Atpicals: Every Day vs As Needed

For those of you who benefit from an atypical anti-psychotic, do you think it is better to take a small maintenance amount every day, or a larger (safe) amount as-needed?

Unfortunately Zyprexa is starting to cause weight gain, but it works really well on many of my symptoms. I am contemplating just taking it on rough days, whenever, since it doesn't make me drowsy. Maybe that way I can still get its benefits without too much weight gain.

And of course I will let my pdoc know. I haven't taken it in two days and feel fine. But if symptoms start coming back, I can pop it for a few days and be back on track.

I take my Geodon everyday. I'm too scared not to. I don't even want to feel a hint of an episode coming on. Since my episodes were so terrifying to me, I never want to go through any of that again. Ever. So I take my daily maintenance of Geodon and haven't had any major episodes in 4 1/2 years. Thank God.

I've never tried taking mine as needed, but can relate to your experience with Zyprexa. I put on 50 pounds. I got switched over to Abilify. Fortunately, I've had no ill effects from it.

As was already suggested, check with your pdoc & go from there. It makes sense if you're non-symptomatic. It's sometimes hard, however, to realize you're symptomatic.

Yeah I've made a list of things to check off daily, to try to keep track. My biggest warning signs are lack of self-care.

I have been wondering about that myself although in a slightly different way. I was in a pretty bad mixed episode and Latuda snapped me out it. I stayed on it for nine months till I could not take the side effects anymore. In the beginning it was a god sent, but as I improved I was more critical of the side effects and how they were affecting my day to day life. So I went off it. But I do have that feeling in the back of my head "what if I need it again. Will it lose it efficacy if I use it on an as needed basis? Or can I keep it in the arsenal in times of need." It scares me quite a bit sometimes like I am over vigilant about every little thing

There are weight neutral meds you can try.

The only medications I tolerated in the past and was truly weight neutral was Invega.

I take Zyprexa every day and Seroquel as needed. I tried stopping the Zyprexa and taking it PRN because I gained 40 pounds and it is impossible to lose the weight. I think it's worse because then I'm not used to it and it makes me really groggy the next day.

I've read that with atypicals the goal is to wean you off them after the mood stabilizer has kicked in, but it seems like a lot of people need to stay on them long term.

Zyprexa made me gain a lot of weight too, in a very short period of time.

I've never taken an AP as a prn, so don't know if that works or not.

Yeah unfortunately it's one of the biggest things that I don't like about them.

If I'm on a high dose holy cow yes I can put on some kilos.

My maintenance dose is okay though and doesn't cause too much concern.

I know that a long time ago we tried using an atypical as a boost when symptoms started (there's a word for it that I'm unable to produce right now) and it just didn't work for me. I need to be on my high dose every single day to manage. But I've been quite treatment resistant (I'm on my 67th cocktail right now and that doesn't include all the different dose changes over the years, just the combinations of meds. I'm trying to get to the 68th but I don't think that is going to happen) and the treatment resistance means that I need to have very consistent, reliable treatment.

My biggest concern if trying to go on PRN would be if I missed the early warnings and then progressed to big stuff where I didn't have insight I don't know that I would always trust someone else to tell me I needed to take the AP. I think a really good back-up system would be needed and someone would have to have the right to say "time for meds" and meds would be taken without question. Which would get tricky since the only person I have to do that reliably is my therapist and I don't know that he can say that since he's not an MD and does see me professionally.

One more thing I wanted to add..

Years ago I was in a really nasty mixed episode and most AP's dont play nice with my Anorexia. My Pdoc brought up Haldol , Its old school but well studied and weight neutral ..

I decided to give it a whirl .. it pulled me right out of that nasty mixed , I didn't crash into a depression. I did need to add Cogentin due to some akathesia issues.. After 3-4 weeks I cut back to every other day, and then on to every 3 days.. It worked fine. I no longer had any issues with akathesia issues with the dose being every 3 days. I took it for about 6-7 months I guess.

Alot of people dont consier the half life of meds and more so alot of pdocs dont want to take the time to look into non traditional prescribing. I know I am lucky that I have a Pdoc that is willing to help find workable solutions for people like me.

Zyprexa has a half life of 21-54 hours depending how your body processes it.

I hope you find somethng that will work or you

I guess I just figured that at least I would gain weight evenly, ya know? Like one of my boobs is a C and one is a B, and I thought well hell maybe I will end up with even hooters or something. But no, my waist is just getting bigger while the rest of me stays the same. I actually look kind of pregnant. Kind of freaking me out.

There's no way I would take my Latuda PRN. I don't know that it can be since it takes a while to really get in your system, but I have really bad hallucinations and want to do as much as possible to keep those at bay.

I'm concerned about long term affects of APs. I was on both a mood stabilizer and AP. after a year of stability I quit the AP and am still stable. It was much easier to catch the signs that an episode might be happening when I saw a T. She was a better more impartial judge than I am. But I don't have a T and I do worry I might not notice the signs until it's to late. My Pdoc asked me to keep the AP on hand, but I need yo know when to use it....that's the catch 22. I do feel some relief in being off the AP though.

The mood stabilizer lamictal has a pretty good record for long term use and I feel ok about taking that one.

I'm on zeldox (geodon) daily. Every time I try to get it below 80mg I end up in crisis. So I'm staying on the maintainence dose for now. My pdocs have agreed that one day I can use it prn instead of daily but I am not ready for that yet it is weight neutral but I have gained possibly due to other things.

I have zyprexa prn for the bad blips, I take the wafers so they work quickly and usually save me from a hospital visit. I take it for a few days but even then I will have the mindless munchies for days after. I am really glad it works for me in conjunction with the zeldox. When I had used it as monotherapy years ago it did not work as well.

I only take Zyprexa when I feel manic. I take it PRN.

I am on 60 mg latuda my doc gave me a sample weekly pack of 80 to prn if I feel manic due to tweaking my meds.

This made me laugh.

The same thing happened to me, but with seroquel, and I think I look pregnant too. Haha! I bet people at work are gossiping about whether or not I'm pregnant.

I take 20mg zyprexa daily right now. I just got out of IP and that's the dose Im taking now. Im worried about gaining more weight as I am already overweight. Im ugly. But...I was seriously suicidal and I don't want to go back there. I think the Zyprexa is helping so I take it. In the future I hope to reduce the dos but for now I will take it.

I don't really mind being a little overweight, it's just the bizarre distribution. Like if I was chubby in general, that wouldn't bother me so much. But the weight gain is just around my mid-section. I'm not even concerned with the number on the scale, but my pants size is increasing and I'm starting to look like I'm pregnant. Not cool.

In my opinion, you should take your medication daily. Have you tried Abilify? Or even less likely to cause weight gain, Latuda?

I look pregnant too, and I'm 56 years old! Lol

I used to take Zyprexa PRN and then had a bad mixed episode which resulted in being put on it daily. Seventeen months later, I'm on it for maintenance and doing well. Sometimes it's just what you've got to do.

I look pregnant too and I didn't even notice the weight gain because it happened over back-to-back hospitalizations. I was out of it, living in yoga pants and sweatshirts with no access to a mirror. Alas, my boobs barely grew but my tummy looks like I have a ball tucked under my shirt!!

I wish more pdocs were open to the idea of PRN meds, especially the AAPs. At least until they have all their research done and can say with conviction it wont cause any permanent harm.


As it is, I don't trust the stuff even though I was on it. My moms BFF (who's like an aunt to me) discovered she has considerable brain atrophy after years on AP after AP.


To put the cherry on the cake, her doctors accused her of illicit drug abuse.


But this discovery was at least two years before doctors admitted that atrophy can and does occur in some patients. So she didn't have a leg to stand on when she told them the only drugs she's ever used was their RXD ones.


Poor lady

I want to go off my AP when I'm not symptomatic and only go on it when I'm having an episode. But so far all of my pdocs have wanted me on 1-3 APs at a time all of the time. I gained SO much weight. 116 lbs. I find that unacceptable.