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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by JohnL on September 1, 2001, at 9:30:48
Hi All,
As we all know, mileage varies considerably from one person to the next and from one drug to the next. There is the good and there is the bad. This post is to highlight the good parts of Zyprexa in all kinds of mood disorders. It seems to be a drug that spans the entire psychiatric symptom cluster range, from schizophrenia to depression to dysthymia to anxiety to personality disorder to mania and to treatment resistant cases.What I like to see is a drug that not only looks good on paper, but also looks good in the real world right here at psychobabble. Zyprexa is such a drug. A lot of people here have found Zyprexa helpful. It has been a real lifesaver for me. Granted, when I say "a lot" of people, that is far from scientific and won't impress the research buffs. Likewise, all clinical studies or abstracts are flawed in one way or another. But I believe if it looks pretty good in literature, AND it looks pretty good at psychobabble, then it is probably pretty darn good.
For anyone struggling with whatever psychiatric symptoms, Zyprexa could be a top contender. Here are some isolated abstracts to look at. Of special note is how fast Zyprexa can work, and how it can work in very tough populations and for a wide range of symptoms. Also of special note is how it appears to work best when combined with an antidepressant, with Prozac being the best partner. One does not need to be schizophrenic to find benefit in Zyprexa.
1: Am J Psychiatry 2001 Jan;158(1):131-134
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A novel augmentation strategy for treating resistant major
depression.Shelton RC, Tollefson GD, Tohen M, Stahl S, Gannon KS, Jacobs TG, Buras
WR, Bymaster FP, Zhang W, Spencer KA, Feldman PD, Meltzer HY.Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN
37212, USA. richard.shelton@mcmail.vanderbilt.eduOBJECTIVE: Treatment-resistant depression is a significant public health concern;
drug switching or augmentation often produce limited results. The authors
hypothesized that fluoxetine could be augmented with olanzapine to successfully treat
resistant depression. METHOD: An 8-week double-blind study was conducted with
28 patients who were diagnosed with recurrent, nonbipolar, treatment-resistant
depression without psychotic features. Subjects were randomly assigned to one of
three groups: olanzapine plus placebo, fluoxetine plus placebo, or olanzapine plus
fluoxetine. RESULTS: Fluoxetine monotherapy produced minimal improvement on
various scales that rate severity of depression. The benefits of olanzapine
monotherapy were modest. Olanzapine plus fluoxetine produced significantly greater
improvement than either monotherapy on one measure and significantly greater
improvement than olanzapine monotherapy on the other measures after 1 week. There
were no significant differences between treatment groups on extrapyramidal
measures nor significant adverse drug interactions. CONCLUSIONS: Olanzapine plus
fluoxetine demonstrated superior efficacy for treating resistant depression compared
to either agent alone.Publication Types:
Clinical trial
Randomized controlled trialPMID: 11136647 [PubMed - indexed for MEDLINE]
1: Neuropsychopharmacology 2000 Sep;23(3):250-262
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Synergistic effects of olanzapine and other antipsychotic agents
in combination with fluoxetine on norepinephrine and dopamine
release in rat prefrontal cortex.Zhang W, Perry KW, Wong DT, Potts BD, Bao J, Tollefson GD, Bymaster
FP.Neuroscience Research Division, Lilly Research Laboratories, Lilly Corporate Center,
Indianapolis, IN 46285-0510, USA.To understand the mechanism of the clinical efficacy of olanzapine and fluoxetine
combination therapy for treatment-resistant depression (TRD), we studied the effects
of olanzapine and other antipsychotics in combination with the selective serotonin
uptake inhibitors fluoxetine or sertraline on neurotransmitter release in rat prefrontal
cortex (PFC) using microdialysis. The combination of olanzapine and fluoxetine
produced robust, sustained increases of extracellular levels of dopamine ([DA](ex))
and norepinephrine ([NE](ex)) up to 361 +/- 28% and 272 +/- 16% of the baseline,
respectively, which were significantly greater than either drug alone. This combination
produced a slightly smaller increase of serotonin ([5-HT](ex)) than fluoxetine alone.
The combination of clozapine or risperidone with fluoxetine produced less robust and
persistent increases of [DA](ex) and [NE](ex). The combination of haloperidol or
MDL 100907 with fluoxetine did not increase the monoamines more than fluoxetine
alone. Olanzapine plus sertraline combination increased only [DA](ex). Therefore, the
large, sustained increase of [DA](ex), [NE](ex), and [5-HT](ex) in PFC after
olanzapine-fluoxetine treatment was unique and may contribute to the profound
antidepressive effect of the olanzapine and fluoxetine therapy in TRD.PMID: 10942849 [PubMed - indexed for MEDLINE]
1: East Afr Med J 2000 Feb;77(2):86-92
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Naturalistic study of olanzapine in treatment-resistant
schizophrenia and acute mania, depression and obsessional
disorder.Ohaeri JU.
College of Medicine, University of Ibadan, Nigeria.
BACKGROUND: Whereas the Fiji government provides all aspects of mental health
care services free of charge to its citizens, many schizophrenics have failed to respond
to classical antipsychotic drugs. OBJECTIVE: To assess the efficacy and safety of
olanzapine among various patients with severe psychiatric disorders. SETTING:
Naturalistic setting. DESIGN: Descriptive study. MEASUREMENTS: Outcome was
based on reduction of symptoms on the PANSS ( > or = 40%) and CGI shift to 1-3.
SUBJECTS: The were 64 patients (30 males) aged 17-77 years. Thirty six (56.3%)
had schizophrenia, eight mania, ten severe depression, four obsessive compulsive
disorder (OCD), one each had schizo-affective and delusional disorders, while the
remaining had chronic brain diseases. RESULTS: At weeks 3, 8, 12, the proportion of
subjects with 40% improvement was 60.6%, 79.9%, and 76.8%, respectively. Positive
and negative symptoms improved. Thirteen (48.1%) of the 27 long-stay
treatment--resistant schizophrenics achieved clinical recovery at eight weeks. All with
primary diagnosis of severe depression and mania achieved full clinical recovery
(mostly within two weeks). Two OCD cases achieved clinical recovery at week eight.
CONCLUSION: Olanzapine was safe for all categories of patients. There was not a
single case of extrapyramidal reaction among subjects who did not have it
pre-treatment; and the drug was safe in a suicidal overdose of 205 mg. Most patients
experienced weight gain; two adolescent girls had temporary amenorrhoea and one
subject had transient rise in liver transaminases which normalised without
discontinuing the drug.PMID: 10774081 [PubMed - indexed for MEDLINE]
1: Biol Psychiatry 1999 Nov 15;46(10):1429-1435
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Olanzapine safety and efficacy in patients with borderline
personality disorder and comorbid dysthymia.Schulz SC, Camlin KL, Berry SA, Jesberger JA.
Department of Psychiatry, University of Minnesota Medical School, Minneapolis
55454-1495, USA.BACKGROUND: Numerous medications have been tested in patients with borderline
personality disorder (BPD) and/or schizotypal personality disorder (SPD). Although
many of the medications tested have been demonstrated to be useful, no clear main
treatment for BPD has emerged. Despite the efficacy of some of the medicines,
acceptability and side effects have proven to be barriers to the use of medication.
Therefore, an open-label olanzapine trial utilizing objective ratings was performed.
METHODS: Patients suffering from BPD and dysthymia were included in an 8-week,
open-label study of olanzapine monotherapy. The first 4 weeks of the trial allowed for
flexible dosing; during the last 4 weeks, olanzapine dose was held constant. Patients
were rated on Hopkins Symptoms Checklist 90 (SCL-90), Brief Psychiatric Rating
Scale (BPRS), Global Assessment of Function (GAF), Barratt Impulsivity Scale (BIS
11), and Buss-Durkee Hostility Inventory (BDHI). RESULTS: Eleven patients
completed at least 2 weeks; nine of the patients finished the entire trial. There was a
robust and statistically significant reduction in the five global ratings. Within the global
ratings, symptoms of psychoticism, depression, interpersonal sensitivity, and anger
were among the symptoms to be reduced. No movement disorder symptoms were
noted for any of the patients. CONCLUSIONS: In this open-label pilot study, patients
treated with olanzapine showed statistically significant reduction in self-rated and
clinician-rated scales. Symptoms associated with BPD and dysthymia were among
those to be substantially reduced. Further studies to explore olanzapine's efficacy
versus placebo, as well as comparison to other potential treatments for BPD, are
important next steps.Publication Types:
Clinical trialPMID: 10578457 [PubMed - indexed for MEDLINE]
Posted by shelliR on September 1, 2001, at 14:41:52
In reply to Zyprexa, a Great Drug (except for the weight gain), posted by JohnL on September 1, 2001, at 9:30:48
Posted by Janelle on September 1, 2001, at 15:59:43
In reply to Zyprexa, a Great Drug (except for the weight gain), posted by JohnL on September 1, 2001, at 9:30:48
Posted by Zo on September 1, 2001, at 17:08:27
In reply to Zyprexa, a Great Drug (except for the weight gain), posted by JohnL on September 1, 2001, at 9:30:48
John, great to see this post. Zyprexa is an amazing med. I had an usual total meltdown in my pdoc's office one day, and (in addition to supporting me, of course)he handed me a little sample bottle and said, "Here, take two of these at bed and your ego will reassemble in the morning." (Have I already told this story?) The amazing thing was, it did. Powerfully so. I felt powerfully together.
The way this was explained to me, Zyprexa blocks the dopamine cascade on the limbic system that is brought on by hypervigilance, hyperarousal, hyperstress. Allowing one to *think* again.
The weight problem is a serious health issue. Zyprexa has been implicated in *causing* Type II Diabetes. It puts on insulin fat, the most unhealthy kind. I spent a few hours roving the web one night, looking for a solution, and the posts I found were unanimous: woman after woman with a 50 to 80 lb weight gain, who also felt *wonderful* on this drug.
In fact, Geodon was developed precisely to compete with Zyprexa. With great fanfair, it was announced: No weight gain! Unfortunately, it isn't Zyprexa, either. I don't know what you've seen, but it's my impression Geodon is not a resounding success.. . .and certainly doesn't replicate Zyprexa's effects.
The latest scoop is that pretreating and treating with 300mg Axid, an OTC antacid, twice a day can block the weight gain. Have you run across any successes with this?
At any rate, the weight gain is more than a cosmetic nuisance. Zyprexa's selling like gangbusters. . .Maybe a fix will be developed.
I'm kind of gathering that men are affected less, so it must be hormonally-related.
Zo
Posted by AngieT on September 1, 2001, at 20:59:07
In reply to and sometimes it gets worse!, posted by Zo on September 1, 2001, at 17:08:27
In my experience, and from what my pdoc's told me with trying the axid with the zyprexa to try to control the weight issue, it just simply does NOT work...too bad, because Zyprexa seems to be the only thing that works for me, I have tried the Geodon to no avail, and the weight gain really bums me out. I've gained 15 pounds, which may not seem like alot but I am really short and it is alot. But you have to weigh (there's that word) the pro's and con's...would you rather be a little overweight and have a good mental attitude and be pretty well off or be thin and suicidal and right at that EDGE and just feel totally 'nuts'....which is how I feel. It's still hard and I still struggle with that. I know it sounds stupid, it's only weight as some people would say.....but it still matters to me!
Posted by Janelle on September 1, 2001, at 21:03:30
In reply to and sometimes it gets worse!, posted by Zo on September 1, 2001, at 17:08:27
Ah-ha, so THAT's the way Zyprexa works ... by blocking the dopamine cascade on the limbic system that is brought on by hypervigilance, hyperarousal, hyperstress. Allowing one to *think* again. I was given Zyprexa to calm me down and stop my racing thoughts and hyper anxiety and it did just that. It "quieted" my noisy brain.
My pdoc has told me that Zyprexa has been implicated in *causing* Type II Diabetes. I am guessing that by stimluating one's appetite that is how it puts on insulin fat?
I've been *managing* my weight okay on it, thankfully the amazon appetite and late night munchies I had developed have gone away. Then again, I'm also on Lamictal, and my pdoc said that at a decent dose of that, it decreases appetite. So, in my case, perhaps the Lamictal is cancelling out the Zyprexa!
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