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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by sheilac on December 19, 2011, at 11:44:12
I've been taking 120mg of Geodon as my mood stabilizer and it has been doing a great job.
Except, now I can't sleep and have terrible insomnia and some depression.
I am wondering if Geodon has lowered my serotonin too much?
Is this possible? If so, what is the solution? If 120mg keeps me stable do I add in an SSRI low dose like Prozac or do I try to lower the Geodon and risk mood issues?
I like being stable for once, but don't like being depressed and sleep deprived.
Posted by herpills on December 19, 2011, at 11:58:48
In reply to Geodon lowered Serotonin?, posted by sheilac on December 19, 2011, at 11:44:12
Have you tried Geodon at a dose higher than 120mg? The prescribing information says you can go up to 160mg.
Posted by sheilac on December 19, 2011, at 12:21:44
In reply to Re: Geodon lowered Serotonin? » sheilac, posted by herpills on December 19, 2011, at 11:58:48
I started out at 40mg and have slowly worked my way up to 120mg over about a year's time. The lower doses make me manic.
I'm afraid if I raise the dose again in a few months I will have no where to go.
I'm just thinking that maybe the Geodon has lowered my serotonin way too much.
Posted by Phillipa on December 19, 2011, at 17:36:49
In reply to Re: Geodon lowered Serotonin?, posted by sheilac on December 19, 2011, at 12:21:44
I didn't know geodon lowered serotonin? Could other neurotransmitters also been lowered? Phillipa
Posted by Christ_empowered on December 19, 2011, at 20:59:20
In reply to Geodon lowered Serotonin?, posted by sheilac on December 19, 2011, at 11:44:12
hey. I'm no expert, but in my experience, any antipsychotic can cause depression. Usually its more of a lethargic, sleepy depression ("neuroleptic induced deficit syndrome" is one term I've read used to describe it), but since Geodon is kind of activating over the long haul, it might be some kind of drug-induced activation. Honestly, I don't know. You also have to deal with the fact that human beings miss nights of sleep and go through depressions on or off meds, so there's often no way to point at a medication and say "yup, that's what's doing it," because, hey, who knows?
I wouldn't add an SSRI. To me, that's asking for trouble. You're already on a good dose of Klonopin. You could switch out the Geodon for seroquel or seroquel xr (the xr is really only worth it if you have a problem with 2x daily dosing). You could raise the Geodon dose at night. You could try a night time dose of a more sedating benzo, such as restoril or valium, either on top of your ongoing Klonopin, or reduce the Klonopin a bit (say, to 2-2.5mgs/day) and then add in the sedative. The second approach would reduce your total sedative intake, which is a good goal.
I don't know what else to do, since I'm not a doctor. Are you restless? When I was on a benzo and tried zyprexa, I had low-grade akathisia that caused some of the problems you described. The benzo suppressed it for a while, until it broke through once the zyprexa dose was slightly increased. Maybe its some kind of low-grade akathisia? Again: not a doc, just throwing stuff out there as it comes out of my brain.
Good luck.
Posted by creepy on December 19, 2011, at 23:47:27
In reply to Geodon lowered Serotonin?, posted by sheilac on December 19, 2011, at 11:44:12
All the AAPs are serotonin receptor antagonists I think. They dont reduce serotonin so much as block certain receptors involved in depression and anxiety.
If youre bipolar adding an AD could make you unstable. What about a stabilizer like lamictal?
It tends to have some AD effects and if youre already on something with stabilizing effects the titration might be easier.
Posted by sheilac on December 20, 2011, at 7:54:50
In reply to Re: Geodon lowered Serotonin?, posted by creepy on December 19, 2011, at 23:47:27
I got the awful rash and terrible side effects from Lamictal, so I can't take that.
I just feel so flat, but stable. The constant depression combined with the insomnia is awful.
I'm hesitant to lower my Geodon because it has kept me stable. But I do feel like I have no personality.
I just thought maybe the Geodon was somehow inhibiting my serotonin because I feel so depressed. At lower levels of Geodon I feel manic.
Posted by BobS. on December 20, 2011, at 15:39:24
In reply to Re: Geodon lowered Serotonin?, posted by sheilac on December 20, 2011, at 7:54:50
Try Lyrica (pregabalin). It has worked wonders for me.
Regards
Posted by Zyprexa on December 20, 2011, at 23:12:56
In reply to Geodon lowered Serotonin?, posted by sheilac on December 19, 2011, at 11:44:12
I found geodon to be quite mild. I took 4x 60mg for 2 years. And didn't find it to do much. So I would not worry about going too high on the dose. But at the same time I might suggest trying something more effective. At one point I was on a dose of 5x 60mg. I didn't find geodon to do much in the way of helping sleep. So maybe zyprexa or perphenazine? That what I take now. Also an SSRI might help the whole thing. Maybe some thing sedating.
Posted by Phidippus on December 21, 2011, at 16:24:38
In reply to Geodon lowered Serotonin?, posted by sheilac on December 19, 2011, at 11:44:12
>I am wondering if Geodon has lowered my serotonin >too much?
Not likely. Geodon is an SNRI and also a 5ht1a partial agonist. Plenty of seratonin to be had with Geodon.
I just don't think Geodon is the right medication for you. BTW, what are you using for a mood stabilizer?
Eric
Posted by sheilac on December 22, 2011, at 9:13:44
In reply to not likely » sheilac, posted by Phidippus on December 21, 2011, at 16:24:38
Actually, I am using the 120mg of Geodon as my mood stabilizer. I can't take Lamictal - rash.
I started losing my hair with Lithium.
So, since Geodon has low weight gain (none for me), doc suggested it as my mood stabilizer.
I am BPII. I wonder why the past few months it has stopped making me sleepy at night?
Posted by Phidippus on December 24, 2011, at 19:36:37
In reply to Eric - Re: not likely, posted by sheilac on December 22, 2011, at 9:13:44
My best guess is is Geodon is not providing the mood stabilization you need. The insomnia may be a part of an unstable mood. Atypical Antipsychotics do not make the best mood stabilizers. Why don't you keep trying different mood stabilizers: trileptal, Zonegran, Depakote, Tegretol are all ones wortha try.
Eric
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