help choosing which side effects to live with

I think risperdal is giving me insomnia. It's a listed side effect and it's gotten worse since they upped the dosage so I'm assuming it's that. It's not even working anymore and my mom says since the voices are back I need to switch. I've been on almost all the atypicals save the new too expensive ones. I'm thinking Seroquel, haldol, or zyprexa
Seroquel makes me sleep/gain weight
Zyprexa makes me gain weight and have high cholesterol
Haldol gives me akathisia, but Cogentin (which I'm already on) helps but doesn't stop it.
They all work as long as I don't **** it up by taking antidepressants or doing drugs, both of which I've stopped. Haldol has the added advantage of coming in shot form.
Which would you choose? Or would you try something you haven't tried before (in my case it would be any of the first gens. or saphris, which I was told likely wouldn't work for me).

Hi spikes. It's impossible for me to know what would be the best and most tolerable for you. Based on your post above, you are offering Seroquel, Zyprexa, and Haldol as choices? I guess, being a fan of my Seroquel XR, and not having tried Haldol (other than a single emergency injection), I'd pick Seroquel, but not the regular kind. I'd pick the extended release. I have taken both the regular and extended release versions of Seroquel over the course of my bipolar treatment. I much prefer the extended release because my weight gain has been less on XR than it had been on the regular. In fact, I would go so far as to say that the XR version was even "weight neutral" for me up to about 500 mg. I was even able to make some progress with slow weight loss (or maintaining) at up to 600 mg. Lately, at 700 mg and 650 mg, I have had an increase in appetite. My Seroquel XR certainly could be a factor, but so could stress and the whole change in routine due to the covid 19 pandemic.

During the early stages of my Seroquel XR treatment, I did have some excess daytime sedation, but for some years now I haven't. I kind of like how the XR works vs. the regular. Very often, the tolerability of extended release forms are better than instant release. I even think the release action of the XR is partially why Seroquel XR is more weight neutral for me, than the instant release.

Seroquel XR is available as a generic, as of maybe two years ago? I have no problem with the generic. I took the name brand for a number of years, also fine. When I took name brand, I used a coupon to save money on my copay. There's still a coupon available from the Seroquel XR website.

I have gained some weight over the years, while on Seroquel XR, but I still regard it as mostly weight neutral. [Note: Not weight "friendly", but "neutral".] After all, a late 40s woman with a family of people who are overweight or even obese won't necessarily be waif thin. Over the past 8 years, I've gained about 20 lbs. That may sound bad, but I am only really 5 lbs more than I was at age 31 before I ever touched a bipolar medication in my life. I have surely been less physically active this past 8 years than I was at age 31. Perhaps if I was as active today as at age 31, I'd be even trimmer now.

I do believe my Seroquel XR contributes to my high cholesterol (especially), and to a lesser degree my high triglycerides. I don't watch my eating that much. Perhaps if I really cut down on the saturated fat, I'd see a positive difference. It is not the case that I am dieting and not seeing positive progress. I'm not dieting and I'm eating high fat high carb. In recent years, when I did eat lower carb, my triglycerides were normal. My glucose level has mostly been normal for the past 10 years, or only very slightly high. My blood pressure has mostly been normal, though it has increased this past year. Because of Seroquel XR? I'm thinking not. It's because of my lifestyle, and perhaps my age.

We're all different, though. Some may say they gained 150 lbs on Seroquel XR, but not me. In fact, other than the issues I mentioned above, I've had ZERO other side effects from Seroquel XR. I've read that (and my psychiatrist said) that in general, Seroquel tends to be less apt to cause EPS than other antipsychotics. It is also less apt to cause issues like hyperprolactenia. Obviously, there are the rare exceptions, but they seem rare.

Zyprexa was a major weight gainer for me AND it gave me akathisia. So I won't recommend that, though it did do a great job leveling my moods.

I like my current medication cocktail.

Hi Spikes!

This is such a common problem for most of us, if not all.

I am sorry you are having to make a new choice, but maybe it will benefit you more than you know. I tell myself this when I have had to change things up yet again!

Is there any chance of you having access to the (more expensive) meds you have mentioned in the beginning of your post?
I have had a problem, too, when trying those meds. It has been very expensive for me , and in the longer term, just not possible.

If the meds you have used, do work as you say, why not use them? It sounds like you might be favoring haloperidol (Haldol)?
I know akathisia is so very uncomfortable. Do you truly get enough relief with cogentin?

I know many of us gain weight on Seroquel. I am wondering if you might be able to find a lifestyle which allows you to maintain your current weight while using Seroquel? It might require a change in diet and some additional exercise. I understand it also makes you tired. I wonder if added exercise might counteract some of the sleepiness?

One time I had to take Seroquel, I did quite well and even lost weight on it. Yet, another time, not so much. It might depend upon my underlying mood?
I do think maintaining weight might be a possibility if some measures are immediately put into place. I think this is a bit different for everyone and can very in each course of Seroquel.

I understand some people use a med called: Metformin to help with weight issues related to some of these meds. I am ignorant to this, in that I have not used this med. I hope someone with experiences with this med might come along and offer more info.

I am not sure how much these meds effect your glucose metabolism; they do cause issues for many. Many become pre-diabetic or diabetic. If this might be the case for you, here is a resource you might find helpful. Metformin is mentioned in this article. Experts recommend two-pronged approach to treating prediabetes

I hope you find the most helpful med with the least bothersome side-effects.

Have you tried Geodon?

I've had better luck with the 1st generation APs than the newer ones honestly

Yeah, didn't do anything for me except give me insomnia and akathisia.
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I'm trying to remember my Seroquel days and compare them to the zyprexa and haldol days. It was the first med I was on so it's hard. I do know I gained about 20 pounds even though I was running XC and track for my school at the time.

I don't really want to try vraylar or rexulti. I didn't do well on Abilify at all (which I
ve heard is similar to rexulti, yes?) and I haven't really heard much about vraylar other than it's expensive.

I'm favoring zyprexa right now because it caused less weight gain than seroquel and less akathisia than haldol (which was mostly tolerable, but I was only on it for like a month). Maybe if I eat right it won't give me high cholesterol and if I'm remembering correctly it was the most effective other than clozaril (which I'm not considering right now).

It's possible that eating right will prevent you from getting high cholesterol, but even though I do eat right (most of the time), I still have high cholesterol. So, I take Lipitor for the cholesterol and it's no big deal for me. I know everyone has different feelings about adding extra pills for side effects, but I will say that at least it's a fairly tiny pill. It's not like some other pills that practically clog your throat. But of course it's up to you if you feel comfortable with taking an extra pill or not. Some people are not comfortable with that and I respect that because it's a personal choice.

I talked to the nurse that gives my injection who emailed my doc and she's sending over a Rx for zyprexa anyways, so I guess that worked out.

Zyprexa is my preferred second place. As long as I can handle the quieter "sounds" I can stay with what I'm on. I hope it helps and the side effects are less this time.

I hope the med combo you settle on works the best it can for you! Good luck

Good luck with the Zyprexa, spikes. I hope it helps.

I believe virtually all of us is running a near-constant balancing effort of benefit versus side effects. I know I do. For me, my lithium does blunt my affect a bit, I think. My Depakote may make me a tad drowsy at times. My Abilify probably elevates my lipids a bit. Occasionally, my Provigil causes a little bit of anxiety. Etc.

It's just really a never-ending attempt to find some sort of livable balance.

Like you, I still struggle with psychosis stuff, as pretty much everyone knows. I have been on all the atypicals but two, I think. If it does not calm down soon, I am probably just going to go on Clozaril. It seems to be the most effective one for people who really struggle with psychotic stuff a lot. Might be worth reading about.

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Originally Posted by spikes I think risperdal is giving me insomnia. It's a listed side effect and it's gotten worse since they upped the dosage so I'm assuming it's that. It's not even working anymore and my mom says since the voices are back I need to switch. I've been on almost all the atypicals save the new too expensive ones. I'm thinking Seroquel, haldol, or zyprexa Seroquel makes me sleep/gain weight Zyprexa makes me gain weight and have high cholesterol Haldol gives me akathisia, but Cogentin (which I'm already on) helps but doesn't stop it. They all work as long as I don't **** it up by taking antidepressants or doing drugs, both of which I've stopped. Haldol has the added advantage of coming in shot form. Which would you choose? Or would you try something you haven't tried before (in my case it would be any of the first gens. or saphris, which I was told likely wouldn't work for me).

You didn’t mention geodon. It saved my life and is very weight neutral.