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Dr. Bob is Robert Hsiung, MD,
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Posted by ed_uk2010 on January 7, 2015, at 11:52:51
In reply to Antipsychotics: Diabetes via malnutrition?, posted by Lamdage22 on January 7, 2015, at 5:51:20
> Hey,
>
> my doc said that Seroquel and Zyprexa dont directly cause diabetes but they do so solely via bad nutrition and overweight.
>
> Is this true?
>
>Well, Zyprexa causes diabetes via multiple mechanisms. It's unfortunate... it tends to be one of the most effective antipsychotics apart from clozapine. Seroquel and Risperdal can also cause diabetes, but not as frequently. The reasons behind the diabetes have been studied in humans and animals.
In rats, Zyprexa rapidly and substantially reduces sensitivity to insulin (ie. it induces insulin resistance). Zyprexa also appears to increase output of glucose from the liver, and to reduce insulin secretion via an effect on the pancreas. These effects can lead to substantially elevated blood sugar (glucose). In humans, some patients treated with Zyprexa become insulin-dependent, at least while on treatment.
Another interesting finding in rats is that Zyprexa increases the uptake of fatty acids into adipose tissue (fat deposits). This may promote the accumulation of fatty tissue on the body, especially when coupled with increased appetite/food intake (and/or decreased physical activity).
Diabetic emergencies such as ketoacidosis with confusion and loss of consciousness have occasionally been reported to occur very soon after starting Zyprexa, but the risk increases over time, especially if a large weight gain has occurred. There have been some fatalities due to such emergencies, which I believe have led to legal action against the manufacturer - mainly based on the belief that the prescribing information was (formerly) inadequate.
Posted by baseball55 on January 7, 2015, at 19:34:59
In reply to Mutiple mechanism with Zyprexa and some atypicals, posted by ed_uk2010 on January 7, 2015, at 11:52:51
I gained weight on atypicals (all except geodon) without eating any more at all. In fact, because I felt better, I exercised more. I still gained incredible amounts of weight. My nephew started zyprexa in November and when I saw him at Christmas, I was shocked by how much weight he had gained in just a month and, he told me, he wasn't eating more at all.
So I would disagree with your doctor. These drugs can significantly change one's metabolism.
Posted by Lamdage22 on January 9, 2015, at 3:47:21
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by baseball55 on January 7, 2015, at 19:34:59
Okay, the options i see now are either replacing Zyprexa with Clozapine (although i wonder if it is any better in the Diabetes department??) or replacing it with amisulpirid (although i heard that some of its side effects occur as frequently as with typical APs!).
Help!
Posted by burial on January 9, 2015, at 8:17:31
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 9, 2015, at 3:47:21
> Okay, the options i see now are either replacing Zyprexa with Clozapine (although i wonder if it is any better in the Diabetes department??) or replacing it with amisulpirid (although i heard that some of its side effects occur as frequently as with typical APs!).
>
> Help!
i don't think replacing zyprexa with clozapine is rational, they're quit similar drugs with clozapine having even more nasty side effects like seizures. Amisulpride would be quite different and as effective as any other atypical for whatever it's prescribed. Stahl says it's a dopamine partial agonist, but i couldn't find anything on the internet to support his claim although it definitely has some action on D2 autoreceptors, it was activating for me. There was a huge study not so long ago which ranked every antipsychotic to groups by how effective are they in treating schizophrenia. Guess what, amisulpride was ranked in top tier along with clozapine and olanzapine, a simple typical antipsychotic couldn't perform so strong
Posted by ed_uk2010 on January 9, 2015, at 9:30:53
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 9, 2015, at 3:47:21
>Okay, the options i see now are either replacing Zyprexa with Clozapine (although i wonder if it is any better in the Diabetes department??)
It isn't - clozapine and olanzapine both produce a high incidence of diabetes. Clozapine causes more side effects overall but is often substantially more effective than olanzapine for resistant psychosis.
>replacing it with amisulpride (although i heard that some of its side effects occur as frequently as with typical APs!)
Amisulpride is very different to olanzapine. It's much less sedating, and causes far less weight gain or diabetes. It causes movement disorders more frequently than olanzapine, but less frequently than typicals. The risk of movement disorders such as tremor and muscle stiffness is highly dose dependent, and can be minimised by cautious dose adjustment. Low doses produce very few or no movement problems, very high doses often produce a lot. Care is needed when adjusting - avoiding doses of more than 800mg per day (in divided/split doses) also makes major problems with movement less likely. It may be useful to have an anticholinergic on hand in case symptoms appear.
Like risperidone and paliperidone, amisulpride produces a very high incidence of prolactin elevation. As a result, women often experience menstrual disturbances. Lactation may occur if prolactin gets very high. Men often experience reduced libido. In spite of the prolactin elevation, those of amisulpride often experience fewer adverse effects overall than pts on other antipsychotics. It's a useful drug.
Posted by Lamdage22 on January 9, 2015, at 9:31:24
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by burial on January 9, 2015, at 8:17:31
But what about EPS though??
Posted by Lamdage22 on January 9, 2015, at 9:34:54
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 9, 2015, at 9:31:24
Oh i mean Tardive Dyskinesia.
On the german wikipedia website it says that for long term treatment, tardive dyskinesia with Amisulpride is as likely as with typical antipsychotics!!!
Posted by ed_uk2010 on January 9, 2015, at 10:19:35
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 9, 2015, at 9:31:24
>But what about TD though??
TD can happen with amisulpride, but it's not as common as with typicals such as haloperidol.
The EPS risk with amisulpride appears rather similar to risperidone.... being highly dependent on dose. The same may apply to TD risk, which is probably higher with risperidone than with olanzapine or (especially) quetiapine. The standard typical haloperidol produces a high incidence of TD at all doses and a very high incidence of EPS except at extremely small doses. I don't think amisulpride is nearly as bad as haloperidol, except perhaps at highly excessive doses. The risk of TD is much higher in the elderly than in young or middle aged adults, it also develops more quickly and is less likely to be reversible.
With amisulpride, those with obsessive-compulsive disorder appear more susceptible to EPS and possibly TD than those with psychotic disorders.
http://www.ncbi.nlm.nih.gov/pubmed/14992963
Posted by Lamdage22 on January 9, 2015, at 10:53:33
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals » Lamdage22, posted by ed_uk2010 on January 9, 2015, at 10:19:35
So what do you think?
Zyprexa or Amisulpride?
Either looking like a moron (twitching tongue and/or jumpy legs) or having diabetes type two, perhaps
I dont know which one id choose. Possibly diabetes.
Is the diabetes risk with Zyprexa higher or lower than the risk of TD with Amisulpride?
I think i should base my decision on that.
Posted by Lamdage22 on January 9, 2015, at 10:53:59
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 9, 2015, at 10:53:33
I dont want to look like a moron for the rest of my life.
Posted by Lamdage22 on January 9, 2015, at 10:56:54
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals » Lamdage22, posted by ed_uk2010 on January 9, 2015, at 10:19:35
Maybe the answer is to take both at a low dosage thus steering clear of trouble?
Posted by ed_uk2010 on January 9, 2015, at 13:51:10
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 9, 2015, at 10:53:33
>Is the diabetes risk with Zyprexa higher or lower than the risk of TD with Amisulpride?
I expect the diabetes risk with Zyprexa is considerably higher, except in the elderly. Of course, your Zyprexa/Seroquel combination can also cause TD.
Posted by Lamdage22 on January 10, 2015, at 4:47:10
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals » Lamdage22, posted by ed_uk2010 on January 9, 2015, at 13:51:10
Well i will talk to my Dr about it.
He wants to abandon Serouqel because he thinks that Zyprexa is NOT pro diabetic.
I will tell him im only up for replacing the Zyprexa.
Will see how it goes. I dont want to tell him that he is wrong.
Posted by ed_uk2010 on January 10, 2015, at 5:24:19
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 10, 2015, at 4:47:10
>He wants to abandon Serouqel because he thinks that Zyprexa is NOT pro diabetic.
How strange. Metabolic disturbance is well recognised with Zyprexa, more so that any other atypical apart from clozapine - which has a similar metabolic profile.
Posted by Lamdage22 on January 10, 2015, at 8:10:46
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals » Lamdage22, posted by ed_uk2010 on January 10, 2015, at 5:24:19
I bet amisulpride is better with weight than Zyprexa.
How is it with sex?
Posted by ed_uk2010 on January 11, 2015, at 12:38:25
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 10, 2015, at 8:10:46
> I bet amisulpride is better with weight than Zyprexa.
It is.
> How is it with sex?Similar to risperidone (and paliperidone depot) ie. it causes a problem to some people due to elevated prolactin.
..............
Aripiprazole (Abilify) does not elevate prolactin and causes less weight gain (in general) than Zyprexa. It may not be as effective overall as Zyprexa or amisulpride. Have you tried it?
Posted by Lamdage22 on January 11, 2015, at 14:50:17
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals » Lamdage22, posted by ed_uk2010 on January 11, 2015, at 12:38:25
Yeah i did. Akathisia hell.
But theres a new one coming out. Brexpiprazole?
Supposedly similar to Abilify with lower incidence of Akathisia.
Well see.
Posted by Christ_empowered on January 11, 2015, at 14:53:46
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 11, 2015, at 14:50:17
could you try abilify again? Maybe with a benzo or some other kinda sedative during start up?
I take 30mgs/day. That dose is less activating or whatever. Keeps me calm and minimizes all the crazy quite nicely. When I get really agitated, I take 200mgs neurontin+2mgs risperidone and I'm good to go.
I just think Abilify is more tolerable and probnably safer than a lot of other AP drugs out there.
Posted by Lamdage22 on January 12, 2015, at 6:31:48
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Christ_empowered on January 11, 2015, at 14:53:46
No christ empowered, cant try again. It was really hell.
Im gonna try the amisulpride. Tomorrow. Starting with 50mg
Posted by ed_uk2010 on January 12, 2015, at 8:57:58
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 12, 2015, at 6:31:48
> No christ empowered, cant try again. It was really hell.
>
> Im gonna try the amisulpride. Tomorrow. Starting with 50mg.I think you'll find it very tolerable at that dose. You may not notice anything different. Even low doses tend to elevate prolactin, but that usually takes time.
How are you planning to reduce your other antipsychotics? When used alone, the usual dose of amisulpride is between 400mg and 800mg per day (split into two doses) for those with prominent hallucinations and/or delusions. Close to 400mg twice a day is often optimal for acutely psychotic patients, but may cause some extrapyramidal symptoms. Around 200mg twice a day is suitable for less severe psychotic symptoms. Less than 300mg per day is used for the relief of negative symptoms and depressive symptoms associated with psychosis, but is rarely sufficient when obvious hallucinations and delusions are a problem (or have been a problem prior to treatment with other drugs). 50mg per day is not antipsychotic, but may improve mood.
Posted by Lamdage22 on January 13, 2015, at 12:21:18
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by ed_uk2010 on January 12, 2015, at 8:57:58
Is there any way to decrease the prolactin? Alternative or meds?
Please no dopamine agonists as you sure know i cant take them.
Posted by Lamdage22 on January 13, 2015, at 12:33:18
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 13, 2015, at 12:21:18
I am not sure if i want a hormone that is made for breastfeeding in my body. Seriously.
Is there a chance that it DOESNT raise prolactin or is it a sure thing??
Posted by ed_uk2010 on January 14, 2015, at 0:32:53
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 13, 2015, at 12:33:18
> I am not sure if i want a hormone that is made for breastfeeding in my body. Seriously.
The hormone is always in your body (not just during breastfeeding). It is present both in men and in women. The level is raised by most antipsychotics however, especially risperidone, paliperidone and amisulpride.
>Is there a chance that it DOESNT raise prolactin or is it a sure thing??
Not always, but it usually raises it to some extent - the amount is very variable. It doesn't always cause any symptoms. You can also have a blood test to check the level.
Are you male or female?
Posted by ed_uk2010 on January 14, 2015, at 0:49:36
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 13, 2015, at 12:21:18
>Is there any way to decrease the prolactin? Alternative or meds?
The major medication used (in combination with other antipsychotics) is aripiprazole (Abilify). Naturally, you don't want to take that given your previous experience.
You shouldn't initially take anything. It may not be required. Treatment depends on several factors... whether you are male or female (to some extent), whether you have symptoms or not, and the blood prolactin level. There is a herbal remedy which has been looked at in trials: peony-glycyrrhiza decoction. The effective dose was 45g/day. The medicine may be available from Chinese medicine shops.
Posted by Lamdage22 on January 14, 2015, at 4:32:13
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by ed_uk2010 on January 14, 2015, at 0:49:36
Thanks, ed for the information..
So this PGD does NOT cause any psychotic symptoms usually?
It sounds cool.
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