Posted by med_empowered on October 16, 2005, at 4:08:38
In reply to I'm doing great! BUT............................, posted by ace on October 16, 2005, at 1:58:32
hmmm...tricky situation. I think the first thing to do would be to try to medicate the weight loss, so its easier to lose w/ exercise and diet. If that truly fails, then it may well be time to consider a change in your "core" meds. Have you tried a traditional, stimulant-type diet pill? They would be tricky to use, considering you're taking both an MAIO and an antipsychotic, but the benefits could be great. In addition to the "golden oldies"--phendimetrazine, phentermine, tenuate, didrex-- there's also Meridia. Meridia costs more, and there are some health conerns with it, but from what I understand its been used to counteract zyprexa-induced weight gain with some success...plus, unlike the older, traditional diet pills which were designed and tested for 8-12 weeks of as-needed use, Meridia has some good data behind it for long-term use. With proper monitoring, it could be useful. Although not usually used for weight loss anymore, stimulants such as Dexedrine, Adderall, and Ritalin could also be used; in low-doses, these could help with your depression, possibly offer benefits with motivation, and also work on decreasing intake and upping your metabolism to burn off extra calories. Desoxyn would be a really potent potential add-on, but its not a very popular stimulant. Provigil (modafanil) seems to have some mild weight-reducing properties; I read a case report where adding provigil to a pre-existing clozapine regimine resulted in a significant reduction of weight, although the patient's weight did not quite return to baseline (keep in mind that this is with clozapine, which in addition to causing massive weight gain also causes **dense** sedation; my guess would be that modafanil+your regimine would have more pronounced results). The only problem with modafanil is its new-ness; no one really knows how it works, and I don't know if docs have yet figured out if it can be combined with MAOIs and, if so, how exactly to go about such a combo.
Finally...as much as I hate to suggest you switch up your core meds after having so much success, I kind of think that maybe if you switched out the seroquel you'd feel better. I read a study where patients switched from zyprexa to abilify (this was full-dose treatment for schizophrenia) lost a considerable amount of weight; they also became more active overall. Abilify in and of its self won't drop weight, but it's weight neutral and (usually) non-sedating, so it will allow your body to return to a more normal state and help you lose weight (keep in mind: abilify may cause blood sugar issues, but they don't seem quite as pronounced as those caused by other drugs, and the problem isn't also accompanied by weight gain). Dosing with antipsychotics is tricky, but I bet if you started on a "sub-therapeutic" dose of Abilify (ex: start at 2.5mgs, go to 5 for a little while, maybe try out 7.5...the usual dose is 10-15mgs), you might find a low-dose that works for you. My only advice from experience would be keep it at or below 10mgs; the jump from 10-15mgs meant a huge increase in side-effects for me, and I've heard this from other people, too. The downside would be increased activation and possibly an increase in anxiety (this is usually temporary, and abilify actually helps some people with anxiety) and a reduction in anti-anxiety effects that you were getting from seroquel. All I could recommend there would be possibly upping the xanax for a while or permanently, adding an old-school antihistamine to mimic some of seroquel's actions (hydroxyzine might be good), or possibly keeping LOW dose (say, 25mgs) seroquel on for as-need use in high-anxiety situations. A switch from seroquel to abilify (or geodon..I just find geodon scary b/c of the heart problems) along with co-prescription of a mild stimulant (i.e., modafanil), a weight-reducing medication (i.e., sibutraime) or a blood-sugar adjusting med (i.e, metformin) seems like it could produce the most results in the shortest period of time. Then again..it could also produce the most side effects. Sorry this was sooooooo long..I wish you the best of luck, and please keep us all posted on your progress.
poster:med_empowered
thread:567505
URL: http://www.dr-bob.org/babble/20051010/msgs/567511.html