My 27 year old son diagnosed with sza has tried risperidone, Rexulti, paliperidone, Seroquel,lithium and epival over the last few years. He has been hospitalized once. Nothing seems to be that effective. His positive symptoms are relentless! He recently developed severe palpitations and the pdoc wants to switch from Seroquel to Olanzapine/zyprexa. I guess my question is has anyone tried zyprexa on their loved ones? For positive symptoms. Any input will be great! Thank you all for your support. This is a cruel isolating condition!
In my experience with my son, olanzapine was very effective. Better than Seroquel. It’s main drawback is that it seems to cause more metabolic problems than almost everything else in head-to-head comparisons. By metabolic, I mean weight gain and in the case of my son caused his triglycerides to be 300% more than the upper limit on a blood test.
See Head-to-head comparisons of metabolic side effects of second generation antipsychotics in the treatment of schizophrenia: a systematic review and meta-analysis.
Like olanzapine, clozapine is also highly effective with positive symptoms and it too messes with a person’s metabolism.
I just looked at the paper I linked to:
Olanzapine produced more increase in glucose than amisulpride, aripiprazole, quetiapine, risperidone and ziprasidone; no difference was found with clozapine.
Metformin was always prescribed when he was taking olanzapine because it reduces blood sugar. Diabetics take it.
I’ve just read this: Many antipsychotic users not getting needed tests
In 2003, the US Food and Drug Administration began requiring a warning on labels of second-generation antipsychotic medications stating that blood sugar levels should be monitored in people with diabetes, at risk for the disease or with symptoms of high blood sugar.
However, there was some evidence that the prescribing habits of doctors changed after the warnings and recommendations; new prescriptions for Zyprexa, which carries a higher risk of blood sugar and cholesterol disturbances, declined significantly following the FDA warning, according to the investigators, whereas prescriptions for the lower-risk drug Abilify increased.
My son tried Zyprexa for a few days and discontinued due to migraines from it .
My experience with Olanzapine is it’s a very effective antipsychotic for positive symptoms. Its main downside is weight gain and blood sugar elevation. There are also reports of raised progesterone levels which occasionally cause male breasts or hormonal problems in females. If possible, encourage an exercise regimen and a healthy diet, but this can be a struggle as it tends to stimulate hunger as you titrate up your doses. The craving tends to level off over time, however. I no longer take it, as there are better options for me, but aside from the weight gain, I didn’t hate being on it.
Thanks @Maggotbrane! It has been a struggle finding the right AP for my son for the last 6 years. He started with Risperidone which didn’t do much at all for the positive symptoms. Infact my gut feeling was that he was getting worse! The pdoc thought I was imagining it😟. Finally he switched him to Rexulti and oh boy! That was what activated my son so much that he was on a spending spree, drinking alcohol and pretty much manic! He became loud, bullying and aggressive! I contacted the pdoc and he upped the dose!! My boy lost it, got arrested! We spent thousands of $ on lawyer fees etc. Fast forward few years and here we are. Still taking Risperidone with Seroquel, lithium and epival added. The nasty side effects being increased prolactin, palpitations, relentless positive symptoms etc. He is a brilliant gifted boy and a shell of his old self! There has got to be a remedy out there!
You mentioned that you switched to another AP. Would you mind sharing more info about what meds you are on and how did you switch from zyprexa to the current AP?
I find your posts insightful and they give me hope. Thanks for being on this forum🙏🏼
Thanks for the info @caregiver1! I have been reading about the nasty side effects of olanzapine with the weight gain and elevated triglycerides. Is that the reason you switched APs? And what did you switch to? Sorry about all these questions! We are hoping something will work for my son enough to have some semblance of normalcy.
I’m sorry to hear that @Linda! Hope your son is doing much better now. What AP is he on now? Take care and thanks for your input!
@Terra He’s on 400 mg of quetiapine. It doesn’t do anything for voices, but so far no delusions, at least what he’s willing to talk about.
Your son might be able to try olanzapine for temporary relief of distressing symptoms, say 6 months at most. I’m pretty sure it can’t be a forever solution because of blood sugar, lipids and weight gain problems. Might be worth getting his psychiatrist’s take on it. Ask the person how long they envision your son being on it in light of it’s known side effects and FDA warning.
Olanzepine was very effective for me in terms of positive symptoms, it did cause a lot of sleepiness and I was sleeping 12 hours some days. Your son needs to manage his diet a lot better on Olanzepine. It is possible to maintain and even lose weight on Olanzepine. When I first took it I gained weight to 195 from 175 then subsequently lost weight back down to 170. The key is to eat lots of vegetables. If your son only eats vegetables, I guarantee he is going to lose weight.
Thanks @Lirik ! Will keep that in mind. Best wishes to you!
Thanks @caregiver1 ! My son is on quetiapine and Risperidone right now. With the gradual onset of severe palpitations the pdoc is deciding on olanzapine. Not much choice out there! Hope the smallest dose will work without piling on the pounds.Quetiapine caused anger and aggression in my son which the pdoc shrugged off.Take care!
Clonzapine in the uk they insist and use the mental health act to put a patient on. After 8 months stay in hospital, and a range of drugs, which they dont like to use. Clonzapine last resort. I struggled to see why use this it no life the tiredness, but it improved my sons life, but a consistent dosage 100mg morning and 200mg eve and that 5mg of ariprozole and the heart tablet and the vitamin d and the magnesium and the zinc as a transporter and the nuerobanacr and the nurofen to all help with inflammation. New one reading omega oils to get through that blood brain barrier…green rea diet. Etc etc a life time of care social interaction. Hope this helps…fluids , no alcohol.caffeine watch
He is taking only 5mg of Abilify and will discontinue it at some point . I bribe him to take it and he doesnt believe he needs it .
I’m often reluctant to share my medication history and dosing because everyone responds differently to medications, and I’m uncomfortable endorsing or discouraging specific medications as a result. As always, consult a psychiatrist before requesting changes to medications.
I’m presently on Abilify (Aripiprazole) largely because of a preference for it by my present Psychiatrist for patients with a mood disorder component. My diagnosis is SZA. I typically have a couple weeks of overlap where I taper the previous medication while titrating up on the new one during transitions. I tend to get a little dizzy and somewhat anxious at transitions with atypicals and this helps minimize dizziness and orthostatic hypotension. Abilify has a very long half-live of two weeks or so, so if I change medications again, I might not bother with overlap.
As you may know, Abilify is also activating. I believe it was one of the first APs to have an activating component, but I’m not sure your son’s reaction to Rexulti necessarily means Abilfy or its cousin Vraylar would be bad fits. I didn’t see any “typical” antipsychotics in your list. I understand Haldol has made a bit of a comeback in recent years, as it is one of the most potent medications for positive symptoms.
Negative symptoms are often very stubborn, and outside of anecdotal reports of people braving the long trail to Clozapine, I’m skeptical that you’ll find quick solutions to negative symptoms in a bottle. My take on negative symptoms is they tend to fade more to adaptations and socializations that come more from CBT and psychosocial experience and training, and reports of atypicals helping with these symptoms have more to do with their effectiveness with positive symptoms and cognition creating space for learning coping skills to adapt for the deficits of negative symptoms.
Thanks @Maggotbrane for your detailed reply. I understand your reluctance to share details of your medications. It’s just that I have been following your posts and so impressed with your knowledge and the way you are overcoming your challenges. When I find myself losing hope about my son’s condition I always think of you. You give me hope! My son’s initial diagnosis was schizophrenia but then it changed to sza couple of years ago. So lithium and epival were added to his cocktail of drugs. Seroquel was one of them and he’s not doing well on it.
I was told that Rexulti was similar to Abilify in activating certain people. My boy turned manic on Rexulti! I therefore fear any medication that’s activating.
I agree with you that negative symptoms can be helped with talk therapies and social support. We first need a handle on his relentless positive symptoms. I am going to check with his pdoc about haldol. We never considered typicals for my boy because of the nasty stuff we’ve heard about them.
Thanks @Maggotbrane for being on this forum! Your input gave me a lot to think about. Take care
My 40 year old daughter has had significant reduction in positive symptoms at various times on
also on Latuda (lurasidone)
Her Psychiatrist prescribed metformin and it’s helped stabilize her weight. Other than weight gain, she’s not had any difficult symptoms
Thanks @MosieAnne for sharing that information! I’m so happy your daughter is doing well. Take care!
So Abilify worked better for your son @Linda ! I hope he continues taking it.
Understandable, tardive dyskinesia was always a worry when I was on typicals, although remember that in the 90’s there was definitely a profit motive to create atypicals since patents for typical AP medications had expired. There were ways to manage or counteract symptoms with close monitoring.
Early atypicals had their own problems with metabolic and lipid issues etc, and I think most would agree promises of their help with negative symptoms were oversold.
On balance I’ve probably been on typicals about as long as atypicals, since I’ve been at this over 30 years. The main difference for me was side effects for typicals tend to be straightforward and predictable, whereas atypicals are more subtle and at times a bit odder. You feel obviously medicated on typicals, not so with atypicals and that has pluses and minuses as far as compliance and medication anxiety goes.
My understanding is Haldol is often delivered in injection format nowadays which wasn’t widespread when atypicals came on the market, and the two classes of APs were in competition at the time. This allows better control of compliance and possible forgetful missed or double doses. This in turn reduces risk of TD. Coming up with a new delivery method allowed the drug companies to extend their patents on older drugs and thus improve profits. The atypicals largely won that marketing war when they started releasing injectable versions too.
You may find your son’s psychiatrist is reluctant to try Haldol for similar reasons that my most recent psychiatrist decided to switch me to Abilify—personal preference and thus more experience with prescribing certain medications to treat symptoms. It may be time to change psychiatrists if you are frustrated in your search for a medication that works for your son, just to get a fresh look and new approaches to his problems.
What I have learned is different people react differently on any of the anti-psychotic medications. It’s hard to determine how each individual will do on any of these medications. You are so right to label this condition as cruel and isolating because that is just what it is, and more. My son experienced Tardive Dyskinesia and will not take medications of any kind after that experience. Keep Benadryl on hand just in case. Good luck