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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by musico on October 31, 2005, at 10:48:09
Hi I am new here, and have been diagnosed with Bipolar not too long ago (after years of suffering with only being told I had depression and anxiety) and was prescribed 10 mg Zyprexa and it really has been working well for me. I am also on 100 mg of Lamictal but my depression still lingers so my doctor prescribed 50 mg Zoloft. Weight gain has been the undesirable side effect, of course from Zyprexa, and have lots of questions. For now, I will ask has anyone found that this side effect diminishes with time? Thanks in advance for your time.
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!
Posted by Phillipa on October 31, 2005, at 19:24:21
In reply to Re: Zyprexa Weight Issues, posted by med_empowered on October 31, 2005, at 17:19:30
Zyprexa is notorious for it's horrible wt gain. And if something makes you gain a lot of wt. It's not going to be taken for long by the pt. Fondly, Phillipa
Posted by musico on November 5, 2005, at 14:19:41
In reply to Re: Zyprexa Weight Issues, posted by med_empowered on October 31, 2005, at 17:19:30
Thank you med_empowered, for such an informative reply. I did not mention that I am also taking 100 mg of Lamictal, along with the 10 mg Zyprexa before bed. I take the 50 mg of Zoloft and .5 mg of Rivotril in the a.m. My hunger is tapering off a bit since I added Zoloft so one can only hope that I can avoid gaining any more weight (I've gained 8 lbs in a month).
The metobilic issues that you mentioned around Zyprexa concern me. My psychiatrist had me do a bunch of blood work and such before I started last month. She plans on keeping a close eye on everything, I'm very lucky to have found her as she goes beyond the call of duty to help me with samples (Zyprexa is EXPENSIVE!), phonecalls to home when needed, and is always available by pager.
Since Zyprexa is working so well for me, no mania (had to add Zoloft for the low side only - which btw has caused the other per usual dreaded - anorgasmia so next I will be address that before the weight gain lol) I am hesitant to stop at this time...Christmas travel back home always sends me for a loop so I'm gonna sit tight until January before switching, if need be. By then I'll be able to really have a good look at whether the weight gain is out of control, have more blood work done, and my mood after major stressors (my parents are ill so Christmas is not going to be easy...)
Sorry for MY long post. Just very grateful for your time and information. I am filing it away to consider with my doctor's advice. Take Care!
Posted by musico on November 5, 2005, at 14:23:54
In reply to Re: Zyprexa Weight Issues » med_empowered, posted by Phillipa on October 31, 2005, at 19:24:21
Yes Phillipa, I tend to agree. I am leveling off from an inital gain of 8 lbs (extreme hunger is not present now so therefor have more self-control with regards to over-eating) and it may be from adding Zoloft, or simply that that undesirable side-effect is departing...fingers crossed. Coming up to feast time with Christmas on our doorstep - yikes - step away from the feast, step away from the feast ;)
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