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Umm, so I thought Zyprexa was supposed to be one of the more sedating AAPs and that Abilify was the real baddie with akathisia. But even on a puny 2.5 mg dose of Z, I started to get really revved up physically and mentally. Bouncy legs, feeling impatient, agitated and unable to concentrate. I've backed down to 1.25 mgs and added Lithium, both of which seem to have helped.

But I'm kind of at a loss as to what to do. I can't go higher than 600 mgs on Lithium or my kidneys start to get a little too much work. My pdoc wants me to either go back up to 2.5 mgs on Zyprexa or switch to Geodon. (The goal here is to prevent me from going into mild hypomania when on an antidepressant ... which I need to quit smoking. Oh, and also to help with my anxiety.)

I'm wondering first if anyone has experienced akathisia on such a low dose of Zyprexa. Second, should I expect it to be any better or worse on, say 20 mg twice a day of Geodon? Also, has anyone had positive experiences with Geodon for anxiety and minor mood stabilization?

Thanks,

cache-monkey

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For bipolar, geodon plus an AD is a Big No-No.

What other APs have you tried? Or have you considered any of the anticonvulsants?

Kassiane

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Well, this would be geodon + low-dose lithium + dopamine agonist (e.g. Mirapex, Bromocriptine, Requip). Do you think that's still a BNN?

In addition to Zyprexa, I tried Seroquel, but never made it past 50 mg due to the histamine blockade. (It wasn't the sedation. It was the dry mouth/throat that turned my borderline sleep apnea into to the full-fledged variety.) Interestingly, even on that low a dose of Seroquel I experienced some of the agitatedness.

As far as the anticonvulsants, my only experience has been with Depakote. Which made me depressed (rather than my usual dysthymia/anhedonia) and dumb.

I'm leaning toward giving Geodon a shot, just to say I've almost done the rounds with the AAPs (leaving Abilify for later). I'm worried about trying another AC because the mostly seem to work by increasing GABA and I feel like my mood issues are mostly dopamine mediated -- my historical pre-med pick-me-ups were cigarettes, coffee and booze. Since GAPA puts the kaibosh on dopamine, I figure that explains my reaction to Depakote. Is a depressive response less common with the other ACs?

Thanks for the thoughts,

cache-monkey

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MOST ACs actually have multiple mechanisms of action, leaving GABA alone and working in sodium and calcium channels.

Lamictal might be good for you, if you tend towards depression. Tegretol and Trileptal also tend to leave GABA alone.

I'm thinkin' that the AD action with Geodon still might be a bit too much, even if its a selective dopamine med...but Im not sure, Ive not seen that combo in action without an SSRI ALSO present (but the one time I saw that, MAN was it a dysphoric manic disaster--geodon plus zoloft plus cogentin. OY!)

Kassiane

<{POST_SNAPBACK}>

Lamictal was actually way too activating/agitating for me. Granted it was a pretty stressful period of my life, but after getting to 50 mg I had a full-fledged panic attack. Not fun.

I think I'm content to try Lithium 300 mg b.i.d. + Geodon 20 mg b.i.d + my usual Klonopin 1.25 mg/day and see how things shake out. Based on what I've heard (both here and elsewhere), I'll look out for signs of hypomania. If I find myself heading that way (which has only really happened once on Celexa + Wellbutrin + no mood stabilizer), the Geodon gets axed and I think Trileptal is the next choice. Who knows, maybe it'll work out in such a way that I don't even need the DA agonist for the quit-smoking blues.

Thanks again,

cache-monkey

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