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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 58. This is the beginning of the thread.
Posted by tensor on February 3, 2012, at 8:14:15
Abilify doesn't seem to help my anergic depression, tried 7.5mg and 15mg. Seroquel didn't help. What's next? Zyprexa, Geodon? I need some help here. How bad is Zyprexa in terms of side effects?
Thanks.
Posted by Phillipa on February 3, 2012, at 10:18:12
In reply to Thinking of Zyprexa, posted by tensor on February 3, 2012, at 8:14:15
Tensor lots of posters here seem to like it. Weight gain is what I read the most. Phillipa
Posted by ed_uk2010 on February 3, 2012, at 13:03:26
In reply to Thinking of Zyprexa, posted by tensor on February 3, 2012, at 8:14:15
>How bad is Zyprexa in terms of side effects?
It's bad in terms of weight gain, diabetes risk and metabolic disturbances, but reasonably well tolerated in most other respects. After long-term treatment, Zyprexa can sometimes prove difficult to discontinue, with insomnia being particularly prominent.
I really hope you find something that helps soon.
Posted by tensor on February 3, 2012, at 13:15:57
In reply to Re: Thinking of Zyprexa » tensor, posted by Phillipa on February 3, 2012, at 10:18:12
Posted by tensor on February 3, 2012, at 13:19:13
In reply to Re: Thinking of Zyprexa, posted by ed_uk2010 on February 3, 2012, at 13:03:26
> >How bad is Zyprexa in terms of side effects?
>
> It's bad in terms of weight gain, diabetes risk and metabolic disturbances, but reasonably well tolerated in most other respects. After long-term treatment, Zyprexa can sometimes prove difficult to discontinue, with insomnia being particularly prominent.
>
> I really hope you find something that helps soon.
>
>
>
>Hi Ed and thanks for replying. Are the fears for diabetes exaggerated? Would you say the benefits would outweigh the risks in my case? Being unipolar depressive and anxious.
Thanks.
Posted by tensor on February 3, 2012, at 13:20:36
In reply to Thinking of Zyprexa, posted by tensor on February 3, 2012, at 8:14:15
How bad are the sexual side effects? Had no trouble on Seroquel, not on Abilify either.
Thanks.
Posted by SLS on February 3, 2012, at 14:06:59
In reply to Re: Thinking of Zyprexa » tensor, posted by tensor on February 3, 2012, at 13:20:36
Latuda (lurasidone) is an atypical antipsychotic that has been out for about a year. Weight gain and metabolic side effects don't seem to be problems according to what I've read. Latuda is a relative of Geodon (ziprasidone), but lacks the NE/5-HT reuptake inhibition of Geodon. Latuda also blocks 5-HT7 receptors, an effect that might explain its purported antidepressant properties.
- Scott
Posted by tensor on February 3, 2012, at 14:33:36
In reply to Re: Thinking of Zyprexa » tensor, posted by SLS on February 3, 2012, at 14:06:59
> Latuda (lurasidone) is an atypical antipsychotic that has been out for about a year. Weight gain and metabolic side effects don't seem to be problems according to what I've read. Latuda is a relative of Geodon (ziprasidone), but lacks the NE/5-HT reuptake inhibition of Geodon. Latuda also blocks 5-HT7 receptors, an effect that might explain its purported antidepressant properties.
>
>
> - ScottI've read about it, but unfortunately it's not available here. Geodon is OTOH, would you say it is to prefer over Zyprexa? In terms of effectiveness i.e.
Thanks.
Posted by Christ_empowered on February 3, 2012, at 15:07:31
In reply to Re: Thinking of Zyprexa » SLS, posted by tensor on February 3, 2012, at 14:33:36
I'm definitely not an expert, but I'd go for Geodon before Zyprexa, just because of the fatty potential.
Posted by tensor on February 3, 2012, at 15:13:49
In reply to Re: Thinking of Zyprexa, posted by Christ_empowered on February 3, 2012, at 15:07:31
> I'm definitely not an expert, but I'd go for Geodon before Zyprexa, just because of the fatty potential.
I didn't gain weight on Seroquel, and I have a healthy diet so I'm losing weight all the time. Not sure if I want to try a possibly weaker agent, although the diabetes risk that comes with Zyprexa is everything but appealing. But I'm at the end of the rope, so..
Posted by SLS on February 3, 2012, at 17:54:05
In reply to Re: Thinking of Zyprexa » SLS, posted by tensor on February 3, 2012, at 14:33:36
Zyprexa can work like magic for manic or schizoid psychotic presentations. In an emergency, it is the go-to drug. For unipolar depression, I don't know how it compares to Geodon. I have never seen a study designed to compare them. Geodon does have SNRI properties that might contribute to its antidepressant effect. For most people, Geodon does not produce cardiac side effects. If someone is suicidal, Zyprexa is probably the better choice. Otherwise, I would choose Geodon so as to avoid the metabolic side effects of Zyprexa. In my experience, the AAPs exert an antidepressant effect during the first week. You don't have to invest months into one of these drugs before coming to a conclusion regarding its therapeutic potential.
- Scott
Posted by emmanuel98 on February 3, 2012, at 18:45:17
In reply to Re: Thinking of Zyprexa » Christ_empowered, posted by tensor on February 3, 2012, at 15:13:49
Geodon and seroquel did nothing for me -- no weight gain, no mood improvement. Zyprexa, abilify and risperdal greatly and rapidly improved my mood, but caused rapid weight gain as well. It had nothing to do with how much I ate or exercised. I tried dieting and working out more, but still gained 2-3 pounds a week. Not everyone gains weight though, and when they do, it tends to occur immediately, so you would know after a couple of weeks and could stop if it seems to be out of control. But the weight gain is no joke. I gained 55 pounds from my various trials of AAPs. Once I went off them -- and it was disappointing because I responded so well to them -- I lost 47 pounds.
Posted by linkadge on February 3, 2012, at 23:01:28
In reply to Thinking of Zyprexa, posted by tensor on February 3, 2012, at 8:14:15
Antipsychotics for anergic depression? Huh?
Linkadge
Posted by Zyprexa on February 4, 2012, at 3:10:20
In reply to Re: Thinking of Zyprexa, posted by linkadge on February 3, 2012, at 23:01:28
Zyprexa is the only AAP that works for me. It didn't give me diabetes, but geodon did, which went away when stoped. No sex sideffects with it. It made me gain weight but I needed that in the beginning. And I've managed to lose weight on a 10mg dose by diet and exercise. I still take it keeping weight down seems easy. I've been taking it for the last 14 years and still works great! I've tried abilify and that was awfull. never taken seroquel, since sideffects are similar I have not. Zyprexa is great for sleep problems. I took risperdal which didn't help at all. Perphenazine I've taken for the past 4 years seems to be effective, if you are looking for some thing with out weight gain. But is sort of similar to zyprexa. Thats my second choice. I still take it and it seems to help keep zyprexa dose down.
Posted by SLS on February 4, 2012, at 3:32:39
In reply to Re: Thinking of Zyprexa, posted by Zyprexa on February 4, 2012, at 3:10:20
> Zyprexa is the only AAP that works for me.
> I still take it keeping weight down seems easy.
You are such a show-off!
:-)
- Scott
Posted by SLS on February 4, 2012, at 3:39:56
In reply to Re: Thinking of Zyprexa, posted by linkadge on February 3, 2012, at 23:01:28
> Antipsychotics for anergic depression? Huh?
Yup.
I know you already know this, but...
APs are not really antipsychotics. They are drugs with antipsychotic properties. Some of these drugs also have antidepressant properties that can be used to treat anergic depression.
Abilify, Risperdal, and Zyprexa are the AP drugs that produced significant antidepressant responses for me. Risperdal and Zyprexa both pooped out on me. By itself, Abilify does very little for me. However, it is adds a great deal of benefit when combined with the other drugs I am taking.
- Scott
Posted by tensor on February 4, 2012, at 4:00:41
In reply to Re: Thinking of Zyprexa » tensor, posted by SLS on February 3, 2012, at 17:54:05
In my experience, the AAPs exert an antidepressant effect during the first week. You don't have to invest months into one of these drugs before coming to a conclusion regarding its therapeutic potential.
>
>
> - ScottThat is something I will tell my pdoc at monday morning when I call him, thanks Scott.
Posted by tensor on February 4, 2012, at 4:02:27
In reply to Re: Thinking of Zyprexa, posted by linkadge on February 3, 2012, at 23:01:28
> Antipsychotics for anergic depression? Huh?
>
> LinkadgePlease share if you have a better idea. They are not really the first meds I try.
Posted by tensor on February 4, 2012, at 4:04:03
In reply to Re: Thinking of Zyprexa, posted by Zyprexa on February 4, 2012, at 3:10:20
> Zyprexa is the only AAP that works for me. It didn't give me diabetes, but geodon did, which went away when stoped. No sex sideffects with it. It made me gain weight but I needed that in the beginning. And I've managed to lose weight on a 10mg dose by diet and exercise. I still take it keeping weight down seems easy. I've been taking it for the last 14 years and still works great! I've tried abilify and that was awfull. never taken seroquel, since sideffects are similar I have not. Zyprexa is great for sleep problems. I took risperdal which didn't help at all. Perphenazine I've taken for the past 4 years seems to be effective, if you are looking for some thing with out weight gain. But is sort of similar to zyprexa. Thats my second choice. I still take it and it seems to help keep zyprexa dose down.
What dosage would you recommend for me, initially?
Thanks.
Posted by tensor on February 4, 2012, at 4:06:26
In reply to Thinking of Zyprexa, posted by tensor on February 3, 2012, at 8:14:15
Can you cross-titrate Zyprexa with 7.5mg of Abilify?
Thanks.
Posted by tensor on February 4, 2012, at 4:13:53
In reply to Re: Thinking of Zyprexa, posted by Zyprexa on February 4, 2012, at 3:10:20
> Zyprexa is the only AAP that works for me. It didn't give me diabetes, but geodon did, which went away when stoped. No sex sideffects with it. It made me gain weight but I needed that in the beginning. And I've managed to lose weight on a 10mg dose by diet and exercise. I still take it keeping weight down seems easy. I've been taking it for the last 14 years and still works great! I've tried abilify and that was awfull. never taken seroquel, since sideffects are similar I have not. Zyprexa is great for sleep problems. I took risperdal which didn't help at all. Perphenazine I've taken for the past 4 years seems to be effective, if you are looking for some thing with out weight gain. But is sort of similar to zyprexa. Thats my second choice. I still take it and it seems to help keep zyprexa dose down.
How bad are the anticholinergic effects? Compared to, say, the TCAs?
Thanks.
Posted by tensor on February 4, 2012, at 4:27:43
In reply to Re: Thinking of Zyprexa, posted by emmanuel98 on February 3, 2012, at 18:45:17
> Geodon and seroquel did nothing for me -- no weight gain, no mood improvement. Zyprexa, abilify and risperdal greatly and rapidly improved my mood, but caused rapid weight gain as well. It had nothing to do with how much I ate or exercised. I tried dieting and working out more, but still gained 2-3 pounds a week. Not everyone gains weight though, and when they do, it tends to occur immediately, so you would know after a couple of weeks and could stop if it seems to be out of control. But the weight gain is no joke. I gained 55 pounds from my various trials of AAPs. Once I went off them -- and it was disappointing because I responded so well to them -- I lost 47 pounds.
May I ask what dosage you were on? I wonder if I can keep Remeron in my regimen, in combination with Zyprexa it could be the weight gaining champion.
Thanks.
Posted by ed_uk2010 on February 4, 2012, at 6:39:57
In reply to Re: Thinking of Zyprexa » ed_uk2010, posted by tensor on February 3, 2012, at 13:19:13
>Are the fears for diabetes exaggerated?
Difficult to say. I think there's a particular risk in the long-term if a large weight gain has occurred.
>Would you say the benefits would outweigh the risks in my case?
Probably yes, because if it doesn't help after a few weeks you can taper off. You will not keep taking it unless it produces a clear benefit.
Posted by ed_uk2010 on February 4, 2012, at 6:41:54
In reply to Re: Thinking of Zyprexa » tensor, posted by tensor on February 3, 2012, at 13:20:36
>How bad are the sexual side effects? Had no trouble on Seroquel, not on Abilify either.
Zyprexa does not usually produce a large prolactin elevation, and so I would not expect sexual side effects to be bad.
Posted by ed_uk2010 on February 4, 2012, at 6:43:27
In reply to Re: Thinking of Zyprexa » Zyprexa, posted by tensor on February 4, 2012, at 4:13:53
>How bad are the anticholinergic effects? Compared to, say, the TCAs?
Usually mild.
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