![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 112 to 136 of 151. Go back in thread:
Posted by ed_uk2010 on January 29, 2015, at 12:05:19
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 29, 2015, at 11:56:37
> Hey ed. I will post a response later when i am on my laptop.
Will be good to hear from you.
Posted by Lamdage22 on January 29, 2015, at 12:52:50
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by ed_uk2010 on January 29, 2015, at 12:05:19
">I dont think i can reduce Zyprexa.
OK, in that case, you just need to look at managing the side effects. You've already had success with metformin. If you are still overweight there are further options to consider."
What options? I am a little over weight but i would like to add Mirtazapine because id did indeed help the depression.
"6. Consider what might be a useful way of improving your depression without risking mood destabilisation or psychosis. What symptoms of depression do you have right now, apart from low mood? If you look at a list of depression symptoms online it might help to clarify what sort of mood state you're in right now, which could potentially help in treatment selection."
The only thing that was useful was Mirtazapine. I tried them all.
All of them:
Difficulty concentrating, remembering details, and making decisions
Fatigue and decreased energy
Feelings of guilt, worthlessness, and/or helplessness
Feelings of hopelessness and/or pessimism
Loss of interest in activities or hobbies once pleasurable (BIG TIME), including sex
Persistent sad feelings
Posted by ed_uk2010 on January 29, 2015, at 13:12:17
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 29, 2015, at 12:52:50
>What options? I am a little over weight but i would like to add Mirtazapine....
Main ones are mirtazapine and trazodone, but there are other possibilities. Although mirtazapine often causes weight gain on its own, I'm not sure it would cause any additional weight gain when added to your current meds. Trazodone probably wouldn't affect your weight.
>The only thing that was useful was Mirtazapine.
Why did you stop taking it? I have a feeling that adding mirtazapine would be more helpful for your depression than trazodone. Mirtazapine is now a common addition to antipsychotics for depression in those with a history of psychosis.
>All of them...
Thanks for the list, it helped me understand your situation. I think you should consider mirtazapine instead of pipamperone. If it's helped you before, I have more confidence in it than trazodone. On the other hand, I'm wondering why you stopped it.
Apart from MAOIs, have any antidepressants induced psychosis or manic symptoms?
Have you tried a tricyclic antidepressant such as nortriptyline in addition to antipsychotics?
Posted by Lamdage22 on January 29, 2015, at 13:15:28
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by ed_uk2010 on January 29, 2015, at 13:12:17
I too think Mirtazapine is my best bet.
I stopped because of nightmaires but i assume its possible that they fade after time.
My doc wants to test my thyroid levels to see if he can improve.
Posted by Lamdage22 on January 29, 2015, at 13:19:17
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 29, 2015, at 13:15:28
Is it likely that psychotic symptoms improve if depression improves?
Posted by ed_uk2010 on January 29, 2015, at 13:25:38
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 29, 2015, at 13:15:28
>I stopped because of nightmares...
Drugs which block serotonin 5-HT2 receptors sometimes cause vivid dreams, which can be nightmares. You already have this pharmacological effect with your current antipsychotics so you should be 'used to it'. It could be that mirtazapine won't cause nightmares at all if you tried it now. Even if you did have nightmares, they might not persist, so I think it's worth a try.
>My doc wants to test my thyroid levels to see if he can improve.Good idea. If you can find out the exact results, post them.
Posted by Lamdage22 on January 29, 2015, at 13:27:38
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by ed_uk2010 on January 29, 2015, at 13:25:38
5ht2 seems to be really evil.
Is that possible?
I will post the results and i will ask my pdoc for Mirtazapine instead of Valproic acid. My argument being that we already know it works for me.
Posted by ed_uk2010 on January 29, 2015, at 13:30:18
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 29, 2015, at 13:19:17
>Is it likely that psychotic symptoms improve if depression improves?
I didn't think you had any psychotic symptoms at the moment?
Antidepressants can sometimes help to relieve depressive delusions, but only in the setting of depressive psychosis. ADs are unlikely to improve any other type of psychotic symptom eg. delusions of reference, delusions of grandiosity, paranoid delusions and auditory hallucinations/voices etc. In psychosis associated with a mixed or manic state, ADs may aggravate the symptoms.
Posted by Lamdage22 on January 29, 2015, at 13:31:29
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by ed_uk2010 on January 29, 2015, at 13:30:18
What i meant was if it could help me get along with less antipsychotics.
Posted by ed_uk2010 on January 29, 2015, at 14:04:09
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 29, 2015, at 13:31:29
>What i meant was if it could help me get along with less antipsychotics.
Considering the amount of antipsychotics you're on (rather a lot), I expect mirtazapine might allow some reduction. If it improves your sleep and depression you might not need as much olanzapine.
Although mirtazapine is associated with weight gain, it doesn't seem to cause such marked metabolic changes as antipsychotics.
Posted by ed_uk2010 on January 29, 2015, at 14:06:44
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 29, 2015, at 13:27:38
> 5ht2 seems to be really evil.
>
> Is that possible?You mean if it's stimulated? Stimulation of 5-HT2a can cause hallucinations. LSD stimulates 5-HT2a, amongst other things. Stimulation of 5-HT2c causes appetite suppression.
Posted by ed_uk2010 on January 29, 2015, at 17:46:45
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 29, 2015, at 13:31:29
I'm concerned about how you did on mirtazapine before.
http://www.dr-bob.org/babble/20131209/msgs/1056317.html
Is sounds like you got better and then worse. Can you explain this more?
Posted by Lamdage22 on January 29, 2015, at 23:39:33
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by ed_uk2010 on January 29, 2015, at 17:46:45
Weird. I dont even remember that!
Posted by ed_uk2010 on January 30, 2015, at 6:32:45
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 29, 2015, at 23:39:33
> Weird. I dont even remember that!
Has it made you feel differently about mirtazapine? It sounds like you were very focused on MAOIs at the time, you even said you'd make up side effects with other meds to get one!
Posted by Lamdage22 on January 31, 2015, at 9:25:30
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by ed_uk2010 on January 30, 2015, at 6:32:45
Yeah, made me feel different. I honestly dont remember.
Im waiting for Glyx-13 by Naurex. Its a long wait but maybe worth it.
Posted by ed_uk2010 on January 31, 2015, at 10:08:26
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 31, 2015, at 9:25:30
>I'm waiting for Glyx-13 by Naurex. Its a long wait but maybe worth it.
I suppose you could try trazodone while you wait!
Posted by Lamdage22 on January 31, 2015, at 12:20:29
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by ed_uk2010 on January 31, 2015, at 10:08:26
im sleeping OK with 900 seroquel and 15 zyprexa
Posted by Lamdage22 on January 31, 2015, at 12:36:20
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 31, 2015, at 12:20:29
I want to be blown out of my mind by antidepressant efficiacy.
I dont want to be normal. What kind of a goal is "normal".
Id prefer normal over the state im currently in but "normal" is not my goal. My goal is "well" and "good".
Posted by ed_uk2010 on January 31, 2015, at 12:51:36
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 31, 2015, at 12:36:20
>What kind of a goal is "normal".
Normal is what most people are. Being truly better than normal on a long term basis generally needs the right life circumstances.
Any drug which 'blows you away' and makes you feel better than normal is likely to be bad news. What goes up will come down.
Posted by Phillipa on January 31, 2015, at 19:02:50
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by ed_uk2010 on January 31, 2015, at 12:51:36
Ed sounds like Lamadge almost wants to feels manic? PJ
Posted by Lamdage22 on February 1, 2015, at 3:37:22
In reply to Re: Multiple mechanism with Zyprexa and some atyp » ed_uk2010, posted by Phillipa on January 31, 2015, at 19:02:50
Compared to me normal people are hypomanic.
Posted by Lamdage22 on February 1, 2015, at 3:52:40
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on February 1, 2015, at 3:37:22
lets replace normal with healthy and lively.
For me normal equals sh*t. Because normal for me is not what normal means to healthy people.
Posted by Lamdage22 on February 1, 2015, at 4:35:23
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on February 1, 2015, at 3:52:40
Do you really think that mental health is "normal"?
I dont.
Psychiatry is over glorifying "normal".
Posted by Lamdage22 on February 1, 2015, at 4:52:32
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on February 1, 2015, at 4:35:23
Besides the goal of therapy is being euthymic. "Reasonably positive mood". Not reasonably negative.
Posted by ed_uk2010 on February 1, 2015, at 7:20:51
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on February 1, 2015, at 4:52:32
So, you want to be other people's normal?
Not sure I've ever been quite normal.
Go forward in 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.