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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 7 to 31 of 31. Go back in thread:
Posted by J Kelly on April 6, 2016, at 11:52:14
In reply to Re: replace zyprexa with what?, posted by linkadge on April 5, 2016, at 15:31:12
> You could try something like perphenazine.
>
> LinkadgeI've seen some posts about this lately. Seems like a popular AP. I'm putting it at the top of my list. Scott is suggesting I wait to switch/add an AP until I'm stabilized on Nardil. I tend to agree.
Thanks,
Jade
Posted by J Kelly on April 6, 2016, at 11:58:00
In reply to Re: replace zyprexa with what?, posted by Christ_empowered on April 5, 2016, at 16:13:33
> what symptom(s) are being treated w/ the zyprexa? I think perphenazine could be a good option, as linkadge pointed out. Loxapine is another older AP that may not be so terrible in low-to-moderate doses.
>
> That's about all I've got for you. Hope you and your MD find something that works.Hi CE,
Zyprexa mainly helps my sleep schedule and possibly anxiety. If its helping my depression its minor. Perphenazine is at the top of my list but i'm gonna look into Loxapine as well.
Thanks,
Jade
Posted by J Kelly on April 6, 2016, at 12:03:01
In reply to Re: replace zyprexa with what?, posted by PeterMartin on April 5, 2016, at 20:22:31
> > I've taken low dosages of seroquel (25 to 100) and don't have any real SIDE effects. Personally haven't gained weight due to it.
> >
> > I mainly use it for sleep and at a tiny dose of 25mg it always knocks me out.
> >
> >
>
> Don't have any side effects it how that should read (typing on phone).Seroquel is great for sleep. I have a family member who had to d/c it due to weight gain. I'll keep it on the list though. Only thing is I may need it to prevent psychosis while on Nardil and the dose would probably have to higher than one would need for sleep :(
Thank you,
Jade
Posted by J Kelly on April 6, 2016, at 12:09:04
In reply to Re: replace zyprexa with what? » J Kelly, posted by SLS on April 5, 2016, at 21:10:09
> Does it make any sense to stay with Zyprexa until you are stabilized on Nardil? You might then look to switch from Zyprexa to another AP or a mood stabilizer.
Yes. I know you are right. I want it all lol.
> A friend of mine does well with Saphris to help protect her from schizoaffective episodes. Saphris has allowed her to lose the weight she gained while on Seroquel.
I took Saphris a few years ago and d/c'd it. Cant remember why. I'm gonna add it to my list of Perphenazine and Seroquel.
Thanks Scott,
Jade
Posted by SLS on April 6, 2016, at 14:37:03
In reply to Re: replace zyprexa with what? » SLS, posted by J Kelly on April 6, 2016, at 12:09:04
> > Does it make any sense to stay with Zyprexa until you are stabilized on Nardil? You might then look to switch from Zyprexa to another AP or a mood stabilizer.
>
> Yes. I know you are right. I want it all lol.
>
> > A friend of mine does well with Saphris to help protect her from schizoaffective episodes. Saphris has allowed her to lose the weight she gained while on Seroquel.
>
> I took Saphris a few years ago and d/c'd it. Cant remember why.Maybe it's not the right drug for you.
> I'm gonna add it to my list of Perphenazine and Seroquel.
The only AP that I would be reluctant to add would be Geodon. It exhibits serotonin reuptake inhibition, so serotonin syndrome might be a consequence when combined with a MAOI.
- Scott
Posted by linkadge on April 6, 2016, at 15:56:17
In reply to Re: replace zyprexa with what? » linkadge, posted by J Kelly on April 6, 2016, at 11:52:14
Some of the older antispychotics were unfairly villainized when newer (on patent) atypical antipsychotics came out.
There was a large study (named 'CATIE' I believe), suggested that newer atypicals were not any better at relieving positive or negative symptoms, and they were associated with higher rates of metabolic issues.
The older medications did have higher rates of TD, but lower rates of inducing metabolic complications.
Although perphenazine is an 'older' antipsychotic, it does have atypical actions in that it affects both serotonin and dopamine systems. It is relatively less potent, and hence can be obtained in weaker doses. I believe it blocks primarily 5-ht2a receptors, and 5-ht2c less so. This means that weight gain is likely not as prominent as it is with Zyprexa.
I mean, it is still an antipsychotic. It should not be used unless an antipsychotic is warranted, but perphenazine is not a bad alternative to try in place of newer atypicals.
Linkadge
Posted by Zyprexa on April 7, 2016, at 0:12:40
In reply to Re: replace zyprexa with what?, posted by linkadge on April 6, 2016, at 15:56:17
I take zyprexa and perphenazine. Other than zyprexa, perphenazine is the only AP I could tolerate. I've been taking perphenazine for about 8 years now, and zyprexa for 18. Zyprexa is better than perphenazine. But perphenazine does not have weight gain. It will also help with sleep. I can't say for sure what the perphenazine is doing, because I have never taken it alone. I tried discontinuing zyprexa but had some problems. I think at best I decreased the zyprexa a lot. Then I had some anger problems when I tried to d/c the perphenazine, so I didn't do that either. I think I was actually grumpy a lot before the perphenazine too.
Perphenazine alowed me to reduce my zyprexa at the time and weight has been more managable. Mind you I didn't eat before taking zyprexa.
When I reduced zyprexa, on perphenazine I also had some holucinations and time disorientation. That may have been the day I didn't take zyprexa, I'm not really sure. I was at work and froze in time not knowing what I was doing. For a brief second and snaped out of it. It gets a lot worse if I stop it for a long time. I have not totaly done that in over a decade now.
Posted by J Kelly on April 7, 2016, at 13:22:34
In reply to Re: replace zyprexa with what?, posted by SLS on April 6, 2016, at 14:37:03
>
> The only AP that I would be reluctant to add would be Geodon. It exhibits serotonin reuptake inhibition, so serotonin syndrome might be a consequence when combined with a MAOI.
>
>
> - ScottHuh. Geodon is what they used at the hospital to treat my Parnate induced psychosis. I experienced extreme anxiety. Now I'm wondering if it was a Geodon side effect or serotonin syndrome. I wont take it again.
Jade
Posted by J Kelly on April 7, 2016, at 13:30:01
In reply to Re: replace zyprexa with what?, posted by linkadge on April 6, 2016, at 15:56:17
> Some of the older antispychotics were unfairly villainized when newer (on patent) atypical antipsychotics came out.
>
> There was a large study (named 'CATIE' I believe), suggested that newer atypicals were not any better at relieving positive or negative symptoms, and they were associated with higher rates of metabolic issues.
>
> The older medications did have higher rates of TD, but lower rates of inducing metabolic complications.
>
> Although perphenazine is an 'older' antipsychotic, it does have atypical actions in that it affects both serotonin and dopamine systems. It is relatively less potent, and hence can be obtained in weaker doses. I believe it blocks primarily 5-ht2a receptors, and 5-ht2c less so. This means that weight gain is likely not as prominent as it is with Zyprexa.
>
> I mean, it is still an antipsychotic. It should not be used unless an antipsychotic is warranted, but perphenazine is not a bad alternative to try in place of newer atypicals.
>
> LinkadgeThanks Linkadge.
It seems cruel that I may have to choose between being obese and being depressed. Hopefully I wont have to make this choice as a result of trialing Nardil.
Jade
Posted by J Kelly on April 7, 2016, at 13:37:28
In reply to Re: replace zyprexa with what?, posted by Zyprexa on April 7, 2016, at 0:12:40
> I take zyprexa and perphenazine. Other than zyprexa, perphenazine is the only AP I could tolerate. I've been taking perphenazine for about 8 years now, and zyprexa for 18. Zyprexa is better than perphenazine. But perphenazine does not have weight gain. It will also help with sleep. I can't say for sure what the perphenazine is doing, because I have never taken it alone. I tried discontinuing zyprexa but had some problems. I think at best I decreased the zyprexa a lot. Then I had some anger problems when I tried to d/c the perphenazine, so I didn't do that either. I think I was actually grumpy a lot before the perphenazine too.
>
> Perphenazine alowed me to reduce my zyprexa at the time and weight has been more managable. Mind you I didn't eat before taking zyprexa.
>
> When I reduced zyprexa, on perphenazine I also had some holucinations and time disorientation. That may have been the day I didn't take zyprexa, I'm not really sure. I was at work and froze in time not knowing what I was doing. For a brief second and snaped out of it. It gets a lot worse if I stop it for a long time. I have not totaly done that in over a decade now.Thanks for this post Zyprexa. This gives me a lot to consider. I'd love to switch to perphenazine but if it doesn't cover me for psychosis while on Nardil then back on the shelf it goes. These decisions are SO hard to make. I'm sure you can relate.
Jade
Posted by linkadge on April 7, 2016, at 20:12:20
In reply to Re: replace zyprexa with what? » linkadge, posted by J Kelly on April 7, 2016, at 13:30:01
Have you tried mirtazapine? It is olanzapine-like, but without the dopamine antagonism.
Linkadge
Posted by Zyprexa on April 7, 2016, at 21:22:16
In reply to Re: replace zyprexa with what?, posted by linkadge on April 7, 2016, at 20:12:20
mirtazapine will make you eat worse than zyprexa.
Posted by Lamdage22 on April 7, 2016, at 23:20:47
In reply to Re: replace zyprexa with what?, posted by Zyprexa on April 7, 2016, at 21:22:16
> mirtazapine will make you eat worse than zyprexa.
It depends.. it may be different for each person.
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In reply to replace zyprexa with what?, posted by J Kelly on April 5, 2016, at 15:25:55
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Posted by Phillipa on April 8, 2016, at 9:41:06
In reply to Re: replace zyprexa with what?, posted by Lamdage22 on April 7, 2016, at 23:20:47
Years ago took 15mg for a month and not more hungry, weight gain nor did it help with sleep even with benzos at the time. Phillipa
Posted by J Kelly on April 8, 2016, at 12:40:09
In reply to Re: replace zyprexa with what? » Lamdage22, posted by Phillipa on April 8, 2016, at 9:41:06
> Years ago took 15mg for a month and not more hungry, weight gain nor did it help with sleep even with benzos at the time. Phillipa
I've never taken 15mg but I suspect I'd be knocked out in 15 minutes for 15 hours. Its wierd how different people respond to different meds.
What is currently working for you?
Jade
Posted by J Kelly on April 8, 2016, at 12:44:41
In reply to Re: replace zyprexa with what?, posted by Zyprexa on April 7, 2016, at 21:22:16
> mirtazapine will make you eat worse than zyprexa.
Oh my gosh... can there be such a thing? :)
Jade
Posted by J Kelly on April 8, 2016, at 12:53:25
In reply to Re: replace zyprexa with what?, posted by linkadge on April 7, 2016, at 20:12:20
> Have you tried mirtazapine? It is olanzapine-like, but without the dopamine antagonism.
>
> Linkadge\No I haven't tried mirtazapine. How might it compare to Zyprexa weight gain? Are you saying it might be more dopamine "friendly"?
Excuse my ignorance.
Jade
Posted by Lamdage22 on April 8, 2016, at 14:11:25
In reply to Re: replace zyprexa with what? » Phillipa, posted by J Kelly on April 8, 2016, at 12:40:09
>Its wierd how different people respond to different meds.
It strikes me all the time.
Posted by Christ_empowered on April 8, 2016, at 14:14:41
In reply to Re: replace zyprexa with what? » linkadge, posted by J Kelly on April 8, 2016, at 12:53:25
its Remeron, a (highly) sedating AD. More popular in Europe than in the US. Lower doses are more sedating; higher doses, less so. Weight gain is an issue, but I've read that higher doses are less weight gain-ey. Never taken it myself, so I can't tell you from experience.
European docs apparently use much higher doses. In the US, its often combined w/ other ADs, often to good effect. I don't know if its compatible w/ MAOI drugs. It is not a serotonin reuptake inhibitor.
Ramble...could be a good option, for sedation, if nothing else (my opinion). What all are you taking?
Remeron is supposed to be less apathy-inducing than many other options, or so I've read (again: personal experience here=0). Since its not a neuroleptic, I would assume that it'd be much less apathy-making than any dose of Zyprexa. You'd also be spared all the neuroleptic side effects...akathisia, eps, tardive everything (dyskinesia, akathisia, dementia, etc.).
Posted by Lamdage22 on April 8, 2016, at 14:27:36
In reply to Re: replace zyprexa with what?, posted by Christ_empowered on April 8, 2016, at 14:14:41
>You'd also be spared all the neuroleptic side effects...akathisia, eps, tardive everything (dyskinesia, akathisia, dementia, etc.).
>
>J Kelly.. thats a good point.
Posted by linkadge on April 8, 2016, at 17:39:43
In reply to Re: replace zyprexa with what? » linkadge, posted by J Kelly on April 8, 2016, at 12:53:25
For an individual responding to an atypical (for depression augmentation), it is necessary to realize that atypical antipsychotics non-selectively block both serotonin and dopamine receptors. It is thought that the serotonin (not dopamine) blockade is responsible for the antidepressant qualities of atypical antipsychotics. Mirtazapine blocks the same serotonin receptors (5-ht2a/c) but does not block dopamine receptors. Hence, it may not induce as much anhedonia / motor side effects.
Mirtazapine can cause weight gain (and improve sleep) like olanzapine, but *may* produce less apathy / anhedonia as a side effect.
It is a stronger antihistamine than olanzapine, so it could cause more increase in appetite.
However, I never gained much weight (unfortunately) on either olanzapine nor mirtazapine, although mirtazapine was better for my mood.
Linkadge
Posted by linkadge on April 8, 2016, at 17:46:24
In reply to Re: replace zyprexa with what?, posted by Christ_empowered on April 8, 2016, at 14:14:41
I have extensive experience with remeron (mirtazapine) and take it alongside Effexor.
As far as core depression symptoms, remeron can be remarkably effective. It can be very sedating, but there are ways to offset this. A few studies suggest it can work faster than other antidepressants, although is not as well tolerated.
It produces a very different side effect profile than SSRIs. It can mix very well with drugs like Effexor.
I would take remeron over olanzapine any day. It has similar effects on sleep and anxiety, but doesn't leave you feeling quite as blah.
Your mileage may vary, of course.
Linkadge
Posted by Phillipa on April 8, 2016, at 18:15:57
In reply to Re: replace zyprexa with what? » Phillipa, posted by J Kelly on April 8, 2016, at 12:40:09
Reading, .5mg xanax, & 5mg valium. Phillipa
Posted by J Kelly on April 9, 2016, at 9:42:48
In reply to Re: replace zyprexa with what?, posted by linkadge on April 5, 2016, at 15:31:12
Thanks guys for the suggestions.
Considering:
Perphenazine
Risperadone (weight gain)
Remeron (weight gain, better on dopamine)
Loxapine (possibly not as effective for psychosis)
Saphris (past use, d/c'd...why?)
Perphenazine looks most promising. I will show this list to my pdoc.Thanks again :)
Jade
This is the end of the thread.
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