Posted by Ant-Rock on November 15, 2000, at 11:57:00
In reply to Re: ZYPREXA OR AMISULPIRIDE? » Ant-Rock, posted by SLS on November 14, 2000, at 22:12:13
> Hi Anthony.
>
> I have been taking Zyprexa (olanzapine) for only 9 days. It was added to a regimen of Parnate 80mg + desipramine 300mg + Lamictal 300mg. I just raised my dosage of Zyprexa from 2.5mg to 5.0mg. My doctor says that some people respond just fine at 2.5mg. I could "feel" after a week that 2.5mg was just a bit shy of what I think I need. The doctor gave me the latitude to make this dosage increase.
>
> It has been helping. Although slightly perceptible at this point, I would say that it is helping with anhedonia. One of my biggest complaints about Parnate is that it doesn't seem to reduce the anhedonia, and actually produces some weird sort of apathy and a reduction of certain motivations. Zyprexa is definitely doing good things that are being missed by the Parnate.
>
> ECT?
>
> GO FOR THE ZYPREXA !!!!
>
> I am not sure to what degree low-dose Zyprexa is analogous to low-dose sulpiride or amisulpride. There may be some overlap. The major difference between Zyprexa and the latter two drugs is that the latter are considered "preferential" for presynaptic autoreceptors - the blockade of which leads to increased dopaminergic tone. As I remember, dopaminergic presynaptic autoreceptors are inherently of higher affinity for DA and other receptor ligands (anything that attaches directly to the receptor). If this is true, I would guess that Zyprexa can produce a similar effect, possibly more effectively at lower dosages. Zyprexa has a relatively low affinity for DA receptors. My silly imagination can see how such a drug would effectively occupy presynaptic receptors before blocking enough postsynaptic receptors to exert an antipsychotic effect.
>
> Zyprexa is a pretty cool drug that I believe exerts true antidepressant effects, particularly when used as an adjunct to SSRIs and MAO-inhibitors. Zyprexa potently blocks 5-HT2a receptors - the SAME receptors that are blocked by Serzone (nefazodone), Desyrel (trazodone), and Remeron (mirtazapine). This mechanism is thought to be of great importance in producing an antidepressant effect, and possibly adds to the ability of Zyprexa to treat the negative symptoms of schizophrenia. I have yet to gain an impression of the efficacy of Zyprexa as an adjunct to the tricyclics, Wellbutrin, Serzone, or Remeron.
>
> As far as Mirapex (pramipexole) is concerned, on a simplistic level, it does the opposite of Zyprexa at the receptor level (although not necessarily at the clinical level). Mirapex stimulates, while Zyprexa and other neuroleptic antipsychotics block, dopamine D2 receptors. However, Mirapex also stimulates D3 receptors - the same receptors that are blocked by amisulpride and amisulpride. Don't be bashful about trying Mirapex before going on to ECT. It is perfectly safe and may possibly help more people with treatment-resistant depression than Parlodel (bromocryptine), an often used D2 agonist. Parlodel augmentation of Parnate is a recognized alternative. I felt better during the first 3 or 5 days after adding it to Parnate. It can work. If you decide to try Mirapex, please post how you do with it. I have it on my list of things-to-do.
>
> I hope you find some of this helpful.
>
> Good luck on your doctor's visit.
>
>
> Sincerely,
> ScottThank you once again Scott, for all your valuable information/advice. I definitely can relate to the parnate's lack of efficacy in the apathy dept. Actually, every time I've restarted this med it has lost potency, and now I feel no difference regarding depression whether I am on a high or low dose. It basically makes me get up in the AM, which is why I always go back to it.
Anyway, my p-doc has been suggesting ECT to me for years, but I made the decision to try every option available before even considering it. So on goes the battle...
Sincerely,
Anthony
poster:Ant-Rock
thread:48787
URL: http://www.dr-bob.org/babble/20001115/msgs/48851.html