Switch vs Add

I'm on 10mg of Zyprexa currently. It has cleared up my psychosis beautifully, and my anxiety and agitation are way down. The anxiety is still there, but not as bad. The agitation problems are almost non-existent.

My remaining problems are that my energy is dipping very low, and I mostly just want to sleep. I feel emotionally raw more often than not, but instead of agitation, it's sorrow and a weird sense of doom, more depressive than anxious. My personal hygiene has started slipping again, I just have very little drive to do much of anything and feel rather powerless. The remaining anxiety I do have is mostly in my chest, like a blunted adrenaline response. It's almost like I'm having mini panic attacks, but the effect is blunted and vague. It comes across as difficulty moving and breathing sometimes (but not in a medical way, I recognize the flavor of a panic attack).

So at my next pdoc appointment in a few days, I guess I can either add something to the Zyprexa, or I can try switching to Abilify since it's a perkier atypical. My pdoc is a pretty good one. She's a good listener, is respectful and lets me have a decent amount of sway in what I'm going to try. So I will probably get to choose whether to add something to Zyprexa, or switch to Abilify, if I come in there with a preference.

Does anyone have experience with a situation like my current one, and whether to switch or add, based on your experience(s)?

i just stopped taking zyprexa due to what i suspect was an increase in prolactin levels...
i was taking 20 mg though

some people report wellbutrin increasing their energy
but it can increase anxiety as a side effect (i have pretty severe anxiety but when i took wellbutrin it didnt increase my anxiety)

i haven't tried abilify but i heard that it is more stimulating and can increase anxiety at lower dosages (which oddly seems to improve at higher dose)

im wanting to stop taking the seroquel as well due to it causing me to be zapped all the time, so i wouldnt recommend seroquel!

since you have a good relationship with your doctor; what i would do is tell her what you told us here and see if she can make a recommendation for you

I did a switch and it's okay so far. But my ap is depakote and I dropped Welly for seroquel.

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I have experienced this very thing but with different medications. My pdoc doesn't give me much say in my medications unless I am adamantly of another opinion.

In my case, my pdoc added a stimulant, Vyvnase, to combat the lethargy. To be honest, it hasn't worked wonders. My pdoc has stated he WILL help me overcome this even if he has too additionally add Adderol for a period of time. He says I hyper metabolize medications and that is why it doesn't work as well as it should. I am becoming frustrated with him and his medication choices, however, and am considering changing pdocs. Best of luck to you; I hope you are feeling back to yourself in which ever decision you make.

Also, on Abilify, I had a much more broad and generally personable affect. It wasn't until the addition of Lithium (and no telling which other of the 4 meds added to my cocktail) that my affect became flat. Hope that helps.

Thanks for the feedback.

I find myself leaning towards Abilify, but then I also feel extremely lucky to have no serious side effects on Zyprexa, no rapid weight gain, no twitching, no sexual dysfunction, etc. It makes me hesitant to ditch it. I could wind up have serious side effects on Abilify, but can't know until I try. It feels like a big roll of the dice.

Then there is the element that Zyprexa works really well at reducing my agitation, but in addition to eliminating psychosis, that is about all it does really well. Abilify can probably bring more to the table in terms of depression symptoms, but one of its most commonly reported side effects is increased agitation. So it might wind up being like swapping out depression for severe agitation again.

So I am pretty torn on it. If I stick with Zyprexa, I know that I have agitation and psychosis covered, and could add something for depression and anxiety. But the idea of monotherapy is extremely appealing, less money and less medication, plus no issues as far medxmed interactions. Just not sure if I will be screwing up a good thing by switching.

I don't know about abilify, it can be very activating. I had terrible akathisia on it. I would see about maybe adding wellbutrin, I've never been on it but have heard good things about it increasing motivation

Welly will perk you up but it deadens me emotionally

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Abilify really made me agitated and restless. When I was on it I literally could not sit still. It was a very uncomfortable experience, but that was just my personal experience.

If you can get away with just switching to a different AP I'd do that. I'd rather switch than add.

In fact, at my next appointment I'm going to ask my pdoc about weaning off lamictal and just being on geodon. I want to be on just one med.

And this shyt is expensive!

If Z is making you a bit to flat you can always decrease your dose a bit or go every other day. Half life being what it is.

Lamictal is often a good counter balance if AAP's or AP's are bringing you down a bit to low and its effecting your ability to go about the basics of daily life. It works basically just on the depressive side of Bipolar. Sure there is the "omg dreaded chance of SJS But its less than 4% chance, and caught early people have no major problems)

Abilify it seems causes more Akathesia than some of the other AP'S and AAP's (or at least I read alot of problems about it here) Akathesia seems to always hit at night on a weekend and there is no option but the ER and that typically isnt very helpful, As most ER doctors think Psych patients are making a mountain out of a mole hill at 3 am literally trying to climb up the wall and dangle there shaking like a bad horror story. Best to get a co scrip for Cogentin in case.

I'm not really understandig why your Pdoc isn't thinking " Mood stabilizer" as thats "usually" what is needed for Bipolar Managment in the long run. But most people present a total mess in the office and the first thought is slap them hard with a AP or AAP to get them out of immediate danger then tweek things down the road. but that can often lead to having med after med layered on each other.

Hope you find a good solution

Thanks, she said that she didn't think I seemed bad enough to need a mood stabilizer, but then pushed for an atypical anti-psychotic. I think it may have been because I was too scared to talk about the suicidal/homicidal ideation issues I was having, and mostly just talked about the sleep deprivation, mild psychosis (pretty sure it was sleep deprivation causing it because I was aware I was hallucinating) and agitation problems. She agreed that based on my history that my previous diagnosis of BP sounded right, but she wanted to go with mood disorder nos and just use Abilify. I rejected the Abilify and asked for Zyprexa because at the time I was terrified of Abilify.

I was on 20mg z for a couple weeks now but I was too sedated so my pdoc said just to take 10mg.

I can decrease dose of z and see how it goes. I'd do that before adding something. I can't give council on abilify as I'm allergic to it.

Good luck!!

I'm finding a lot of good reviews for Lamictal in terms of both anxiety and depression. If my pdoc approves of adding it, I think I'm going to try taking Lamictal daily and Zyprexa as-needed. I'm actually kind of shocked there are so many positive reviews for it. Most people don't review drugs unless something bad happened.

hellooooo....
i find wellbutrin to perk myself up quite a bit, but not into mania-region, thankfully.
I took zyprexa and it was amazing for my mood, got me out of a big depression, but i gained so much weight. had to sacrifice that for my self esteem...it took many months but i eventually got on abilify and wellbutrin, among other meds. wellbutrin increased positive affect, but abilify eventually caused so much restlessness and agitation.
just my two cents, good luck, we all know how hard it can be to find the right mixture.

Yup Welly made me agitated which happens if you get treated for depression when you are actually BP

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