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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Krazy Kat on January 18, 2002, at 14:22:22
I found some good archives on this, but was curious if there were any new opinions? I'm thinking of Zyprexa + Prozac for BPII. (My pdoc has suggested the addition of Zyprexa again.)
Zyprexa was actually the first med I tried, 2-1/2 years ago. My eye started to twitch and it didn't seem to do anything, but then I stopped after a few days. My research suggests it works well with Prozac for BP.
Any comments appreciated.
- KK
Posted by Greg on January 18, 2002, at 14:52:14
In reply to What do you all think of Zyprexa for BP?, posted by Krazy Kat on January 18, 2002, at 14:22:22
IMHO, Zyprexa is the best med for BP II symptoms. I tried a lot of meds before the Zy, but nothing even came close to working as well as it has. I've been taking it for about 15 months. It does cause weight gain for a lot of people so you have to be very disiplined in your eating and exercise habits. Topamax as a mood stabilizer can help with the weight gain too.
Greg
> I found some good archives on this, but was curious if there were any new opinions? I'm thinking of Zyprexa + Prozac for BPII. (My pdoc has suggested the addition of Zyprexa again.)
>
> Zyprexa was actually the first med I tried, 2-1/2 years ago. My eye started to twitch and it didn't seem to do anything, but then I stopped after a few days. My research suggests it works well with Prozac for BP.
>
> Any comments appreciated.
>
> - KK
Posted by Krazy Kat on January 18, 2002, at 15:19:02
In reply to Re: What do you all think of Zyprexa for BP? » Krazy Kat, posted by Greg on January 18, 2002, at 14:52:14
Thanks Greg. That seems like sound advice (I had thought of adding a little Topamax, too. :) It really curbed my appetite before.)
My pdoc just left a rather cryptic message - he mentioned Geodon and Risperadole(sp?). I don't know - it seems like Zyprexa might be the best bet to try first.
Posted by TSA West on January 19, 2002, at 5:38:00
In reply to Re: What do you all think of Zyprexa for BP? » Greg, posted by Krazy Kat on January 18, 2002, at 15:19:02
Do not consider Zyprexa just an antipsychotic or an anti-manic medication. It has many effects that may be valuable to you, such as the anti-anxiety effect. Zyprexa is a solution for persistent, rapid, and uncontrollable thoughts which interfere with emotional well-being and sleep.
It of course has an antidepressant effect too, similar to nefazodone in the form of 5HT-2A antagonism.
Wishing you the best of health,
Wild Wild West
Posted by cindylou on January 19, 2002, at 20:43:00
In reply to Re: What do you all think of Zyprexa for BP? » Greg, posted by Krazy Kat on January 18, 2002, at 15:19:02
Hi Kat,
I tried Zyprexa in the past, but couldn't handle the strange disorientation I felt. I only stayed on it for about a week.Does your pdoc think Zyprexa and Geodon are safe during pregnancy? Just checking for my own future reference!
Thanks, and hang in,
cindy> Thanks Greg. That seems like sound advice (I had thought of adding a little Topamax, too. :) It really curbed my appetite before.)
>
> My pdoc just left a rather cryptic message - he mentioned Geodon and Risperadole(sp?). I don't know - it seems like Zyprexa might be the best bet to try first.
Posted by TSA West on January 20, 2002, at 7:23:26
In reply to Re: What do you all think of Zyprexa for BP? » Krazy Kat, posted by cindylou on January 19, 2002, at 20:43:00
You asked about Zyprexa in pregnancy, and I found a journal article with that subject:
Olanzapine-Exposed Pregnancies and Lactation: Early Experience. Goldstein, David J. MD, PhD*; Corbin, Lois A. RN†; Fung, Man C. MD, FACP†
"This very early information on olanzapine-exposed pregnancy and lactation suggests a favorable risk-to-benefit ratio for the fetus and infant. Although a very small number, the initial 23 prospectively identified pregnancies did not have an increased risk of spontaneous abortion, stillbirth, prematurity, or major malformation in offspring exposed to olanzapine during pregnancy."
You are in my thoughts,
Sal
Posted by cindylou on January 20, 2002, at 7:30:04
In reply to Zyprexa in pregnancy » cindylou, posted by TSA West on January 20, 2002, at 7:23:26
Thanks so much!
> You asked about Zyprexa in pregnancy, and I found a journal article with that subject:
>
> Olanzapine-Exposed Pregnancies and Lactation: Early Experience. Goldstein, David J. MD, PhD*; Corbin, Lois A. RN†; Fung, Man C. MD, FACP†
>
> "This very early information on olanzapine-exposed pregnancy and lactation suggests a favorable risk-to-benefit ratio for the fetus and infant. Although a very small number, the initial 23 prospectively identified pregnancies did not have an increased risk of spontaneous abortion, stillbirth, prematurity, or major malformation in offspring exposed to olanzapine during pregnancy."
>
> You are in my thoughts,
> Sal
Posted by Krazy Kat on January 20, 2002, at 9:39:17
In reply to Re: What do you all think of Zyprexa for BP? » Krazy Kat, posted by cindylou on January 19, 2002, at 20:43:00
Cindy:
My pdoc seems to think it's better than the stabilizers and from what I've read it appears to be - but it is Category C, just like the others. Tough decision, isn't it?
- KK
Posted by OldSchool on January 20, 2002, at 20:50:47
In reply to What do you all think of Zyprexa for BP?, posted by Krazy Kat on January 18, 2002, at 14:22:22
> I found some good archives on this, but was curious if there were any new opinions? I'm thinking of Zyprexa + Prozac for BPII. (My pdoc has suggested the addition of Zyprexa again.)
>
> Zyprexa was actually the first med I tried, 2-1/2 years ago. My eye started to twitch and it didn't seem to do anything, but then I stopped after a few days. My research suggests it works well with Prozac for BP.
>
> Any comments appreciated.
>
> - KKI understood that for longterm management of bipolar, mood stabilizers like lithium or depakote were the mainstays. Antipsychotics should be reserved more for the manic episodes, especially when its psychotic mania as is quite common with classic manic depression. Zyprexa is formally FDA approved for short term, ACUTE manic episodes associated with bipolar disorder. I have not read anything about Zyprexa being FDA approved for the more longterm "core" management of bipolar disorder.
If it was me Id be trying to play it safe and stick to the mood stabilisers more. Reserving atypical anti-psychotics for acute mania.
Old School
Posted by Blue Cheer 1 on January 20, 2002, at 23:53:34
In reply to Re: What do you all think of Zyprexa for BP?, posted by OldSchool on January 20, 2002, at 20:50:47
> > I found some good archives on this, but was curious if there were any new opinions? I'm thinking of Zyprexa + Prozac for BPII. (My pdoc has suggested the addition of Zyprexa again.)
> >
> > Zyprexa was actually the first med I tried, 2-1/2 years ago. My eye started to twitch and it didn't seem to do anything, but then I stopped after a few days. My research suggests it works well with Prozac for BP.
> >
> > Any comments appreciated.
> >
> > - KK
>
> I understood that for longterm management of bipolar, mood stabilizers like lithium or depakote were the mainstays. Antipsychotics should be reserved more for the manic episodes, especially when its psychotic mania as is quite common with classic manic depression. Zyprexa is formally FDA approved for short term, ACUTE manic episodes associated with bipolar disorder. I have not read anything about Zyprexa being FDA approved for the more longterm "core" management of bipolar disorder.
>
> If it was me Id be trying to play it safe and stick to the mood stabilisers more. Reserving atypical anti-psychotics for acute mania.
>
> Old School
Olanzapine (Zyprexa) has been used to treat all phases of bipolar disorder for several years now. Try a Medline search using keywords "olanzapine bipolar" or "olanzapine fluoxetine". Lilly has been conducting studies using the combination of Zyprexa and Prozac (OFC) for treatment-resistant depression for at least five years (multi-site). All of the atypical APs are used to treat bipolar disorder (psychiatric AIDS). :) Personally, I would exhaust AEDs and/or other drugs before adding a neuroleptic.Blue
Posted by OldSchool on January 21, 2002, at 9:31:42
In reply to Re: What do you all think of Zyprexa for BP?, posted by Blue Cheer 1 on January 20, 2002, at 23:53:34
>
> Olanzapine (Zyprexa) has been used to treat all phases of bipolar disorder for several years now.I have the PDR right in front of me and Zyprexa is only FDA approved for the acute management of mania. Im sure some Pdocs are using it off label for longterm management of bipolar disorder, which I personally do not agree with unless real psychosis is present all the time.
>Try a Medline search using keywords "olanzapine bipolar" or "olanzapine fluoxetine". Lilly has been conducting studies using the combination of Zyprexa and Prozac (OFC) for treatment-resistant depression for at least five years (multi-site).
Yeah, I already know that. In fact, I turned down a chance to get into this very study myself which combined Prozac/Zyprexa for TRD. I do not agree with using Zyprexa/Prozac for the management of non psychotic TRD. A person whose problem is unipolar major depression is more susceptible to neuroleptic induced movement disorders than are schizophrenics. Im personally trying to get over EPS induced from low dose Seroquel as I write this and I dont appreciate the Seroquel induced EPS. Zyprexa could have caused the same thing to me.
> All of the atypical APs are used to treat bipolar disorder (psychiatric AIDS). :) Personally, I would exhaust AEDs and/or other drugs before adding a neuroleptic.
I think atypicals should be reserved for REAL psychosis and mania and not for TRD.
Old School
Posted by Blue Cheer 1 on January 21, 2002, at 11:22:00
In reply to Re: What do you all think of Zyprexa for BP?, posted by OldSchool on January 21, 2002, at 9:31:42
> >
> > Olanzapine (Zyprexa) has been used to treat all phases of bipolar disorder for several years now.
>
> I have the PDR right in front of me and Zyprexa is only FDA approved for the acute management of mania. Im sure some Pdocs are using it off label for longterm management of bipolar disorder, which I personally do not agree with unless real psychosis is present all the time.It's been over 15 years since I've seen a psychopharmacologist who relies on the PDR. In fact, if I encountered a psychiatrist who restricted his prescribing to the PDR (a reference book), I'd have to go elsewhere. May I ask what state you're from? Atypical APs are *routinely* used in the management of bipolar disorder (including mixed states, mania, bipolar depression, rapid cycling, and for long-term management. A cursory online search will confirm this. As far as AEDs, only Depakote is approved in BD. Since I can't tolerate Depakote at any dose, I use Lamictal and Trileptal -- an excellent combination in my case. There's really not much of an economic incentive for drug companies to seek approval for AEDS in psychiatry, since they're already so widely prescribed.
>
>
>
> >Try a Medline search using keywords "olanzapine bipolar" or "olanzapine fluoxetine". Lilly has been conducting studies using the combination of Zyprexa and Prozac (OFC) for treatment-resistant depression for at least five years (multi-site).
>
> Yeah, I already know that. In fact, I turned down a chance to get into this very study myself which combined Prozac/Zyprexa for TRD.At what site, if you don't mind me asking? I declined to participate in a two-year OFC study at Penn in September, 1997 (ongoing, btw).
I do not agree with using Zyprexa/Prozac for the management of non psychotic TRD. A person whose problem is unipolar major depression is more susceptible to neuroleptic induced movement disorders than are schizophrenics. Im personally trying to get over EPS induced from low dose Seroquel as I write this and I dont appreciate the Seroquel induced EPS. Zyprexa could have caused the same thing to me.
Have you ever considered ECT? I agree with you that all APs (conventional and atypical) carry the risk of incurring EPS and worse -- even NMS. Seroquel and Geodon are least likely to cause movement disorders.
>
> > All of the atypical APs are used to treat bipolar disorder (psychiatric AIDS). :) Personally, I would exhaust AEDs and/or other drugs before adding a neuroleptic.
>
> I think atypicals should be reserved for REAL psychosis and mania and not for TRD.It's actually a decison one should make with their treating psychiatrist -- weighing the risks vs. benefits, and an informed consumer can better participate in his/her care.
>
> Old School
Posted by jimmygold70 on January 21, 2002, at 15:57:20
In reply to What do you all think of Zyprexa for BP?, posted by Krazy Kat on January 18, 2002, at 14:22:22
Whit is BPII ? Bipolar Disorder II ? For that, it does work. But Depakote+Prozac works better with less side effects (i.e. Weight Gain and sedation from Zyprexa). Zyprexa is better for acute states of hypomania/mania.
Jimmy
Posted by Krazy Kat on January 21, 2002, at 19:03:52
In reply to Re: What do you all think of Zyprexa for BP? » Krazy Kat, posted by jimmygold70 on January 21, 2002, at 15:57:20
for the info, everyone, although Old School and Blue lost me with their acronyms. :)
I do think Depakote has been a life saver for me, but I am considering getting pregnant and Zyprexa appears to be safer. Also, I'm pretty bad about getting my lab work done on time. Basically if Zyprexa wored as well as Dep., I would switch.
Seems like it might be worth a try, at least during a pregnancy if I decide for that. I can always go back to Depakote afterward.
Posted by Blue Cheer 1 on January 21, 2002, at 22:21:05
In reply to Re: What do you all think of Zyprexa for BP? » cindylou, posted by Krazy Kat on January 20, 2002, at 9:39:17
> Cindy:
>
> My pdoc seems to think it's better than the stabilizers and from what I've read it appears to be - but it is Category C, just like the others. Tough decision, isn't it?
>
> - KKA google search for "altshuler bipolar pregnancy" or "cohen bipolar pregnancy" turns up some helpful information. Also, you can call Lilly at 1-800-LillyRx for their advice about Zyprexa. A Medline search: http://www4.ncbi.nlm.nih.gov/PubMed using the search terms "olanzapine pregnancy" is encouraging, too.
I wish you the best.
Blue
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