AP Questions...Advice really really appreciated.

[Pamito]

Hi All,

I don't post much here but i read all the time. I'm in a bit of an antipsychotic crisis. My seroquel has worked beautifully for 5 years. Now, I think it's "pooping out".

My PDoc suggested that if another week of 1500mg (OMG ) of Seroquel doesn't work, he wants to add another drug in. I have three choices:

(a) Haloperidol

(b) Geodon

© Lithium.

I really don't want to change as I love my seroquel, but I'd have to admit that it should be working at this dose.

Has anyone had experience with any of the 3 options, and what are the good and bad aspects of them? If you were in my position, which one would you go for?

Any input would be really appreciated!!!

Pamito

[papertrees]

Choose geodon. I hated haldol. It made me unable to think, unable to feel. It's one of the oldest antipsychotics (and the cheapest too) but you wont like the side effects.

[AirMarshall]

Of course there is no "Correct" answer. There are no 'bad' drugs. YMMV

I have experience with lithium only, and can't speak to these specific combinations.

Lithium is a mood stabilizer, not an antipsychotic like the others. It is fairly fast acting, you should feel effects in 3-5 days. It plays well with other meds because it is a salt and is not metabolized by the liver, but is excreted thru the urine by the kidneys. Lithium is a proven antidepressant/antisuicide. It may make your emotions feel flat at first, but that can be a relief too. I like my lithium.

In summary, Lithium probably won't control psychotic symptoms alone, but it helps provide a more stable base.

Let us know how you do. a.m.

[Silver]

Of those three, with this information? Lithium.

I don't see what the benefit would be of adding Geodon to Seroquel, as you're certainly at an antipsychotic dose already.

If the concern is that underlying affective problems are worsening your thought processes, then lithium makes the most sense. Treat the disease process, don't just engage in the psychiatric whack-a-mole game of symptom suppression.

You could swap out Serpquel for Haldol, but I really question the idea of adding Haldol to Seroquel for antipsychotic effect. You'll get the D2 effect from the Haldol, and I don't see benefit to keeping the Seroquel going at the same time for psychosis. (For sedation, anxiolytic effect, etc., sure, the Seroquel may make sense.) Response to haloperidol (in terms of tolerability) varies hugely. I've taken it as a prn while getting affect under control, and it worked quite well, but I find it difficult to tolerate if I'm not out at one extreme or another of affect.

Just my pre-coffee 2 cents.

[MaryPoppins]

To add my two cents I would recommend Geodon. It works well when it works. I know going with a new med is scary. Trust me, I've been in your shoes. I wasn't able to handle the side effect of the (td) affects, but that's just ME and MY body. I would definitely try Geodon first.

[papertrees]

I forgot to add, definitely go with lithium and an AAP. it works wonders.

[Pamito]

Thanks a lot for all the replies.

The seroquel 1500 seems to be starting to help the psychosis. Phew. I hope it keeps going and it hasn't stopped working. I am staying as quiet as can be. I think the Geodon will be right for me if I have to add something to the Seroquel. Do NOT need any more flattening added to the sero. I really have to say thanks to everyone for replying as I had no idea about any of these drugs. Fingers crossed the Sero keeps improving my thinking!

Cheers,

Pamito

[netsavy006]

Glad to hear the increased dose of Seroquel is working.