Need a temporary “rescue” med

[Cinnamon]

So, I was off all meds for a while - my doc okayed the experiment- but I just got smacked in the head with what I think is becoming a manic episode. My pdoc started me on Abilify 2 days ago, which will hopefully work, but it’s not one of those meds that slows you down immediately, and I’m feel more and more erratic. (I have PRN Klonipin, but I might as well be popping tic tacs.) Does anyone have any experience with a med that’s been effective at making the thoughts stop racing until the main drug kicks in? I’m getting really scared. Thanks!

[Gearhead]

I always start with Seroquel. If you get desperate, Zyprexa usually stops a charging bull rhino.

[Cinnamon]

Thanks! I’ll ask about that. She’s not the best doc - best I can do with my finances - and there’s no chance anything will happen over the weekend but I’ll call and ask about Seroquel Monday. She’ll probably be ok with that since I was on Seroquel XR for a looong time.

[gb84]

I recommend Zyprexa as well.  It has completely reversed my paranoia and delusional thoughts.  I don't have the constant racing thoughts anymore as well.  I started on 5mg, now steady at 10mg which is where I think I will stay for the time being.  I also started taking Deplin (L-Methylfolate supplement) and it has really helped me as well.  I was on Abilify before Zyprexa and it did nothing to calm me down, and I couldn't sleep as well.  I sleep great on Zyprexa. 

Just my 2 cents, I wish you the best in your search. 

[Cinnamon]

3 minutes ago, gb84 said:

I recommend Zyprexa as well.  It has completely reversed my paranoia and delusional thoughts.  I don't have the constant racing thoughts anymore as well.  I started on 5mg, now steady at 10mg which is where I think I will stay for the time being.  I also started taking Deplin (L-Methylfolate supplement) and it has really helped me as well.  I was on Abilify before Zyprexa and it did nothing to calm me down, and I couldn't sleep as well.  I sleep great on Zyprexa. 

Just my 2 cents, I wish you the best in your search. 

Thanks for the advice! Honestly, I’ve wanted to try Zyprexa forever because I’ve heard incredible things about it from so many people. It’s one of those drugs I’ve always been terrified to take because of side effects though... well, side EFFECT, really. I have a 16 year history of anorexia nervous and have mostly refused to take meds that were not weight neutral. I just got out of a long inpatient eating disorder stay, and am at a healthy weight for the first time in a decade but am so afraid of gaining more. I’m getting very close to the point of thinking enough is enough and I should just try it (Zyprexa, that is), so thanks for the extra boost. Sorry for the earful!

[gb84]

3 minutes ago, Cinnamon said:

Thanks for the advice! Honestly, I’ve wanted to try Zyprexa forever because I’ve heard incredible things about it from so many people. It’s one of those drugs I’ve always been terrified to take because of side effects though... well, side EFFECT, really. I have a 16 year history of anorexia nervous and have mostly refused to take meds that were not weight neutral. I just got out of a long inpatient eating disorder stay, and am at a healthy weight for the first time in a decade but am so afraid of gaining more. I’m getting very close to the point of thinking enough is enough and I should just try it (Zyprexa, that is), so thanks for the extra boost. Sorry for the earful!

No apologies needed.  I have gained 5 lbs since I started taking it.  I understand your worries about weight.  I used to be 430lbs before I had gastric bypass surgery.  I'm a compulsive eater.  But now I am on a keto diet with fasting.  I highly recommend the diet.  It really helps to keep my weight in check.  Don't be afraid to ask for help.  This board is great and helped me a lot.  

[browri]

I have never taken Seroquel, but I can't speak more highly of Zyprexa at least when it comes to efficacy. @Gearhead is right. Zyprexa can definitely stop a bull rhino as he put it lol. What's good about it though is that it has a longer half-life. So you can give yourself a good 5-10mg kick and it will last for a bit. Generally speaking though, I trust Zyprexa 100% to abort a manic/hypomanic episode and have decent antidepressant effect as well. In fact, Rexulti is the only other AP I've taken that has given me a decent antidepressant effect that's also been tolerable. I did gain weight on Zyprexa though, which was unfortunate. However, I ultimately quit it more because of lipids and blood sugar than my weight alone.

[Iceberg]

I used Thorazine but that is a bit "rougher"

Worked better than zyprexa tho

[browri]

On 5/21/2018 at 1:25 PM, Iceberg said:

I used Thorazine but that is a bit "rougher"

Worked better than zyprexa tho

Tagging on Thorazine, I would also recommend loxapine. Zyprexa has ~32 hour half-life, give or take. Its metabolism can be variable for some people. However, the half-life of loxapine itself is much shorter (7-12 hours). You can actually dose it really low. The strategy my pdoc has taken with some of his patients is to have them start out at just 5mg at night and then go to 10mg at night. Reason being is that despite the short half-life of the parent compound, it's broken down into several metabolites with half-lives up to 32 hours, one of which was actually brought to market as an antidepressant: amoxapine. At doses <25-50mg, it has more affinity for serotonin antagonism then it does for dopamine antagonism making it more of an crossover antipsychotic. It's always been marketed as a classic/typical antipsychotic at its normal dosing of 50-100mg 2-3 times a day, but at doses <50mg daily, it behaves more like an atypical antipsychotic.

In my personal experience, I started taking 10-15mg at night and using 5mg during the day if I needed it to calm agitation. The only problem was that 20-25mg was my threshold for restlessness. To be fair, my akathisia threshold is pretty low for most APs. But what I couldn't get past were the noradrenergic side effects. It would calm my thoughts, but I didn't feel like I was getting enough "all-day coverage" out of it and it would increase my heart rate a bit which would make me want to move around.

However, using just 5mg as a PRN med during the day would probably be quite tolerable and very mild. 10mg might be a bit too sedating and would be reserved for the evenings.

TL;DR: This would be good in low doses if you're already fairly well-controlled on an AAP and just need something light to smooth the waves.

Edited May 24, 2018 by browri

[Sjs]

I might be a little late to this thread.

I am currently taking zyprexa in the midst of a manic episode.   Doc said lowest dose to start.  So 5mg for one night, 10mg for 2 more nights and I felt pretty good. But 2 days later my mania was back full force, actually a little worse .  So I am on day 2 of 20 mg.  It has stopped the mania in its tracks.  I have one more say to go but I am dropping it back down today to 10 mg for the next 2 days.  Only problem is i am super groggy.  But I am only to take it temporarily to reset the brain and shut down the mania.  

I'm Dx bipolar.

[CeremonyNewOrder]

In addition to Zyprexa, I'd recommend resperidone. Also, it is a horrible drug to take long term but haldol is a very effective med for extreme mania and psychosis. My local hospital always uses haldol when it is a mental health emergency situation. Like I said just for a while until your newer antipsychotic kicks in. Personally, I found abilify kicked in right away.  

[mellifluous]

Agree with zyprexa, suggest dissolvables as less likely to produce weight gain. 

Also agree with haldol suggestion. I've had numerous haldol injections for acute episodes and they mix it with cogentin and maybe Ativan, those shots have cut my hospital length of stays in half. But that's if you really need to get a handle on something maybe.