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Just a couple of questions..

How long do the experts recommend staying on anti-psychotics for after a psychotic episode? Is there a time limit? Can you be prescribed APs for life? Does it vary from illness to illness? I'm just wondering how long I can expect to stay on APs. Surely they can't be good for your health over the long term (though I guess its better than suicide)? Sre there any APs that are safer to take long term than Olanzapine?

questions questions questions!

Also with regards to ADs, how long do you have to stay on them after a major depressive episode? My last major depressive episode was in 2001 but I get the most godawful withdrawal symptoms every time I try to quit Prozac - barely functional, depressed as hell. Can I expect to be on Prozac then for the rest of my life?

feedback appreciated

blackbird x

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this is my totally opinionated, non-medical, non-researched opinion, so take it with a grain of salt.

i don't think that the atypicals have been out long enough yet for us to know a whole lot about them. they've done studies that seem to indicate that zyprexa is safe in pregnancy, so i can assume it would be safe for a lifetime, except the risks of diabetes and whatnot.

i've heard of them being used long-term as a defense against future psychosis, but have never heard of a limit.

again, totally off the top of my head.

as far as prozac goes, i know exactly what you're going through. i had to quit paxil and it took me 6 tries to do it, over a 3 year period! i was determined to quit, but it was like my body was physically dependent on it or something. i just couldn't get off of it without major symptoms.

i finally got off of my paxil by reducing it basically by milligrams, part by part and bit by bit. when i was getting down to the lower doses, i got liquid and even reduced down by milligram per 2 weeks! it had to be that slow. finally i stopped, and i did have symptoms, but they were symptoms i could live with. i was having symptoms all the way down from 20mg, but i could live with them.

and as far as how long you need to be on them since your last depressive episode, i guess that would be up to you and your pdoc to decide. i don't think there's a set formula for that. since i'm prone to depression, i take wellbutrin all the time, and always will, even when i'm not depressed. if i don't have another deperssion for 5 years i'll still take the stuff, just because i know it is holding me up.

now with your zyprexa, it is possible that the zyprexa is holding you up. i don't know. talk to your pdoc about if you still need the prozac, in light of the rest of the meds you take, and if you decide to discontinue it, do it very, very slowly. and be ready for a possible rebound depression or to restart it should depression strike.

i went through a depressive state about a month ago and my pdoc ended up raising my risperdal and klonopin, but didn't touch my wellbutrin (because i'd go through the roof). i ended up coming out of it i think because of the risperdal. but we were talking about bringing back the paxil. had i been depressed another week, we would have reintroduced the paxil. i'm ready for that possibility.

i hope you figure out what you need to do and feel as well as possible!

loon

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Just a couple of questions..

How long do the experts recommend staying on anti-psychotics for after a psychotic episode? Is there a time limit? Can you be prescribed APs for life? Does it vary from illness to illness? I'm just wondering how long I can expect to stay on APs. Surely they can't be good for your health over the long term (though I guess its better than suicide)? Are there any APs that are safer to take long term than Olanzapine?

It probably depends a lot on the patient. If you are doing well on Zyprexa+ PRN Haldol, and your liver and such are holding out,

why risk another episode? From what I've read, the preference is to use the "atypicals" in place of the old-line standards

wherever possible, so there's probably no time limit with Sz.

Also with regards to ADs, how long do you have to stay on them after a major depressive episode? My last major depressive episode was in 2001 but I get the most godawful withdrawal symptoms every time I try to quit Prozac - barely functional, depressed as hell. Can I expect to be on Prozac then for the rest of my life?

Off the top of my head, I think it's a 6 months to a year of follow-on medication. (ref.) I suspect at some point (multiple relapses,

non-response to multiple medications, probably other stuff) the patient and/or the doctor will decide that life-long

intervention is needed. However, it's NOT so likely that the medication schedule cannot be reduced as long as the patient

is reasonably stable. After all, the goal should be to keep people able to look after themselves and function in society,

not to keep them medicated into oblivion, right?

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I don't know about APs. I'm a little worried about long term effects myself, but right now it's worth the risks. I would play it safe and be on them for a bit longer, your last psychosis wasn't really a long time ago, was it?

As for antidepressants, my mom was on Efexor for maybe nine months after her depression (I should say depressive symptoms), she's going off it now and she's doing fine. I think the general rule is around six months. Not six years... I guess it's hard to tell what is withdrawal and what is rebound depression.

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With any dx where you have the potential for kindling you really want to take meds prophetically.

It's my understanding that with Sz meds are usually for life. It's true that the long term effects of medications are unknown. The long term effects of mental illness is known, however. If you've got a likely relapse on one hand and an unknown on the other, common sense says go with the unknown.

Yhey are now saying if you've had more than three depressive episodes it's best to take an AD prophetically as well.

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Thanks for all the feedback guys!

It is very hard to get prescribing guidelines for BPD. I think I might have to be on Prozac for the rest of my life because the withdrawal is so harsh, though I haven't done it mg by mg like Loon has. I am happy enough to continue taking Prozac - if it aint broke, don't fix it.

As far as anti-psychotics go, I am still worried about the long term effects but at the minute it is what I need - good old Olanzapine and lots of it. Perhaps when I am more stable I can switch back to Abilify which I would be happier taking long term. I don't want to end up fat, diabetic and with heart failure - ok this isn't guaranteed to happen to me, but I am still sufficiently concerned. Is it generally agreed that during schizophrenia APs should be taken as prophylaxis indefinitely?

thanks again!

blackbird x

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I have to start saving articles on this subject to put up on the boards.

this is from a fairly generic patient information thing that veryone gets when they're first diagnosed (with sz, I couldn't find one for psychosis and schizotypal)

For How Long do I Need toTakethe Medication?Some people will require anti-psychotic medication for long periods. Usually the medication is continued for one to two years after the person has achieved excellent recovery from their first episode, and is stable in life with regard to relationships, work or accommodation.In the early years there is a high risk of relapse and if the person experiences another episode they may need anti-psychotic medication for two to five years before ceasing use. For those who have multiple episodes, they may need to use medication for much of their life.

new zealand reatment guide for consumers and carers

Long term studies tend to be in relation to the old meds. It's kind of assumed that the newer atypcals don't have drastic effects so a lot of doctors recomend ong term or life long usage and certainly a lot of patients prefer the peace of mind (though relapse still happens on meds), it's kinda scarey that we have to make our own choices with this.

For me I have heart issues and a seizure disorder so my docs want me off meds as soon as feasable.

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