With this post, we continue our biweekly series on medications used to treat bipolar disorder and related symptoms. This week, we shift our focus from anti-seizure medications to atypical antipsychotics – also known as second-generation antipsychotics or atypical neuroleptics.
Atypical antipsychotics were designed primarily to treat schizophrenia but have proven effective in treating mania and mixed-manic episodes and in the maintenance treatment of bipolar disorder. They are generally very useful in treating psychotic “breaks” that may accompany severe manic episodes. The atypicals may also be helpful in treating depression. This post shines the light on Zyprexa (olanzapine) – the first atypical antipsychotic approved for the treatment of acute bipolar mania.
These medications are called “atypical” because they work a little differently than the older, standard antipsychotics, including Thorazine and Haldol. The older generation of medications carried risks of movement and muscle disorders that could be irreversible. The “second generation” group does not carry as high a risk of movement problems but carries its own set of risks that can be as difficult to manage. Several large recent studies have clearly indicated that the older medications are often equally effective to the newer ones and that the side-effect profiles, while different, are no better or worse in terms of patient satisfaction. In particular, the older medications do not typically cause weight gain, which is one of the biggest problems with the newer ones.
All antipsychotic medications work by blocking the neurotransmitter dopamine. The different medications do this to lesser or greater degrees and they also have differing effects on other transmitter systems, most notably serotonin. This group of medications is powerful and typically quite effective at eliminating psychosis (hallucinations and delusions, for example) and at reducing overall agitation and manic excitement. Some of the atypicals have an antidepressant effect as well, which can make them valuable in bipolar disorder.
People who don’t respond well to the first-tier bipolar medications, including lithium and Depakote, often respond well to one of the atypical antipsychotics – either alone or in tandem with other bipolar medications.
The side effects that can be seen with these medications include the following:
The weight gain issue is the biggie for most people, especially in the case of Zyprexa. Some patients report gaining over 50 pounds in a matter of weeks, which can lead to other serious medical conditions, including diabetes. Of course, the weight gain also creates a host of other problems related to general well being and self image. Although diet and exercise may alleviate the weight gain for some people, these solutions are often unrealistic and place a further burden someone who’s already dealing with plenty of emotional pain and stigma. (See “Preventing and Reversing Weight Gain Associated with Psychiatric Medications.”)
Lilly offers Zyprexa in four formulations:
If you’ve taken any form of Zyprexa for bipolar disorder or are a doctor who has prescribed it, please share your experiences, insights, and observations.
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hi i have taken zyprexa and felt it did alright. i was on 300mg a day. i get samples from my clinic and they stopped getting it as it is going ganeric. instead they changed me over to prastiq. that is the new zyprexa. i am on 100mg of it a day and it does not seem to be working as good. i also have the zydis for anxiaty attacks. it works okay. it takes about 10 min to kick in. i am bipolar nos
I used to take Zyprexa. It worked well, but I now weigh about 300lb (up from 220) and can’t seem to lose it. I also have diabetes. It made me fall asleep every morning at work.
I had to change, Abilify is a real improvement for me.
I have been using Zyprexa since year 2000.
I have mood disorder.
Fist time, I used for 10mg on daily basis, and now it has been reduced to 2.5mg on daily basis.
After one year using it, my weight was up to almost 15 kgs. Now, I am still overweight for about 17kgs (before 45kgs and now almost 65kgs)
Also I noted that my breasts enlarged much, almost double than before I used it. This disturb me much.
I can’t wear t-shirts or blouses comfortably,
since they are too big, improportional with my body…. even I am not slim anymore.
My menstruation also doesn’t come regularly after I used it, can come after 4 months.
And the last one, my hands often trembling.
It will be better, if there is any new medication that has more less side effects.
zyprexa is an amazing drug. i would never take it unless forced but during mania it grounded me and though i couldn’t really stop eating i could almost sleep. when i took z with depression it totally knocked me out and for days was in a really bizarre state of hallucination and dizzyness
My son started taking zyprexa at age 16 for bipolar disorder. This summer, at age 21, he started to experience severe coordination problems, legs buckling, muscle weakness and problems walking, especially after taking the zyprexa. Reducing the dosage and then stopping the medication did not stop the problems. The neurologist said he should heal once the medication left his body, but now it is more than 5 months since he stopped the medicine and his symptoms are even more severe. He has convulsions/muscle spasms about 3 times a week, has continual pain throughout his body, is extremely weak, has problems walking (one moment he can walk, next moment he needs crutches, next moment he cannot even crawl). He has not been able to go to school (he is in college) and cannot work. He has gone to several neurologists, and no one has answers. THIS MEDICINE IS A TIME BOMB. ANYONE ON IT, PLEASE TALK TO YOUR DOCTOR TO TRY TO GET OFF OF IT–I believe that all neuroleptics have movement disorders as side effects–and it increases as much as a 5-7% per year! Anybody else having similar experiences as my son? Any suggestions for help?
I was on Zyprexa for about five years. I gained about 40 pounds. I have gone off, and in 2 1/2 monthes, I am down 25 and nearing in on my target weight. I realize that I have to go back on something. I quit the lamictal, lithium and welburin all at the same time. I have been periodically out of control recently. I no longer sleep, I am beyond irritable. I am being eaten up with anxiety. I have started taking the welbutrin again, to try to curb my appetite for cigarettes. I am going to go back on the lamictal as well, I suppose. What I have read about lamictal doesn’t seem to be to bad. I am not looking forward to the foginess and lack of memory that I experience on it though. The decrease in libido will be nice though!!
does the effectiveness of olanzapine reduce when i have my monthly periods?
Hi Tina -
olanzapine should not typically be less effective during your menstrual cycle - but if you are noticing a pattern you should mention it to your prescriber. Every individual is different - some people notice worsening of their mood symptoms before or during their cycle - so the dose may need to be adjusted during different times of the month.
I have been tapering off of zyprexa for 15 months i am down to .12mg a day since november. i am now experiencing anxiety again, but it doesn’t hit til afternoon/evening. could this be from the low dose i am on? I too had gain 50 lbs. quite quickly and have now lost 29 since november. I do not want to up the dose of zyprexa. I am also on 300mg of luvox for anxiety, and ativan .05 when needed, but I don’t like to take the ativan because it is so addicting. what else can i try!
I am wondering if any of you have experienced a movement disorder following treatment with Zyprexa?
Also,has anyone attempted to sue the maker of this drug because of a movement disorder?
Thank you, Pati
oc took me off Risperidone (another anti psychotic) and put me on Olanzapine, I’ve read it has larger weight gain than Risperidone also I am on 5mgs for 3 days and then up to 10mgs, anyone been on this, what was your experience. I’m on it for Bipolar Disorder.
OHHHH people are saying there were LAW SUITS in America…..ohh I’m really worried now I already put on some weight and feel hungry when I take Risperidone so I reckon the new pill will be worse…should I get some weight loss pills to counteract the side effect?
Also what about Alcohol and this drug, I drink normally about once a week when we go out…usually a few too many double vodka and lemonades.
To Pati Wolf; Yes, I experienced a movement disorder (tardive diskynesia) from taking Zyprexa. Here’s the brief facts:
took: 5 mg zyprexa daily (lowest dose) for a period of six month in 2002;
reason: bipolar depression
result: at six months, I noticed involuntary jerking of the left corner of my mouth and twitching around left eye. Immediately after this, I stopped taking zyprexa.
At present: seven years later I still have involuntary twitching, though it is somewhat better. It is worse at times of stress or sickness/weakness. Also, at first, for about a month, the medication was very effective at relieving a very deep and long-lasting bipolar depression I had been experiencing. After about a month, however, the amount of relief it provided greatly decreased, and I felt I would’ve had to increase the dose, but was unwilling to do that for fear of the drug’s purported dangers.
I have not tried to sue or heard of any successful suits against the maker, Lilly, for this consequence of taking zyprexa, though I sure wouldn’t mind suing them and thing they deserve being found liable in a lawsuit.
Hi, there. My meds before going onto Zyprexa were Prozac 40mg, Lamictil 250mg & Lithium 1200mg. I went into mixed states about 2 months ago and was put onto Zyprexa 5 mg. This was later increased to 10mg, and then I was taken off Prozac. The aggression and irritability finally improved but didn’t disappear compeletely. My weight climbed from day one of going onto Zyprexa, and has now increased by 12kg’s (26lbs). I am now being completely weaned off the Zyprexa, which leaves me only with the Lamictil and Lithium. My doc said it’s possible to get relief from just these 2. I hope so. I am currently swinging again, but with no euphoria inbetween. Any comments? Allison - South Africa.
My mom was on zyprexa with other anti depressents and anxiety medication. She ended up in the emergency room with low sodium and the internal medicine doctor said her symptoms of parkinson’s and low sodium was due to the medications she was on. He took her off all medications. Zyprexa is a bad drug that psychiatrist prescribe to their patients. We trusted this doctor who did not tell us anything about the drug and for a year kept upping the dosage. I would like to sue either the drug company or doctor for what happened to my mother. she almost died. Her shakiness has not gone away yet and the doctor says we have to wait and see if it will. He blames the zyprexa.
I have been on zyprexa for seven years, and I have definately noticed a difference in my weight gain and have problems with my overall health. I gained 120 pounds. I have dangerouslly high cholesterol and my doctor is thinking about giving me a prescription for cholesterol at the age of 33!. Being at risk for diabetes is another reality I need to face aswell and it scares me. None of the other antipsychotics worked for me so I am stuck. If your doctor is considering zyprexa for you, please keep in mind the side effects, and ask yourself if it is worth it.
I am on Zyprexa 10mg,Lexapro 20mg,Klonopin 2mg,Prosom 2mg,Benadryl 50mg and Risperdal 1mg. My Psyquiatrist says that I have Schizoaffective Disorder with Schizophernia and Bipolar Disorder,he says that I need to be put on Zyprexa 10mg with Prosom 2 mg at nightime.The reason that he says is that Zyprexa would put on time I do not know what he means with that. If somebody knows something please be free to email me .I need help please.
Gina, I would be very interested in hearing more about your experience with you Mom, we are going thru what appears to be the same thing with my Mother-In Law. Already on Celexia, Ativan or Valium 5 days a month and started taking Zyprexa in June 5mg a day. After complaining of being more depressed, suddenly starting to be suicidal, instead of stopping Zyprexa they upped it to 5 mg 3x/day and added Divalproex Sodium at 250 mg to her daily drug menu. She was in ER within 4 days of this and all they did was up the Divalproex up to 250 mg 3x/day. Well within 3 days of this she had completely changed…like a switch was turned off….her eyes glazed over, no interest in anything, no emotion, very robot or zombie like. Back in ER they switched her from Zyprexa to Seraguel but all that has done is within 48 hrs she developed pain in her calves which is now in her thighs and will not stop. We are at the moment trying to figure out how to get her off these meds and stop the neverending leg pain. Please post more on the steps involved in your Mom’s recovery. Thanks in advance