Is Zyprexa given for GAD/insomnia?

[sumihari]

Just curious as I live outside the US ie Australia. It came to my attention recently through my therapist that Zyprexa which is an antipsychotic is given to people suffering from other common anxiety disorders. A few years back when I had chronic insomnia and got very anxious and depressed due to the sleep loss, a psychiatrist prescribed me Remeron and Zyprexa. Zyprexa to get the sleep going until Remeron kicks in. I fortunately saw my doctor who got very angry with the psychiatrist for giving me Zyprexa as I was not psychotic and secondly there are very bad side effects from it.

I also read somewhere in the internet that there were lawsuits against manufacturers of Zyprexa for using the medication for off label use and apparently covering up data that the medication causes diabetes.

I am just curious how freely is Zyprexa prescribed for anxiety disorders outside Australia?  I will certainly discuss this with my doctor when I see him next, but I welcome anyone who has more knowledge on this matter.

Thanks.

Sumi

[RCA7591]

Zyprexa is in the class of therapeutics known as the "atypical antipsychotics". The indication for Zyprexa is bipolar disorder and schizophrenia. It has no useful indication for the treatment of anxiety states, insomnia, or any other condition. Off-label use of drugs is common practice and often desirable, but not in this case.

This drug should only be prescribed if the benefits outweigh the risks. Here, in your case, there would be no benefit and all risk. The risks are Neuroleptic Malignant Syndrome (NMS), Extrapyramidal Symptoms (EPS), Tardive Dyskinesia (TD), and the development of hyperglycemia and drug-induced Diabetes.

EPS is a Parkinson-like movement disorder, and TD is a permanent movement disorder induced by agents that alter Dopamine (cheifly, the antipsychotics). NMS induces autonomic dysregulation, temperature rises, and your brain fries.

Your doctor is correct.

Ryan

[xanweaner]

Ryan summarized this quite well.....especially the risk/benefit ratio when you decide what medication that you are willing to take for treatment.

The analogy I use re: the use of any antipsychotic for sleep or anxiety is this: It's like using a hammer to kill a fly.

When you need sleep, there are sleep aids specifically for this problem. When you have anxiety, there are anxiolytic agents specifically for this problem. You do not risk potential irreversible side effects like Tardive Dyskinesia to treat conditions that can be appropriately addressed with safer alternatives.

Once you see Tardive Dyskineisa, you will never forget it. It's quite disfiguring and rather disturbing. I saw a lot of it in state mental hospitals when I used to sell pharmaceutical drugs.

Thank goodness for your doctor....

[sumihari]

Thanks Ryan . You have confirmed my suspicions about Zyprexa.  I think I need to have a chat with my doctor again.

Have a good day.

Sumi

[sumihari]

Hi xanwaner,

I didn't see your post earlier as I was writing my post. I do a problem with therapists. They think psychiatrists are like god and so whatever has been prescribed should be okay. I have 2 great doctors who know my medical history and have managed me well. Now I am seeing another therapist and I am making good progress with her with the CBT stuff , but I hate it when she brings the topic of medication. For example she and my previous therapists both think Lexapro would do me good but my doctor disagrees and I don't know how to politely tell this therapist to just stick to her CBT stuff and that she is not my doctor, I hope you know what I mean. Maybe this is why therapy doesn't work for me after about the 6th session, when they push for medication. I get confused and get very anxious.

Maybe I could do this as another topic.

Thank you

Sumi

[xanweaner]

I find that quite interesting that a psychologist is pushing meds. Many feel that the psychiatric community is over-prescribing drugs...
If you feel that you are getting good results from your CBT, I would let your therapist know that you prefer to approach your treatment without an AD.

You're lucky that you have some good doctors who have managed you well.

I'm sorry that your therapy is getting side-tracked by the pushing of meds, and I hope that you can continue to get  positive results with your current therapist.

I think that it's a good idea to present this as a topic, too.

Best,
xan ♫

[RCA7591]

I see you're located in Austrailia. There happens to be a very good Benzodiazepine anticonvulsant known as Clobazam, which, when used off-label, also serves as an exceptionally good anxiolytic. It is best suited for generalized anxiety, rather than panic.

Like Clonazepam and Diazepam, Clobazam carries a prolonged half-life. The half-life of Clobazam is 18 hours, and the half-life of its active metabolite Desmethylclobazam is 60 hours.

Starting dosage is 10-20 milligrams, b.i.d. After a month of use, it accumulates to 8 times that of steady-state, and this provides for round-the-clock relief. The key is to take it twice daily.

It may be used alone, or in combination with Remeron. Like Clonazepam, Clobazam will never lose its efficacy over the long-term. Both drugs are Benzodiazepine anticonvulsants with prolonged halve-lives.

Certainly, Clobazam would be far more effective than Zyprexa for your indication. It is also essentially void of side effects (transient sedation initially). Maximum benefit is apparent after three weeks of b.i.d. dosing. Starting dose = 10 mg, b.i.d. Maintenance dose = 20 mg, b.i.d.

Just wanted to notify you about this option.

Ryan

[sumihari]

Hi RCA,

You are sounding more like my doctor now!! Clobazam known as Frisium has been prescribed by my GP (doctor) to trial out and then choose between diazepam and Frisium. I had a previous post on this. My doctor mentioned that Frisium was used by the pilots during the Falklands War and was preferred as it was less sedating. Despite this frisium is not commonly prescribed and I don't understand why.

I have taken Frisium only once so far, it didn't have that sedating , relaxed feel like Valium.  So I am staying with Valium for emergency. Can I have bad withdrawal symptoms or tolerance issues  if I took Valium or  Clobazam? With Xanax I built tolerance very quickly like in a week (I had chronic insomnia then, now it is mild insomnia), and I was in pretty bad shape with Xanax. So that is why I am a bit cautious and I try to use these benzos for emergencies. I will probably have to go back on Physioten (a centrally acting agent) for the blood pressure spikes.

You mention, "Clobazam will never lose its efficacy over the long-term"how long is long term and how easy would it be to come off it. At the moment I take 1 tablet once every 3 weeks and perhaps I should take it more often and for longer. But I don't know how hooked I could get on this - that Xanax experience scares me.

Thank you for sharing this information, perhaps one day you might work in Australia. There is always a shortage of doctors here especially in the country and they pay rather  good incentives for country doctors.

Have a good day.

Sumi

[lynn57]

Even though klonopin does not lose it's efficacy over the long term, the dosage does have to be increased occassionally.  Right?

[RCA7591]

Sumi -

A single dose of Frisium would have no obvious effect on you. It's a maintanence medicine, indicated for the management of epilepsy and anxiety disorders. The full benefit would be appreciated within three weeks. Valium, on the other hand, would work immediately. Both drugs are indicated for the management (long-term) treatment of generalized anxiety disorder and other forms of tension-anxiety. With daily use, a modest physical dependency would be formed, which simply means the drug must be continued gradually. This dependency is not as severe as seen with Xanax (which is not indicated for prolonged use).

Frisium is selective - it targets only a certain aspect of the GABA neurotransmitter. Valium is non-selective and targets the limbic and hypothalamus regions, and thus, it is more sedating. Due to Frisium's specificity, it has fewer side effects than does Valium. However, in general, the Benzodiazepines have very few side effects.

Often times (more often than not), sedation is mistaken for anxiolysis. The two are discrete. The treatment goal is to provide normalcy. In short, you ideally shouldn't "feel" anything from the drugs (other than initially, during the adjustment phase).

Long-term = forever, as is the case with Frisium, Klonopin, Librium, Tranxene and Valium.

Physioten is a catecholamine-depleting agent, a false neurotransmitter. This prevents the autonomic nervous system from releasing excessive amounts of Adrenaline (responsible for the blood pressure spikes). This is a good choice for labile hypertension, however, if you can manage your anxiety, it may not be required. It does have a few untoward effects.

It sounds to me like your doctor is very knowledgable, and I would not hesitate to take his suggestions. I searched for your post on Frisium and was somewhat dumbfounded when I read the negative comments. There is nothing wrong with this drug.

My local hospital sends all of their imaging studies to Australia (Nighthawk Services) for interpretation during the night hours. I once had a CT scan performed at 2:00 in the morning, and it was read by an Australian physician. I had the results in twenty minutes, and spoke to him over the phone about the results. Quick service!

Lynn -

The Klonopin dosage may be decreased or increased as-needed over the long-term. It would not be unusual to require slightly more or less of the drug. Adjustments are typically made in 0.25 mg increments, and the average therapeutic range varies from 1.5 - 4 milligrams. Your dosage will fluctuate over the long-term depending on your status.

Ryan

[707]

Hey, my name is zelda. I am on Subutex 4mg for painkiller addiction, but have been on it for almost a year and might be staying on it for a while. My doc says 20mg will not clash with the subutex,but he means 2x10mg daily. I take 20mg in one dose and sometimes another 10mg at night. I have been doing this for a week. I must admit I took a little more the first few days due to EXTREME anxiety, but is feeling better now. What is your opinion on this.