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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Agomelatinehope on August 29, 2012, at 6:59:23
Hi,
I suffer from GAD and MDD. My psychiatrist thought it'd be a good idea to give Ziprasidone a try (She told me it would give me a lift in mood and in confidence)
This is my 3rd day and it's been a nightmare since I started this med. I cannot stand up since I got this terrible dizziness which does not go away. Moreover, I have now terrible insomnia and increased anxiety with tremors. I'm not even able to drive.
However, I felt a couple of times a "high" feeling in which I actually felt pretty good, with confidence and increased sex drive but didn´t last long...
Do these symptoms (specially dizziness and insomnia) subside after a few days or this med is just not for me?
Thank you so much
PS: I'm also taking Cymbalta 60mg
Posted by Emily Elizabeth on August 29, 2012, at 14:01:43
In reply to 3rd day on Geodon 20mg for GAD, should I quit?, posted by Agomelatinehope on August 29, 2012, at 6:59:23
I have no experience with this particular med, but due to the severity of your side effects, I'd call my pdoc right away. He can tell you if it is anything to be concerned about, if it is likely to lessen, and if a lower dose (at least in the beginning) might be a good option.
Best,
EE
Posted by Agomelatinehope on August 29, 2012, at 17:49:44
In reply to 3rd day on Geodon 20mg for GAD, should I quit?, posted by Agomelatinehope on August 29, 2012, at 6:59:23
Thank you for replying
This is an update since I got strange news...
Today I felt awful, worst than 1st two days and I had already decided to quit today but the last two hours I felt again that strange feeling of being high, in which I have enjoyed pretty much being self-confident, impulsive and with my sex drive back (didn´t feel this way since teenage). It has lasted about 2 hours, now (0.45pm Spain) I just feel like if I had taken 10 coffees
I also experienced more side effects like tachichardia, cramps and muscle stiffness
May it be possible that this "high" feeling is what the drug makes you feel when it has kicked in?
I'm 30min from taking my 4th dose and I don't really know what to do :S
Thank you again
Posted by SLS on August 29, 2012, at 18:58:33
In reply to Re: 3rd day on Geodon 20mg for GAD, should I quit?, posted by Agomelatinehope on August 29, 2012, at 17:49:44
> Thank you for replying
>
> This is an update since I got strange news...
>
> Today I felt awful, worst than 1st two days and I had already decided to quit today but the last two hours I felt again that strange feeling of being high, in which I have enjoyed pretty much being self-confident, impulsive and with my sex drive back (didn´t feel this way since teenage). It has lasted about 2 hours, now (0.45pm Spain) I just feel like if I had taken 10 coffees
>
> I also experienced more side effects like tachichardia, cramps and muscle stiffness
>
> May it be possible that this "high" feeling is what the drug makes you feel when it has kicked in?
>
> I'm 30min from taking my 4th dose and I don't really know what to do :S
>
> Thank you againSteven Stahl has pointed out that Geodon (ziprasidone), at dosages below 40 mg/day, can produce activation and agitation. These things disappear at 40 - 60 mg/day:
http://www.medscape.org/viewarticle/484929
"Here's a very interesting thing about ziprasidone. Have you ever given ziprasidone at 20 mg and had a patient become activated and agitated? If you have, the reason is that the dosing is too low. Because this is such a powerful 5HT2C antagonist, at low doses, that's all it does. It doesn't have any dopamine antagonism, so it's potentially activating â' at least for those people whose genes don't want to have their 5HT2C receptors blocked. Have you ever given a dose of fluoxetine (Prozac) to a patient and had them have an activation? Fluoxetine is the only other drug that has powerful 5HT2C antagonist properties; in fact, fluoxetine has more powerful antagonist properties than reuptake blocking properties. To prevent this, you've got to do a counterintuitive thing, which is to stop using 20 mg, because you're going to make patients "go bonkers." You've got to use probably 60 mg to have enough robust D2 on board so that the patient doesn't get activated. This is an art. Some patients tolerate different doses than others; but the counterintuitive thing is that you raise the dose, you get less activation. If you've had bad experience with this particular drug, that might help you understand how to dose it."
- Scott
Posted by Sheilac on August 30, 2012, at 5:55:59
In reply to 3rd day on Geodon 20mg for GAD, should I quit?, posted by Agomelatinehope on August 29, 2012, at 6:59:23
Geodon was a weird drug for me. At 20mg I was sleepy and had to nap during the day. At 40mg I was a little manic - shopping and spending money.
I didn't feel "normal" until I got up to 80mg - 120mg
I finally had to stop because it just wasn't consistent. Half the time I felt manic the other time I felt drugged.
Posted by Agomelatinehope on August 30, 2012, at 7:15:20
In reply to 3rd day on Geodon 20mg for GAD, should I quit?, posted by Agomelatinehope on August 29, 2012, at 6:59:23
I took my 4th dose yesterday and eveything seems to be fine now.
My tremors and anxiety have faded away. I had to take ativan in order to sleep since I couldn't sleep but overall I had a good night rest.
This is the first day I can function almost normally, no more dizzinness or headache. It's just so strange that yesterday I felt so agitated and today I feel so relaxed...
Well, it seems it's starting to work
I'll keep you updated
PD: I moved from 60mg cymbalta to 30mg today as suggested by my Dr
Posted by Agomelatinehope on August 30, 2012, at 18:18:54
In reply to 3rd day on Geodon 20mg for GAD, should I quit?, posted by Agomelatinehope on August 29, 2012, at 6:59:23
I had a terrible experience tonight.
I had been feeling GREAT during all day (confidence, talkative, sexual desire, etc) but towards evening I started to have more and more anxiety. When this anxiety has reached its maximum, I have started to cry desperately, as if someone was controlling mi brain part related to that emotion. I was also moving my legs while crying without explanation, my jaw was also about to explode because of the muscular tension.
Never again
Posted by Phillipa on August 31, 2012, at 16:59:09
In reply to Re: 3rd day on Geodon 20mg for GAD, should I quit?, posted by Agomelatinehope on August 30, 2012, at 18:18:54
So you stopped the geodon? If so did you also raise back up the dose of cymbalta as took it at a period of time and actually tolerated 60mg as long as taken with benzos? Phillipa
Posted by phidippus on August 31, 2012, at 20:15:23
In reply to 3rd day on Geodon 20mg for GAD, should I quit?, posted by Agomelatinehope on August 29, 2012, at 6:59:23
This med is not for you. Have her try you onn Latuda or Abilify to augment your treatment.
Eric
Posted by Agomelatinehope on September 1, 2012, at 11:37:05
In reply to Re: 3rd day on Geodon 20mg for GAD, should I quit? » Agomelatinehope, posted by phidippus on August 31, 2012, at 20:15:23
I'm not going to try any other antipsychotic in my life. I've never been so terrified before.
I only took it on the minimum dose for 5 days and it almost destroyed my life. It's been 3 days without it and I'm still suffering some side effects.
I suffered until yesterday what seemed symptoms of parkinsonian syndrom and muscle pain in several parts of my body
As I said before. Never again :(
Posted by SLS on September 2, 2012, at 1:56:42
In reply to Re: 3rd day on Geodon 20mg for GAD, should I quit? » Agomelatinehope, posted by phidippus on August 31, 2012, at 20:15:23
> This med is not for you.
Why do you say this? Perhaps you are right, but how sure are you?
You say this with such certitude. Might it not be a bad move to abandon Geodon at this juncture given the episodic improvements it has produced?
Did you read my post:
http://www.dr-bob.org/babble/20120818/msgs/1024414.html
It may be that increasing the dosage by 20 mg/day would produce remission. Perhaps that should be explored first before switching drugs. It would only take a couple of days to have an answer.
> Have her try you onn Latuda or Abilify to augment your treatment.
Yes, but then you lose the SNRI actions. Is it possible that these are important in this case? It might be necessary to add a SNRI to Latuda to bring about remission.
I don't think Latuda is a bad idea. It is a sensible choice given its overlapping properties with Geodon minus the potent 5-HT2c antagonism. It also adds 5-HT7 antagonism.
What are your reasons for choosing Abilify? I understand that it has properties that overlap with those of Latuda, but it also can produce akathisia-like side effects. Some people cannot tolerate the anxiety, agitation, and insomnia that Abilify produces, even at 2.5 mg/day.
- Scott
Posted by Agomelatinehope on September 2, 2012, at 8:11:46
In reply to Re: 3rd day on Geodon 20mg for GAD, should I quit? » phidippus, posted by SLS on September 2, 2012, at 1:56:42
Hi, Today is Sunday and I took my last 20mg dose on Wednesday night. I'm experiencing a terrible discontinuation syndrome (flu-like symptoms, tremors, a very uncomfortable internal agitation which does not wear off, confusion, insomnia, unable to focus, diarrhea and back pain)
I only had 4 doses, how can this be even possible?
This morning I took a 10mg Prozac dose to see if that could help me overcome this withdrawal as it already did in other occasions with benzo withdrawals
I may have experienced good effects while taking this drug but I think it does not worth it to take an antipsychotic unless you really need one (schizophrenia and such)
Posted by SLS on September 2, 2012, at 9:12:52
In reply to Re: 3rd day on Geodon 20mg for GAD, should I quit?, posted by Agomelatinehope on September 2, 2012, at 8:11:46
> Hi, Today is Sunday and I took my last 20mg dose on Wednesday night.
What is your current diagnosis?
Why was Geodon chosen for you in the first place?
> I'm experiencing a terrible discontinuation syndrome (flu-like symptoms, tremors, a very uncomfortable internal agitation which does not wear off, confusion, insomnia, unable to focus, diarrhea and back pain)
> I only had 4 doses, how can this be even possible?
I am not sure.
You may have temporarily sensitized receptors to produce an exaggeration of withdrawal effects. One can become sensitized to cocaine after a few exposures. It might be a 5-HT2c receptor thing, which would include the modulation of 5-HT3 receptor function (thus the nausea). It can also be resonsible for the flu-like symptoms and agitation. Of course, dopamine neurotransmission might be contributory. Wild guesses.
One way or another, you experience what you experience. Theories often don't do justice to the complexity of the human brain. However, you are bound to feel better soon.
> I may have experienced good effects while taking this drug but I think it does not worth it to take an antipsychotic unless you really need one (schizophrenia and such)
What about using a drug that has antidepressant and anxiolytic properties in addition to its antipsychotic properties? What if such a drug works better than the drugs traditionally chosen to treat these conditions?
- Scott
Posted by Agomelatinehope on September 2, 2012, at 9:23:14
In reply to Re: 3rd day on Geodon 20mg for GAD, should I quit? » Agomelatinehope, posted by SLS on September 2, 2012, at 9:12:52
> What is your current diagnosis?
MDD, GAD and anhedonia, lack of motivation, etc
>
> Why was Geodon chosen for you in the first place?It was my Dr's choice. I don't have a clue
>>
> > I may have experienced good effects while taking this drug but I think it does not worth it to take an antipsychotic unless you really need one (schizophrenia and such)
>
> What about using a drug that has antidepressant and anxiolytic properties in addition to its antipsychotic properties? What if such a drug works better than the drugs traditionally chosen to treat these conditions?This has been one of the worst weeks in my whole life. I'd rather be depressed/lethargic than completely disabled/unstable :(
>
>
> - Scott
Posted by SLS on September 2, 2012, at 9:53:58
In reply to Re: 3rd day on Geodon 20mg for GAD, should I quit?, posted by Agomelatinehope on September 2, 2012, at 9:23:14
> This has been one of the worst weeks in my whole life. I'd rather be depressed/lethargic than completely disabled/unstable :(
You'll get through it. I can't imagine how painful it must be.
- Scott
Posted by phidippus on September 2, 2012, at 21:18:45
In reply to Re: 3rd day on Geodon 20mg for GAD, should I quit?, posted by Agomelatinehope on September 2, 2012, at 9:23:14
What is your main medication? For severe depression and GAD you should be taking an antidepressant. Geodon makes sense as an augmentaton to an antidepressant and to help treat your depression, but it is a poor choice to treat GAD, as Geodon has been known to cause anxiety.
Get off the Geodon.
Eric
Posted by phidippus on September 2, 2012, at 22:55:27
In reply to Re: 3rd day on Geodon 20mg for GAD, should I quit? » phidippus, posted by SLS on September 2, 2012, at 1:56:42
"This is my 3rd day and it's been a nightmare since I started this med. I cannot stand up since I got this terrible dizziness which does not go away. Moreover, I have now terrible insomnia and increased anxiety with tremors. I'm not even able to drive."
Its pretty obvious he's reacting very poorly to the drug. I was concerned about the physical side effects he was experiencing.
As far as the drugs I recommended as alternatives to Geodon, I was pulling names out of a hat. I chose Latuda and Abilify based on personal experience. The loss of SNRI benefits would be tragic if the Geodon were stopped but maybe unavoidable because the guy can't stand up because he's so dizzy. I think Abilify is a great alternative despite the 1.4% chance of akathisia, I've been on both Geodon and Abilify and Abilify treated my depressive symptoms better than Geodon. I also recommended Latuda thinking it might confer special benefit as a 5ht7 antagonist.
But, in all honesty, I think Seroquel might be the best choice. A ton of data support it as good treatment for depressive and anxiety synptoms.
Eric
Posted by Agomelatinehope on September 3, 2012, at 4:23:35
In reply to Re: 3rd day on Geodon 20mg for GAD, should I quit? » SLS, posted by phidippus on September 2, 2012, at 22:55:27
I'm too scared to try any other antipsychotic. Not only because of this terrible experience but I really fear the long term permanent side effects of this kind of drugs (especially TD, which is reported in cases with even the lowest dose of abilify).
I think I'll stick with antidepressants. It may not be that effective but they're much safer (at least in my experience so far)
Posted by SLS on September 3, 2012, at 7:10:13
In reply to Re: 3rd day on Geodon 20mg for GAD, should I quit?, posted by Agomelatinehope on September 3, 2012, at 4:23:35
> I'm too scared to try any other antipsychotic. Not only because of this terrible experience but I really fear the long term permanent side effects of this kind of drugs (especially TD, which is reported in cases with even the lowest dose of abilify).
I haven't seen more than one or two reports on Medline. If anything, Abilify is significantly less likely than most of the others antipsychotics at producing TD. Abilify is actually being studied as a way to reduce TD precipitated by other antipsychotics. Akathisia remains a concern, though.
- Scott
Posted by phidippus on September 3, 2012, at 15:40:24
In reply to Re: 3rd day on Geodon 20mg for GAD, should I quit?, posted by Agomelatinehope on September 3, 2012, at 4:23:35
You can allways do two antidepressants.
Eric
This is the end of the thread.
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