Posted by bleauberry on November 1, 2009, at 5:51:51
In reply to How long do the effects of Zyprexa last., posted by theconfusedone on November 1, 2009, at 4:39:05
Since anxiety is the primary issue at hand, my feeling is that no antipsychotics should be used until safer conventional treatments have been tried, such as xanax or klonopin. All medications have longterm risks, but with the antipsychotics the stakes are raised quite a bit.
But I've already gotten ahead of myself. The first thing is this. I do not believe a strategy makes any logical sense whatsoever when it takes a medication that is not working...as in lexapro in this case...and adding something else to it. Why not just ditch the loser? Easier said than done, I realize, been there done that many times, but still, the logic is glaring.
Since lexapro isn't doing the trick, it might be considered to switch straight across to something else...amitriptyline, zoloft, zoloft+nortriptyline. I can think of others as well, but just have a hunch they may be anxiety-prone as well.
I am not a fan of Cymbalta, but it could be considered. A better choice might be Savella. I mention both of these because the norepinephrine reuptake component has the potential to shut down excess adrenaline activity, through negative feedback loops. I found that to be true with me. These kinds of cases usually, in my mind, indicated a level of adrenal gland insufficiency, which in my mind can be directly caused by longterm SSRI usage (strains the adrenal glands by forcing them to overwork in an effort to match the artificially unbalanced high level of serotonin).
Along that same line of thinking...norepinephrine...the tricyclics offer that as well as strong antihistamine which is usually strongly anti-anxiety. And anti-cholinergic, if overactive choline is a hidden problem. The TCAs cover a lot of bases. Specifically I'm thinking of either amitriptyline monotherapy or ssri+nortriptyline combo therapy.
On the other hand, if you have depression and lexapro is working well for that, but anxiety is the problem, then I would add something else to lexapro specifically for the anxiety. In my mind, an antipsychotic would be a last choice, not a first choice. First choice add on would be xanax for immediate control, klonopin as a second choice if xanax wasn't right, and the third part of the plan would be to add a tricyclic...either amitriptyline or nortriptyline...with the goal of eliminating the xanax/klonopin.
I could be wrong, but I see two primary topics here. First, lexapro probably should not be in the mix. Second, antipsychotics for anxiety should be last-line, not first-line. Just my opinions.
To answer your original question...I was on zyprexa for 8 years. I usually took it about 4pm, excellent anti-anxiety up until bedtime, then good sleep...but then strong anxiety kicking in at waking, smoother during the day, and then a strong wave in afternoon that made me crave my upcoming dose. What I didn't know at the time was that all of this was not actually anything related to zyprexa or how long it lasts, it was a shot adrenal system. Adrenal herbs or norepinephrine meds put a stop to that stuff within days. Zyprexa only served to temporarily cover it up for a few hours, and in actuality probably make it worse in the longterm due to its alpah-2 receptor blocking, common to most antipsychotics, that causes even more adrenaline to be released.
poster:bleauberry
thread:923792
URL: http://www.dr-bob.org/babble/20091029/msgs/923794.html