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So, saw pdoc today.  

I did not get put on new med (clozapine).  I am doing bloodwork to make sure I HAVE to go off of loxapine, and then I see him in three weeks.  My husband came to the appointment as we were discussing clozapine and I wanted his input.  Pdoc went through the questions I'd emailed to his admin and it was really good.

My husband asked if there were any other options, and pdoc said I was out of the good ones, other than perhaps zyprexa.  

We talked about it, and I think it's likely in three weeks I'll be going on zyprexa - try the less side-effect/monitoring option first.

So - what do I need to know?

Weight gain/diabetes - I know it's an issue.  Will eat low carb, for same reasons as I would if I were going on clozapine.  Pdoc said if need be they could give me metformin.  

Sedation, I know it's sedating.  I suppose how sedating is dose dependent?  

What else?

Pdoc wants something to address mania.  I've always tended heavily to depression but I wonder if my lack of mania is because the AAPs I was on were controlling it (don't talk to me about lithium monotherapy, yikes).  I've had breakthrough mania (that or I rapid cycle) for years, my current pdoc takes it seriously, old pdoc dismissed it as 'agitation'.

If I go on zyprexa, the rest of my cocktail is lamotrigine 300mg and gabapentin 900mg.  Does zyprexa do anything for depression or is it just psychosis/mania?

And it is good for psychosis, right?  I have had psychotic issues on every antipsychotic, though loxapine has been the best, only briefly last April/May after a hypomanic episode.  On AAPs I get psychosis without mood issues, so at least with loxapine it was simply an after-effect of the hypomania.    

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I've found zyprexa to be a very effective mood stabilizer.  I went off it briefly and it caused all sorts of sleep difficulties.  Not mania or hypomania, but symptoms that suggested I was headed in that direction, so I got back on it and those went away.  I've also found it to be very good for me cognitively-speaking.  I think of it as "brain glue" - it's like it organizes my brain.  I can't explain it better than that, sorry.

I will add the disclaimer that I haven't found it helpful for psychosis (which is really atypical to my understanding).  I have to have Fanapt on board for that, which makes sense since it's FDA approved for schizophrenia, so good for psychosis.  I tried each without the other and it didn't work.

I've lost about 25 pounds while on zyprexa.  spread out over a year, so it's not super quickly, but it is possible.  I know (think?) you might have some reasons to not count calories.  But the weight gain isn't an automatic. 

I don't know if sedation is dose dependent.  I haven't felt it go in either direction when I move it around. 


This may just translate to - I've had a positive but weird experience and think it doesn't hurt to try it.

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If zyprexa handles mania but not  enough for depression, there is a drug here called 


it is a fixed ratio for prozac + zyprexa. Im not sure how sensitive you are to SSRIS in terms of mania/mixed but that could be the ticket.

the ratio only goes up to 12/50 zyprexa to prozac, but im sure if you have to take 20mg of zyprexa, your doc might be able to play around with the prozac dose.

im guessing at the end of the day, zyprexa has a bias on controlling mania vs depression 

i think cheese is doing well with adding prozac to her zyprexa.

of course listen to your doc

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Thanks dances!  That's good to hear about cognition.  I hope it works well for psychosis.  I've heard it's good, so hoping you're an outlier.  

I'm really glad to hear you've lost weight!  I need to lose weight.  And yes, I have an ED(s) so while I do count it's not ideal.  I try to make sure I eat enough, so it goes both ways.  Except when I fast, which I won't discuss here as I know some people find it controversial.  

How sedating do you find it?

Thanks argh!  I've only ever been on two ADs and I don't remember which they were - pretty sure one was celexa.  One made me manic (how I got dx'd) and one I was on mood stabilizers and stayed okay.  

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for me, the sedation isn't really right away at night (which I think it is for most).  I notice it if I take it in the morning (like if I accidentally take my evening meds in the morning), and I take so much at night that it's hard to say what is doing what, but I'm really overly sedated and physically uncoordinated.  But 20mg isn't enough to put me to sleep, like it is for most people.

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I ran into an issue at high doses where it was more sedating than actually calming so I ended up with like a weird drowsy/agitated state that was unpleasant for all involved, also first time I ever had weight issues. At lower doses it was a pretty good stabilizer and helped to get me out of inpatient 

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Thanks @Iceberg.  I've been guessing on dose and thinking 10-20mg?  But I truly have no clue.  I hope pdoc puts me on something sufficient from the get-go, he started me at a sub-therapeutic dose of Haldol recently.  

6 hours ago, ~nestling~ said:

I just wanted to say hi, as another person with an ED going onto Olanzapine. 

Here's hoping we both do well on it!  Let me know.  When do you start?  I'm a few weeks away still.  

@saintalto that's really good to hear.  Psychosis is a big concern for me after the great Haldol debacle (which also ended in mania/suicidal depression, but started with psychosis)

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@jarn the dosing suggests starting at 10mg if there are other meds on board for mania. However, knowing how much of a zombifyier this med can be I wouldn’t blame them for starting at lower end (like 5 maybe) to make sure it’s not just gonna weirdly kick your ass. Also, who knows what if five - or maybe 7.5 which they stabilized me on inpatient (semi briefly) could have effect and lower the side effect risk 

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6 hours ago, jarn said:


Here's hoping we both do well on it!  Let me know.  When do you start?  I'm a few weeks away still.  


I start as soon as the info gets from the CMHT to my GPs. Which hopefully will be next week sometime. Thanks, you too. 

Edited by ~nestling~
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Hi @jarn! I take 20 mg zyprexa in the Zydis melt in your mouth (but not in your hands ;)) form and it is my miracle med. That’s what a hospital pdoc called it one time while I was IP. I was stupid and got off of it for fear of weight gain and more and I’ve lost so many years because of that. I should have just stayed on it.

I have heard that the Zydis form is better for not gaining weight but I don’t know if those are just rumors flying around. I like the Zydis anyway because it hits me very fast when I go to bed and I’m trying to sleep as compared to the pill form.

It really is a great med for me. It is the one med I’d pick if I had to choose to be on one med only. It quiets my brain, it lessens my anxiety and irritability, it has prevented mania and I’m able to take an AD even (!) which is major, I believe it has helped with the psychosis because I don’t think abilify or rexulti are doing much for that. But it’s hard to tell I guess for sure.

Oh and I’ve been losing weight since coming off a high dose of seroquel and getting on Zyprexa Zydis! So it can be done for sure! Everyone is different but I have been losing weight, slowly but surely!

I hope you have great success with zyprexa. It’s a great med for me so I hope it works great for you too. Keep us posted.


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Thanks all!

@Iceberg good point.  As long as it's a somewhat therapeutic dosage.  I don't want another psychotic break this year.  Two's been enough.  

@the maze runner - clozapine is the next place.  Hoping olanzapine works though.  

@~nestling~ thanks!  Good luck!

@Wonderful.Cheese hmm...I wonder which is better then.  I know my workplace medication insurance prefers generics and I doubt zydis comes generic.  I can check whether it'll cover zydis though.  Does it taste as bad as Saphris?

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