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Dr. Bob is Robert Hsiung, MD,
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Posted by phidippus on October 3, 2012, at 16:25:51
In reply to Re: PS. what should i do? » phidippus, posted by b2chica on October 3, 2012, at 15:38:21
>i'm sure it is messing things. but quite frankly i'd rather deal with this end then the crazy bad depression i get.
I've been there.
Eric
ps. Up your Olanzapine! I promise you won't go crazy.
Posted by SLS on October 3, 2012, at 16:47:02
In reply to Re: PS. what should i do?, posted by phidippus on October 3, 2012, at 16:15:57
Just because a drug has therapeutic properties doesn't mean that it must not be judged by evaluating its benefits versus costs and risks. It does.
Lithium is an effective mood stabilizer. Yet, people have died of kidney failure for having taken it. How would you evaluate the value of lithium?
I don't understand your point.
If Zyprexa has no value, why do you recommend it to others that they take it and take more of it?
I think your definition of "mood stabilizer" is far too broad. For some people, Xanax prevents "mood swings". Is Xanax a mood stabilizer?
Zyprexa is what is. According to your definition, it is a mood stabilizer. In addition, according to the definition suggested by the literature you cited, Zyprexa is a mood stabilizer while Xanax is not.
What other drugs do you consider to be "true" mood stabilizers?
"A true mood stabilizer will work in acute manic episodes without inducing depression, acute bipolar depression without inducing mania, and protect the patient from future episodes of mania or depression."
It's really not a bad definition.
- Scott
Posted by Zyprexa on October 3, 2012, at 20:01:59
In reply to Re: PS. what should i do? » Zyprexa, posted by b2chica on October 3, 2012, at 8:48:09
Are you taking brand name zyprexa or a brand of generic olanzapine?? And which one?
Posted by brynb on October 3, 2012, at 20:57:44
In reply to Hospital when feeling ok??, posted by b2chica on October 2, 2012, at 12:11:18
Hi b2c,
Hope you're doing ok. I may have missed it somewhere, but have you ever taken lithium (even a low dose)? I like how it addresses the depression, mania and suicidal thoughts.
Also, do you take Adderall for fatigue/depression or ADD? I find it to be a pretty rough drug emotionally, but maybe because I don't have ADD.
Be well...
Posted by phidippus on October 3, 2012, at 23:32:10
In reply to Re: PS. what should i do? » phidippus, posted by SLS on October 3, 2012, at 16:47:02
>How would you evaluate the value of lithium?
I had kidney failure on lithium. I still take it. For me, Lithium is invaluable and represents a true mood stabilizer. Zyprexa is simply an anti-manic and does nothing else.
>I don't understand your point.
Do you have to? This is simply a difference of opinion. My point is simply that Zyprexa is not a mood stabilizer. Its mechanism of action differentiates it from Lithium and all the anticonvulsants called mood stabilizers.
>why do you recommend it to others that they take it and take more of it?
Others? I recommended an increase in dosage because 1. the person wasn't going to switch to something else and 2. the person was happy with Zyprexa.
>Xanax prevents "mood swings"
Wow.
>According to your definition, it is a mood stabilizer
Sh*t, I totally forgot what I wrote as a definition. Your definition is fine, I just think its too bipolar specific. My definition is broad on purpose-it takes into account other disorders, such as borderline personality.
Eric
Posted by jono_in_adelaide on October 4, 2012, at 0:01:07
In reply to Re: PS. what should i do? » SLS, posted by phidippus on October 3, 2012, at 23:32:10
Now now you guys, both take a Zyprexa and kiss n make up!
Posted by SLS on October 4, 2012, at 6:56:03
In reply to Re: PS. what should i do? » SLS, posted by phidippus on October 3, 2012, at 23:32:10
I hate to burst you bubble, but opinions do not go unchallenged here.
"Your definition is fine, I just think its too bipolar specific"
I thought that bipolar disorder was the issue we were discussing. You believe that lithium is acting as a mood stabilizer for you, despite your not having bipolar disorder. I really can't dispute your belief that the diathesis of your condition does not lie along the bipolar spectrum without further evidence.
Re: Zyprexa as a mood stabilizer?
Your opinion that Zyprexa is nothing more than an antimanic agent has merit as it is sometimes portrayed in the medical literature. However, there doesn't seem to be a consensus at this point. Scientific data is limited for Zyprexa monotherapy. However, it is not terribly common that any one drug effectively treats bipolar disorder - even lithium. It is fascinating when lithium monotherapy completely resolves bipolar I disorder, though. It is quite dramatic.
The value that a drug has as a mood stabilizer is measured by time to relapse. There are studies indicating that time to relapse in bipolar order is greater with Zyprexa than with placebo.
"Lithium continues as our oldest well-established maintenance treatment in bipolar disorder with somewhat better efficacy in preventing mania than depression. Lamotrigine, olanzapine, and quetiapine have bimodal efficacy in preventing both mania and depression..."
http://www.ncbi.nlm.nih.gov/pubmed/22510036
"Lithium levels ≥0.6 mmol/L and olanzapine doses ≥10mg/day may be necessary for optimal protection against manic/mixed or depressive episodes, respectively in patients with bipolar I disorder."
http://www.ncbi.nlm.nih.gov/pubmed/20430594
The following three studies were performed in associated with Lilly, the manufacturer of Zyprexa. They were performed by well-published researchers. I segregated them because some people will invalidate the work of these researchers on the basis that Lilly was involved.
http://www.ncbi.nlm.nih.gov/pubmed/16449478
http://www.ncbi.nlm.nih.gov/pubmed/19054570
http://www.ncbi.nlm.nih.gov/pubmed/15994710
The following studies reported no therapeutic effect or mixed results:
http://www.ncbi.nlm.nih.gov/pubmed/19828571
http://www.ncbi.nlm.nih.gov/pubmed/19160237
http://www.ncbi.nlm.nih.gov/pubmed/16426094
It is hard to argue with Terrence Ketter.
Zyprexa certainly has antidepressant properties and makes a good augmenter, especially when combined with antidepressants like Prozac. Zyprexa can even precipitate a manic reaction. Personally, I have observed in others that Zyprexa has a potent anti-suicide effect. I am guessing that it is equally effective to Clozapine, a related drug. This, however, is not the same thing as maintenance mood stabilization.
> My point is simply that Zyprexa is not a mood stabilizer. Its mechanism of action differentiates it from Lithium and all the anticonvulsants called mood stabilizers
Must a drug have same properties as another in order treat the same illness effectively? This does not follow from logic. You lose your own argument because anticonvulsants do not have the same physiological properties as lithium, yet they can be effective.
All in all, I still question the classification of Zyprexa as a mood stabilizer as it is strictly defined for the treatment of bipolar disorder. However, it does act as an antimanic and/or an antidepressant for some percentage (unknown) of people who take it, especially when used as an augmenting agent as is often done with lithium.
If you have no problem with lithium shutting down your kidneys, I don't understand why you would have a problem with Zyprexa producing diabetes. Both sequelae are serious. You value lithium because it works for you. Others value Zyprexa because it works for them.
- Scott
Posted by b2chica on October 4, 2012, at 7:54:50
In reply to Re: PS. what should i do? » b2chica, posted by Zyprexa on October 3, 2012, at 20:01:59
ws taking brand (that worked fine but only had one sample bottle -7day) so then i went to teva, bad effect, now i'm on the other one. cant recall the name...odd name kinda unusual.
but so far i think its going better. and this one i dont crave food on...
Posted by SLS on October 4, 2012, at 8:10:19
In reply to Re: PS. what should i do? » Zyprexa, posted by b2chica on October 4, 2012, at 7:54:50
> ws taking brand (that worked fine but only had one sample bottle -7day) so then i went to teva, bad effect, now i'm on the other one. cant recall the name...odd name kinda unusual.
>
> but so far i think its going better.
This is a relief to hear.> and this one i dont crave food on...
Interesting.
In your experience, are food cravings dose-dependent?
- Scott
Posted by b2chica on October 4, 2012, at 13:14:09
In reply to Re: PS. what should i do? » b2chica, posted by SLS on October 4, 2012, at 8:10:19
yes. when i'm at 5mg (brand name) i was always so thirsty, and drank lots water. but didnt really crave sweets. at 10mg i've always craved (after about the 2nd or 3rd day) the cravings come and its for sweets and its like i dont know that im full when i eat.
with teva generic i had some initial food cravings but then none after a while.
with this brand i cant say that i've noticed cravings (but i'm still eating poorly out of habit now) but at dinner and lunch i eat less than before. and dont CRAVE the sweets like before.
i'm quite suprised as i am up at 10mg of the olanzipine "aurobindo" mfg.
Posted by phidippus on October 4, 2012, at 17:25:18
In reply to Re: PS. what should i do? » SLS, posted by b2chica on October 4, 2012, at 13:14:09
I'm proud o' ya.
Eric
Posted by phidippus on October 4, 2012, at 18:15:02
In reply to Re: PS. what should i do? » phidippus, posted by SLS on October 4, 2012, at 6:56:03
>I hate to burst your bubble, but opinions do not go unchallenged here.
My bubble is fine, so is my cherry.
>I thought that bipolar disorder was the issue we were discussing.
Why not include borderline personality in the discussion? Mood stabilizers are used to treat it as well.
http://www.psychiatrictimes.com/display/article/10168/46801
>You believe that lithium is acting as a mood stabilizer for you, despite your not having bipolar disorder.
I am diagnosed Bipolar I with ADHD and OCD, did I say otherwise?
>> My point is simply that Zyprexa is not a mood stabilizer. Its mechanism of action differentiates it from Lithium and all the anticonvulsants called mood stabilizers
Let me modify my statement. No mood stabillizers are antipsychotics and no antipsychotics are mood stabilizers
>Must a drug have same properties as another in order treat the same illness effectively?
In some ways, yes. Antipsychotics are all similar in the way they treat schizophrenia-I don't know of any that don't antagonize dopamine receptors.
>I don't understand why you would have a problem with Zyprexa producing diabetes.
I have a problem with Lilly's mishandling of reporting Zyprexa's serious side effects.
Honestly, I think our argument is moot when we look at Verapamil as a mood stabilizer. Verapamil is going to be huge!
Eric
Eric
Posted by phidippus on October 4, 2012, at 18:16:02
In reply to Re: PS. what should i do?, posted by jono_in_adelaide on October 4, 2012, at 0:01:07
Smooch
Eric
Posted by SLS on October 4, 2012, at 21:23:01
In reply to Re: PS. what should i do? » SLS, posted by phidippus on October 4, 2012, at 18:15:02
> >I hate to burst your bubble, but opinions do not go unchallenged here.
>
> My bubble is fine, so is my cherry.Good to know?
> >I thought that bipolar disorder was the issue we were dscussing.
> Why not include borderline personality in the discussion? Mood stabilizers are used to treat it as well.
And they work, too. Trileptal is the one that helps most. Zyprexa can be effective, too. In fact, the combination of the two can be an excellent treatment, especially when combined with DBT. I had the true privilege of being exposed to well over one hundred people who were treated for a variety of mental illnesses over an 8 year period while I was in a partial hospitalization program. This includes BPD. I remember one patient in particular who was refractory to behavioral therapies. Even with the unconditional support of her by the community, she remained very much affected. However, a new treatment regime was begun comprised of a combination of Trileptal and Zyprexa. Within a month her tantrums and crying spells disappeared, and she made excellent progress behaviorally. Unfortunately, she gained more weight than was healthy for her, and the Zyprexa was discontinued. I left the program not too long after this, so I don't know what became of her. However, until I left, she seemed stable on Trileptal monotherapy.
> http://www.psychiatrictimes.com/display/article/10168/46801
This is actually a very good article as it approaches the issue of what constitutes a "mood stabilizer". As I indicated in a previous post, there is quite a bit of debate as to how to define one.
"A consensus definition of mood stabilizer remains to be established, and international regulatory authorities do not officially recognize the term as a mode of drug activity.5 Clinicians and researchers apply the concept of mood stabilization to a range of compounds used in the treatment of bipolar disorder, although considerable variability can be found in the literature concerning the meaning and use of the term.6-11 In its broadest form, a mood stabilizer has been operationally described as an agent that is useful in at least 1 of the 3 phases of bipolar disorder (mania, bipolar depression, or long-term maintenance) while not increasing the frequency or severity of any of the other phases of the illness.6"
Zyprexa?
> > Your definition is fine, I just think its too bipolar specific.
> > You believe that lithium is acting as a mood stabilizer for you, despite your not having bipolar disorder.
> I am diagnosed Bipolar I with ADHD and OCD, did I say otherwise?
I apologize. So, you are not an example of mood stabilization in unipolar depression. Do you know anyone with unipolar MDD who has remitted as a result of lithium monotherapy? I don't, but that proves very little.
> > > My point is simply that Zyprexa is not a mood stabilizer. Its mechanism of action differentiates it from Lithium and all the anticonvulsants called mood stabilizers
> Let me modify my statement. No mood stabillizers are antipsychotics and no antipsychotics are mood stabilizers
Your surety is refreshing.
> > Must a drug have same properties as another in order treat the same illness effectively?
> In some ways, yes. Antipsychotics are all similar in the way they treat schizophrenia-I don't know of any that don't antagonize dopamine receptors.
How is this supportive of your assertion that any drug that acts as a mood stabilizer must have the pharmacology of lithium or of an anticovulsant exclusively? Are all drugs that treat tuberculosis MAO inhibitors? (Hint: No.)
> > I don't understand why you would have a problem with Zyprexa producing diabetes.
> I have a problem with Lilly's mishandling of reporting Zyprexa's serious side effects.
Me, too. So? The drug itself is not to blame for this. The drug is what it is. SSRIs were purported to be weight-neutral by the drug companies. Let's not use them anymore because the drug companies lied about this side effect. I guess the drugs stopped working as soon as they discovered their cover was blown.
> Honestly, I think our argument is moot when we look at Verapamil as a mood stabilizer. Verapamil is going to be huge!
Your enthusiasm for verapamil is interesting. I am having trouble detecting any sarcasm that might be present. In any event, this drug was looked at closely over 20 years ago. Success stories were sparse, and two clinical trials were negative. Then again, there has been no incentive to study this drug any further because it is off-patent.
- Scott
Posted by Zyprexa on October 4, 2012, at 21:52:54
In reply to Re: PS. what should i do? » SLS, posted by b2chica on October 4, 2012, at 13:14:09
Thanks for posting that! I was worried it was only me that didn't eat as much. Do you find the generic is as effective as brand for your symptoms?
Posted by B2chica on October 5, 2012, at 10:05:02
In reply to Re: PS. what should i do? » b2chica, posted by Zyprexa on October 4, 2012, at 21:52:54
No certainly not just you.
but i think we respond similarly to zyprexa it seems. (and perphenazine)i did NOT find the TEVA brand similar at all. it either did not work (at 5) then went to 10 and things got worse either because of natural acceleration of symptoms or Because of...Teva.
been on aurobindo brand generic for four/five days, doing Much better.
i'm hoping that once i've leveled for about a month i can decrease back to 5 and stick with that. pdoc did add 2mg perphenazine about 2 in afternoon. i forgot to take it yesterday and doing ok. but i'd rather drop zyprexa to 5 and add back the 2mg in afternoon than stay at 10 of zyprexa.i had never heard of 'aurobindo' before...You? which generic mfg are you working with? and what dosage?
i wonder if the Teva was too concentrate for me? cuz i think you tend to use a slightly higher dose of zyprexa/perphenazine than i.***************
good news is yes feeling better, but also no crazy side effects (other than still eating a bit crappy).
i think its not that i'm over eating now but used to eating like 6 times a day. i need to stack my lunch box with fruits and veggies to snack on during the day.
also, normally on zyprexa i crave chocolate stuff, oreos/cupcakes, etc. Im not normally a huge chocolate person so i know its the meds.
but with this aurobindo brand i'm not craving the chocolate stuff. Although last night i binged a bit on chocolate dinobytes cereal... :P**************
now i just need to level off and try to find a time of day that i can exercise. its really hard with the kids, cuz if i do it anyother time than am i feel guilty that i'm not spending time with them. and since i take my night pills around 6:00 by the time kids are in bed...i almost am too. im tired about 9 these days. been getting to bed about 9:30 10.
which is SO opposite my natural cycle. i have always been a night person. sleeping late. but since kids ive been forced to change my hours.the only advantage about being to work at 7:30 is i'm off at 3:45. and i have about an hour to myself that i can read, write, journal or whatever i need.
i wish i could hit the gym during that time. but its clear on other side of town. then id have to back track to pick up child at daycare...i'd endup spending 30min driving and 15 exercising. ugh.sorry so wordy.
Thanks Z!
Posted by phidippus on October 5, 2012, at 16:16:09
In reply to Re: PS. what should i do? » phidippus, posted by SLS on October 4, 2012, at 21:23:01
>How is this supportive of your assertion that any drug that acts as a mood stabilizer must have the pharmacology of lithiuum or of an anticovulsant exclusively
My brain is starting to shrivel. I can find no consensus. Even the experts seem to have a hard time defining the word mood stabilizer. Crap, how do we end this
>Your enthusiasm for verapamil is interesting. I am having trouble detecting any sarcasm that might be present.
You need to work on your smart-*ss meter.
Eric
Posted by Beckett on October 5, 2012, at 18:11:12
In reply to Re: PS. what should i do? » Zyprexa, posted by B2chica on October 5, 2012, at 10:05:02
B2c, you sound so much better. Yes?
Posted by SLS on October 6, 2012, at 0:26:43
In reply to Re: PS. what should i do? » SLS, posted by phidippus on October 5, 2012, at 16:16:09
> >Your enthusiasm for verapamil is interesting. I am having trouble detecting any sarcasm that might be present.
>
> You need to work on your smart-*ss meter.
I'm slow sometimes - naive, too.:-)
- Scott
Posted by Zyprexa on October 6, 2012, at 4:15:16
In reply to Re: PS. what should i do? » Zyprexa, posted by B2chica on October 5, 2012, at 10:05:02
I'm glad the Aurobindo is working! Currently I take Teva, since that is what Costco sells right now for $45. Aurobindo is make in India and sold through Sandos. I think is got bought out by india. I take 10mg olanzapine, and 8mg x2 perphenazine. I find that the Teva does not stay fresh as long as Aurobindo, so maybe you got older stuff, or maybe it just does not work for you. I would probably buy Aurobindo if it was at costco or not $400 since I'm in the gap right now. Do you find the perphenazine helps? And how? I might be stoping or not and just take zyprexa.
Posted by B2chica on October 8, 2012, at 8:43:22
In reply to Re: PS. what should i do? » B2chica, posted by Zyprexa on October 6, 2012, at 4:15:16
i actually prefer the perphenazine to zyprexa, mostly in the no weight gain at all category. i'm kind of in a fed up of being fat...mode right now.
but i like the perphenazine in that it doesnt have the sedation yet it helps with my anxiety (or it did at first).
i would prefer to up perphenazine and lower zyprexa.
last night i forgot to take my zyprexa so i'm going to take an extra bit of perphenazine today.
also, only $9/mo.
but i like zyprexa in that (at least before) it always helped immediately.i dont know what happened this time, my best guess is that it was a bad mix of an acute episode along with bad generic (or slow acting?not right dose?)
Posted by B2chica on October 8, 2012, at 8:46:05
In reply to Re: PS. what should i do? » B2chica, posted by Beckett on October 5, 2012, at 18:11:12
i'm hesitant to say yes...but, yes.
my mood shifts have been smaller. but i've gained so much weight that i cant/dont feel that good about myself. but its a normal not feel good. not biological.
this weekend was kinda crazy so after kids went to bed i watched two movies. stayed up late AND forgot my zyprexa.
should be enough in my system not to make that much difference.
but i'm going to take an extra perphenazine today.thanks Beckett
Posted by Zyprexa on October 8, 2012, at 9:49:27
In reply to Re: PS. what should i do? » Zyprexa, posted by B2chica on October 8, 2012, at 8:43:22
It seems the olanzapine is realy helping you right now. And you may have avoided hospital, right?
How do you get perphenazine for $9?
Maybe once you get stable you can take less olanzapine.
Posted by B2chica on October 8, 2012, at 13:30:08
In reply to Re: PS. what should i do? » B2chica, posted by Zyprexa on October 8, 2012, at 9:49:27
yes. i think. problem is i want to stop taking it now that i feel better. but i told myself friday that i would take it for one more week. i did start to have some weirdness (visually) again friday so i talked with pharmacist, between you and me i think i knew more about the medication than he but i digress) anyway, we...I...decided to go down to 5mg olanzapine for a couple days and see what happens.
but i made appt with pdoc for friday. since i'm doing better i want to cancel. and save the spot for someone who REALLY needs to get in.i really want to stop this eating. Sat night i couldnt stop eating (made homemade bread) and you know how that stuff swells in your stomach. i felt like a bloated whale. i couldnt even pull up my sweat pants over my belly! now THATS Bad. i only have two pair of pants that fit me and those i just bought last month. and they are already getting snug.
i dont know why i "feel" fatter, as my eating hasnt been bad the last week maybe.
**************************
its now about 1:30 central time and my mood is significantly down. although i have narrowed my worst time of the day to 2:00.
but i guess this means that my mood has shifted down regardless of olanzapine? (though i forgot last nights, would just one missed dose do that?***************************
i work at a place that has great benefits so i'm assuming its just that my co-pay for old generics is $9. my pristiq is $31. and i think the rest of what i'm on is $12? i think all my Rx for each month is around $100. which is still very high for us. but i'm SO thankful i have the benefits i have from work. otherwise i dont know what i'd do. i should be more grateful, but i'm constantly reminded by my DH that $100 a MONTH is Just for my meds... :(
Posted by Zyprexa on October 8, 2012, at 18:19:31
In reply to Re: PS. what should i do? » Zyprexa, posted by B2chica on October 8, 2012, at 13:30:08
Yes one missed dose of zyprexa could do that. I often notice when I take zyprexa at different times can even have an effect. I say to try 5mg for a couple days. But keep taking the zyprexa!
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