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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by bipolarspectrum on May 31, 2005, at 22:10:40
Hi,
I'm currently taking zyprexa for bipolar depression.. It seems to helping a bit for the depression.. But it makes me very sleepy and gives me tremors.. i think i might ask my pdoc to change soon... which atypical have you found to have the most antidepressant effect?
thanx
bps
Posted by SLS on May 31, 2005, at 23:06:48
In reply to which ANTIPSYCHOTIC helps most for depression??, posted by bipolarspectrum on May 31, 2005, at 22:10:40
> Hi,
> I'm currently taking zyprexa for bipolar depression.. It seems to helping a bit for the depression.. But it makes me very sleepy and gives me tremors.. i think i might ask my pdoc to change soon... which atypical have you found to have the most antidepressant effect?
> thanx
> bps
I like Abilify. It gives me more motivation and takes the edge off of the deepest of depression. However, one must anticipate the mild to moderate akathisia-like side effects and perhaps insomnia during the first week or two of treatment. It tends to disappear altogether.
- Scott
Posted by cache-monkey on June 1, 2005, at 0:57:01
In reply to which ANTIPSYCHOTIC helps most for depression??, posted by bipolarspectrum on May 31, 2005, at 22:10:40
Only three of the atypicals have been clinically studied for their efficacy in bipolar depression: Risperdal, Seroquel and Zyprexa. The work on Risperdal is based on small samples and seems to be mixed. Zyprexa has some anti-depressant effect, but is much more potent when combined with Prozac.
A recent study found that Seroquel had a remarkably strong antidepressant effect (at doses of 300 and 600 mg). Much stronger than that found with Zyprexa monotherapy. Basically the total effect on the MADRS scores from Seroquel alone was equivalent to Zyprexa plus Prozac. Also, in terms of monotherapy Seroquel seperated from the placebo on 8-9 out of ten items on the MADRS, while Zyprexa only did so on 3.
The big drawback of Seroquel, though, seems to be somnolence/sedation (probably a function of super-strong H-1 blockade), which was the leading source of drop-outs in the BOLDER study. Some people are more susceptible to this than others, and this can also potentially drive weight gain.
HTH,
cache-monkey
Posted by hawkeye on June 1, 2005, at 5:23:36
In reply to which ANTIPSYCHOTIC helps most for depression??, posted by bipolarspectrum on May 31, 2005, at 22:10:40
Geodon is the best antidepressant I ever took. Aside from it's AP properties it is an SNRI.
Posted by SLS on June 1, 2005, at 6:35:14
In reply to Re: which ANTIPSYCHOTIC helps most for depression?? » bipolarspectrum, posted by cache-monkey on June 1, 2005, at 0:57:01
Hi C-M.
> A recent study found that Seroquel had a remarkably strong antidepressant effect (at doses of 300 and 600 mg).
Thanks for your detailed and accurate reporting. I didn't know there had been studies showing such strength in Seroquel. I have seen this personally in some people.
Seroquel is a funny drug, though. It tends to be more sedating at 25-50mg than it is at the higher dosages. It is too bad that many of the drop-outs in studies aren't encouraged to wait for side effects to dissipate.
On occasion, Zyprexa has made people manic.
- Scott
Posted by holymama on June 1, 2005, at 13:08:45
In reply to Re: which ANTIPSYCHOTIC helps most for depression??, posted by SLS on June 1, 2005, at 6:35:14
I'm glad to see this thread. It's very pertinent to my last week's experiences. My doctor raised my lithium dose while at the same time prescribing 1 mg risperdal and within a few days I was MANIC; not sleeping, cleaning, organizing, I spent $400-500 very quickly on home improvement items.
That was Sunday. Now it's wednesday and I've been sleeping soundly with the help of ativan and keeping up a hypomanic pace that my doctor wants to let be and see how it will settle eventually.
WHat's up with this?? I didn't know an antipsychotic would work on my bipolar. It's very very powerful, even at a low dose. I need to research this antipsychotic stuff.
Posted by bipolarspectrum on June 1, 2005, at 16:03:08
In reply to Re: which ANTIPSYCHOTIC helps most for depression?? » bipolarspectrum, posted by cache-monkey on June 1, 2005, at 0:57:01
Thanx for the replies,
I like the idea of abilify, with its unique d2 agonist/antagonism... Just wondering about the study u were talking about cache... the only big study i can find involves depressive symptons in psychotics..
bps
Posted by cache-monkey on June 1, 2005, at 17:50:39
In reply to Re: which ANTIPSYCHOTIC helps most for depression??, posted by bipolarspectrum on June 1, 2005, at 16:03:08
> Thanx for the replies,
> I like the idea of abilify, with its unique d2 agonist/antagonism... Just wondering about the study u were talking about cache... the only big study i can find involves depressive symptons in psychotics..
> bpsIt's a company-sponsored study, but led by Dr. Joe Calabrese who is a big name in bipolar med research. Most of the information on the BOLDER study can be found on a Seroquel company website:
http://www.psychiatryinpractice.com/
Click on "Seroquel News" link on the left for various press releases about the study.More informative is to click on the "Bipolar webcast Feb 05" and view the Webcast portion for Calabrese. This outlines how Seroquel stacks up agains Zyprexa on the MADRS.
Obviously this has to be taken with a grain of salt, since it's company sponsored. But Calabrese is a pretty good researcher and admits his own surprise with the positive findings of the study. But in terms of the benefits, the study seems to be well-designed and was double-blind, so it's kind of hard to argue with. In terms of the side effects, that's might be where a little spin comes in...
Best,
cache-monkey
Posted by yesac on June 2, 2005, at 15:19:04
In reply to Re: which ANTIPSYCHOTIC helps most for depression??, posted by SLS on June 1, 2005, at 6:35:14
>
> Seroquel is a funny drug, though. It tends to be more sedating at 25-50mg than it is at the higher dosages. It is too bad that many of the drop-outs in studies aren't encouraged to wait for side effects to dissipate.
Really? I currently take 100mgs. I'd like to go up because I'm not sleeping well and I'm agitated and depressed. I know that a higher dose could potentially help with these symptoms, but I'm afraid of going up because I am afraid of becoming too tired.Maybe I should just give it a try.
Too bad it's so expensive though. That's another issue.
Posted by SLS on June 2, 2005, at 21:01:39
In reply to seroquel » SLS, posted by yesac on June 2, 2005, at 15:19:04
> >
> > Seroquel is a funny drug, though. It tends to be more sedating at 25-50mg than it is at the higher dosages. It is too bad that many of the drop-outs in studies aren't encouraged to wait for side effects to dissipate.
>
>
>
>
> Really? I currently take 100mgs. I'd like to go up because I'm not sleeping well and I'm agitated and depressed.This would be a reasonable thing to try. If Seroquel successfully alters your brain chemistry and confers an antidepressant effect, the attendant depressive symptoms of agitation and insomnia might dissipate as the depression resolves.
Good luck.
- Scott
Posted by med_empowered on June 3, 2005, at 2:48:02
In reply to Re: seroquel » yesac, posted by SLS on June 2, 2005, at 21:01:39
Zyprexa is the reigning champ of the antipsychotic world, so it makes sense that its the #1 in terms of antidepressant augmentation (in terms of usage, not necessarily therapeutic benefit). Low-dose Abilify (7.5mgs; then 10) helped with my depression A LOT, while the higher doses caused more problems than I would have liked, and also seemed to lose the anti-depressant benefit...this seems to be true with many people; you have to hit just the right dose to find benefit, as going too high or low causes problems. I think Risperdal is kinda rough in terms of side-effects, so I'd personally opt for Abilify, Geodon, or seroquel. Geodon has qTC interval heart weirdness, so one might want to avoid it if there's a history of cardiovascular problems and/or other drugs involved, like Tricyclics, also have cardiovascular effects. Seroquel is pretty benign in terms of side effects for most people, and the anti-insomnia benefit is a major plus. Another one I think might become more popular, because of new research and cost effectiveness, is amoxapine, which is marketed as Asendin. Its a tricyclic antidepressant, but its also similar to Loxapine, a conventional anti-psychotic that seems to have an "atypical" structure; in fact, some shrinks consider loxapine to be the first atypical antipsychotic. Anyway, amoxapine does double duty as an anti-psychotic/anti-depressant in one med, so its great for psychotic depression and some caes of treatment resistant depression. I read somewhere that, when it works (about 70% of the time, like most ADs) 80% of those for whom it works find that it works fast--from 4 to 14 days. Low-dose loxapine itself seems promising as a cheap, effective way to augment antidepressants.
This is the end of the thread.
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