which varies throughout the day).
Seroquel was finally my agent. Yes, people will note the lipid changing qualities of Zyprexa and Seroquel (and even Risperdal for that matter in some cases), but its all I have left. And this is off label. It doesn't work as well as it used to, but since they haven't invented anything as calm and free of EPS as it except for Clozaril, its about the only option I have.
-- tidings
Jay
Posted by Bob on July 29, 2008, at 19:13:12
In reply to Re: AAP's comparison » Bob, posted by yxibow on July 29, 2008, at 1:58:11
>
> The response varies wildly to them as I've seen in this thread.
>
> Potency can roughly be said to be Risperdal/Invega (at a high enough dose nearly Haldol occupancy), Geodon/Abilify, and Zyprexa/Seroquel.
>
>>
> Seroquel was finally my agent. Yes, people will note the lipid changing qualities of Zyprexa and Seroquel (and even Risperdal for that matter in some cases), but its all I have left. And this is off label. It doesn't work as well as it used to, but since they haven't invented anything as calm and free of EPS as it except for Clozaril, its about the only option I have.
>
> -- tidings
>
> Jay
When you refer to potency, are you talking about against psychosis, or some other effect?Do you use AAP's as an augmentation strategy for AD's, or for some other reason?
Posted by yxibow on July 30, 2008, at 1:01:25
In reply to Re: AAP's comparison » yxibow, posted by Bob on July 29, 2008, at 19:13:12
>
> >
> > The response varies wildly to them as I've seen in this thread.
> >
> > Potency can roughly be said to be Risperdal/Invega (at a high enough dose nearly Haldol occupancy), Geodon/Abilify, and Zyprexa/Seroquel.
> >
> >
>
>
>
> >
> > Seroquel was finally my agent. Yes, people will note the lipid changing qualities of Zyprexa and Seroquel (and even Risperdal for that matter in some cases), but its all I have left. And this is off label. It doesn't work as well as it used to, but since they haven't invented anything as calm and free of EPS as it except for Clozaril, its about the only option I have.
> >
> > -- tidings
> >
> > Jay
>
>
> When you refer to potency, are you talking about against psychosis, or some other effect?
Well that's one measure, but no, occupation of D2 at a standard dose is one way of measuring, increased amount of EPS (extrapyramidal symptoms) is another. At some point all APs will occupy D2 100% at a high enough dose, but its the tenacity of how they grab and let go of it. Haldol and stronger typicals have relatively extreme tenacity and don't let go as much as low potency atypicals as Seroquel. Zyprexa is a slight exception in that it does occupy D2 more, so does its cousin Clozaril -- but again, it lets go, usually, faster.
>
> Do you use AAP's as an augmentation strategy for AD's, or for some other reason?
Yes and yes -- I have a rare/orphan somatiform disorder, which you can look up in previous postings in length, it is off label -- it probably does something to have Seroquel and Luvox on board at the same time, who knows.Primarily, Seroquel improves my "functionality" by reducing "confusion" (not exactly diassociation) and to whatever extent it can, it fights an unknown reason why D2 is higher than it should be, causing ordinary psychiatric vision to be exaggerated (bright lights, etc.) and some auditory stuff like scraping of spoons on soup occasionally can set me off.
Plus a whole clustermess of additional somatoform symptoms not on the list, but most of those are transitory -- obsession about thirst, etc.
This is the end of the thread.
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