# Zyprexa Advice needed?



## seattleguy35 (Dec 14, 2005)

Hey everyone,

I haven't been on this post for long time due to lot of work (teaching!!!)

I have a question that I hope someone will answer (especially "Dr. Caedmon")

My SAD/GAD and depression is still on even with:

Zoloft 100 mg - 150 mg
Klonopin 0.5 twice a day

So I went to my doctor today for a followup management ( this time, it's not a weekly but monthly followup management)

I mentioned to him that I continue to have anxiety/depression.... So he gave me a week of Zyprexa 2.5 mg to be taken only a NIGHT due to sleepy

Do you know of any other common side effects?

I researched the website for Zyprexa and was surprised that it is prescribed to people who have schizophrenia or bipolar mania.

I don't have schizophrenia or bipolar mania. I have SAD/GAD and depression...

Is this drug "off label" for GAD/SAD and Depression? 

Any thoughts? I'm thinking about not taking it.... haven't decided it although I do have the 7 day sample....

Thanks!!!!!  

SeattleGuy35


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## UltraShy (Nov 8, 2003)

I'll keep my Zyprexa rant short, since so many have already seen it.

Zyprexa is the worst drug I've ever had the misfortune of taking. It made me gain 25 pounds in just six weeks. I was aware of this side effect and asked my doctor when he decided Zyprexa was just the thing for me. His dismissed my concerns saying "Not everyone gains weight on Zyprexa." (Yeah, and 5 our 6 people playing Russian Roulette don't end up with a bullet in their head, but I still don't want to play.)

I weighed 246 at that time and my GP thought a drug infamous for extreme weight gain was a good idea, even though I've never had any symptoms of psychosis nor mania -- the only two FDA approved uses. He also didn't care that there was virtually a total lack of research to support Zyprexa as being an effective drug for SA or any other anxiety disorder. That was 3 years ago and I still have yet to find any research that shows it to be effective (one SAS member was able to dig up a study that included 4 patients that got Zyprexa for anxiety, but obviously the sample size leaves very much to be desired).

The first FAQ on Zyprexa's website deals with the weight gain problem. Given that it gets top billing, it appears that even Lilly can't ignore this most obvious problem. As I recall, they basically dance around the issue saying something to the effect that fatter patients gain relatively less weight in percentage terms. Sure, 25 pounds is a smaller percentage when you're 250 than when you're 125, but neither one is going to be happy with an extra 25.

After I stopped Zyprexa due to the weight gain, I then learned about it's other effects. It's also been linked to diabetes (more than the weight gain alone can explain).

My opinion is that Zyprexa is for doctors who lack a brain and lack the balls to prescribe enough of a controlled substance. Your Klonopin dose should be increased instead of giving you Zyprexa, IMO.


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## Guest (May 4, 2006)

i'm on zyprexa and it makes your appetite increase dramatically for a little while....i didnt gain more than two pounds, but have a very fast metabolism. it does make you tired too. i havent really experienced any other side effects.


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## guitarik (Apr 18, 2006)

My gdr.gave me that for anxiety and insomnia. He said it would help me sleep. After reading about it ,I stopped taking it and had Ambien Rx instead. He wouldn't Rx me any kind of benzos for anxiety, he told me to seek some kind of counseling for that.


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## Noca (Jun 24, 2005)

Zyprexa works wonders for my appetite and it helps me sleep at night. Very good drug in my opinion, tho it doesnt do much for SA it seems to work on my OCD.


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## workman (Mar 5, 2004)

I would never take it. Diabetes and Diabetic Coma doesn't sound very fun.


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## Caedmon (Dec 14, 2003)

Hi Michael,

Have you responded to Zoloft at all, do you think?

Zyprexa is an antipsychotic used for acute treatment of mania and longer-term treatment of schizophrenia. It's also used off-label for a lot of purposes, probably the most common one is depression. The manufacturer has studied it for augmentation of SSRIs in unipolar depression. There is a lot of debate on its appropriateness for off-label use (there is also a lot of debate just how long or how much to use it for bipolar disorder, too). I haven't figured out what to think of Zyprexa personally, because it's such a complicated and controversial drug.

It will probably cause weight gain and in some causes precipitates blood glucose irregularities, leading to diabetes. It tends to sedate. It can help GAD, OCD, and depression in some people.

*from rxlist.com:*_ Olanzapine is a selective monoaminergic antagonist with high affinity binding to the following receptors: serotonin 5HT2A/2C , 5HT6 , (Ki =4, 11, and 5 nM, respectively), dopamine D1-4 (Ki =11-31 nM), histamine H1 (Ki =7 nM), and adrenergic a1 receptors (Ki =19 nM). Olanzapine is an antagonist with moderate affinity binding for serotonin 5HT3 (Ki =57 nM) and muscarinic M1-5 (Ki =73, 96, 132, 32, and 48 nM, respectively. Olanzapine binds weakly to GABAA , BZD, and b adrenergic receptors (Ki >10 mM).

The mechanism of action of olanzapine, as with other drugs having efficacy in schizophrenia, is unknown. However, it has been proposed that this drug's efficacy in schizophrenia is mediated through a combination of dopamine and serotonin type 2 (5HT2 ) antagonism. The mechanism of action of olanzapine in the treatment of acute manic episodes associated with Bipolar I Disorder is unknown. _

Basically, by being an antagonist at those receptor sites, you end up with more serotonin and dopamine floating around. I think. Another drug that is a 5HT2 antagonist is trazodone. It is heavily sedating and usually helps with sleep, and it can help anxiety and depression.

On the positive side, you will know within a week whether or not Zyprexa does anything for you and if it's tolerable. That's kind of a refreshing change from antidepressants, which can take weeks. If it's not helping within 5-7 days, I would stop. If it is, then consider it at least for the time being. You may have found a good "emergency" antidepressant. I generally wouldn't recommend using Zyprexa long-term, but that's just me. On the negative side, if it's not tolerable, you will _hate it_. Just FYI you can always try beginning with half a pill (1.25mg).

There are about a billion other choices to augment, and I'm kind of surprised your doc didn't try something else. Well, actually, I'm not surprised, but I am a little disappointed. Maybe the most common-sense thing would be to try another benzo, maybe at a higher equivalent dose. (Alprazolam [Xanax] can be really helpful in mixed anxiety/ depression.)

P.S. I take Risperdal, another antipsychotic. From time to time. I love it, it works very well. I don't take it long-term though.


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## seattleguy35 (Dec 14, 2005)

Hello to everyone,

First of all, I want to say THANKS for all of your replies!!!!

To answer questions:

1) Zoloft DOES help my anxiety yes but I do still have significant anxiety symptoms even with Zoloft at all dosage. It's still better although compared to my pre-medication times (a year ago). Klonopin does the same thing...

Basically, what it does "take off the edge" of the anxiety but NOT deeply reduce it significantly? Make Sense......

Ultrashy and workman, I agree that it's a huge risk in getting diabetes and a huge weight gain for "similiar" benefits that I currently am taking from Zoloft/Klonopin Combo.... So I think the risks outweigh benefits for me in case of Zyprexa

Taking 100 mg, 125 mg, 150 mg respectively at three different doses on Zoloft doesn't help reduce anxiety at any dosage level. It's just the same level. Same is true for Depression.

Now I have a question, I think I now prefer to have a medication that FDA is approved specifically FOR:

GAD
SAD
Depression

"off-labels" medications, I am aware, are very COMMON, but I prefer to take medications that FDA specifically approve for GAD/SAD/Depression.

Can anyone recommend which medications for these disorders?

Oh, one more thing.... when I pop Klonopin every day (twice a day), I don't feel "addicted" to it.....My body doesn't react any need for Klonopin at all. Does the "addiction" factor come in only when you stop using Klonopin? 

Thanks

SeattleGuy/Michael


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## Caedmon (Dec 14, 2003)

Does the Klonopin seem to cause any depression? If not, I might increase that. It could help. It isn't FDA approved for any of those things, but it's well-documented in independent evidence that clonazepam helps social phobia. 

If that didn't work I'd try swapping it for another benzo. Mess with the dose of the new benzo maybe. Then if none of those works, try to augment. Buspar is usually well-tolerated and could help all three conditions.


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## redkit (Mar 14, 2006)

2.5 mg is the lowest dose. schizophrenics usually need 20mg or higher.
Low doses of antipsychotics can be helpful for anxiety and/or depression problems for non-psychotic people.
give it a try and see whether it is helpful or not.


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## UltraShy (Nov 8, 2003)

seattleguy35 said:


> "off-labels" medications, I am aware, are very COMMON, but I prefer to take medications that FDA specifically approve for GAD/SAD/Depression.


If you want the FDA's stamp of approval for all three conditions then all I'm aware of is Zoloft, Paxil, Lexapro, and Effexor. That gives you 3 SSRIs, one of which you're already on, and an SNRI.

Personally, I would not put to much emphasis on FDA approval for a specific use, since it's largely an economic issue in many cases and often has little to do with efficacy.

Benzos & MAOIs are generally considered to be the most effective SA treatment available, but since the patent has expired on all of the drugs in these classes (other than the new MAIO patch called ENSAM) there is absolutely no economic incentive for any drug maker to do costly clinical trials to prove them effective for SA and submit all that data to the FDA for approval.

Despite a lack of FDA approval, benzos (especially Klonopin which has gotten the most research) and Nardil are widely regarded as the gold standard of SA treatment.

As for depression, MAOIs are generally considered the most effective drug treatment available (ECT -- "shock therapy" -- is the only thing more effective), but you seem to be far from going to those extreme measures that are last resorts.

I have a strong distrust of antipsychotics for use in SA because they're still under patent & very expensive (Zyprexa, depending on the dose, can cost over $500 a month). Clearly, when a drug costs that much there is a very clear economic incentive for its maker to get it approved for every condition possible. Yet, after being on the market for at least 8 years Zyprexa still isn't FDA approved for SA nor any other anxiety disorder. What does this mean? I see only two possibilities:

1) Lilly has been unable to produce any study to substantiate the notion that Zyprexa is effective in anxiety. BTW, no other antipsychotic has FDA approval for anxiety treatment either.

Or

2) Lilly is fiscally insane and doesn't want the largest possible market for their very profitable drug. Keep in mind that SA and GAD are very common problems, so getting FDA approval for those uses would vastly expand their market & profit potential.

#1 strikes me as more likely, since I don't think Lilly is crazy.


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