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Dr. Bob is Robert Hsiung, MD,
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Posted by ed_uk2010 on January 25, 2015, at 13:51:35
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 25, 2015, at 13:41:06
>perhaps taking the seroquel all at night will knock me out.
You could consider taking more at night and less during the day assuming that your blood pressure and pulse are OK (both sitting and standing). I don't think it would be a good idea to try it unless you've had these tests. Several measurements should be taken on a few different occasions.
Do you know what your BP and pulse are, taken sitting and shortly (a couple of mins) after standing up?
Also, I think you would need to gradually reduce your daytime dose by 100mg and increase your night time dose by 100mg in several steps.
Posted by Lamdage22 on January 25, 2015, at 13:54:10
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by ed_uk2010 on January 25, 2015, at 13:51:35
Ed, no i dont know.
I used to get dizzy upon standing up from lying but i dont anymore.
I will take this into consideration.
Posted by ed_uk2010 on January 25, 2015, at 14:08:24
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 25, 2015, at 13:54:10
>I used to get dizzy upon standing up from lying but i dont anymore.
That's a good sign. Be careful of the dizziness returning if you take more in one dose. The risk is fainting and falling. So, do it in stages if you do do it.
Posted by Lamdage22 on January 25, 2015, at 14:24:37
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by ed_uk2010 on January 25, 2015, at 14:08:24
Okay. Thanks. Ed-
Posted by Lamdage22 on January 26, 2015, at 5:22:25
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 25, 2015, at 14:24:37
My doctor prescribed a low potency sedating antipsychotic called pipamperone for sleep and further he suggested valproic acid for my depression.
Posted by ed_uk2010 on January 26, 2015, at 9:21:00
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 26, 2015, at 5:22:25
> My doctor prescribed a low potency sedating antipsychotic called pipamperone for sleep and further he suggested valproic acid for my depression.
Your doctor certainly likes antipsychotics!
You're already on a low potency sedating antipsychotic: Seroquel - and lots of it, as well as Zyprexa. It is an unusual choice to add a third antipsychotic for sleep in someone already on two antipsychotics. What's his logic?
So, how bad is your depression right now? And how bad is your insomnia (when not attempting to reduce Zyprexa)? Are you hearing any voices, experiencing any paranoia or suffering any other psychosis-like symptoms?
Posted by Lamdage22 on January 26, 2015, at 9:33:16
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by ed_uk2010 on January 26, 2015, at 9:21:00
No insomnia unless i try to reduce Zyprexa.
No voices, nothing.
Depression though. Particularly seasonal affective i suspect.
The low potency AP was my idea. I think it doesnt carry a risk of diabetes and i have tolerated it well in the past!
Posted by Lamdage22 on January 26, 2015, at 10:58:56
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 26, 2015, at 9:33:16
What would you recommend for my insomnia, ed?
Posted by ed_uk2010 on January 26, 2015, at 11:48:03
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 26, 2015, at 10:58:56
>What would you recommend for my insomnia, ed?
Initially, I'd suggest that you try taking more Seroquel in the evening and less during the day, rather than adding more medication. I'm unsure of the value or safety of adding a third antipsychotic acting on some of the same receptors which are already blocked by your current high dose antipsychotic treatment.
The thing is about adding pipamperone.... low dose mainly block 5-HT2a receptors, high doses block D2 receptors as well. I imagine your 5-HT2a receptors are substantially blocked already by Seroquel and Zyprexa. I don't think the TD risk or the diabetes risk of pipamperone are well known. Pipamperone is usually classified as a typical antipsychotic but its receptor binding profile is slightly atypical, despite its chemical similarity to haloperidol (Haldol).
How bad is your insomnia? Perhaps it would improve on treating your depression.
Have you struggled to find a suitable treatment for depression? You seem to be on a very small dose of venlafaxine. Do you have a history of symptoms being worsened by antidepressants eg. a manic episode being induced?
Posted by Lamdage22 on January 26, 2015, at 13:16:30
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by ed_uk2010 on January 26, 2015, at 11:48:03
> >What would you recommend for my insomnia, ed?
>
> Initially, I'd suggest that you try taking more Seroquel in the evening and less during the day, rather than adding more medication. I'm unsure of the value or safety of adding a third antipsychotic acting on some of the same receptors which are already blocked by your current high dose antipsychotic treatment.
>
> The thing is about adding pipamperone.... low dose mainly block 5-HT2a receptors, high doses block D2 receptors as well. I imagine your 5-HT2a receptors are substantially blocked already by Seroquel and Zyprexa. I don't think the TD risk or the diabetes risk of pipamperone are well known. Pipamperone is usually classified as a typical antipsychotic but its receptor binding profile is slightly atypical, despite its chemical similarity to haloperidol (Haldol).
>
> How bad is your insomnia? Perhaps it would improve on treating your depression.
>
> Have you struggled to find a suitable treatment for depression? You seem to be on a very small dose of venlafaxine. Do you have a history of symptoms being worsened by antidepressants eg. a manic episode being induced?I take the low dose of venlafaxine to be able to orgasm.
Higher doses werent more effective.
I havent struggled, i didnt find anything for depression
Posted by ed_uk2010 on January 26, 2015, at 13:23:13
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 26, 2015, at 13:16:30
OK, so how bad is your depression now? And how bad is the insomnia? I mean, do you feel very distressed by it? Or not so bad?
Perhaps lithium carbonate might help the depression, rather than lithium orotate.
Posted by Lamdage22 on January 27, 2015, at 3:00:09
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by ed_uk2010 on January 26, 2015, at 13:23:13
My mood is like a 4 out of 10.
I could sleep yesterday with 40 mg pipamperone and 12.5 Zyprexa (instead of 15).
Lithium at 300 led to humongous weight gain so i dont even want to know about, say 900.
Posted by ed_uk2010 on January 27, 2015, at 5:56:40
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 27, 2015, at 3:00:09
Morning.
> My mood is like a 4 out of 10.
It does sound like you need further treatment for this. Which antidepressants have you tried and how do you respond? It looks like you don't tolerate high doses of serotonergic drugs like venlafaxine.
>I could sleep yesterday with 40 mg pipamperone and 12.5 Zyprexa (instead of 15).
Excellent that you could sleep!
I suppose what I'm wondering is..... taking pipamperone may allow you to reduce Zyprexa to some extent by blocking some of the same receptors, but do you think things will be better by taking three antipsychotics instead of two? What do you plan here? The incidence of side effects with pipamperone does not seem very well established but sexual dysfunction/libido loss is often reported so I assume it elevates prolactin.
Regarding Seroquel, do you find you need the daytime doses to relieve agitation?
>Lithium at 300 led to humongous weight gain so i dont even want to know about, say 900.
You may need to be cautious about valproic acid (valproate) since it causes weight gain so frequently. It's generally more effective against manic symptoms than depression. Do you have a history of mania or mixed states? I'm wondering if this is why your doctor mentioned it.
Posted by Lamdage22 on January 27, 2015, at 7:10:50
In reply to Re: Multiple mechanism with Zyprexa and some atyp » Lamdage22, posted by ed_uk2010 on January 27, 2015, at 5:56:40
Hi Ed,
it is clear that i need depression tteatment, but this treatment is not on the market yet. Trust me we tried all that could be tried or all that is worth trying.
Im not taking the valproic acid.
Its not worth the risk.
So do you think trazodone could be better for me? The "non-addicting" sleep meds arent too many.
Posted by Lamdage22 on January 27, 2015, at 7:14:06
In reply to Re: Multiple mechanism with Zyprexa and some atyp » Lamdage22, posted by ed_uk2010 on January 27, 2015, at 5:56:40
i took like 900 seroquel all at night the other day, i still couldnt sleep. I just took like 300mgs ontop of the 500 i take at night.
No sleep until 15mg of Zyprexa.
Pipamperone is more sedating than zyprexa but it is way less potent than zyprexa.
Thats what im ttying to do. Replace the high potency stuff with lower potency.
Im still for trazodone.
Posted by Lamdage22 on January 27, 2015, at 7:20:37
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 27, 2015, at 7:14:06
Or not trazodone.
Idk seriously and im not going to worry sick about all this.
Posted by ed_uk2010 on January 27, 2015, at 8:52:09
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 27, 2015, at 7:14:06
> i took like 900 seroquel all at night the other day, i still couldnt sleep. I just took like 300mgs ontop of the 500 i take at night.
Oh right, I guess that's not going to work then.
>Pipamperone is more sedating than zyprexa but it is way less potent than zyprexa.
Less potent just means fewer milligrams though, it doesn't mean better. In general, highly potent antipsychotics like haloperidol cause less weight gain than low potency neuroleptics, but there are many exceptions (as you know!). I doubt pipamperone causes as much weight gain as Zyprexa, for example.
>I'm still for trazodone.Trazodone is probably worth a try, as a non-antipsychotic alternative to pipamperone which might allow you to sleep on a lower total antipsychotic dose. Trazodone is one of the more weight neutral options and doesn't elevate prolactin. It doesn't normally cause sexual dysfunction either. I don't know whether it would help your depression - it might. Would your doctor be up for trying it?
Posted by Lamdage22 on January 27, 2015, at 9:16:11
In reply to Re: Multiple mechanism with Zyprexa and some atyp » Lamdage22, posted by ed_uk2010 on January 27, 2015, at 8:52:09
I dont know. He might be.
But trazodone can cause arrythmias as well as Seroquel and Zyprexa.
Its hard to tell which is the better alternative for me.
Posted by ed_uk2010 on January 27, 2015, at 9:34:14
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 27, 2015, at 9:16:11
>But trazodone can cause arrhythmias as well as Seroquel and Zyprexa.
It's possible, but the same risk applies when adding another antipsychotic. Either way, you should be having an ECG to check your QTc interval.
>Its hard to tell which is the better alternative for me.
You'd really have to try trazodone to see if it helps, and to find out whether it allows you to sleep on a lower antipsychotic dose.
Posted by Lamdage22 on January 27, 2015, at 11:21:23
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by ed_uk2010 on January 27, 2015, at 9:34:14
> >But trazodone can cause arrhythmias as well as Seroquel and Zyprexa.
>
> It's possible, but the same risk applies when adding another antipsychotic. Either way, you should be having an ECG to check your QTc interval.
>
> >Its hard to tell which is the better alternative for me.
>
> You'd really have to try trazodone to see if it helps, and to find out whether it allows you to sleep on a lower antipsychotic dose.Hey ed. I had an ecg yesterday. Its totally fine.
I will think about trazodone until my next appointment.
Posted by ed_uk2010 on January 27, 2015, at 12:37:53
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 27, 2015, at 11:21:23
>I had an ecg yesterday. Its totally fine.
Good to hear.
Have you ever been stable on Seroquel without Zyprexa, apart from insomnia?
Posted by Lamdage22 on January 27, 2015, at 12:40:06
In reply to Re: Multiple mechanism with Zyprexa and some atyp » Lamdage22, posted by ed_uk2010 on January 27, 2015, at 12:37:53
Ed, i once was stable on 200mg Seroquel. (No psychosis)
A ludicrous trial with Parnate, a trial with tianeptine and a "therapeutic" session with an parents=antichrists therapist have led to the dosages i am on now.
Posted by ed_uk2010 on January 27, 2015, at 13:04:40
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 27, 2015, at 12:40:06
> Ed, i once was stable on 200mg Seroquel. (No psychosis)
OK. Was this recently, and how long were you stable for?
I was wondering really, whether your use of multiple antipsychotics was required for psychosis, or whether the doses had been increased to their current level for insomnia or other reasons?
What was your psychosis like? Schizoaffective disorder is quite variable so I'm unsure.
Posted by Lamdage22 on January 27, 2015, at 13:08:11
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by ed_uk2010 on January 27, 2015, at 13:04:40
> > Ed, i once was stable on 200mg Seroquel. (No psychosis)
>
> OK. Was this recently, and how long were you stable for?No it was 2013. For as long as i didnt try Parnate. Ok i was on 300 then after some time but i could have been on 200 as well.
> I was wondering really, whether your use of multiple antipsychotics was required for psychosis, or whether the doses had been increased to their current level for insomnia or other reasons?
Im not sure if it is psychosis. It does go away with meds though. We call it "pre-psychotic"
> What was your psychosis like? Schizoaffective disorder is quite variable so I'm unsure.
Loss of control.
Posted by Lamdage22 on January 27, 2015, at 13:09:38
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 27, 2015, at 13:08:11
And yes, after the Parnate trial, after the tianeptine trial and after this ridiculous session with the therapist i was full blown psychotic and thus increased the dosages.
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