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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by jerrypharmstudent on July 24, 2009, at 16:22:26
I've been doing well since starting Zyprexa about 6 weeks ago. However for a bout a week now in the afternoon I have this extreme internal restlessness - mostly in my upper body/neck/shoulders/arms. It's hard to explain. This my be gross but it feels like I want to rip the skin off my arms (not that I do any self harm or anything - this is just an example).
I see my doctor on Monday but I don't know how to explain this. COuld the Zyprexa be causing it? I have Cogentin prescribed to me for restless legs if needed, but I haven't been taking it - maybe I should now? Maybe it would help?
Anyone know what I'm taking about? Here's a list of my meds:
Zyprexa 5mg
Lexapro 30mg
Adderall 20mg 3x daily
Klonopin 1mg 4xdaily
Ambien 10mg HS
Cogentin 1mg 2x dailyHELP!
THANKS!
Posted by linkadge on July 24, 2009, at 16:35:08
In reply to Extreme internal restlessness/agitation!!!! HELP, posted by jerrypharmstudent on July 24, 2009, at 16:22:26
What about lowering the lexapro, reducing/eliminating the zyprexa and using a TCA instead for augmentation?
A low dose of nortriptyline or amitriptyline might replace zyprexa and boost the effectivness of the lexapro, while not overly exaserbating the agitation.
Linkadge
Posted by jerrypharmstudent on July 24, 2009, at 16:48:14
In reply to Re: Extreme internal restlessness/agitation!!!! HELP, posted by linkadge on July 24, 2009, at 16:35:08
> What about lowering the lexapro, reducing/eliminating the zyprexa and using a TCA instead for augmentation?
>
> A low dose of nortriptyline or amitriptyline might replace zyprexa and boost the effectivness of the lexapro, while not overly exaserbating the agitation.
>
> LinkadgeGood idea. I wish you were my Pdoc! I have about 10-15 mins at max to see/talk with him because he has many clients and barely has time to THINK. I'm thinking he's going to blame it on the Adderall or pile on another med like Lamictal. Who knows. I've just started seeing him since my old Pdoc resigned and we don't have a good working relationship as of yet so my ideas may just go through on ear and out the other.
LOL - how's that for positive thinking? But thanks Link for the ideas!
Jerry
Posted by linkadge on July 24, 2009, at 17:34:50
In reply to Re: Extreme internal restlessness/agitation!!!! HE » linkadge, posted by jerrypharmstudent on July 24, 2009, at 16:48:14
I know, its frustrating.
Do you have any relatives that did well on TCA's?
My mother did well on a TCA and this was what convinved my doctor to try a TCA. Other than that you could just be honest.
Say you were discussing the problem on an online psychiatric site, and some people suggested that a TCA might cause less akathesia than the SSRI's. What do you think?
As far as reducing meds, you can always do that on your own.
Linkadge
Posted by Phillipa on July 24, 2009, at 20:39:52
In reply to Re: Extreme internal restlessness/agitation!!!! HE, posted by linkadge on July 24, 2009, at 17:34:50
I was also thinking akethesia. Phillipa
Posted by jerrypharmstudent on July 24, 2009, at 21:04:00
In reply to Re: Extreme internal restlessness/agitation!!!! HE, posted by linkadge on July 24, 2009, at 17:34:50
> I know, its frustrating.
>
> Do you have any relatives that did well on TCA's?
>
> My mother did well on a TCA and this was what convinved my doctor to try a TCA. Other than that you could just be honest.
>
> Say you were discussing the problem on an online psychiatric site, and some people suggested that a TCA might cause less akathesia than the SSRI's. What do you think?
>
> As far as reducing meds, you can always do that on your own.
>
> Linkadge
>
>Sounds like a plan. I'm just thinking: WOuld a TCA cover what an Anti-Psychotic would cover? Because like I said before the Zyprexa has helped me a a lot in some ways. I just don't want to sink back into the dark hole of depression.
Posted by SLS on July 25, 2009, at 0:08:28
In reply to Re: Extreme internal restlessness/agitation!!!! HE » linkadge, posted by jerrypharmstudent on July 24, 2009, at 21:04:00
Don't you think that there is a possibility for akathisia to develop from the Zyprexa being added to the Lexapro?
I don't know, but perhaps it makes sense to reduce the dosage of Lexapro first before taking away the drug that made you feel better. Otherwise, I think making the swap between Zyprexa and nortriptyline is a reasonable course of action.
What is the Cogentin for? That doesn't always eliminate akathisia.
- Scott
Posted by softheprairie on July 25, 2009, at 4:11:12
In reply to Re: Extreme internal restlessness/agitation!!!! HE » jerrypharmstudent, posted by SLS on July 25, 2009, at 0:08:28
I'm sorry to hear of what sounds like akathisia. I had it from Abilify and it bites. If it ends up being from Zyprexa, I think you should not rule out a trial of perphenazine; I'm pretty pleased w/ it. Or you might like risperidone (?sp).
Posted by Zyprexa on July 25, 2009, at 6:22:04
In reply to Extreme internal restlessness/agitation!!!! HELP, posted by jerrypharmstudent on July 24, 2009, at 16:22:26
I think its likely that the adderol is doing it. You could always try to add back in the cogentin and see if it helps. I've never had that problem with zyprexa, in 11 years.
Posted by linkadge on July 25, 2009, at 7:22:45
In reply to Re: Extreme internal restlessness/agitation!!!! HE » linkadge, posted by jerrypharmstudent on July 24, 2009, at 21:04:00
Whether a TCA would completely cover what zyprexa does isn't 100% clear. There is overlap in the receptors that they hit.
A number of doctors think that zyprexa (and other atypicals) augments SSRI's owing to its 5-ht2a/c receptor blockade and possibly its muscarinic receptor antagonism. Most TCA's share these effects (less so with imipramine and desipramine though).
If depresson is the core issue, I think there is a good chance that something like nortriptyline or amitriptyline would have a similar (if not more possitive) effect but one cannot say for sure.
Linkadge
Posted by SLS on July 25, 2009, at 8:17:46
In reply to Re: Extreme internal restlessness/agitation!!!! HE » jerrypharmstudent, posted by linkadge on July 25, 2009, at 7:22:45
> A number of doctors think that zyprexa (and other atypicals) augments SSRI's owing to its 5-ht2a/c receptor blockade and possibly its muscarinic receptor antagonism. Most TCA's share these effects (less so with imipramine and desipramine though).
Your rationale for substituting Zyprexa with nortriptyline makes a lot of sense.
Interestingly, I gleaned a brief antidepressant response to all of the atypicals I tried except for Seroquel. Seroquel is the one drug in this class that does not antagonize 5-HT2c receptors.
- Scott
Posted by Alexanderfromdenmark on July 25, 2009, at 9:37:05
In reply to Extreme internal restlessness/agitation!!!! HELP, posted by jerrypharmstudent on July 24, 2009, at 16:22:26
> I've been doing well since starting Zyprexa about 6 weeks ago. However for a bout a week now in the afternoon I have this extreme internal restlessness - mostly in my upper body/neck/shoulders/arms. It's hard to explain. This my be gross but it feels like I want to rip the skin off my arms (not that I do any self harm or anything - this is just an example).
>
> I see my doctor on Monday but I don't know how to explain this. COuld the Zyprexa be causing it? I have Cogentin prescribed to me for restless legs if needed, but I haven't been taking it - maybe I should now? Maybe it would help?
>
> Anyone know what I'm taking about? Here's a list of my meds:
>
> Zyprexa 5mg
> Lexapro 30mg
> Adderall 20mg 3x daily
> Klonopin 1mg 4xdaily
> Ambien 10mg HS
> Cogentin 1mg 2x daily
>
> HELP!
>
> THANKS!Sounds like akathsia. Not good. Too little dopamine in the system. Zyprexa or lexapro is likely offenders.
Posted by linkadge on July 25, 2009, at 11:37:10
In reply to Re: Extreme internal restlessness/agitation!!!! HE, posted by SLS on July 25, 2009, at 8:17:46
>Your rationale for substituting Zyprexa with >nortriptyline makes a lot of sense.
>Interestingly, I gleaned a brief antidepressant >response to all of the atypicals I tried except >for Seroquel. Seroquel is the one drug in this >class that does not antagonize 5-HT2c receptors.
No, but the metabolite, norquetiapine does. Not sure why you would preferentially respond to the other atypicals in this case.
Linkadge
Posted by SLS on July 25, 2009, at 12:44:45
In reply to Re: Extreme internal restlessness/agitation!!!! HE » SLS, posted by linkadge on July 25, 2009, at 11:37:10
> >Your rationale for substituting Zyprexa with >nortriptyline makes a lot of sense.
>
> >Interestingly, I gleaned a brief antidepressant >response to all of the atypicals I tried except >for Seroquel. Seroquel is the one drug in this >class that does not antagonize 5-HT2c receptors.
>
> No, but the metabolite, norquetiapine does. Not sure why you would preferentially respond to the other atypicals in this case.I might not have been taking it long enough or at a high enough dosage. I stopped taking it within a week because it was making me irritable and somewhat dysphoric. The other drugs did not affect me this way, and they produced an improvement within the first few days.
- Scott
Posted by jerrypharmstudent on July 27, 2009, at 13:52:19
In reply to Re: Extreme internal restlessness/agitation!!!! HE » jerrypharmstudent, posted by linkadge on July 25, 2009, at 7:22:45
> Whether a TCA would completely cover what zyprexa does isn't 100% clear. There is overlap in the receptors that they hit.
>
> A number of doctors think that zyprexa (and other atypicals) augments SSRI's owing to its 5-ht2a/c receptor blockade and possibly its muscarinic receptor antagonism. Most TCA's share these effects (less so with imipramine and desipramine though).
>
> If depresson is the core issue, I think there is a good chance that something like nortriptyline or amitriptyline would have a similar (if not more possitive) effect but one cannot say for sure.
>
> Linkadge
>Saw my pdoc today and he instead wanted to try Geodon. I've gained 20 lbs from the Zyprexa in just 6 weeks. I had a good and very immediate response from Zyprexa so now I'm nervous to be switching. Anything you can tell me about Geodon?
Thanks
Jerry
Posted by linkadge on July 27, 2009, at 20:28:28
In reply to Re: Extreme internal restlessness/agitation!!!! HE » linkadge, posted by jerrypharmstudent on July 27, 2009, at 13:52:19
Not exactly sure about geodon, I've never taken it. Some people have apparently had sucess with it for depression augmentation. If its worse than the zyprexa just go back and tell him that.
Linkadge
Posted by Phillipa on July 27, 2009, at 23:36:55
In reply to Re: Extreme internal restlessness/agitation!!!! HE, posted by linkadge on July 27, 2009, at 20:28:28
Seriously I read here it's weight neutral. Jerry good luck. Phillipa
Posted by SLS on July 28, 2009, at 6:11:43
In reply to Re: Extreme internal restlessness/agitation!!!! HE » linkadge, posted by jerrypharmstudent on July 27, 2009, at 13:52:19
> Saw my pdoc today and he instead wanted to try Geodon. I've gained 20 lbs from the Zyprexa in just 6 weeks. I had a good and very immediate response from Zyprexa so now I'm nervous to be switching. Anything you can tell me about Geodon?
I think there is a trend in psychiatry to use Geodon more often as an augmenter of antidepressants. 80mg was of great help to a friend of mine who is taking Lexapro and Wellbutrin. Zero weight gain. I think 40mg is the dosage most often targeted for depression. I became a bit of a zombie at dosages above 40mg. I would have been much more happy with the drug if the antidepressant response I received from it were to last for more than a week. But my system is notorious for short robust responses. Right now, I am having success with a combination of medications that includes Abilify.
Geodon does a bunch of different things, much of which are antidepressant-like:
5-HT reuptake inhibition
NE reuptake inhibition
5-HT2a antagonist
5-HT2c antagonist
5-HT1d antagonist
5-HT1a agonist/partial agonist
D2 antagonist
NE alpha-1 antagonist
- Scott
Posted by Zyprexa on July 28, 2009, at 7:28:49
In reply to Re: Extreme internal restlessness/agitation!!!! HE » linkadge, posted by jerrypharmstudent on July 27, 2009, at 13:52:19
Geodon didn't work for me. I was hearing voices. I take zyprexa and it works well.
Posted by jerrypharmstudent on July 28, 2009, at 16:34:11
In reply to Re: Extreme internal restlessness/agitation!!!! HE » jerrypharmstudent, posted by SLS on July 28, 2009, at 6:11:43
> > Saw my pdoc today and he instead wanted to try Geodon. I've gained 20 lbs from the Zyprexa in just 6 weeks. I had a good and very immediate response from Zyprexa so now I'm nervous to be switching. Anything you can tell me about Geodon?
>
> I think there is a trend in psychiatry to use Geodon more often as an augmenter of antidepressants. 80mg was of great help to a friend of mine who is taking Lexapro and Wellbutrin. Zero weight gain. I think 40mg is the dosage most often targeted for depression. I became a bit of a zombie at dosages above 40mg. I would have been much more happy with the drug if the antidepressant response I received from it were to last for more than a week. But my system is notorious for short robust responses. Right now, I am having success with a combination of medications that includes Abilify.
>
> Geodon does a bunch of different things, much of which are antidepressant-like:
>
> 5-HT reuptake inhibition
> NE reuptake inhibition
> 5-HT2a antagonist
> 5-HT2c antagonist
> 5-HT1d antagonist
> 5-HT1a agonist/partial agonist
> D2 antagonist
> NE alpha-1 antagonist
>
>
> - ScottYeah my doc started me out on 40mg BID. Thanks so much for your information Scott - much appreciated.
Jerry
Posted by alchemy on July 29, 2009, at 0:29:30
In reply to Re: Extreme internal restlessness/agitation!!!! HE, posted by SLS on July 25, 2009, at 12:44:45
My oppinion is the Zyprexa. Did you change the dose when you noticed the agitation? Those antipsychotics seem to do that to me, especially Seroquel.
Posted by Zyprexa on July 29, 2009, at 11:07:08
In reply to Re: Extreme internal restlessness/agitation!!!! HE » linkadge, posted by jerrypharmstudent on July 27, 2009, at 13:52:19
Geodon sucks! Perphenazine is more like zyprexa than geodon. Perphenazine is not a weight gainer either. I take zyprexa and geodon.
Posted by jerrypharmstudent on July 29, 2009, at 12:27:44
In reply to Re: Extreme internal restlessness/agitation!!!! HE, posted by alchemy on July 29, 2009, at 0:29:30
> My oppinion is the Zyprexa. Did you change the dose when you noticed the agitation? Those antipsychotics seem to do that to me, especially Seroquel.
Nope didn't change the dosage - it stayed at 5mg. But saw my Pdoc on Monday and since I gained so much weight on the Zyprexa he switched me to Geodon 40mg BID.
Posted by jerrypharmstudent on July 29, 2009, at 12:29:21
In reply to Re: Extreme internal restlessness/agitation!!!! HE » jerrypharmstudent, posted by Zyprexa on July 29, 2009, at 11:07:08
> Geodon sucks! Perphenazine is more like zyprexa than geodon. Perphenazine is not a weight gainer either. I take zyprexa and geodon.
What about Geodon makes you say it sucks? I took my first dose last night and slept really well and then again this morning and just noticed some sleepiness, but that's it so far.
Posted by Zyprexa on July 29, 2009, at 18:14:06
In reply to Re: Extreme internal restlessness/agitation!!!! HE » Zyprexa, posted by jerrypharmstudent on July 29, 2009, at 12:29:21
I ment to say I take zyprexa and perphenazine.
I say geodon sucks because I started hearing voices when I was on it. I also got diabetes when I started it. It made my vision very blurry. It didn't help me sleep either. I went through a ruff time when I was on geodon. This is when I started drinking again and smoking pot. Just so I could calm down and sleep.
It wasn't till I went back on zyprexa that I started to go back to normal.
This is the end of the thread.
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