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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 Schess81 on September 27, 2005, at 10:20:14
I was google-ing I read an abstract about prozac (fluoxetine) and zyprexa(olanzapine) having been used together for treatment resistant unipolar depression. I'm curious, has anyone here had success with using an atypical antipsychotic with an SSRI for depression?
Posted by Emily Elizabeth on September 27, 2005, at 13:26:10
In reply to Atypical antipsychotics for TRD?, posted by Schess81 on September 27, 2005, at 10:20:14
I've never tried it, but my pdoc has put it out there as an option. Instead, I added Lithium and it seems to have been fairly helpful. (I'm TRD, not Bipolar).
Best,
EE
Posted by med_empowered on September 27, 2005, at 15:49:52
In reply to Re: Atypical antipsychotics for TRD? » Schess81, posted by Emily Elizabeth on September 27, 2005, at 13:26:10
Symbyax, the new-ish prozac+zyprexa combo, is FDA-approved for the treatment of Bipolar I Disorder, Depressed Phase. However, there's a pretty long history of treating treatment resistant (or agitated, severe, or psychotic) depression w/ a combination of antidepressant(s)+antipsychotic (both the older ones and the atypicals). Zyprexa was and is used pretty widely for this indication ("off-label", meaning without the official OK of the FDA), so its no surprise that the Symbyax combo was approved for Bipolar Depression, which is notoriously hard to treat. Although Symbyax is probably the best studied combo, there are other options...all of the atypicals seem to have some antidepressant effects in some people, and if they're used at lower-end dosages in combo with antidepressant(s) (usually an SSRI, but drugs like Effexor, Cymbalta, and the Tricyclics can also be used), the antidepressant effect can be very pronounced. I had good results with low dose (about 5mgs) Abilify (the usual "therapeutic" dose for Abilify when treating schizophrenia or bipolar disorder is at least 10mgs; 30mgs is preferred for florid psychosis or acute, psychotic mania) when combined with low-dose (20mgs) celexa. The biggest improvement was in my anxiety--even with Klonopin, I was stuck in my apartment b/c I was freaking out all the time. Within 2 days or so, there was a profound anti-anxiety effect; within a week, my depression had more or less resolved itself. I'd personally recommend that you look out for some major problems associated with the atypicals, namely the "metabolic syndrome" (elevated LDL cholesterol, insulin resistance, etc.) and the mega-weight gain that can occur, but is particularly common and pronounced with Zyprexa and Clozapine. Geodon is more or less weight neutral, but it does carry some cardiovascular risks (prolongation of the qTC interval). No one really knows the clinical significance of this; for this reason, I'd advise against Geodon unless nothing else is tolerable...also, when doing med combos, your doc will have to be very careful if she opts for Geodon. Seroquel can cause weight gain, type II diabetes, etc. just like zyprexa, but the risk isn't quite as great; the big problem is sedation. That said, seroquel seems to have pronounced anti-depressant effects, at least in those with Bipolar Disorder. Risperdal is another option; its "high-potency," so doses are smaller and sedation is less of an issue. However, its kind of rough; I think one can view Risperdal as drug sort of midway between the old drugs (haldol, perphenazine, thorazine) and the new drugs (clozapine, zyprexa, abilify) in terms of side effects. Abilify is my favorite b/c of the reduced drowsiness (its non-drowsy for a lot of people, but it can be a problem for some) and it doesn't cause weight gain...it can cause metabolic issues, but these seem to be less pronounced than with, say, zyprexa. Plus, Abilify both blocks (antagonises) and boosts (agonises) dopamine and serotonin; the overall effect seems to be much lower EPS (muscle twitches and jerks often seen with antipsychotics). But...it does cause anxiety in some people, especially the beginning of treatment, and there's a big difference in side effects depending on dosage; if you opt for Abilify, I'd really recommend that you try to keep dosage at or below 10mgs/day. Good luck!
Posted by Schess81 on September 27, 2005, at 18:50:56
In reply to Re: Atypical antipsychotics for TRD?, posted by med_empowered on September 27, 2005, at 15:49:52
Thanks for all the information. After reading everything you said, I'm definitely going push my p-doc to give it a try. SSRIs and friends just dont seem to do anything for me; Ive talken prozac, paxil, effexor, wellbutrin, lamictal and now I've given remeron a try- but since I'm not Bipolar a Dr doesnt seem to be able to look past the usual medication paradigm and mention possibly adding an atypical antipsychotic. I've been so miserably depressed for so long, I'll try anything- if something works but makes me fat and diabetic, that still sounds better than living the rest of my life like this.
I'm curious, but are you on the abilify at present? and if not, were you able to go off it and the depression not come back?
Posted by Ilene on September 27, 2005, at 19:40:05
In reply to Atypical antipsychotics for TRD?, posted by Schess81 on September 27, 2005, at 10:20:14
In a word, no. I've taken Risperdal, Zyprexa, and Abilify in combo with various drugs and had no response whatsoever. I gained 20 lb. on Zyprexa, which didn't go away after I discontinued the drug.
I.
Posted by Schess81 on September 27, 2005, at 21:53:44
In reply to Re: Atypical antipsychotics for TRD? » Schess81, posted by Ilene on September 27, 2005, at 19:40:05
Either way, it sounds like antipsychotics aren't and ideal choice, expecially in the long term. In a perfect world I'd rather go back to a stimulant combo- adderall with paxil worked wonders for about 9 months, but the adderall seemed to poop out on me: now if I take it I get fewer positive effects but I crash when it wears off. (you might be wondering how I ever got a Dr to prescribe a stimulant for depression- and the answer is I didnt: the Dr I saw at that time diagnosed me as ADD also.) Anyway, when the adderall stopped working so well it was actually my decision to go off of it- like I said, I was starting to feel a bad crash when it would wear off- but ever since I weaned off of it I haven't had a full remission of my depression. Well, getting back to whatever I was talking about ..oh yeah, I'd rather add ritalin or provigil to the prozac and remeron I'm taking right now, cause I'm almost sure it would work, but I'm not sure the Dr I have now is going to go for it. Unfortunatly I'd probably have better luck asking about the atypical antipsychotic combo. But maybe I shouldnt be so pessimistic. Or maybe I ought to try lithium like Emily Elizabeth mentioned. I should really add that the only reason I'm writing on this board so much today is because I took some of my old adderall XR at about noon and I'm feeling great. Oh, I love amphetamine and hate it at the same time. Well I'm sure many others on this board understand...
Posted by Emily Elizabeth on September 27, 2005, at 22:16:11
In reply to Re: Thanks for the honesty Ilene, posted by Schess81 on September 27, 2005, at 21:53:44
I wish that you could see my pdoc. :( She would be more aggressive in treating your TRD. I also know that I have read at least 2 journal articles about protocols for TRD that include some of the things that you mentioned. Do you have access to medline or something like that to look for articles? If I can figure out what I read, I'll let you know. Or someone else here might know. Perhaps bringing in the article to discuss w/ your pdoc would be helpful. Some back-up for what you want to do.
BTW, I have also tried a stimulant (dexedrine) in my mix. It helped, but not completely. I currently take: lexapro, neurontin, desipramine, dexedrine, ambien, and lithium. They all have helped some, so we have hesitated to drop something. If the Li keeps helping though, we'll drop something.
Good luck in your search.
Best,
EE
Posted by Ilene on September 27, 2005, at 22:39:37
In reply to Re: Thanks for the honesty Ilene » Schess81, posted by Emily Elizabeth on September 27, 2005, at 22:16:11
> I wish that you could see my pdoc. :( She would be more aggressive in treating your TRD. I also know that I have read at least 2 journal articles about protocols for TRD that include some of the things that you mentioned. Do you have access to medline or something like that to look for articles? If I can figure out what I read, I'll let you know. Or someone else here might know. Perhaps bringing in the article to discuss w/ your pdoc would be helpful. Some back-up for what you want to do.
>
> BTW, I have also tried a stimulant (dexedrine) in my mix. It helped, but not completely. I currently take: lexapro, neurontin, desipramine, dexedrine, ambien, and lithium. They all have helped some, so we have hesitated to drop something. If the Li keeps helping though, we'll drop something.
>
> Good luck in your search.
>
> Best,
> EEMy current combo is Prozac, Wellbutrin, Cytomel, and Trazodone. I'm on it pretty much by chance--I stopped the Abilify on my own, and my pdoc threw in the Wellbutrin to counteract sexual problems from the Prozac. It didn't work for that, but the Prozac/Wellbutrin combo has helped me some with depression. The Trazodone is for the insomnia from the Wellbutrin. I've taken desipramine, Neurontin, Dexedrine, and lithium, although not all at once.
My new pdoc is okay but not aggressive. She's also young, and said she'd never prescribed MAOIs or worked w/ patients outside of a hospital who'd had ECT (which didn't work either).
I use PubMed, but haven't looked for articles on depression.
Thanks,
I.
Posted by denise1966 on September 28, 2005, at 4:04:52
In reply to Re: Thanks for the honesty Ilene » Emily Elizabeth, posted by Ilene on September 27, 2005, at 22:39:37
Hi,
10mg of Zyprexa now and again really helps my depression and anxiety when I take it. It helps better if I take it with an SSRI but also helps if I take it on it's own. I'm not bipolar but suffer from TRD.
Kind Regards......Denise
Posted by ed_uk on September 28, 2005, at 14:51:36
In reply to Re: Zyprexa, posted by denise1966 on September 28, 2005, at 4:04:52
Denise,
You really should experiment more with the atypicals. Seroquel or Abilify might be the answer to your depression.
~Ed x
Posted by blueberry on September 28, 2005, at 18:31:46
In reply to Atypical antipsychotics for TRD?, posted by Schess81 on September 27, 2005, at 10:20:14
I had tried so many antidepressants over the years and none of them quite did the job. One day my doc added zyprexa to my prozac. The very next day I knew my life had changed for the better. And things got better so fast.
Just recently the prozac kind of faded on me and I have replaced it with lexapro, but the zyprexa still has all the power it did in the beginning and it has been 5 years so far. Seroquel is also supposed to be good for depression, but I found it to be much too sedating with an intensely dry mouth. Zyprexa is milder in side effects.
My doctor says he combines antipsychotics with all of the antidepressants and the combinations works good. From personal experience, I would have to agree. The trick though I think is to keep the antipsychotic dose low for longterm use.
For many people, a powerful turbocharger for an antidepressant is either an antipsychotic or a stimulant.
This is the end of the thread.
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