Posted by med_empowered on October 31, 2005, at 17:19:30
In reply to Zyprexa Weight Issues, posted by musico on October 31, 2005, at 10:48:09
of all the atypicals, zyprexa is probably the *best* studied as a mood-stabilizer...it seems that, for a lot of people, it acts as a true mood-stabilizer, reducing the severity and frequency of both depression and mania. The problem, of course, is the weight gain: lots of people gain lots of weight. And even if you don't gain weight, there's still a risk of metabolic syndrome, which could ultimately lead to diabetes. You could try adding Metformin (Glucophage, Glucophage XR) and/or amantidine; both of these seem to help with reducing weight gain, and the metformin also seems to help with the metabolic weirdness zyprexa can cause, so its worth looking into (its also available in generic, which is nice). Some docs seem to think it also helps with the underlying mood disorder somehow--apparently, some patients end up being able to reduce dosages of their medications when they add metformin, which is a definite plus. Switching atypicals could also be a good idea...geodon is weight neutral, but can induce mania and causes heart weirdness (qTC prolongation)...I'd recommend Abilify. Its activatig, and lots of people get start-up akathisia, but it seems to help a lot of people if you can deal with those side effects (they usually go away after a while..taking a benzo or propranolol short-term can make the start up much more pleasant). Dosing varies widely; 10mgs is considered the "therapeutic dose", so that's usually the minimum if there's psychosis involved...doses can go up to 30mgs, which is usually reserved for more resistant schizophrenia and/or intense/psychotic mania. Personally, dosing below 10mgs--2.5-7.5--worked quite well for my Bipolar NOS. Abilify is weight neutral, but can cause metabolic issues (right now it seems that this is less of a problem than with other atypicals, but abilify is pretty new so...no one knows for sure). Given that, you might still want to talk to your doc about adding the metformin, or maybe monitoring your blood sugar for a bit to make sure everything's OK. Zyprexa 10mgs is effective as an antipsychotic, but its kind of on the low-end...my guess would be that you could respond pretty well to 10mgs/abilify, but its hard to say (abilify both boosts and dampens dopamine and serotonin; zyprexa functions mainly to lower levels of both neurotransmitters). You could also try working on getting your mood under control with anticonvulsants--trileptal, keppra, lamictal, etc.--and then using an atypical on "as-neeed" basis. This seems to help some people...zyprexa seems to be the most popular antipsychotic for this, but I've heard of seroquel and abilify also being used. Sorry this was so long...I wish you luck, and please keep us all posted. HAPPY HALLOWEEN!
poster:med_empowered
thread:573755
URL: http://www.dr-bob.org/babble/20051031/msgs/573857.html