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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on October 3, 2012, at 13:51:26
In reply to Re: PS. what should i do? » SLS, posted by phidippus on October 3, 2012, at 10:17:10
Is this what you present as proof that Zyprexa is not a mood stabilizer, or is it proof that Zyprexa produces metabolic side effects and that Lilly is a ruthless capitalist corporation?
I can't read all of that. What I do see, though, is a piece of writing that appears to me to be more political than scientific. It is more concerned with Lilly than it is with the clinical value of Zyprexa to real people.
Does Zyprexa act as a mood stabilizer?
Do you agree with the following?
"A true mood stabilizer will work in acute manic episodes without inducing depression, acute bipolar depression without inducing mania, and protect the patient from future episodes of mania or depression."
If not, how would you define "mood stabilize"?
- Scott
Posted by b2chica on October 3, 2012, at 14:07:28
In reply to Re: PS. what should i do? » b2chica, posted by phidippus on October 3, 2012, at 13:33:34
i dont really know what happens chemically. i've always thought (somehow) zyprexa increases my dopmanine (i know its labeled antagonist) but maybe it allows for more inthe syntaptic cleft? thus getting me out of stupor. Zyprexa for almost 10 years has been my 'go to' drug when things got too tough for me and ALWAYS worked within 24/48 hours. ReALLY fast.
anyway i wasn't suicidal last night but my thoughts were of death in general. and i was so immobilized that i couldnt have acted if i wanted to.
no pdoc never mentioned CLozapine with me.
am currently on
Pristiq 100mg (am)
Adderall (20mg am, 10mg noon and 4pm-ish)
gabapentin (rx'd for 5xday, but then i was supposed to stop, and then he said no, dont stop...im a little confused so i'm using minimal. about 3x day.)
perphenazine added 2mg 2:00 (oops gotta take now) and 6mg pm. yesterday i took one extra. got urge to eat my pills (again not really suicidal just thoughts of death)
i'm fine now.
then xanax up to 2mg PRN, normally take 1mg in evening.
oh and zyprexa last night i started 10mg.
Posted by Beckett on October 3, 2012, at 14:38:02
In reply to Re: PS. what should i do? » phidippus, posted by b2chica on October 3, 2012, at 14:07:28
B2C, have you factored in the increase in Pristiq this time as a possible reason why the zyprexa is not doing the trick in the same way? Could this be a factor?
Posted by b2chica on October 3, 2012, at 14:53:13
In reply to Re: PS. what should i do?, posted by Beckett on October 3, 2012, at 14:38:02
yes. i even suggested that the up in pristiq is the cause of the up mood.
but the fact was i was getting bad before the 'uppage'. So he left it alone.hasn't mentioned anything about it since.
but about the zyprexa, the name brand worked, i just only had a few samples when i stopped taking name brand the symptoms came back.thanks.
Posted by SLS on October 3, 2012, at 15:14:27
In reply to Re: PS. what should i do? » phidippus, posted by b2chica on October 3, 2012, at 14:07:28
Have you discontinued Lamictal?
Why are you still taking Pristiq if it is not preventing depression?
Did Pristiq work when you first started taking it? Does it continue to give you a partial response?
Did it make a difference to raise the dosage of Pristiq from 50 mg to 100 mg?
When you tried Wellbutrin, were you also taking Pristiq?
When you tried Wellbutrin, were you also taking Zyprexa?
Have you ever taken Effexor 300 mg/day?
I bet there are lots of things you haven't tried yet. You actually seem quite treatable. Just keep taking your Trileptal 600 mg/day. If you can induce mania, it should be easily controlled by using a mood stabilizer or an antimanic antipsychotic.
I think you are going to need an anticovulsant mood stabilizer (Trileptal 600 - 900 mg/day), an antimanic antipsychotic (Zyprexa 15 - 20 mg/day) and, if necessary, one or two antidepressants (Effexor 300 mg/day or Pristiq 200 mg/day; Wellbutrin 300 mg/day).
One can make the argument that treating you with only a combination of Trileptal and lithium makes sense. I guess it depends on where along the bipolar spectrum you are, and how much depression persists despite continued treament.
Try to keep things simple and have patience. This is not an easy thing to do. To tell you the truth, to avoid suicidaity and remain employable, it might make sense to continue with Zyprexa or switch to Abilify while continuing with Trileptal. As you can see, there are plenty of alternative treatments available. You have reason to be optimistic, despite the difficult time you are enduring right now.
- Scott
Posted by phidippus on October 3, 2012, at 15:17:20
In reply to Re: PS. what should i do? » phidippus, posted by b2chica on October 3, 2012, at 14:07:28
>i've always thought (somehow) zyprexa increases my dopmanine (i know its labeled antagonist) but maybe it allows for more in the syntaptic cleft?
Zyprexa downregulates dopamine and antagonizes 5ht receptors. It is not a dopamine reuptake inhibitor. If there were something left in the synaptic cleft it would just stay there. It would not set off an action potential and the neuron would remain at rest. Usually anything residing in the synaptic cleft gets cleaned up by one enzyme or another.
>ALWAYS worked within 24/48 hours.
It still should, I just think you need a higher dose because you're not on a mood stabilizer.
>i was so immobilized that i couldnt have acted if i wanted to.
Good. If you ever are in crisis, just babblemail me.There is another problem. You're taking 100 mg of Pristiq , which may be destabilizing your mood. That's a maximum dose. Oi, mi ija! I became manic on 50 mg of Pristiq. I'm not going to tell you to change the dose or anything, just know it could be f*ck*ng you up.
Eric
usu
Posted by b2chica on October 3, 2012, at 15:35:10
In reply to Re: PS. what should i do? » b2chica, posted by SLS on October 3, 2012, at 15:14:27
i dont think this was meant for me... is it?
b2c
Posted by b2chica on October 3, 2012, at 15:38:21
In reply to Re: PS. what should i do? » b2chica, posted by phidippus on October 3, 2012, at 15:17:20
> >i've always thought (somehow) zyprexa increases my dopmanine (i know its labeled antagonist) but maybe it allows for more in the syntaptic cleft?
>
> Zyprexa downregulates dopamine and antagonizes 5ht receptors. It is not a dopamine reuptake inhibitor. If there were something left in the synaptic cleft it would just stay there. It would not set off an action potential and the neuron would remain at rest. Usually anything residing in the synaptic cleft gets cleaned up by one enzyme or another.Hey thanks. that helps to know.
> >ALWAYS worked within 24/48 hours.
>
> It still should, I just think you need a higher dose because you're not on a mood stabilizer.
>
> >i was so immobilized that i couldnt have acted if i wanted to.
>
> Good. If you ever are in crisis, just babblemail me.i just might. thanks.
> There is another problem. You're taking 100 mg of Pristiq , which may be destabilizing your mood. That's a maximum dose. Oi, mi ija! I became manic on 50 mg of Pristiq. I'm not going to tell you to change the dose or anything, just know it could be f*ck*ng you up.
>
> Erici'm sure it is messing things. but quite frankly i'd rather deal with this end then the crazy bad depression i get.
Gracias mi hermano> usu
Posted by SLS on October 3, 2012, at 15:46:14
In reply to Re: PS. what should i do? » b2chica, posted by phidippus on October 3, 2012, at 15:17:20
> There is another problem. You're taking 100 mg of Pristiq , which may be destabilizing your mood.
That's very possible.
> That's a maximum dose.
I wish it weren't.
I think 100 mg/day is too low to set as a maximum dose.
http://www.ncbi.nlm.nih.gov/pubmed/22883315
Also, the original clinical trials went up to 400 mg/day. It is in the best interests of the drug company to recommend the lowest dosage they think they can get away with so as to minimize side effects and make their product more marketable. It's a juggling act.
http://www.ncbi.nlm.nih.gov/pubmed/17917552
Pristiq 50 mg/day made you manic. Would 200 mg/day make you more manic? Perhaps this was an all-or-nothing phenomenon once you reached a threshold dose. If I were depressed and had not responded to Pristiq 100 mg/day, I would sure lobby a doctor to try 200 mg/day. I am all but sure that we will see higher dosages of Pristiq used once clinicians begin to push the envelope. Perhaps 300 mg/day of Pristiq will be used as commonly as is 300 mg/day of Effexor. Wyeth suggested a maximum dose of Effexor as 225 mg/day when it first came out. Now, Wyeth recommends 375 mg/day. Interesting, right?
- Scott
Posted by b2chica on October 3, 2012, at 15:46:15
In reply to Re: PS. what should i do? » b2chica, posted by SLS on October 3, 2012, at 15:14:27
> Have you discontinued Lamictal?
i haven't been on lamictal
> Why are you still taking Pristiq if it is not preventing depression?
> Did Pristiq work when you first started taking it? Does it continue to give you a partial response?
the pristiq is working on depression...or it was/is..??unsure
pristiq has worked for an amazing 3 years (except normally once or so a year things go wacky and we have to augment)
> Did it make a difference to raise the dosage of Pristiq from 50 mg to 100 mg?yes made difference going up to 100, worked great. then too great.
> When you tried Wellbutrin, were you also taking Pristiq?
i tried wellbutrin back inthe day. it was the first AD to really work well for me. pooped out after about a year. then three years later tried again, both generics and name brand, didnt work.
no wasnt taking pristiq at same time> When you tried Wellbutrin, were you also taking Zyprexa?
yes off and on wellbutrin and zyprexa, mostly no though.
> Have you ever taken Effexor 300 mg/day?
effexor was HORRIBLE to me.
> I bet there are lots of things you haven't tried yet. You actually seem quite treatable. Just keep taking your Trileptal 600 mg/day. If you can induce mania, it should be easily controlled by using a mood stabilizer or an antimanic antipsychotic.
i'm confused with questions...are you sure your talking to me?
i'm not on Trileptal either. it almost gave me a stroke. got ataxia, nystagmus, and was 'locked in' for about 12 hours.
> I think you are going to need an anticovulsant mood stabilizer (Trileptal 600 - 900 mg/day), an antimanic antipsychotic (Zyprexa 15 - 20 mg/day) and, if necessary, one or two antidepressants (Effexor 300 mg/day or Pristiq 200 mg/day; Wellbutrin 300 mg/day).
>
> One can make the argument that treating you with only a combination of Trileptal and lithium makes sense. I guess it depends on where along the bipolar spectrum you are, and how much depression persists despite continued treament.
>
> Try to keep things simple and have patience. This is not an easy thing to do. To tell you the truth, to avoid suicidaity and remain employable, it might make sense to continue with Zyprexa or switch to Abilify while continuing with Trileptal. As you can see, there are plenty of alternative treatments available. You have reason to be optimistic, despite the difficult time you are enduring right now.
> - Scottif the pristiq hadn't worked i wanted to try your suggestion of desipramine from a few months ago. but the pristiq worked...then too well. now, wacky.
i listed my meds earlier but here:
pristiq 100
adderall 20, 10, 10
perphenazine 2mg, 6mg
gabapenting rx'd 5xday, only taking about 3 now
xanax rx'd 2mg, only take about 1mg pm for sleep
zyprexa starting yesterday 10mg pmi'm going to try to stablize out and change the gabapentin back to at least 3-4 times day (mid morning when anxiety hits, 1pm, 6pm and bedtime.
i'm going to lower xanax as that can cause me depression at times. (unless its really needed for anger etc.)
and keep zyprexa at 10 for 4 more days.IF that doesn't work i'll do outpatient hospital so they can sort things out.
right now i feel a little fuzzy (like i do when depression hits) but i have a lot of electric energy inside, some physical but mostly mentally. i'm trying to read some physics books to calm my mind. and also crocheting when i can, helps as its physical AND very repetative.
thanks ALways Scott!
b2c.
Posted by b2chica on October 3, 2012, at 15:47:29
In reply to Re: PS. what should i do? » phidippus, posted by SLS on October 3, 2012, at 15:46:14
Very...
Posted by SLS on October 3, 2012, at 15:50:00
In reply to Re: PS. what should i do? » SLS, posted by b2chica on October 3, 2012, at 15:46:15
Oh, my.
I am indeed confusing you with someone else. It's like I made up a hybrid patient out of two different people.
I guess you can take 1/2 of the advice I gave.
But which 1/2?
LOL.
Sorry.
- Scott
Posted by phidippus on October 3, 2012, at 16:15:57
In reply to Re: PS. what should i do? » phidippus, posted by SLS on October 3, 2012, at 13:51:26
>I can't read all of that
You should read it all. It's just damn interesting.
>Is this what you present as proof that Zyprexa is not a mood stabilizer
Hardly. Its just a revealing read.
>Lilly is a ruthless capitalist corporation?
You have to admit they can be *ssh*l*s.
>appears to me to be more political than scientific
Does it have to be scientific? If it is political, how does that denigrate the piece?
>the clinical value of Zyprexa to real people.
I incurred diabetes as a result of taking Zyprexa. Lilly ended up paying me a lot of money for their clinically valued drug.
Bottom line is Lilly bought its FDA approval for Zyprexa and its status as a mood stabilizer so they could make a few more people fat. The fatter we are, the more meat their is for the zombie horde Lilly is preparing for the end of days.
Ahem, I would call a mood stabilizer "any medication that controls severe mood swings". I wouldn't specify mania or depression.
Eric
Posted by phidippus on October 3, 2012, at 16:25:51
In reply to Re: PS. what should i do? » phidippus, posted by b2chica on October 3, 2012, at 15:38:21
>i'm sure it is messing things. but quite frankly i'd rather deal with this end then the crazy bad depression i get.
I've been there.
Eric
ps. Up your Olanzapine! I promise you won't go crazy.
Posted by SLS on October 3, 2012, at 16:47:02
In reply to Re: PS. what should i do?, posted by phidippus on October 3, 2012, at 16:15:57
Just because a drug has therapeutic properties doesn't mean that it must not be judged by evaluating its benefits versus costs and risks. It does.
Lithium is an effective mood stabilizer. Yet, people have died of kidney failure for having taken it. How would you evaluate the value of lithium?
I don't understand your point.
If Zyprexa has no value, why do you recommend it to others that they take it and take more of it?
I think your definition of "mood stabilizer" is far too broad. For some people, Xanax prevents "mood swings". Is Xanax a mood stabilizer?
Zyprexa is what is. According to your definition, it is a mood stabilizer. In addition, according to the definition suggested by the literature you cited, Zyprexa is a mood stabilizer while Xanax is not.
What other drugs do you consider to be "true" mood stabilizers?
"A true mood stabilizer will work in acute manic episodes without inducing depression, acute bipolar depression without inducing mania, and protect the patient from future episodes of mania or depression."
It's really not a bad definition.
- Scott
Posted by Zyprexa on October 3, 2012, at 20:01:59
In reply to Re: PS. what should i do? » Zyprexa, posted by b2chica on October 3, 2012, at 8:48:09
Are you taking brand name zyprexa or a brand of generic olanzapine?? And which one?
Posted by brynb on October 3, 2012, at 20:57:44
In reply to Hospital when feeling ok??, posted by b2chica on October 2, 2012, at 12:11:18
Hi b2c,
Hope you're doing ok. I may have missed it somewhere, but have you ever taken lithium (even a low dose)? I like how it addresses the depression, mania and suicidal thoughts.
Also, do you take Adderall for fatigue/depression or ADD? I find it to be a pretty rough drug emotionally, but maybe because I don't have ADD.
Be well...
Posted by phidippus on October 3, 2012, at 23:32:10
In reply to Re: PS. what should i do? » phidippus, posted by SLS on October 3, 2012, at 16:47:02
>How would you evaluate the value of lithium?
I had kidney failure on lithium. I still take it. For me, Lithium is invaluable and represents a true mood stabilizer. Zyprexa is simply an anti-manic and does nothing else.
>I don't understand your point.
Do you have to? This is simply a difference of opinion. My point is simply that Zyprexa is not a mood stabilizer. Its mechanism of action differentiates it from Lithium and all the anticonvulsants called mood stabilizers.
>why do you recommend it to others that they take it and take more of it?
Others? I recommended an increase in dosage because 1. the person wasn't going to switch to something else and 2. the person was happy with Zyprexa.
>Xanax prevents "mood swings"
Wow.
>According to your definition, it is a mood stabilizer
Sh*t, I totally forgot what I wrote as a definition. Your definition is fine, I just think its too bipolar specific. My definition is broad on purpose-it takes into account other disorders, such as borderline personality.
Eric
Posted by jono_in_adelaide on October 4, 2012, at 0:01:07
In reply to Re: PS. what should i do? » SLS, posted by phidippus on October 3, 2012, at 23:32:10
Now now you guys, both take a Zyprexa and kiss n make up!
Posted by SLS on October 4, 2012, at 6:56:03
In reply to Re: PS. what should i do? » SLS, posted by phidippus on October 3, 2012, at 23:32:10
I hate to burst you bubble, but opinions do not go unchallenged here.
"Your definition is fine, I just think its too bipolar specific"
I thought that bipolar disorder was the issue we were discussing. You believe that lithium is acting as a mood stabilizer for you, despite your not having bipolar disorder. I really can't dispute your belief that the diathesis of your condition does not lie along the bipolar spectrum without further evidence.
Re: Zyprexa as a mood stabilizer?
Your opinion that Zyprexa is nothing more than an antimanic agent has merit as it is sometimes portrayed in the medical literature. However, there doesn't seem to be a consensus at this point. Scientific data is limited for Zyprexa monotherapy. However, it is not terribly common that any one drug effectively treats bipolar disorder - even lithium. It is fascinating when lithium monotherapy completely resolves bipolar I disorder, though. It is quite dramatic.
The value that a drug has as a mood stabilizer is measured by time to relapse. There are studies indicating that time to relapse in bipolar order is greater with Zyprexa than with placebo.
"Lithium continues as our oldest well-established maintenance treatment in bipolar disorder with somewhat better efficacy in preventing mania than depression. Lamotrigine, olanzapine, and quetiapine have bimodal efficacy in preventing both mania and depression..."
http://www.ncbi.nlm.nih.gov/pubmed/22510036
"Lithium levels ≥0.6 mmol/L and olanzapine doses ≥10mg/day may be necessary for optimal protection against manic/mixed or depressive episodes, respectively in patients with bipolar I disorder."
http://www.ncbi.nlm.nih.gov/pubmed/20430594
The following three studies were performed in associated with Lilly, the manufacturer of Zyprexa. They were performed by well-published researchers. I segregated them because some people will invalidate the work of these researchers on the basis that Lilly was involved.
http://www.ncbi.nlm.nih.gov/pubmed/16449478
http://www.ncbi.nlm.nih.gov/pubmed/19054570
http://www.ncbi.nlm.nih.gov/pubmed/15994710
The following studies reported no therapeutic effect or mixed results:
http://www.ncbi.nlm.nih.gov/pubmed/19828571
http://www.ncbi.nlm.nih.gov/pubmed/19160237
http://www.ncbi.nlm.nih.gov/pubmed/16426094
It is hard to argue with Terrence Ketter.
Zyprexa certainly has antidepressant properties and makes a good augmenter, especially when combined with antidepressants like Prozac. Zyprexa can even precipitate a manic reaction. Personally, I have observed in others that Zyprexa has a potent anti-suicide effect. I am guessing that it is equally effective to Clozapine, a related drug. This, however, is not the same thing as maintenance mood stabilization.
> My point is simply that Zyprexa is not a mood stabilizer. Its mechanism of action differentiates it from Lithium and all the anticonvulsants called mood stabilizers
Must a drug have same properties as another in order treat the same illness effectively? This does not follow from logic. You lose your own argument because anticonvulsants do not have the same physiological properties as lithium, yet they can be effective.
All in all, I still question the classification of Zyprexa as a mood stabilizer as it is strictly defined for the treatment of bipolar disorder. However, it does act as an antimanic and/or an antidepressant for some percentage (unknown) of people who take it, especially when used as an augmenting agent as is often done with lithium.
If you have no problem with lithium shutting down your kidneys, I don't understand why you would have a problem with Zyprexa producing diabetes. Both sequelae are serious. You value lithium because it works for you. Others value Zyprexa because it works for them.
- Scott
Posted by b2chica on October 4, 2012, at 7:54:50
In reply to Re: PS. what should i do? » b2chica, posted by Zyprexa on October 3, 2012, at 20:01:59
ws taking brand (that worked fine but only had one sample bottle -7day) so then i went to teva, bad effect, now i'm on the other one. cant recall the name...odd name kinda unusual.
but so far i think its going better. and this one i dont crave food on...
Posted by SLS on October 4, 2012, at 8:10:19
In reply to Re: PS. what should i do? » Zyprexa, posted by b2chica on October 4, 2012, at 7:54:50
> ws taking brand (that worked fine but only had one sample bottle -7day) so then i went to teva, bad effect, now i'm on the other one. cant recall the name...odd name kinda unusual.
>
> but so far i think its going better.
This is a relief to hear.> and this one i dont crave food on...
Interesting.
In your experience, are food cravings dose-dependent?
- Scott
Posted by b2chica on October 4, 2012, at 13:14:09
In reply to Re: PS. what should i do? » b2chica, posted by SLS on October 4, 2012, at 8:10:19
yes. when i'm at 5mg (brand name) i was always so thirsty, and drank lots water. but didnt really crave sweets. at 10mg i've always craved (after about the 2nd or 3rd day) the cravings come and its for sweets and its like i dont know that im full when i eat.
with teva generic i had some initial food cravings but then none after a while.
with this brand i cant say that i've noticed cravings (but i'm still eating poorly out of habit now) but at dinner and lunch i eat less than before. and dont CRAVE the sweets like before.
i'm quite suprised as i am up at 10mg of the olanzipine "aurobindo" mfg.
Posted by phidippus on October 4, 2012, at 17:25:18
In reply to Re: PS. what should i do? » SLS, posted by b2chica on October 4, 2012, at 13:14:09
I'm proud o' ya.
Eric
Posted by phidippus on October 4, 2012, at 18:15:02
In reply to Re: PS. what should i do? » phidippus, posted by SLS on October 4, 2012, at 6:56:03
>I hate to burst your bubble, but opinions do not go unchallenged here.
My bubble is fine, so is my cherry.
>I thought that bipolar disorder was the issue we were discussing.
Why not include borderline personality in the discussion? Mood stabilizers are used to treat it as well.
http://www.psychiatrictimes.com/display/article/10168/46801
>You believe that lithium is acting as a mood stabilizer for you, despite your not having bipolar disorder.
I am diagnosed Bipolar I with ADHD and OCD, did I say otherwise?
>> My point is simply that Zyprexa is not a mood stabilizer. Its mechanism of action differentiates it from Lithium and all the anticonvulsants called mood stabilizers
Let me modify my statement. No mood stabillizers are antipsychotics and no antipsychotics are mood stabilizers
>Must a drug have same properties as another in order treat the same illness effectively?
In some ways, yes. Antipsychotics are all similar in the way they treat schizophrenia-I don't know of any that don't antagonize dopamine receptors.
>I don't understand why you would have a problem with Zyprexa producing diabetes.
I have a problem with Lilly's mishandling of reporting Zyprexa's serious side effects.
Honestly, I think our argument is moot when we look at Verapamil as a mood stabilizer. Verapamil is going to be huge!
Eric
Eric
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