![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by stewie on January 28, 2012, at 23:06:27
I am one of 7 children. 3 of us have severe issues with mental illness. My brother, perhaps, has the most severe symptoms. Over 20 years ago he was labeled as schizo-affective. But he was lucky to find a good doctor who really put her heart and soul into him, and he learned to live pretty well with his illness. He has worked steadily and was always medication compliant, so until this year he had not seen the inside of a psych ward for nearly 20 years.
Dr. T had him on lithium and Haldol until zyprexa came out. My brother did incredibly well on zyprexa and lithium. Dr. T died over 5 years ago,but my brother was still OK.In retrospect, my family and I noticed changes in his behavior which gave us pause as early as 2009, when he kept getting laid off from manufacturing jobs by companies who opened more and more factories in China. He tried another career, but it was a huge mistake. I know that he started messing around with his meds a bit during that brief period.
Early this year he experienced a lot of changes in his life -- not all bad. He has landed in hospitals very far from home twice in 9 months. He promises all of us that he has been taking his meds. I don't really believe him. I think he has been seduced by hypomania and early mania for the first time in many years. But could it be that zyprexa and lithium "poop out" the way SSRIs often do? If he makes it out of this latest situation alive, I wonder if it is worth discussing medication changes with him and with a doctor, if he were to allow any of us to help him in this way.Sorry this was so long, but thoughts would be appreciated, and I guess I needed to get it off my chest with people who have "been there" and know the heartache.
Thanks very much...
Posted by bleauberry on January 29, 2012, at 7:37:01
In reply to Can zyprexa + lithium cocktail stop working?, posted by stewie on January 28, 2012, at 23:06:27
Well, zyprexa was a friend of mine for quite a while, about 8 years, before it pooped out on me. But I think sometimes we have to consider the possibility that the med did not poop out, but rather the underlying disease progressed, morphed, whatever.
Is he on brand name Zyprexa? Sometimes generics don't measure up, despite the claims on paper they should. Lots of evidence of that.
Zyprexa is such a unique med, and in my opinion the best of the class, so I don't know where you would go from this point. A really good doctor would certainly help, but they are few and hard to find.
If you are a believer, pray on it. God will give the wisdom you need.
Posted by Phillipa on January 29, 2012, at 12:23:56
In reply to Re: Can zyprexa + lithium cocktail stop working?, posted by bleauberry on January 29, 2012, at 7:37:01
Definitely let his doctor know and make sure he is safe and compliant. Anything can poop out. Good luck and keep posting Phillipa
Posted by stewie on January 29, 2012, at 12:56:19
In reply to Re: Can zyprexa + lithium cocktail stop working?, posted by bleauberry on January 29, 2012, at 7:37:01
I am quite sure that he is not on a generic. I went to fill a scrip with him when I picked him up this summer, and he had to pay over 1K for the medication!!!
Bleuberry - did you wind up changing antipsychotic meds after those 8 years?
One huge problem is that since Dr. T died, my brother has not had a steady doctor. He finds people in the yellow pages and pays cash and never tells any of us the name of his docs. Perhaps if any of us knew even one of his yellow pages docs, we could at least get a medical professional involved and his hospital stays would not be so short. There is no way to "prove" that he is a danger to himself or others. Besides, none of us wants to put him through the indignity of a competency hearing. It is like throwing out the baby with the bath water. It would destroy his ability to ever trust us again, and in the end, that would give him less opportunity to be "well" again.
Phillipa, thank you for encouraging me to post. It is truly a relief and a help to do so. We are a pretty close family, but a lot of "family stuff" comes up when we discuss this, or when we sheepishly contact each other, wondering if anyone has heard anything from him, the police or anyone.
If he allows me again to be involved in his care, I will mention to his attending that I am not sure that his cocktail is working anymore. Having some anecdotal evidence here makes me more confident that this should be explored. Besides - he has the idea that 5 mgs. of zyprexa make him slur his words. None of us hear it, but if he believes it, that counts for a lot.
With gratitude,
S.
Posted by Christ_empowered on January 29, 2012, at 21:40:07
In reply to Re: Can zyprexa + lithium cocktail stop working?, posted by stewie on January 29, 2012, at 12:56:19
Wow. Lithium+Haldol. That's...risky. Glad it worked, though.
Anyway, sometimes you have to up the antipsychotic dose. I don't know much about what's going on there--some changes in brain structure from long-term neuroleptic exposure, I dunno--but its not uncommon to see someone start on, say, 5mgs zyprexa in year 1 and end up on 20 in year 6. It happens.
Lithium can stop working, but I seem to recall reading that its not so prone to "poop out." Then again, compliance is low, especially over the long haul (your brother is one of relatively few patients who take it without fail, every day, for years) and episodes after stopping lithium can be more severe than episodes before lithium treatment. This is also true of antipsychotics--drop an antipsychotic suddenly, and you can have INTENSE freak outs, the likes of which didn't happen before the neuroleptic.
Lithium, from what I've read, can also be kind of hard to reinstate. If someone is one it, it works, then they drop it for whatever reason, there's no guarantee that the lithium will work as well (or at all) in round 2.
Posted by Christ_empowered on January 29, 2012, at 21:42:27
In reply to Can zyprexa + lithium cocktail stop working?, posted by stewie on January 28, 2012, at 23:06:27
maybe an anticonvulsant? I read somewhere that docs sometimes use depakote in schizophrenia and in cases where a long-term neuroleptic isn't working so well, or there's evidence of "tardive psychosis" (a worsening of psychosis caused by the medication) and a need for ongoing neuroleptic treatment. I have *no* idea how that works. Personally, depakote plus any "atypical" neuroleptic always gave me the shakes, but that may not be typical. Could also be the neuroleptic choices (risperdal, then abilify).
Posted by stewie on January 29, 2012, at 23:21:47
In reply to oh, yeah, and...., posted by Christ_empowered on January 29, 2012, at 21:42:27
That you, Christ Empowered, for your input. Probably my brother and I are older than you...he was diagnosed in the late 80s -- probably when Haldol was much more commonplace, because there were no atypicals yet.
It was nice of you to give ideas. I hope, very much, that he will choose to be around his family again very soon, that he is safe now, and that he will let people who love him help him. THEN, we can all start looking at other medication options if we have to.
I guess our bodies and brains go through changes as we hit 40. Perhaps that is part of what is going on now. It is a very slippery slope -- wanting to feel FREE, but knowing that you need some medicating. I have similar issues with Depression or Bipolar II, or whatever it REALLY is...
I have read your posts, and it seems you are going through that to some extent. I hope you will be safe and careful. It seems to me that people on this board care a great deal for you.
I truly wish you the best...and again, I thank you.
Posted by Zyprexa on January 31, 2012, at 7:44:57
In reply to Can zyprexa + lithium cocktail stop working?, posted by stewie on January 28, 2012, at 23:06:27
Zyprexa never poops out. Unless you take anouther antipsychotic for a while. Abilify in particular. But being off the abilify and back on zyprexa it starts to work again. I've been taking zyprexa since 98. Stayed around the same dose of 10mg the whole time. Some times less and sometimes more, 5-15mg seems to be the effective range for me. Except when coming off abilify, I did that 3 times and each time it took a while for it to start working again. The good thing about zyprexa is if you stop it and start it again it works right away and just as well. My guess is he went off the zyprexa. I've never taken lithium. Every time I go off it(zyprexa) I go back to the state I was in before the zyprexa. I used to take 4 month holidays from it in the begining and go back on it and pop right back into it. I did that for the first 2 years on it once a year. I have not been totaly off it since, except for a few days. And I have not been in a total state except for the time I took abilify, which totaled me for a while. I also have schitzo affective. I've tried a lot of other APs and none worked as well as zyprexa, if at all. I can't live with out it. You can inject zyprexa. That would be one way to know if hes taking it.
Posted by Zyprexa on January 31, 2012, at 8:06:20
In reply to Re: Can zyprexa + lithium cocktail stop working?, posted by Zyprexa on January 31, 2012, at 7:44:57
I will say when I stoped the abilify the last time I had to take some realy high doses of zyprexa for a while. Like 30-50mg. But after a few months I got it down to 20mg. Then I added perphenazine, which works pretty well compaired to the other APs and got me down to 10-15mg zyprexa. Currently I still take the perphenazine and 10mg zyprexa.
Posted by stewie on January 31, 2012, at 11:08:51
In reply to Re: Can zyprexa + lithium cocktail stop working?, posted by Zyprexa on January 31, 2012, at 8:06:20
Thank you Zyprexa. I definitely will not advocate for a medication change to Abilify IF we ever find my brother.
The poor kid will just have to come off of this high, get to a hospital and loose his pride and whatever and just let us help him.
When he is in hospital he is compliant. He needs a long stay and then some time in out-patient therapy with one of his parents or siblings nearby... and he can get that.
Thank you for sharing your knowledge. It has been a great comfort.S.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.