Jump to content
CrazyBoards.org

Recommended Posts

Im trying to figure out what it is that makes one AAP a good choice over another. So please forgive me If I am asking something stupid or that has been asked a million times.

I have personally taken seroquel and zyprexa. They just arent right for me. Breast sorness, and extreme drowsiness are to hard for me to take so I searched around and found that most people who took Geodon, Abilify and Risperdal werent as affected by those side effects.

So looking at abilify first. For some people it seemed activating. Does it tend to be activating at higher or lower doses? Also I have horrible panic attacks and things that activate tend to exacerbate the problem so does abilify have any evidence pos or neg about panic.

Geodon, The heart thing is sort of hard for me to understand. It seems like most of the reported deaths were from people that were elderly or that had a history of heart attacks right? I have a healthy heart (as far as I know) So what would I expect from Geodon. Did anyone notice a change in their heartbeat or anything like that? Also it has a short half-life so its taken in multiple daily doses. Is there a noticeable withdrawl when you are late for a dose? Is there a need for hyper-vigilance about taking the medicine at the same times?

I looked up Abilify and Geodon on Crazymeds and they had this to say about both of them.

Ziprasidone functioned as an antagonist at the D2, 5HT2A, and 5HT1D receptors, and as an agonist at the 5HT1A receptor. Ziprasidone inhibited synaptic reuptake of serotonin and norepinephrine. No appreciable affinity was exhibited for other receptor/binding sites tested, including the cholinergic muscarinic receptor (IC50 >1μM).

Agonist @ 5HT1A, reuptake inhibitor serotonin and norepinephrine.

An agonist is a substance that binds to a specific receptor and triggers a response.

Reuptake inhibitors are compounds that elevate the extracellular level of the neurotransmitter in the central nervous system by inhibiting its reuptake.

O.K., that was a mouthful so what does it mean?

SSRIs, SNRIs & MRIs hit the same receptors. The mechanism is a little different but the results are the same.

You are essentially double dosing on your AD. Or better yet, you've created a super AD cocktail.

You shouldn't take this combination unless you're stuck in bed for days. If you can boot your computer and chat on a forum it's not for you.

So does that render them both ineffective as a choice for an AAP taken with an anti depressant. (I am switiching to lexapro next month)

Risperdal, how is the side effect profile at low doses? Specifically on the boob growth and muscle soreness?

Also on any of these three drugs did anyones nightmares increase?

The symptoms I am most trying to control are mood instability/impulse control/and panic-anxiety. I have tried most mood stabilizers all ready so I'm exploring the AAP option.

Thank you for any help ;)

Link to comment
Share on other sites

You are right on the Zyprexa thing. I am not able to handle the weight issue though, and I do realize that all AAPs have a penchant for weight gain but Z seems to be the worst.

I was on seroquel for three months a few years ago. I was really out of it though, I didnt have any panic but I also had no will or drive so I'm trying to stay away from the super sedating AAP's.

I realize that the Z fiasco makes me seem that I am bad about medication compliance but I really am not, Z is the only drug that I quit before giving a chance. I just couldn't deal with the weight stuff. :-/

Link to comment
Share on other sites

Neither Geodon nor Abilify are noted for being especially helpful with panic or anxiety. Of course, YMMV, as always, but in general, these are in the 'activating' category for many folks.

Abilify, in particular, doesn't seem well supported for anxiety. I'm sure there is someone who has had that result, but far more people seem to report agitation, restlessness, and activation. The agitation and restlessness often aren't tolerated by folks with anxiety, and, despite the manufacturer arguments that it's an issue of partial blockade and it just requires a much higher dose, that's not what people seem to report back in real life.

Here's the problem with the literature in humans I find on Abilify and anxiety.

The article that's promising is in a pharma-sponsored journal, pharma-sponsored study, pharma-linked authors.

The less promising article - the improvement was in psychotic symptoms, look at the side effects - is in an academic journal, non-pharma-sponsored study.

It's been kind of a trend.

If, for some reason, you and your psychiatrist do elect to start Geodon, and you are concerned about cardiac risks of Geodon, you can always ask to have an ECG done if you haven't had one done in the past year or two. (If you have anxiety and panic, I'm guessing you may have had one done anyway... use that one, unless you had other interesting cardiac drugs on board at the time. Ask your psychiatrist.) The issue on the ECG is the QTc, which should be <450 ms, same as for Haldol, tricyclics, etc. Otherwise, your psychiatrist will want to talk to a cardiologist about adjusting the dose and appropriateness.

If you've just had a heart attack, no, Geodon ain't the drug for you.

Geodon is a twice-a-day drug for most folks. I've taken it and it was not horribly UNforgiving; I was frequently 6-10 hours late on the second dose due to my work schedule.

Risperdal has its own prolactin-elevating moments at higher doses, which may be what you mean by 'boob soreness,' or may not. I don't know what point you were at in your menstrual cycle when you took the other drugs, or how long you took them. I also am not sure what you mean by muscle soreness. It is, however, less activating than the other two for most people. It can be started at very low doses, which gives at least the illusion of flexibility.

Geodon and risperidone should not, in theory, worsen nightmares much, as they each have alpha-blocker effects. I bet 20 people can promptly tell me the theory was wrong in their case. ;)

There are also regular old boring 'typical APs, such as Stelazine and Trilafon, which can have anti-anxiety effects and arguably as much mood-stabilizing effect, and are as tolerable in the lower doses. If you tend to lactate on antipsychotics, these don't usually work out well, but the mid-potency ones can be workable sometimes. Stelazine continues to be my emergency stabilization drug of choice, because apparently my brain just prefers old cheap drugs.

Zyprexa continues to be probably the best of the AAPs as a mood stabilizer, with a low risk of hyperprolactinemia (which is what I think of with breast soreness, although plain old water retention can cause that, as well as other things), and it's really worth trying to make a go of it if at all possible.

Link to comment
Share on other sites

Thank you silver! And yes that is what I meant by 'boob soreness' ;)

I am going to try and find some info about the older neuroleptics but I'm having a hard time. Thank you for taking the time to research!

Also not to overshare but I only have 2-3 periods a year so any of the prolactin would be from the meds.

Link to comment
Share on other sites

I'll add that if impulse control is the big thing you're looking at, then maybe the Zyprexa would be worth a go again. It's more than decent for the impulsiveness. I went back through your posts. If you have an overall wellness plan in mind, and if you're worried about carb cravings... then keep the food that you want you and your family to be eating around the house. You're trying to stop self-harm in all aspects of your life. So keep foods that are helpful to your body and brain around, as part of helping yourself, and maybe let the med do its thing as far as keeping you from self-harm in other ways. I hope that made something like sense.

The majority of people don't gain weight on Zyprexa. Really. I'm not minimizing that it's a significant thing when it happens, but it's not a given that it will.

If your eating's been really disordered (and I don't know if it has been), there's the risk of weight shift with anything that helps clear up your thinking. Some folks would say, aha, see, she wants to be sick, so she's undermining her treatment, but I don't think that's the case; clearly you're making efforts to get better, because you're looking at your options, and you have a place that you want to mentally be, and so on and so forth. You're not focused on weight-to-the-exclusion-of-all-else - you write a lot about trying to get less labile and less impulsive and more stable, so I'm guessing that's the top priority for you.

So... while you're looking up on the other stuff... maybe talk to your psychiatrist about another go-round on the Zyprexa? You're not married to the stuff, after all, and you have the option of a change in therapy down the road.

When weight gain (or loss) does occur with Zyprexa, it is NOT dose-dependent, by the way, so if you do talk to her about it and go for it, just go for the dosage she wants to try.

OK, just wanted to add that--

Link to comment
Share on other sites

I'll add that if impulse control is the big thing you're looking at, then maybe the Zyprexa would be worth a go again. It's more than decent for the impulsiveness. I went back through your posts. If you have an overall wellness plan in mind, and if you're worried about carb cravings... then keep the food that you want you and your family to be eating around the house. You're trying to stop self-harm in all aspects of your life. So keep foods that are helpful to your body and brain around, as part of helping yourself, and maybe let the med do its thing as far as keeping you from self-harm in other ways. I hope that made something like sense.

The majority of people don't gain weight on Zyprexa. Really. I'm not minimizing that it's a significant thing when it happens, but it's not a given that it will.

If your eating's been really disordered (and I don't know if it has been), there's the risk of weight shift with anything that helps clear up your thinking. Some folks would say, aha, see, she wants to be sick, so she's undermining her treatment, but I don't think that's the case; clearly you're making efforts to get better, because you're looking at your options, and you have a place that you want to mentally be, and so on and so forth. You're not focused on weight-to-the-exclusion-of-all-else - you write a lot about trying to get less labile and less impulsive and more stable, so I'm guessing that's the top priority for you.

So... while you're looking up on the other stuff... maybe talk to your psychiatrist about another go-round on the Zyprexa? You're not married to the stuff, after all, and you have the option of a change in therapy down the road.

When weight gain (or loss) does occur with Zyprexa, it is NOT dose-dependent, by the way, so if you do talk to her about it and go for it, just go for the dosage she wants to try.

OK, just wanted to add that--

I would never say 'I wont take z again.' I just got so stressed about the weight, and no energy not to mention the prolactin made me so sore. I do realize that its a pretty awesome drug but I think since whatever I take will be less than 5mg I will wait and see if something else knocks off the problem before going back.

If you have a second could you maybe explain one last thing to me. (I wish you were my pdoc lol I'm serious if she knew a thimble full of the things you do I would be well by know ;) ) Neurontin is a mood stablizer that I haven't tried (I think its the only one I haven't tried) but I'm trying to understand why for panic it's better to try AAP's over anti-convulsants? I just feel like the side effects for AAP's are much more serious so wouldn't it be better to go the mood route, even though it may prove to be ineffective?

I dont the the abilify is right for me so I'm tossing around the geodon & risperdal, but I still feel confused about why neurontin is considered so bad?

Thank you again! You should charge for your advice :)

Link to comment
Share on other sites

I don't think that Zyprexa could really kick in prolactin that fast, if you only took it one day. Maybe it was fallout from another drug? Or breast tenderness from something else? Again, there are a lot of causes of breast soreness. Antipsychotic or antiemetic gets the reflex "prolactin" response, but it's more often benign causes.

I don't know why AAPs would be considered that superior to anticonvulsants for panic or anxiety disorders, with the exception of maybe Seroquel and Zyprexa, particularly Seroquel. Neurontin is sort of generally suspect for things other than seizure disorders and specific kinds of nerve pain, because it was inappropriately marketed. Also, I don't think Neurontin's generally recognized as a first or second or third line mood stabilizer. I mean... it tested out worse than placebo as a mood stabilizer in one kind of infamous study, which may be unfair to bring up (but still is kind of amusing when you look at their marketing.) You'd talked about Lamictal in the past, so maybe that's worth rediscussing with your psychiatrist too.

For now, I think it's good that you're keeping an open mind. And maybe look around the rest of the board at other classes of drugs that have been used for anxiety disorders...

--S.

PS: I've been fairly crazy for a while, and reading up on it for a while, and I continue to be fairly crazy. I am just now well-read and crazy. If education fixed crazy, my family'd be a lot less... loony / dead/ whatever. Your psychiatrist knows a shitload of things, but the system you guys are in might not give you time to talk about it. Any chance you could schedule more frequent appointments for some education visits for a little bit? Or is there someone else you could meet with for some psychoeducation? Sounds like you're totally up for that. Your earlier post way back said something about 'being stationed.' Do they still have PCMs/case managers on the base? When my friend was pregnant and had post-partum depression, her PCM was fabulous.

Link to comment
Share on other sites

I don't think that Zyprexa could really kick in prolactin that fast, if you only took it one day. Maybe it was fallout from another drug? Or breast tenderness from something else? Again, there are a lot of causes of breast soreness. Antipsychotic or antiemetic gets the reflex "prolactin" response, but it's more often benign causes.

I don't know why AAPs would be considered that superior to anticonvulsants for panic or anxiety disorders, with the exception of maybe Seroquel and Zyprexa, particularly Seroquel. Neurontin is sort of generally suspect for things other than seizure disorders and specific kinds of nerve pain, because it was inappropriately marketed. Also, I don't think Neurontin's generally recognized as a first or second or third line mood stabilizer. I mean... it tested out worse than placebo as a mood stabilizer in one kind of infamous study, which may be unfair to bring up (but still is kind of amusing when you look at their marketing.) You'd talked about Lamictal in the past, so maybe that's worth rediscussing with your psychiatrist too.

For now, I think it's good that you're keeping an open mind. And maybe look around the rest of the board at other classes of drugs that have been used for anxiety disorders...

--S.

PS: I've been fairly crazy for a while, and reading up on it for a while, and I continue to be fairly crazy. I am just now well-read and crazy. If education fixed crazy, my family'd be a lot less... loony / dead/ whatever. Your psychiatrist knows a shitload of things, but the system you guys are in might not give you time to talk about it. Any chance you could schedule more frequent appointments for some education visits for a little bit? Or is there someone else you could meet with for some psychoeducation? Sounds like you're totally up for that. Your earlier post way back said something about 'being stationed.' Do they still have PCMs/case managers on the base? When my friend was pregnant and had post-partum depression, her PCM was fabulous.

Well im having to switch pdocs so I am at the mercy of off-base providers who are already backed up a few months to get an appt. I can see my onbase pdoc one more time but after that I'm out of the clinic. (They are kicking all non active duty out of the clinic, this sounds virtuous but many of the providers are not allowed to handle active duty cases so many of the Social workers, therapists, and counselors, are now just doing paperwork all day because they have no one to see.) Thats why I'm so nervous about finding something that can last me a while because I wont be seeing someone for a few months.

Okay that was a semi-rant. I apologize :)

I dont know maybe seroquel is another option. I just was so out of it when I tried it years ago but I think I was only 16 so maybe it would change now that I'm older? I wish that the answer was easier. I would love to have a 'quieting' pill that didnt make me sleepy, but that seems like it isnt so easy to find.

Maybe I should be looking more at Risp/Seroquel since they are calmers which is really what I need.

In the original post that I wrote I posted that Crazymeds seems to think that by taking geo or ablify, I'm just doubling the ssri, do you know if there is any truth to that?

Im really intrested in the typical anti psychotics you posted but my pdoc is really unaware and leaves all the decisions up to me but if she hasn't heard of it she just denies that it works so I'm worried we would get into a situation like that.

Oh and please dont feel like you have to reply I hate putting someone on the spot ;)

Link to comment
Share on other sites

Things might be a lot different now than they were when you were 16, yes. For one thing, you now have more insight and some more skills as far as keeping yourself motivated, and you can go into a med trial saying, 'These are the things I'm going to do to keep myself on track.'

I don't know that it's a good idea to get into big med changes right before you leave your base psychiatrist, especially if you can only see her one more time. If Seroquel is something you've tried with some success, it might be worth talking to her about trying that again, and then using that at least until you can get connected to someone offsite. That might be less anxiety-provoking than some totally new drug.

I think your psychiatrist will have heard of Stelazine and Trilafon - it would be odd indeed if she hadn't - but, again, the time to do a major change is probably not right before you have to transfer, if that makes sense. Same idea as not buying brand new hiking boots right before a long backpacking trip.

Do you have any friends or anyone else who can recommend someone they like offbase? Or do any of the therapists, etc., have offbase providers they recommend? If you can find a medical school/psychiatry residency site within a reasonable distance, that would be a good thing, maybe - you would get access to people who have some special expertise with BPD, maybe, particularly in WA state (as U of WA has some interest in that area.) Therapy's a big piece, too, obviously.

If you find someone and you're booked a few months out, keep calling and checking back every 2 weeks or so, enough to stay in touch but not to be a pain in the butt. Most offices have a cancellation list. (If you have the kind of schedule where you can just drop everything and go on a few hours' notice, let them know that too.) If they have a cancellation, being "that nice Changed girl from the base who called last week" rather than "#10 on the list" might get you in quicker.

As to the "doubling the SSRI" kind of idea... well, yes, it's sort of a duplication of effort, and, with those drugs, I don't know if it really stabilizes anything. I'm trying to come up with a good analogy and it's a little too late at night... There certainly are people Geodon's worked well for (ditto Abilify), but not so often for the anxiety/BPD thing, it seems, or at least that I hear about.

Link to comment
Share on other sites

I've just got to get it together and then I will find someone to see. I dont know I just feel strange and like I dont care today. I dont know whats going on. ;)

Anyway I am thinking that it's probably better to go the risperdal/seroquel route due to them being more calming. I am just scared of the weight thing which is tottally in my own head but it is still something I have to get over.

How much faith should I put into the revolution health drug ratings. lol Geodon did better than the others for panic and everything so that sort of threw me. But I realize I need hard evidence over opinion. Im just so desperate. The well/celexa thing is not doing anything and I am just so tired of the roller coaster.

Thanks silver! you have really helped me figure this stuff out.

Link to comment
Share on other sites

Archived

This topic is now archived and is closed to further replies.

×
×
  • Create New...