Posted by med_empowered on August 14, 2005, at 21:03:30
In reply to is SEROQUEL better than ZYPREXA for depression?, posted by bipolarspectrum on August 13, 2005, at 2:37:45
Hey! Your mileage will vary but...seroquel is usually pretty sedating. Its used as a sleep aid, and its the antipsychotic/mood-stabilizer of choice for those with insomnia. But...some people seem to do well on it, and they adjust to the sedation. Seroquel is usually dosed 2X daily, but 3X daily might be useful to reduce daytime sedation. Atypicals can help depression, but they can also cause problems--akathisia, EPS, worsened depression--so careful dosing and med combination is absolutely essential. Zyprexa has been the leader in treating bipolar disorder/BP depression/severe depression, but there are a number of studies out now (supported by the manufacturer, I think) that show that Seroquel can be effective for both the manic and depressive ends of bipolar (and control psychosis and insomnia) as monotherapy. If this holds true in real-life, Seroquel could be the first medication to be truly effective bipolar monotherapy. On the other hand, you do have other options. I don't like antipsychotics, but I did respond well to low-dose (5-7.5mgs) Abilify, in combo with Celexa...at higher doses, I just felt apathetic and stupid. But...Abilify is pretty much weight neutral, doesn't *seem* to cause as much metabolic weirdness as the other atypicals (time will tell though), is usually non-sedating (sometimes even activating...you might want to take it in the morning), and seems to have a very good side-effect profile. On the other hand...its mechanism of action (both reducing and bumping up dopamine and serotonin levels) is unique, so no one really knows how its going to play out long-term. The other option would be Geodon. Geodon is sedating, mostly at first, but some people do stop taking it b/c of sedation. Its a 2X daily medication, like seroquel. It tends to be more or less weight neutral and has a very good side-effect profile in terms of EPS; even in overdose, tremor, akathisia, etc. usually aren't major problems (EPS is usually dose-dependent, so those who overdose on neuroleptics show *incredible* EPS...with Geodon, this seems to be much less of a problem). I believe Geodon still has the metabolic-weirdness factor that many of others have, and it seems to push some people *into* mania--this seems to happen at the lower doses, so you may want to aim for a mid-to-high-range dose if you opt to take Geodon and titrate as quickly as possible. Geodon also causes cardiovascular weirdness kind of like that seen with Mellaril, an old antipsychotic (only it seems to be milder). Mellaril was recently re-packaged with a warning regarding the cardiovascular stuff; it may be connected to some of the "sudden deaths" seen in neuroleptic-treated schizophrenics...no one knows how often this happened, since it really wasn't studied that well (Mellaril was introduced around 1962, and the warning was only recently required, if that gives you any idea of how long it can take for side effects like this to be studied and understood...and for action to be taken). Whatever you do, keep in mind that although tardive dyskinesia is much less common with the atypicals (the rate seems to be .5-1%/year baseline, compared to 3%/year baseline for the old drugs; the elderly, especially older women, have a higher risk...people with disorders such as bipolar or severe depression or "moody schizophrenia" may be at a higher risk of tardive dyskinesia than those with more "pure" schizophrenia). The development of diabetes type II is an issue with all atypicals, although Zyprexa seems to be the biggest offender and Abilify seems to be less damaging in this regard. Weight gain is an issue with most of the atypicals except for abilify and geodon--you may gain a pound or two on these, but the gain is insignificant enough for the drugs to be considered "weight neutral". I didn't mention Risperdal in this post, and that's b/c Risperdal is harsher than the other atypicals, particurarly at higher doses, and it causes hormonal weirdness and things of that nature. I also didn't mention clozapine, because clozapine is usually reserved as a last-ditch effort for resistant schizophrenia or resistant bipolar disorder
Good luck!
poster:med_empowered
thread:540969
URL: http://www.dr-bob.org/babble/20050811/msgs/541726.html