My son had this first episode of psychosis a few weeks ago, was hospitalized for 9 days and has been discharged from the hospital now for 17 days.
His prescriptions were olanzipine 20 mg at bedtime, trazadone 50 mg at bedtime (the bottle says as needed but the doctor just said to take it at bedtime for sleep), and hydroxizine 25 mg as needed for anxiety 4 times a day.
My son has been very sleepy. He wasn’t sleeping for days prior to the hospitalization and has been taking his meds as prescribed and was sleeping for about 9 hours or so from what I can tell at night, getting up and eating breakfast but the tired again very quickly. He just seems sleepy and often needs a nap in the afternoon.
So, 2 weeks after discharge was his first follow up with a new provider (never had one before all this), a psychiatric ARNP. He wants to go back to work very badly because he is bored. So the provider said to stop the trazadone and was going to prescribe 15 mg of olanzapine instead of 20 mg.
The two nights after this he had trouble going to sleep, second night was worse. So he was too tired to get up on time to get to work.
From what I read the daytime sleepiness is more likely from the olanzapine than the trazadone. Am I wrong? I was so worried about him not sleeping and losing progress that he took 1/2 of the original dose of the trazadone tonight in hopes of getting to sleep easily and staying asleep until morning.
I feel like this provider maybe doesn’t know what he is doing. I was expecting him to give any medication change at least a week to see if my son could return to work. He also told him his admittedly delusional thoughts were “all in your head”. Noone else we have met so far, from our local First Episode program, has ever talked to him that way.
Sorry for the convoluted post. I’m just unsure whether this provider is any good or not and what to do about the trazadone.
Well, olanzepine is known for drowziness. Trazodone also makes a person go to sleep. Coupled with the other anxiety med he is taking, of course he is going to sleep a lot. I have taken Olanzepine and trazodone in the past and they both made me sleep a lot.
Tell your son to take some time off. If this is his first psychotic episode couple weeks ago, he needs to rest and recover more than anything else. I would say the drastic change with the lowering of Olanzepine and removal of Trazodone has made him not sleep. Give it a few more weeks and maybe he will sleep alright with the Olanzepine alone. I used to sleep 12 hours on it by itself.
Your son needs to rest for at least a few months before heading back to work. If money isn’t an issue, there is no rush to head back to work. I am assuming he is on disability leave? If so, even more reason to take his time. If he is bored, tell him to spend his time reading and learning new things, especially related to schizophrenia. Always make sure he takes his medications as prescribed. Good luck.
During the discharge meeting the psychiatrist told him he’d suggest taking at least a month off. But then said he’d write him a note for two weeks and then re-evaluate. I was only on the phone for this so I don’t know what make him back off immediately on the “at least a month”. Maybe my son gave him a look?
I was really hoping the follow up provider would have him take more time but no such luck.
So my son was scheduled to go back yesterday but was too tired to get up and said he wanted to go back on a different day.
Last night he took half the trazadone dose and had no trouble going to sleep or getting up this morning. So I took him to work for a partial shift (6 hours instead of his typical 10 hours).
I wish he’d stay home and rest longer but he really doesn’t want to.
ETA, he rarely takes the hydroxyzine.
All of that makes you really drowsy. I agree he should take time off work. You can’t imagine how hard it is to take major tranquilizers and try to function. It takes getting used to. Encourage the time off. He needs it.
Hi @kitmom, my son is being weaned off quetiapine and started with zydis 5 mg titrated to 10 mg few days ago. He’s on Risperidone, lithium and depakote too. He falls asleep quickly after taking the zydis wafer but wakes up in the night because hunger kicks in. He gets over 10 hours sleep. He’s been experiencing palpitations and his right knee is swollen up. We are not sure if these are side effects of zydis or if they are withdrawal symptoms of quetiapine. We are keeping a close eye on his weight. With these meds, it’s trial and error. And it doesn’t help that they are on multiple meds. Hope you son stabilizes enough to get back to work. Good luck!
@Zannah I am encouraging him to take more time or at the very least let us know if he doesn’t feel up to going. He said he doesn’t have sick time left and doesn’t want to waste the last of his hours to stay home tomorrow and that he will get fired if he doesn’t go. I assured him that that won’t happen and we can get paperwork from the doctor so he can take more time off. I made it clear that he doesn’t have to feel like he has to go. But then he says he wants to. Ugh. I will ask for a note that allows for flexibility, depending on how he feels.
That’s tough. Some jobs require a lot of focus, like operating machinery. I hope, since he’s going to work, that everything turns out ok. I’m not sure how to convince him to take time off.
As I expected, he was too tired this morning to get up and go to work. And he does operate machinery, so it wouldn’t be safe for him to go and do this under the circumstances.
I’m so glad he didn’t go then.
Hi, I’m both a family member to a recently symptomatic brother and a veteran of the disease myself. I tried different antipsychotics for a couple of years before landing on olanzapine, but I had side effects so we kept lowering the dose. 7.5mg is where we stopped, and I take it as early as possible for a night med, around 9PM. I find that I can still get up and not be too cloudy on this dosage, and it still treats my symptoms pretty effectively.
20mg caused me a lot of grief. 10mg also wasn’t great, 5mg wasn’t enough, and I was ready to give up before my doctor suggested 7.5mg.
Best of luck. Also with Zyprexa being sedative on its own, I am surprised the doctor thinks he needs another medicine for sleep. Keep in mind I’m not a medical professional myself.
@agent101g I think he needed it in the hospital for sure. He was so sleep deprived and maybe manic? Even after discharge he seemed high energy despite tiring very quickly if that makes sense. Like wanting to go places constantly but then not having enough energy to enjoy the things he wanted to do. And the sleepiness seemed to get worse as time went on. So he was definitely not “getting used to it”. The pharmacist yesterday said it’s building up in the body and that is why the sleepiness gets more pronounced. Since last night he’s on 15 mg.
When he stopped the trazadone at the direction of the provider, he couldn’t get to sleep. So we eventually started it again, but at half the dose.
@kitmom My son has been taking Zyprexia at various dosages for about 3 years now. As @agent101g mentioned some dosages are too much and some too little. Currently my son takes 10 mg in the am & 10 in the pm around 9:00 pm. The Zyprexia definitely helps him sleep. And also has trouble waking up before 8:00 or 9:00 am. He also takes Depakote as he has OCD in addition to SZ. He had a major episode in late August & was hospitalized for 2 weeks. He wants to get back to work also, but both his prescriber and Therapist say he needs to take a couple of months off to rest and heal his brain. He is thinking of going back part time towards the end of October or November. He has been doing a lot of tasks around the house, reading, and taking care of our pets. He also visits with a couple of neighbors whom he gets coffee with. This helps keep him busy and both slows the rumination & turn down the volume of voices. We think he actually may need either a small increase in dosage (maybe at night). He says he still gets self harming commands but can reason himself out of it or talk to a family member about it.
It does take awhile to adjust to the med. Good luck!!
@PNWMom Taking a couple of months off makes so much more sense to me than what my son’s provider’s seem to feel is reasonable.
He has been taking the 15 mg (down from 20) for the past two nights now. He was generally asleep quickly after his meds at night. Now it has been an hour and he is still awake.
How long does it usually take for people to realize that their delusions or hallucinations are not things that really happened?
15 hours, 2 days, 3 weeks, 4 months, 5 years or never. There’s no “usually”. The point of AP medication is to get people to think more clearly, be less anxious and help with hallucinations going forward, not to FIX or erase the past. When you begin to think more clearly, you may begin to question some things you believed, and some not.
From experience, they’ll be some things that will always seem were real and thus the experience was “real”. When you begin to question things, it’s not an on/off switch— it’s a continuum. You don’t wake up one morning with every aspect of long held beliefs evaporated all at once. Think of it a bit like religious conversion: there are vestiges of pagan rituals throughout Judeo-Christian and secular society that have endured for centuries. Missionaries gave up on this battle long ago. Focus on moving forward, and don’t expect a miracle in a bottle—it’s long hard work.
@Maggotbrane Right. I didn’t think they would be erased, rather that at some point the person realizes. Your answer makes total sense to me. And I have been reading a lot. I found a great thread with very thoughtful (as always) and comprehensive posts from you and I have bookmarked them to refer back to.
My son seems less stressed and definitely much more clear thinking that he was a few weeks ago. Then yesterday I found out that he still feels that part of his delusions, a group of young women he was going to meet for a hookup at the mall were disguised as kids/teenage girls, makes total sense. He was wondering that they didn’t say anything to him, so he left. When I said maybe they relly were just teenage girls, just like it seemed, he said “maybe”.
I really try to put myself in his shoes so that I don’t accidentally do or say anything that erodes his trust. It’s hard, but it is getting better.
When an episode or crisis occurs ones meds are definitely on a higher dose and different to ones maintenance does. Remember a crisis period can last for months six months or more or a few months at least. My mother has been put on olanzapine after a lifetime of old school drugs with awful side effects. Olanzapine has had the least side effects of all of them 
, very little sedative effect, infact the opposite. She has more energy than before. She at the moment is on 7.5mg with another mood stabilizer. It has helped with the lethargy that she used to suffer from. It has made her hungry during the day I suspect, so one has to watch ones weight. She was diagnosed with ps at 25 years and she is now 82. So in crisis the doses are expected to be higher, and keep reviewing his doses and meds. Olanzapine 7,5mg has been a wonder in my mother’s case. The other thing I have noted in my mother’s case that she has always needed medication, since the age of 25 years. If she stopped taking them she went into crisis each time. It’s about finding the right dosage for the time of ones condition.
Welcome @art_fan31. Shouldn’t a person never have another episode if they are on the right maintenance dose?
I suppose that since some percent of people do recover from Sz everyone wants to see if they don’t need the meds or how low you can go with them.
Every time in my son’s case when he felt better and the drugs were tapered too fast and down too low he’s relapsed. Now he’s on a very high dose. They’ll be some tapering, but I’m pretty sure it will be slow this time and the maintenance dose will be higher than before.
@caregiver1 What has been too fast and too low for your son?
I guess I also am not sure what constitutes an “episode”. Is the episode over when the person realizes their delusions and hallucinations were just that? We are very new to this and it confuses me even though I feel like I generally understand, at least the psychosis part of it.
Not necessarily. Administration and compliance aren’t perfect by a long shot. Moreover symptoms are often brought on by stressors which can escalate and subside with environmental and social factors, and the disease is thought to be degenerative in some ways as it’s documented that brain mass in sufferers decreases over time, although there’s some question over the cause. This said, a not insignificant percentage of sufferers “spontaneously remit” even without medication.
Regular monitoring and medication and dosage adjustments improve your chances, but ultimately there’s a life-long chance of additional episodes, even in stable patients. Over about 35 years of recovery, I’ve been on four medications at about two or three dosages per medication. I’ve avoided a second hospitalization so far, but that’s likely because I’ve developed a repertoire of coping mechanisms and a network of social contacts through additional therapies. Still, I view an episode of recurrence a possibility which may take the form of dementia.
@kitmom, too fast was:
olanzapine quetiapine
9/20 10 300
10/20 7.5 200
11/20 2.5 ?
12/20 0 300
3/21 hospitalized
Not sure whose idea this was. He works collaboratively with his psychiatrist, so it they both might have done it, or he may have been non-compliant between 12/20 - 3/21.
Probably the olanzapine tapering was because of metabolic effects, for which olanzapine is one of the worst offenders.
A psychotic episode is having delusions, possibly accompanied by hallucinations, which from what I’ve seen are usually auditory. My son has described visual hallucinations but hasn’t talked or acted about them when they are happening.