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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 5 to 29 of 29. Go back in thread:
Posted by vince on June 12, 2001, at 23:21:00
In reply to Geodon really works and I won't shut up about it, posted by SalArmy4me on June 12, 2001, at 17:05:08
SalArmy, Do you experience any drowsiness after taking geodon?
That is the only side effect that I have from it. I get some relief from it but not complete yet? I'm not taking full dosage (160mg/day) yet because of the drowsiness. I'm hoping I'll adjust.
Vince
Posted by stjames on June 13, 2001, at 0:16:25
In reply to Re: Geodon really works and I won't shut up about it, posted by sl on June 12, 2001, at 19:39:46
> I have no benefits. I'd have to get samples every month from my Doc. That's why I asked.
>James here....
Take a look at http://www.themedicineprogram.com/
where you can get your meds for free.James
Posted by SalArmy4me on June 13, 2001, at 8:26:52
In reply to Re: Geodon really works and I won't shut up about it » SalArmy4me, posted by vince on June 12, 2001, at 23:21:00
I don't know whether its the Lithium that's making me drowsy or the Geodon. But I do take Lithium too, along with Effexor and desipramine.
Posted by terra miller on June 13, 2001, at 19:10:04
In reply to Geodon really works and I won't shut up about it, posted by SalArmy4me on June 12, 2001, at 17:05:08
my apologies for not keeping up on the threads relating to this med, so i'm clueless.
i know this is new. is it for depression? is it similar to an ssri? or anxiety? or what? a link would be fine. thanks. seeing pdoc in two days and want to be armed with information.
would it mix with wellbutrin? would it help wean me off ativan? so many questions....
terra
Posted by SalArmy4me on June 13, 2001, at 20:15:39
In reply to Re: Geodon really works and I won't shut up about it » SalArmy4me, posted by terra miller on June 13, 2001, at 19:10:04
Posted by terra miller on June 13, 2001, at 23:40:17
In reply to Re: Geodon really works and I won't shut up about it, posted by SalArmy4me on June 13, 2001, at 20:15:39
> http://www.medsafe.govt.nz/Profs/datasheet/z/zeldoxcap.htm
this sent me to zeldox/ziprasidone
???
Posted by SalArmy4me on June 13, 2001, at 23:45:52
In reply to Re: Geodon really works and I won't shut up about it » SalArmy4me, posted by terra miller on June 13, 2001, at 23:40:17
Zeldox and ziprasidone are Geodon.
> > http://www.medsafe.govt.nz/Profs/datasheet/z/zeldoxcap.htm
>
> this sent me to zeldox/ziprasidone
> ???
Posted by Zo on June 16, 2001, at 21:26:29
In reply to Re: Geodon really works and I won't shut up about it » SalArmy4me, posted by vince on June 12, 2001, at 23:21:00
> SalArmy, Do you experience any drowsiness after taking geodon?
>
> That is the only side effect that I have from it. I get some relief from it but not complete yet? I'm not taking full dosage (160mg/day) yet because of the drowsiness. I'm hoping I'll adjust.
>
> Vince160 mg a day! Wow, how do you afford it!
And, my pdoc just told me the dose for us non-psychotics is in the 20-40 mg range. . .Zo
Posted by Zo on June 16, 2001, at 21:30:29
In reply to Geodon really works and I won't shut up about it, posted by SalArmy4me on June 12, 2001, at 17:05:08
And thanks, SalArmy, this was just what I needed to hear! . .am counting the hours. Had to make switch from Zyprexa, couldn't waddle anymore. . . Risky business, I was doing so well on it. So your post is right on time.
Tick tick tick tick. . . .
Posted by Bob on October 5, 2001, at 16:22:21
In reply to Geodon really works and I won't shut up about it, posted by SalArmy4me on June 12, 2001, at 17:05:08
> *I have non-psychotic unipolar depression, and it worked for me in 9 days (this is because it works on serotonin and norepinephrine like venlafaxine).
> *It has moderate dry mouth.
> *No drowsiness.
> *It can be taken with any medication except for MAOI's.
> *It doesn't cause weight gain like its relatives Risperdal, Zyprexa, or Seroquel (I've taken them all too).
>
> The downside:
> *Its horrifically expensive. 60 of the 40mg tablets costs $400 (US). That isn't even enough for a whole month either. You would have to have your doctor call the pharmacist to get this covered by insurance.
> *It could cause mania if you are bipolar.
> *Its not good for people with heart problems.***********************************
Sal:
Do you still take this med? If not, why not? I would like to know, as I'm considering it. You sound very positive about it here.
Bob
Posted by SLS on October 5, 2001, at 23:05:03
In reply to Re: Geodon really works and I won't shut up about it, posted by Bob on October 5, 2001, at 16:22:21
Dear Bob,
I have been taking Geodon (ziprasidone) for about three weeks. Given my history of extreme refractoriness to treatment, that Geodon helps at all might be an indicator of its potential to exert an antidepressant effect. It has been helping a bit as an adjunct to Effexor + nortriptyline + Lamictal. I am currently taking 40mg/day in divided doses. I was gratefully greeted by insomnia for the last few nights. Historically, this has been a good prognosticator for me.
1. I have experienced transient improvements with Risperdal and Zyprexa.
2. Risperdal was somewhat sedating at first, and later produced some cognitive impairments at 1.5mg and higher; dosages that were necessary to sustain an improvement.
3. Zyprexa was cleaner than Risperdal and somewhat more robust. I did experience some increase in appetite as well as a slurring of speech over the first two weeks that later dissipated. I would experience occasional somnolence during the afternoon. I experienced diminishing returns in the second week.
4. So far, the antidepressant effect produced by Geodon has not reached the degree that I saw early in the Zyprexa trial, but it seems to be more consistent and stable. It has not increased my appetite nor produced any slurring of speech. So far, I would say that Geodon is well worth consideration. I have not experienced EPS with any of these three neuroleptics. Of note is the fact that all three have been observed to induce mania. It is my impression that Geodon is more liable to produce mania than either Risperdal or Zyprexa. I see the relative maniogenic potential as Geodon > Zyprexa > Risperdal. > Stelazine.
Regarding pharmacology, all three are mild to moderate antagonists at DA2 receptors, and moderate to potent antagonists at the 5-HT2a receptor. Geodon, unlike Risperdal and Zyprexa, displays considerable agonism at the 5-HT1a receptor. In this respect, it is similar to buspirone, gepirone, ipsapirone, and flesinoxan, all drugs known to display mild to moderate antidepressant effects. In addition, Geodon is often *cited* as capable of inhibiting the reuptake of both serotonin and norepinephrine. However, I am not so confident that this is accurate, although I have no reason to believe otherwise. I have yet to see the investigations that are said to have yielded this conclusion. Were this to be so, Geodon would then possess five pharmacological properties associated with drugs known to possess antidepressant properties:
1. DA2 antagonism – if it is preferential to presynaptic autoreceptors at low dosages.
2. 5-HT2a antagonism
3. 5-HT1a agonism
4. NE reuptake inhibition
5. 5-HT reuptake inhibition.
It is a very interesting drug. It probably has the second lowest risk of producing EPS, Seroquel being perhaps lower. This might be due to its high ratio of 5-HT2a / DA2 binding ratio. It is without the H1 receptor antagonism displayed by Zyprexa and Clozaril. One notable detraction is that it can affect cardiac function, as it prolongs the QT interval in a manner similar to Mellaril, albeit less robustly. However, it is significant enough as measured in the laboratory to take into consideration when making a decision.
Some people on Psycho-Babble have reported Geodon to have produced excitation, insomnia, manic-like symptoms, and various presentations of EPS, including lingual dystonias.
I hope this helps.
Sincerely,
Scott
P.S. I’m in Minnesota right now. I had to wear my winter jacket today. I just thought you’d like to know.
Posted by SLS on October 5, 2001, at 23:06:40
In reply to Re: Geodon really works and I won't shut up about it » Bob, posted by SLS on October 5, 2001, at 23:05:03
Sorry, I forgot.
I don't think Sal is taking Geodon anymore.
- Scott
Posted by bob on October 6, 2001, at 0:14:40
In reply to Re: Geodon really works and I won't shut up about it, posted by SLS on October 5, 2001, at 23:06:40
> Sorry, I forgot.
>
> I don't think Sal is taking Geodon anymore.
>
>
> - Scott*****************************
Scott:
Your post was extremely informative and helpful. I have a number of questions/comments, as it was highly technical.
1. Isn't it tough for you to switch from drug to drug? You seem to go through a lot of meds. I've been on my share, but it has always been extremely tough to taper and switch for me. I mean REAL difficult. Maybe that's because I've largely done solo trials in the past and come almost completely off of one before going on another, but I don't know how I'd understand what's doing what otherwise.
2. What is EPS? What does that stand for, and what does it mean?
3. Induction of mania, as long as it was a mild hypo-variety would not be entirely unwelcome to me. All of the SSRIs and and related meds (including Depakote) have been very sedating and apathy producing for me. I assume you haven't experienced any mania with these APs? You didn't mention as much.
4. What is the DA2 receptor - dopamine, or norepinephrine?
5. Why do you have a lack of confidence in Geodon's norepinephrine boosting properties? If you haven't seen any investigative results, then where did you hear it?
6. I think I understand reuptake inhibition, but what are antagonism and agonism, and how do they relate to reuptake?
Now I'd like to make a few comments (or maybe more than a few -- this will be long):
You seem to be taking quite a powerful combo: Effexor + Nortriptyline + Lamictal. If I was taking that, I'd probably gain 40% body weight, and not be able to know I had genitals anymore unless I could see them in the mirror with my own eyes. I took Anafranil and it was brutal -- sweating, sedation, significant weight gain, impotence, etc. I took Effexor and I again had significant weight gain, and loss of sexual capability. More insidious though with this drug, was something that I have now found to be a hallmark of all the classic SSRI drugs for me (Celexa, Paxil, Zoloft, Luvox): a severly shifted Circadian rhythm. I begin waking up later and later in the day, COMPLETELY independent of when I go to bed. Eventually, I literally don't hear my blasting alarm clock, and don't get out of bed until mid-afternoon. It's almost like a coma. This is REGARDLESS of when I go to sleep. It was very severe with Effexor, and I am now experiencing it with Luvox. When it gets like this, a 12 hour night is AVERAGE. Nothing I've ever tried has alleviated this effect (stimulants, sleeping pills, having someone call me on the phone etc...). In addition to that, I have started getting waxing and waning "muscle tightness" with these SSRIs, and my body seems to alternate between being overheated, and cold (thyroid disregulation???). I tried Lamictal before this Luvox thing (when I was on Celexa) and got a rash almost immediately. I then tried Topomax and it was rough, but allowed me to make the transition away from SSRIs -- I tapered off of Celexa. Then, for the first time in my life of medicating, I was free of anticholinergic effects and shifted sleep patterns (and the weight and muscle tension problems faded)!!!!!! Alas, it was too good to last. I began getting very aggressive, angry, and emotionally labile. I had a breakdown, and had to back off. While backing off, I had a battle with no less than 4 kidney stones, precipitated by the Topomax. I'm very scared now, as it feels as if my body will no longer tolerate SSRIs, and tricyclics are even worse! Now I've also had a heinous experience with the "newer" anticonvulsants. My doctor has suggested Tegretol. I have significant reservations about this also, as I took Depakote for a long while and was never more tired in my life... not to mention depressed. It's getting harder and harder to switch from drug to drug. I think my condition is deteriorating, and I don't know how much longer I can stand it. Maybe I should taper off everything and try ECT? I can't even try something like rTMS, because the loser FDA is too cost prohibitive for those small manufacturers to pursue approval here in the U.S. They do use that for people who can't tolerate drugs, right?
It just seems that the physical effects of these drugs are so significant I'm not going to be able to put up with it much longer. When all this started about 12 years ago, it was 99% a mental problem. No I'd say its about 40% mental concerns and 60% physical. Maybe it's even more towards the physical side than that. All the side-effects notwithstanding... they don't even always help me mentally. They do, however, eventually lead to a state of minimized physical activity, and endemic apathy. I am very demoralized at this point. The only class I haven't tried is MAOIs, but I hear they are even harder to tolerate than tricyclics, and then there's the diet. Besides, I literally don't think I could survive a washout period.
You don't have to answer the following questions but I'm going to ask them anyway:
1. Do you have any ability whatsoever to have sexual relations any longer?
2. Have you experienced significant weight gain? You mentioned that Geodon didn't cause increased appetite, but don't Effexor and Nortriptyline??? Effexor was a killer for me. I'd eat, and 10 minutes later, I'd be ready for another meal.
3. With 3 significant meds in your cocktail already, why do you need a fourth?
4. How is you tolerablity in general? Do you consider yourself susceptible to side-effects, or can you take large doses without many problem?
5. Isn't Nortriptyline a bear to tolerate?
Sorry for being on such a downer, but that's the way it is right now?
Bob
P.S. I'm in Baltimore right now, and the temp was in the mid-eighties today. However, a cold front is moving through tonight, and they said by Sunday the highs will only be in the fifties. :-)
Sorry to bombard you with all this crap! I'm thinking about posting an involved history of my med odyssey on here as a new thread to see if anyone has any suggestions for me.
Posted by bob on October 6, 2001, at 0:26:14
In reply to Re: Geodon really works and I won't shut up about it, posted by SLS on October 5, 2001, at 23:06:40
> Sorry, I forgot.
>
> I don't think Sal is taking Geodon anymore.
>
>
> - Scott**********************
Does Geodon have significant anticholinergic effects for you?
Posted by bowflex man on October 6, 2001, at 20:12:42
In reply to Re: Geodon really works and I won't shut up about it, posted by bob on October 6, 2001, at 0:26:14
I have been on Geodon since Sept 1 and it makes me very drowsy. I have to drink a lot of coffee and sodas just to stay awake in the morning. I take 40 mgs twice a day, maybe I should get on Provigil. any suggestions?
Posted by SLS on October 7, 2001, at 10:42:58
In reply to Re: Geodon really works and I won't shut up about it, posted by bob on October 6, 2001, at 0:14:40
Dear Bob,
It will take quite some time to read through your post. Hopefully, I'll get to it later today.
One comment I would like to make is that I do *not* go through drugs so quickly - at least, not any more.
I believe quite strongly that people who have failed many drug trials in the past cannot afford to go through drugs quickly. There are sufficient numbers of cases for which it takes as much as 2-3 months to obtain adequate results to drug treatment so as to warrant continuation beyond 4 weeks. Of course, this makes that much more critical the choices of which drugs and drug combinations to invest so much time in. This is why I am trying as much as possible to defer to experts these decisions. I'm paying them for a reason, and it isn't for me to teach them how to treat me. I think I am fortunate to have found someone competent to direct my treatment.
I do not find Geodon at all sedating and it has not produced dry mouth or any of the other side effects usually associated with drugs that are anticholinergic.
- Scott
Posted by bob on October 7, 2001, at 11:55:07
In reply to Re: Geodon really works and I won't shut up about it, posted by bowflex man on October 6, 2001, at 20:13:29
> I have been on Geodon since Sept 1 and it makes me very drowsy. I have to drink a lot of coffee and sodas just to stay awake in the morning. I take 40 mgs twice a day, maybe I should get on Provigil. any suggestions?
**************************
I wouldn't have much to suggest for you here, as I have had that problem with just about every drug that has a significant SSRI boosting effect. I simply can't get out of bed, because I'm too sleepy. I've tried many many things, and although some of them worked for a short period of time (1-2 weeks), they all eventually ended up being a bust. Sorry I couldn't be of help here.
Bob
Posted by bob on October 7, 2001, at 12:07:42
In reply to Re: Geodon really works and I won't shut up about it » bob, posted by SLS on October 7, 2001, at 10:42:58
> Dear Bob,
>
> It will take quite some time to read through your post. Hopefully, I'll get to it later today.
>
> One comment I would like to make is that I do *not* go through drugs so quickly - at least, not any more.
>
> I believe quite strongly that people who have failed many drug trials in the past cannot afford to go through drugs quickly. There are sufficient numbers of cases for which it takes as much as 2-3 months to obtain adequate results to drug treatment so as to warrant continuation beyond 4 weeks. Of course, this makes that much more critical the choices of which drugs and drug combinations to invest so much time in. This is why I am trying as much as possible to defer to experts these decisions. I'm paying them for a reason, and it isn't for me to teach them how to treat me. I think I am fortunate to have found someone competent to direct my treatment.
>
> I do not find Geodon at all sedating and it has not produced dry mouth or any of the other side effects usually associated with drugs that are anticholinergic.
>
>
> - Scott*************************************
Scott:
I didn't mean to imply that you don't give drugs adequate trial times. It's just that, these days for me, coming off of a drug and switching to another one has become an extremely harrowing and nasty experience. When you had mentioned all those APs and your take on them, I was suprised that you could have tried all of them already. Then again, I don't know when you started.
Please take your time on getting back to me on that long post.
I have a dumb question to ask. How do you post a message without having the other person's message on your post? You seem to be able to do it, but I don't know how.
Bob
Posted by SLS on October 7, 2001, at 23:37:35
In reply to Re: Geodon really works and I won't shut up about it, posted by bob on October 7, 2001, at 12:07:42
Hi Bob.
> I didn't mean to imply that you don't give drugs adequate trial times.
I am becoming more and more concerned that people may not be fully exploring different drugs due to underdosing or inadequate trial duration. I guess I just wanted to make sure that the point was made.
> It's just that, these days for me, coming off of a drug and switching to another one has become an extremely harrowing and nasty experience. When you had mentioned all those APs and your take on them, I was suprised that you could have tried all of them already. Then again, I don't know when you started.
>
> Please take your time on getting back to me on that long post.
>
> I have a dumb question to ask. How do you post a message without having the other person's message on your post? You seem to be able to do it, but I don't know how.You can simply highlight and delete the unwanted text by holding down the shift key and moving the mouse or using the arrow keys. I like to compose my posts using a text editor or word processor. I'll highlight the whole post, and copy-and-paste to the word processor for editing. I'll then delete the entire message box and transfer the text from the word processor by copy-and-pasting.
Going on and off the atypical APs is generally easy to do when working with the low dosages that are used for augmenting antidepressants. I think you can get a good feel for what one of these drugs will do within two weeks of adding it to an existing regime.
JohnL has some great ideas on how to minimize the agony during the wait between drug trials. Some people find Ritalin helpful. It might be preferable to continue with a drug that has produced even marginal improvement and simply add the new drug to it, so long as they are not incompatable. You can taper one while increasing the other if necessary.
- Scott
Posted by AngieT on October 10, 2001, at 19:42:48
In reply to Geodon really works and I won't shut up about it, posted by SalArmy4me on June 12, 2001, at 17:05:08
> *It could cause mania if you are bipolar.
Is this true? Is there proof to this? Because I am bipolar and on Geodon and been having alot of behavioral problems since starting the Geodon; would love to know if there is proof to it causing mania so I can bring it to the attention of my pdoc.
Posted by SLS on October 10, 2001, at 22:25:15
In reply to Does Geodon really Cause Mania?, posted by AngieT on October 10, 2001, at 19:42:48
>
> > *It could cause mania if you are bipolar.
> Is this true? Is there proof to this? Because I am bipolar and on Geodon and been having alot of behavioral problems since starting the Geodon; would love to know if there is proof to it causing mania so I can bring it to the attention of my pdoc.
Hi Angie.What sorts of things have you been experiencing?
- Scott
Posted by judy1 on October 11, 2001, at 0:39:03
In reply to Does Geodon really Cause Mania?, posted by AngieT on October 10, 2001, at 19:42:48
I had manic symptoms within a week on Geodon, but I have a lot of trouble with mania versus depression. I went a couple of days w/o sleep than all hell broke loose- the spending, speeding tickets, traveling, etc. Once I stopped I REALLY crashed, so I have no scientific data to share with you, I'm guessing it's a low percent (had the same problem with risperdal) but it does exist. I really upped my depakote during this episode and it helped. Good luck- Judy
Posted by houstongirl on October 12, 2001, at 20:03:04
In reply to Re: Geodon really works and I won't shut up about it, posted by bowflex man on October 6, 2001, at 20:12:42
I am on Depakote and Celexa (100 mg!), with EXTREME somnolence. Provigil has made making it through the work day possible. I still have problems waking up - literally sleeping through three alarm clocks, no matter what time I go to bed. (average 12 hours) I'm thinking of trying something besides the Depakote, though, b/c of weight gain. Topamax maybe? How does Geodon do for weight? Anyone know?
> I have been on Geodon since Sept 1 and it makes me very drowsy. I have to drink a lot of coffee and sodas just to stay awake in the morning. I take 40 mgs twice a day, maybe I should get on Provigil. any suggestions?
Posted by longsfrng on October 13, 2001, at 14:20:29
In reply to Re: Geodon really works and I won't shut up about it, posted by houstongirl on October 12, 2001, at 20:03:04
I have been on Geodon for a few months and it hasn't caused weight gain. In fact, I am starting to lose the more than 40 pounds I gained while on elavil and effexor.
Posted by NikkiT2 on October 13, 2001, at 15:02:08
In reply to Re: Geodon really works and I won't shut up about it, posted by longsfrng on October 13, 2001, at 14:20:29
Just get the damned thing liscened in the UK!! :o)
Does anyone have any information on when it might be available here.
Nikki
This is the end of the thread.
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