In need of some voices of reason! Enough time, right?!?

[Wonderful.Cheese]

How long would a zyprexa increase take to work? Because the last 1.5 days have been tolerable, rather than the last few weeks, which were completely unbearable. The increase was 3 weeks ago. 

But I worry things will go south again though because....

This is most likely a blip because I know I'm seeing pdoc today so I feel some hope.

Yet, I'd rather not remain on zyprexa honestly because I know pdoc will want to increase it to like 40 mg (she already mentioned that). And I'd rather try to avoid getting diabetes as much as possible.

I feel stupid and I'm nervous for this appointment. I made a symptom list. Said I'd like to try Vraylar possibly or go back to Seroquel XR/Latuda or rexulti combo and ditch Abilify because I'm not sure if it is working anymore after 10+ years. Seroquel XR really takes care of squashing mania but doesn't help my depressions. So I think that Latuda or rexulti might be beneficial here with the Seroquel XR. I cannot handle AD's, unfortunately. And I know I know I should suck it up and ask to try clozaril but I'm such a big chicken about everything about it.  The blood draws, the possible cost, the side effects, the having to be IP to start it, etc. ARGH JUST ARGH!

I shouldn't stay on zyprexa right? One ok day doesn't make up for 3 ish weeks of hell? I gave it enough time to work right? CONFUSED

Edited March 23, 2018 by Wonderful.Cheese

[mikl_pls]

29 minutes ago, Wonderful.Cheese said:

How long would a zyprexa increase take to work? Because the last 1.5 days have been tolerable, rather than the last few weeks, which were completely unbearable. The increase was 3 weeks ago.

1

Theoretically, 5 half-lives. The half-life of olanzapine is 33 hours, so 165 hours or roughly a week. theoretically, not clinically.

31 minutes ago, Wonderful.Cheese said:

I feel stupid and I'm nervous for this appointment. I made a symptom list. Said I'd like to try Vraylar possibly or go back to Seroquel XR/Latuda or rexulti combo and ditch Abilify because I'm not sure if it is working anymore after 10+ years. Seroquel XR really takes care of squashing mania but doesn't help my depressions. So I think that Latuda or rexulti might be beneficial here with the Seroquel XR. I cannot handle AD's, unfortunately. And I know I know I should suck it up and ask to try clozaril but I'm such a big chicken about everything about it.  The blood draws, the possible cost, the side effects, the having to be IP to start it, etc. ARGH JUST ARGH!

4

Please don't feel stupid, you have no reason to. You made a symptom list, that was a smart thing to do.

If it were me, any pairing of AAPs I would choose would be Seroquel XR + Vraylar or Rexulti if you're wanting to get off the Zyprexa Zydis. Seroquel XR + Latuda probably wouldn't do much.

As for your depressive symptoms, if it were me, I would probably wait to see if the Seroquel + Vraylar/Rexulti combo took care of it first, then if it doesn't after dose tweaking, I would ask if raising the Lamictal would help (I was on 400 mg at one point, some people need more), ask if lithium might help (low dose, which acts as an antidepressant rather than an antimanic), or ask if a tiny dose of any antidepressant might be worth a try (preferably something splittable); e.g., Lexapro 5 mg, Celexa 10-20 mg, Paxil 10 mg (some of these come in liquid solutions so you might be able to get even smaller doses), you get the point, or if you haven't tried it, Wellbutrin, since it supposedly has a lesser chance of causing switches to mania. That's what I would ask about. Although I think I seem to remember you tried Wellbutrin and didn't do well with it... Sorry, Topamax wreaks havoc on my memory...

I'm not pressuring you into asking about anything, I'm just throwing some ideas on the table for consideration.

[Wonderful.Cheese]

1 hour ago, mikl_pls said:

Theoretically, 5 half-lives. The half-life of olanzapine is 33 hours, so 165 hours or roughly a week. theoretically, not clinically.

Please don't feel stupid, you have no reason to. You made a symptom list, that was a smart thing to do.

If it were me, any pairing of AAPs I would choose would be Seroquel XR + Vraylar or Rexulti if you're wanting to get off the Zyprexa Zydis. Seroquel XR + Latuda probably wouldn't do much.

As for your depressive symptoms, if it were me, I would probably wait to see if the Seroquel + Vraylar/Rexulti combo took care of it first, then if it doesn't after dose tweaking, I would ask if raising the Lamictal would help (I was on 400 mg at one point, some people need more), ask if lithium might help (low dose, which acts as an antidepressant rather than an antimanic), or ask if a tiny dose of any antidepressant might be worth a try (preferably something splittable); e.g., Lexapro 5 mg, Celexa 10-20 mg, Paxil 10 mg (some of these come in liquid solutions so you might be able to get even smaller doses), you get the point, or if you haven't tried it, Wellbutrin, since it supposedly has a lesser chance of causing switches to mania. That's what I would ask about. Although I think I seem to remember you tried Wellbutrin and didn't do well with it... Sorry, Topamax wreaks havoc on my memory...

I'm not pressuring you into asking about anything, I'm just throwing some ideas on the table for consideration.

Thanks so much again. I was really hoping someone would reply before my appointment. I really appreciate all the help you give me! I hope I am not too much of a bother!

So latuda is not worth it. I have only been on it with abilify and that was not a pretty sight. But I figured maybe the seroquel xr would keep a cap on things. But I do remember it not doing anything for me unfortunately except initiating an IP stay. So I do think it's a bad idea too. I wasn't thinking. Yikes.

So I will beg to return to seroquel XR and pair it with either rexulti or vraylar. I have a copay card for rexulti thanks to you suggesting one in my other thread. It is $0 for the first month. Then I can mail order it if it works out which is much less expensive than a local pharmacy. But I will defer to my pdoc's opinion. If she thinks vraylar is best I will try that one. But damn $0 is tempting then I can start up dose for free and then mail order next time. I do love a good deal. I'm mostly kidding just so you know. Ha.

But this is all speculation. Ideally I would like these changes, but she might not do anything at all. I hope she is receptive to my ideas still.

I was on 400 mg lamictal at one point and can't recall why it was lowered. I've never been on lithium since a bad OD on it. My pdoc is very against using an AD on me. I wish she would be more open to trying one. I can ask again if the above changes do not help. Wellbutrin was tried, yes, but ANXIETY AND JITTERY! Yikes. I'm like that enough on my own. Ha. And I feel ya on the topamax memory and thinking issues. I take it myself. But it helps so much with the overeating. I don't dare stop it. Ouff.

And I have never felt pressure from you to do anything. I always like ideas to run by my pdoc. I don't feel like it's pressure at all. So absolutely no worries there!