Risperdal Vs. Seroquel Vs. Zyprexa Experiences

[Ferdy]

I have suffered with severe anxiety and panic disorder w/agoraphobia for nearly 5 years.
 
As you can see in my signature line, I've tried almost everything under the sun and moon---but nothing has worked. I am completely intolerable to SSRI's and SNRI's---they make me feel REALLY bad.
 
The only thing that even dents the anxiety is Klonopin, which I am trying to D/C over time, since I have been taking it for so long, and have really lost their effectiveness. I don't want to go up anymore in dose than I am already taking.

I MUST find a solution to this terrible disabling nightmare of being completely homebound---I have been told that it will eventually deterioate my physical health. By the way, COUNTLESS hours of CBT have been completely ineffective, so I have no choice other than finding a med that will work for me.
 
My Pdoc has been great, a very patient doctor that has done and still is doing everything that he can to help me find the right med to cure this affliction. His latest suggestion is that we try one of the atypical antipsychotics (He doesn't want to try TCA's or MAOI's due to their cardio side effects---I have an irregular heartbeat (PVC"S) and HBP well controlled with Bystolic and Hyzaar).
 

So he has given my the choice of Risperdal, Seroquel or Zyprexa. Obviously, cost is an issue and Risperdal is the only generic available at the moment. My pharmacist tells me that Zyprexa's patent expires in November this year and Seroquel expires in March 2012. But, COST ASIDE, which (in real world experiences) would be your choice?
 

Thanks in advance for your comments and sharing your experiences with me with these drugs---
 


Ferdy
 

[carolinalight]

Hi Ferdy.  Is there some off label use of these meds for anxiety, because they don't seem to be generally applied as such.  These three medications all seem to target bi-polar, and are used for people who don't respond to other antidepressants, but there's nothing tying them to the specific treatment of anxiety.  Did your doctor mention that he thinks your anxiety could be the result of untreated bi-polar, then?

I hope you find something to help you soon. 

[sixpack]

my daughter is on risperdal for behavior issues (she is multiplihandicapped).  She is on 1mg a day.  IDK if it helps or not.  Seroquel is often used around here.  My daughter's neuro nixed it as it can be VERY sedating.  I don't know anything about zyprexa.

[Ferdy]

Thanks for responding, Carolinalight.

My pdoc is 100% positive that I am not bi-polar or manic, DX is strictly unipolar treatment resistant depression.

You're right, these 3 meds are only approved (on label) for bi-polar depression, schizophrenia, and something else that I can't remember (autism in children, I think).

But there are several studies that have shown them to be effective as an adjunct add on (off label) to patients who don't respond to typical antidepressants---which as you can see, I certainly fit the bill there as the ONLY AD that I can tolerate is Remeron (mirtazapine).

Although there are not any studies that I have been able to find to support their (atypical antipsychotics) use specifically for anxiety, there is PLENTY of anecdotal and "real life" evidence to support that they do, in fact, help some people with anxiety disorders.  And my doc also tells me that folks with depression usually have anxiety, and vice-versa, with some that leads to extreme anxiety disorders (like me) and in turn leads to panic disorder and sometimes phobias like agoraphobia (me again) and is a cycle---and if you can break the cycle (like improving or eliminating the depressive part of the cycle) the other conditions will usually follow suit and improve as well.

Thanks again for your reply.  Hopefully someone with real anecdotal experience with trying these 3 drugs can shed some light on their results---

Ferdy

[Ferdy]

Thanks sixpack.

I wish you and your daughter the very best.  How old is she?  These illnesses are the devil for sure.

Ferdy

[mrmanic]

 When I was in outpatient rehab they prescribed seroquel as the be all and end all for depression/anxiety. They would not prescribe benzos if you came into program not on any, which I find interesting, did they have a vested interest in prescribing seroquel or are they very averse to prescribing benzos? In any case, seroquel seemed to work well for the people who were prescribed it, tho it is sedating, you might wanna try to taper klonopin when and if you try seroquel. Have you tried to raise dose of remeron to 30mg.? I like you, could not stand but dealt with ssris/nris for a while. Remeron 30 and klonopin .25 bid are my drugs as of now and they seem to be working good for me. Hope you find peace.

[sixpack]

Thanks sixpack.

I wish you and your daughter the very best.  How old is she?  These illnesses are the devil for sure.

Ferdy

thanks ferdy.

she is 24 and multiplihandicapped.  She has a significant brain malformation that affects all facets of her being.

[Ferdy]

When I was in outpatient rehab they prescribed seroquel as the be all and end all for depression/anxiety. They would not prescribe benzos if you came into program not on any, which I find interesting, did they have a vested interest in prescribing seroquel or are they very averse to prescribing benzos? In any case, seroquel seemed to work well for the people who were prescribed it, tho it is sedating, you might wanna try to taper klonopin when and if you try seroquel. Have you tried to raise dose of remeron to 30mg.? I like you, could not stand but dealt with ssris/nris for a while. Remeron 30 and klonopin .25 bid are my drugs as of now and they seem to be working good for me. Hope you find peace.

Hi Mrmanic,

Yep, I've tried going up to 30mg on the mirtz, but it makes me MORE anxious at that dose. 

About the Seroquel (or Zyprexa or Risperdal depending on which one I decide to try), that is definitely my plan to try to wean off the K if they reduce my anxiety and allow me to get back to some semblance of a normal life again.

Thanks again, and good luck to you as well.

[WiSp]

With me, also considering that I used zoloft at 200mg all the time, in combination:

Zyprexa gave me short strong headaches for 3 weeks and it disappeared. I was extremely thin before to start it, since I was with a crazy anxiety and not eating a lot anymore. In 2 or 3 months on zyprexa, I got from 130 pounds to 200 pounds. My spine was not able to handle this fast, so I got horrible back pain and big stretch marks appeared each side of my hips, due again to the fast weight gain. Finally I got to 210 pounds. In my life, I never got over 165 pounds, whatever I do and I'm 29.

Now for the good. Zyprexa killed my depression and any will to die, in only 2 or 3 days even just at the minimum. Unfortunately, it has done nothing for my anxiety, my main problem, but at least it never worsened it. I loved zyprexa because I started to eat normally again with it, and the taste of food was better than never before. But at 210 pounds I was forced to stop taking it...I used up to 15mg.

I tried seroquel before zyprexa but it was impossible for me to take it, since I cannot stand up after 20min and my heartbeat is getting very low. However...seroquel xr is wonderful. I switched from zyprexa to seroquel xr, and I got no stunning effect, no drowsiness, in fact the only side effects were occasionally burning stomach (treatable), and intern pain related to sexuality. I suspect the pain was coming from the prostate. It was sometimes very painful, but only after having sex. My prostate has been examined and appeared to be healthy. This problem disappeared almost after 2 months only, even if it still hurt a bit sometimes and I still get a burning stomach randomly. Also unfortunately, my weight is stuck at 210 pounds and whatever I do, it never go down (and never go up). It will surely stay like this until I stop taking seroquel xr. That's sad but I still prefer this than to live even just a minute on the anxiety level that I was on, all day long. Because seroquel xr killed my anxiety completely, whatever crazy it was, and I also think that it almost killed my depression. I used up to 400mg. I still take it and I live normally, which is something impressing considering the 2 years of slowly going down into hell just before, where I was not acting normal at all anymore.

I never tried risperdal. But those three can cause weight gain. Of course, their prices are also a problem, but since it's the only thing that work so good for me, I must try to stay on it. I was ordered to stay one year on it.

[Ferdy]

With me, also considering that I used zoloft at 200mg all the time, in combination:

Zyprexa gave me short strong headaches for 3 weeks and it disappeared. I was extremely thin before to start it, since I was with a crazy anxiety and not eating a lot anymore. In 2 or 3 months on zyprexa, I got from 130 pounds to 200 pounds. My spine was not able to handle this fast, so I got horrible back pain and big stretch marks appeared each side of my hips, due again to the fast weight gain. Finally I got to 210 pounds. In my life, I never got over 165 pounds, whatever I do and I'm 29.

Now for the good. Zyprexa killed my depression and any will to die, in only 2 or 3 days even just at the minimum. Unfortunately, it has done nothing for my anxiety, my main problem, but at least it never worsened it. I loved zyprexa because I started to eat normally again with it, and the taste of food was better than never before. But at 210 pounds I was forced to stop taking it...I used up to 15mg.

I tried seroquel before zyprexa but it was impossible for me to take it, since I cannot stand up after 20min and my heartbeat is getting very low. However...seroquel xr is wonderful. I switched from zyprexa to seroquel xr, and I got no stunning effect, no drowsiness, in fact the only side effects were occasionally burning stomach (treatable), and intern pain related to sexuality. I suspect the pain was coming from the prostate. It was sometimes very painful, but only after having sex. My prostate has been examined and appeared to be healthy. This problem disappeared almost after 2 months only, even if it still hurt a bit sometimes and I still get a burning stomach randomly. Also unfortunately, my weight is stuck at 210 pounds and whatever I do, it never go down (and never go up). It will surely stay like this until I stop taking seroquel xr. That's sad but I still prefer this than to live even just a minute on the anxiety level that I was on, all day long. Because seroquel xr killed my anxiety completely, whatever crazy it was, and I also think that it almost killed my depression. I used up to 400mg. I still take it and I live normally, which is something impressing considering the 2 years of slowly going down into hell just before, where I was not acting normal at all anymore.

I never tried risperdal. But those three can cause weight gain. Of course, their prices are also a problem, but since it's the only thing that work so good for me, I must try to stay on it. I was ordered to stay one year on it.

Thanks WiSp, that is very encouraging results, other than the weight gain and prostate pain (I'm male, too).  Based on your and others response on other forums, I've really narrowed my choice down to Seroquel and Risperdal.  Others have complained also about the severe weight gain on Zyprexa, not to mention the SHOCKING cost of this med, since I don't have insurance.  The best price I could find for 30 tabs (of any size/mg of Zyprexa) is $450/month!!!  That is more than my mortgage payment!!! 

I understand that all 3 have the potential for weight gain.  I'd still like to hear from and get least a few more (hopefully male) experiences with Risperdal, since one of the possible listed side effects is high prolactin levels that could cause male breast development and lactation, although this seems to be a rare side effect.

Thanks again, and pleasure meeting and hearing from you!   

[WiSp]

You know, it's simple in fact. By trying a med, you can have a good idea in one week of what side effects will appear, and if one is not acceptable for you, just stop taking the med.

And even if all three could cause you weight gain, it's still just a possibility, and there are also some others meds that never do it, like geodon and abilify. But again, there is no generic. Geodon will be generic after March 2012 and abilify, after March 2015. I had horrible experiences on both, though.

[Ferdy]

You know, it's simple in fact. By trying a med, you can have a good idea in one week of what side effects will appear, and if one is not acceptable for you, just stop taking the med.

And even if all three could cause you weight gain, it's still just a possibility, and there are also some others meds that never do it, like geodon and abilify. But again, there is no generic. Geodon will be generic after March 2012 and abilify, after March 2015. I had horrible experiences on both, though.

WiSp, I couldn't agree more---you never know until you try.

But, I would certainly like to try the one that would have the best chance in terms of efficacy and tolerability based on others' experiences, since cost is a factor, but not the major factor in making a decision.  Since I'm unemployed and disabled by my condition(s), it is much harder on me financially to trial a drug that costs several hundred dollars per Rx, only to find out after taking 1 or 2 doses that I can't continue taking it for before mentioned reasons. 

And for some reason (I've never asked him why), my pdoc doesn't give out samples---

Thanks again for your responses!

[Irishmanwrites]

Hello again Ferdy.

Hers a verdict, a male verdict! On Risperdal at least.

I am known to be very positive re meds, I genuinely am a positive person and subscribe to the theory of optimism with meds, but Risperdal was awful. I had to make an emergency call to my psych after a short period on this med. I do not consider myself to be med sensitive (see what I'm on!), but Risperdal made me very sick. I've heard a lot of positives for Seroquel. One vote here Ferdy!

[Ferdy]

Hello again Ferdy.

Hers a verdict, a male verdict! On Risperdal at least.

I am known to be very positive re meds, I genuinely am a positive person and subscribe to the theory of optimism with meds, but Risperdal was awful. I had to make an emergency call to my psych after a short period on this med. I do not consider myself to be med sensitive (see what I'm on!), but Risperdal made me very sick. I've heard a lot of positives for Seroquel. One vote here Ferdy!

I appreciate you, Irishman, vote duly noted!!

When you say sick, do you mean nauseated/vomiting or something else?

Thanks again!

[Irishmanwrites]

My vision went haywire and I started to vomit heavily and felt dizzy and off. I'm just one Perron though. I'm now settled on Lexapro, Lyrica and Valdoxan, as you know!

I know your waiting on Valdoxan to hit the states and that shouldn't be much longer.

I know you didn't do well on Neurotonin (Gabopentin) and your PDoc said Lyrica is similar (as did I), but reactions  differ and it's a godsend to many.

What about Lexapro?

Have you tried Amitriptyline? Welbutrin?  Just thinking of other options, putting them out there. There must be other options too!



 

[Ferdy]

My vision went haywire and I started to vomit heavily and felt dizzy and off. I'm just one Perron though. I'm now settled on Lexapro, Lyrica and Valdoxan, as you know!

I know your waiting on Valdoxan to hit the states and that shouldn't be much longer.

I know you didn't do well on Neurotonin (Gabopentin) and your PDoc said Lyrica is similar (as did I), but reactions  differ and it's a godsend to many.

What about Lexapro?

Have you tried Amitriptyline? Welbutrin?  Just thinking of other options, putting them out there. There must be other options too!

Oh God, I've been round and round the med-go-round---it seems to never stop---LOL!!!

I'll be sure to ask the pdoc about Lyrica again---you never know, it may work A LOT differently than gabapentin--in my case, it would have to.  I know for sure that gabapentin was pretty nasty (for me).  It made me feel like my head was stuffed full of cotton (I'm sure most peeps here KNOW that feeling, it's hard to describe).  I was in a complete mental fog, difficulty concentrating, just felt mentally numb, and paradoxically interfered with my sleep--most people find it helps with sleep, especially deep slow wave sleep.  AND, this was at a super duper low dose (75mg/night).  I see a lot of people are taking 1200, 1800, and even 3600mgs of gabapentin/day---I can't imagine how taking that kind of dose would feel.  ER for sure, LOL!!  I stole the nickname Morontin for Nuerontin from another board---it's sure how it made me feel!!

Yes, tried escitalopram and citalopram both---I simply cannot tolerate SSRI's or SNRI's of any sort.  The side effects (just a general feeling of unwellness, nothing in particular, but VERY intense) never went away, even giving them a full trial of at least 6 weeks each (and all the other SSRI's the same).  My pdoc couldn't believe that I would stay on them so long feeling so bad, but I wanted to make sure and give them a fair chance to kick in and work, which they never did at any dose, big or small.  Maybe I'm just SUPER sensitive to meds---I had the same problem finding a hypertension regimen that worked without intolerable side effects.  Finally found Bystolic, which is a beta blocker that was just approved a couple of years ago, after going through AT LEAST a dozen different generic meds.

Pdoc won't try the TCA's due to the cardio side effect risks, so those are out.

So, you can see why I hope to make the right choice the best that I can for the AAP's because I'm quickly running out of options----

Thanks again for your help

Ferdy

[bluerose]

I'm female and I've been on risperdal and zyprexa and they both helped my anxiety tremendously.  I'm not bipolar or schitzophrenic.  I have OCD, depression and anxiety.  What I was on for about 12 years was celexa, which knocked out my OCD, klonapin and hydroxyzine which helped with sleep and anxiety and risperdal which helped with sleep and anxiety also.  I did gain a lot of weight I believe from the risperdal, but I'd rather be sane and overweight than thin and crazy.  The atypical antipsychotics (also called second generation antipsychotics) can affect your heart rhythm so that's something to be aware of, but the only time I had a problem was when I was on a no carb diet for the summer to lose weight and passed out.  My blood pressure was low and my heart beat was fast. I was on 2 mg. of risperdal.  After 12 years it quit working, but that's a pretty long run!  I'm now on 5 mg. of zyprexa and sometimes the anxiety kicks in, but not usually.  Good luck with the medication, hopefully something will work.

[Daisy131]

just a random question...has your doctor mentioned abilify at all? or is there a reason he didn't? i ask b/c that's what i was put on, and it's an AAP as well...

[Ferdy]

Yes, we have discussed Abilify---but here's the deal with according to him regarding my intolerance to the SSRI's, SNRI's (and Abilify).

He has determined that I am one of those pretty rare  patients (<10% of the population using SSRi's) that are SUPER sensitive to blockade (either agonism or antagonism) of the 5-HT1a-c receptor complex---and not sensitive to any of the other 5-HT receptors like the 5-HT2, 5-HT3, 5-HT4, etc.  This is the reason that I can tolerate AD's (like Remeron) that do not hit directly on the 5-HT1 receptors. Remeron has a totally unique pharmacodynamic mechanism of action and acts more on other receptors other than the 5-HT1's like norephenephrin, dopamine and histamine receptors, which is why it is so sedating and increases appetite. 

Anyway, if you look at the pharmacology of Abilfy, it's major action in on the 5-HT1a receptor, whereas the other AAP's do not.  They work more on the 5-HT2, dopamine, histamine and alpha 1 receptors and to a lesser extent some small melatonin action.

So, that's the long story about why it's not an option.  Thanks for your suggestion, though!!