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On top of my 25 mg of lexapro, Im either going to get zyprexa or abilify added to my meds. Only 2.5 mg a day to begin with. Do you think that will make any difference? What experiences have you had with either of those?

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26 minutes ago, notloki said:

Avoid zyprexa, it is most likely among AP's to effect weight, lipids, and glucose levels. Used prn for a short time is the safest way to use it, often quite beneficial.

okay thankyou.

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I take abilify and the only problem I have had with it (that just started recently, and I have been on it since 2003) is that going over a certain amount I get a 24/7 headache.  YMMV with the dose, and it might not even happen, but for me if I go over 15 mg, I'll get a never-ending headache that won't go away until the dose is lowered.  It is a good med for me otherwise.

YMMV with it though.

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  • 2 weeks later...

Zyprexa will run you a higher risk than Abilify of affecting blood sugar and lipids as well as your weight. Zyprexa almost invariably causes weight gain. However, Abilify can be hit or miss. Some special snowflakes find Abilify doesn't affect their weight at all but some gain like 30 pounds. These are antipsychotics so weight gain is somewhat inevitable to a certain degree depending on your body and the medication that you take.

One thing to keep in mind with Abilify is to stay parked at a dose for a fair amount of time before you commit to increasing. Abilify has a really long half-life of like 75 hours which means it can take over 2 weeks for a dose to be considered at a steady level in your blood stream. Some pdocs like to start aggressively with Abilify at like 5mg, which may work fine in a pinch, but 3-4 weeks down the road, it starts making you restless (akathisia) because you didn't start low and work your way up slowly. What I'm getting at here is that if you go the way of Zyprexa, which will be significantly more calming than Abilify, start out with the 2.5mg for 3-5 days before going up to 5mg. Make sure to take it at night. If you go the way of Abilify which will be more stimulating, start on the 2mg and stay there for 2 weeks before you decide to go up. Probably should start out taking it in the morning. And don't be afraid to push back if your doctor is titrating up too aggressively. These are antipsychotics after all, so trying to manage with as little as possible is a safer way to go simply because of the side effects.

Another antipsychotic that I always recommend is loxapine. It's older and considered a typicaly antipsychotic but it behaves like an atypical antipsychotic. It's very similar to Zyprexa and Seroquel in how it functions and is low on side effects. In days of old, it was dosed 50-100mg twice a day. I only have to take 25mg at bed time. Like I said, light touch. I try to manage most of my symptoms with other medications where possible and only increase the antipsychotic when there really is no other option.

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I didn't get any benefit from Abilify until I hit 15 mg, and I really need 10 mg of Zyprexa to do the trick. Both meds can be very effective, and both can have nasty side effects. You won't know until you try them, unfortunately. 

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5 hours ago, browri said:

Some special snowflakes find Abilify doesn't affect their weight at all but some gain like 30 pounds. These are antipsychotics so weight gain is somewhat inevitable to a certain degree depending on your body and the medication that you take.

I think it is one of those things where YMMV.

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12 hours ago, melissaw72 said:

I think it is one of those things where YMMV.

This also is true. After taking Zyprexa for only 4-6 months I gained quite a bit of weight. But when I switched to loxapine, I lost more weight than I put on from Zyprexa which shows not all APs will make you gain weight. It's possible to even lose weight.

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Zyprexa made me feel calm but I still avoidded the object of my phobia (school) and it did not fix my depression. It certainly helped my generalised anxiety disorder. But I was ravenous and went from stick thin to mildly overweight in a month. I stopped because of the weight gain.

I started taking Abilify 10 days ago. I take 5mg a day. If it were possible I would have started at the lowest starting dose which is 2mg, but I can't access the formulation of tablet for this. 

So far I feel much better. Less depressed, much more functional, want to do things, positive and optimistic. I love it. It doesn't dull or sedate me at all, nor do I feel anxious.

I have had some trouble sleeping through the night and a little constipation.

Based on my experience, I recommend Abilify over Zyprexa.

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Zyprexa made me absolutely balloon. In a few months I put on over 50lbs, also had extreme sedation, acne and sexual dysfunction from it. I get no side effects from abilify and have even been able to lose 30lbs of the weight I put on while taking zyprexa. Definitely take abilify over zyprexa imo.

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@The Hitcher That's interesting, with loxapine and olanzapine (Zyprexa) I always found that a dose increase actually increased my sex drive, even if it was only for a few days. But I would agree with you that if you have a choice between the two, you should try the Abilify first. And if you need something as settling as Zyprexa, there are other options that work just as well with fewer side effects.....like loxapine....I can't emphasize more that if quetiapine, olanzapine, or clozapine work for you, you have to try loxapine. I'm a total fan boy. 

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17 minutes ago, Iceberg said:

well...unless you are especially sensitive to EPS or akathisia...that might be risky to take a typical

See that's the funny thing. I've been through Latuda, Saphris, Abilify, Fanapt, Zyprexa and now loxapine. I quit Latuda, Saphris, and Abilify because of akathisia. Zyprexa didn't have any akathisia but it did give me some serious tics. Taking 25mg of loxapine at night has given me absolutely no signs of any sort of EPS or akathisia. I have no doubt though that if I was taking the usual dose schedule of 50-100mg two to three times a day, I would most likely have a serious case of TD. And that's how high they dosed you on loxapine when it first came out but they're now realizing that loxapine at lower doses can be just as effective as quetiapine, clozapine, or olanzapine but more tolerable because you aren't taking full doses.

Also, I do realize that loxapine is officially classified as a typical. However, generally one of the major things that differentiates atypical antipsychotics from typical antipsychotics is that they generally have a higher affinity for the 5HT2A receptors than the D2 or D3 receptors. While loxapine is classified as a typical it pharmacologically behaves as an atypical in this regard. I asked my pdoc about this because I figured it was too good to be true, but he said that he's finding whenever a patient can't tolerate the conventional antipsychotics for mania or bipolar depression, he always gives loxapine a try and most patients end up loving it. He has several patients on it now including myself and I can see why. I hated antipsychotics until I met loxapine.

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14 hours ago, Iceberg said:

I have heard success stories definetly but in a severe pinch is still try clozaril first 

Loxapine is structurally very similar to clozapine and it has an intermediate binding profile to the dopamine receptors like olanzapine and quetiapine. The difference is that loxapine doesn't run you as much of a risk for metabolic syndrome as quetiapine and olanzapine and doesn't run you as much of a risk of agranulocytosis as clozapine. By all accounts it should be less risky despite the bad rap it gets by default for being classified as a typical antipsychotic.

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umm...have you seen all the movement problems in the Side effects list...

I'm not sure it's the better mousetrap 

And agranulocytosis is pretty rare. My psych with 25 yrs private practice has never seen it happen...it also must be the "go to" for treatment resistant schizophrenia for a reason

then again...some people do swear by it so it must do something right 

Edited by Iceberg
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couple things to remember though that change the perspective a bit.

There's a general trend (although not always a hard rule) that typical antipsychotics lean towards movement related side effects whereas atypical antipsychotics lean more towards a metabolic syndrome for their side effects. Most of both typicals and atypicals have both of these side effects but there is a clear delineation between the two. I think the worst tics I had were on olanzapine even though it is known for having a much lower risk of movement disorders and cholesterol and sugars aside was actually quite tolerable in trials and had a low drop out rate due to intolerability. If we stop thinking about loxapine in its traditional classification as a typical and focus on the fact that loxapine has a higher affinity for 5HT2A than D2 then we would consider that loxapine could be like a cross-over SUV, not quite one, not quite the other.

Loxapine is also a very old medication, so you know the older meds always have the longest list of side effects because they've been around long enough for everything under the sun to be reported as a side effect. We also know that those side effects were reported generally across a dosing schedule that dictates 100-250mg per day in divided doses. Speaking to my pdoc, he's said that there's an upward trend of doctors prescribing 5mg, 10mg, 25mg, and 50mg all at night with high rates of success and tolerability. In fact, Alexza Pharma. came out with an inhaled form of loxapine called Adasuve (10mg) that is meant to be an alternative to traditional emergent intramuscular antipsychotics like haloperidol or other APs. It's been shown to be incredibly effective in recent trials to calm acute agitation in bipolar disorder or schizophrenia with results in less than 10 minutes and full effect in less than 2 hours.

One could reasonably hypothesize that if something were dosed lower then some of the possible side effects may not occur and others may have a much decreased severity proportionate to the dose (although I do recognize that for some this is not always the case). I can say that I do have some tics on loxapine but no akathisia whatsoever. I actually lost weight when I started on it first at 5mg then at 10mg for quite some time. I did notice as I increased up to 25mg however a much more increased appetite that leveled out on its own, however I do take Adderall so take it with a grain of salt. I haven't really noticed any anticholinergic side effects. I feel mood-wise much the same way that I did on olanzapine. It's very calming even at this low a dose, and I've spoken with @jarn who I'm pretty sure is taking a lower dose than was laid out in the original dosing schedule for psychosis with much success.

Abilify is another prime example of a drug that started out for schizophrenia and bipolar mania and quickly turned into an AD add-on when they realized that teeny doses were much better tolerated and had just as much of a positive effect on unipolar depression as higher doses had on mania or psychosis.

Loxapine isn't for everyone. I know that. But in my case I had already trialed Latuda, Saphris, Abilify, Fanapt, and Zyprexa and for most of them quit because of akathisia. Even at 2.5mg of Saphris I had the most restless legs and Abilify made me want to crawl out of my skin even at 5mg. Zyprexa was the first time I started getting comfortable with an antipsychotic but the weight gain was too much. My pdoc told me it was then that he realized that if I tolerated Zyprexa and it worked well for me that my rate of success on loxapine would be extremely high and chances are really good I would respond to clozapine as well but I wasn't willing to take the risk on agranulocytosis.

Another bit of science: loxapine is metabolized into 8-OH-loxapine and 7-OH-loxapine which is then broken down into amoxapine which is a tetracyclic antidepressant like mirtazapine (which on another FYI is a cousin to Saphris as they are both analogues of mianserin). Amoxapine is most strongly a norepinephrine reuptake inhibitor but its metabolite is more-so a serotonin reuptake inhibitor and all of these metabolites are dopamine antagonists and 5HT2A antagonists making them a pretty harmonious bunch of substances. You gotta wonder if loxapine would be a suitable enhancer to an AD for treatment-resistent depression.

Okay I'm done. :P

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Ok...I agree with you about the crossover part...it is at least atypical-ish. Which is good for people who can't take aaps I'll give you that. And I agree...it's not a trade off whether movement disorder/weight gain...I had akathisia AND terrible weight gain on zyprexa...I'm just saying that if someone is super treatment resistant it seems like cloz. Is a better shot...as evidenced by any bipolar treatment flow chart where the third line is clozaril or ECT

I think we may have to agree to disagree here :P

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1 hour ago, Iceberg said:

Ok...I agree with you about the crossover part...it is at least atypical-ish. Which is good for people who can't take aaps I'll give you that. And I agree...it's not a trade off whether movement disorder/weight gain...I had akathisia AND terrible weight gain on zyprexa...I'm just saying that if someone is super treatment resistant it seems like cloz. Is a better shot...as evidenced by any bipolar treatment flow chart where the third line is clozaril or ECT

I think we may have to agree to disagree here :P

I can definitely agree with you that clozapine is the go-to for sure because it's tried and true. I'm advocating for loxapine to make a comeback because I'm a total fanboy. Can you tell?   (XD)

In all seriousness I would recommend that anyone give it a try though if you don't respond well to other AAPs. I find it at low doses to be significantly more tolerable than tiny doses of any other AAP I've taken. The tics aren't bad enough to bother me. My only complaint would be morning sleepiness. I can sometimes be so drowsy in the morning that I'm worried about driving to work because I leave before the Adderall kicks in. That feeling is usually relegated to the days immediately following a dose increase though. Then it usually levels out.

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