With this post, we continue our biweekly series on medications used to treat bipolar disorder and related symptoms. Over the past couple weeks, we covered three commonly used atypical antipsychotics – Zyprexa (olanzapine), Risperdal (risperidone), and Seroquel (quetiapine). Because the Zyprexa post contains a great deal of information that applies to the atypical antipsychotics as a group, we encourage you to read it first.
Like Zyprexa and the other atypical antipsychotics, Geodon (ziprasidone) was developed primarily to treat schizophrenia and psychosis but is approved to treat acute bipolar mania. It does not have FDA approval for maintenance treatment or treatment of bipolar depressive episodes at this time. Geodon can improve symptoms of schizophrenia and psychotic breaks that may occur in bipolar, including the following:
It may also improve conditions such as social isolation, limited motivation, and reduced speech activity for some people.
Geodon can also improve symptoms related specifically to mania, including the following:
Geodon is well established as a treatment to reduce manic episodes but, there is less data regarding its ability to reduce the frequency of cycling in bipolar disorder. Most bipolar specialists believe that it will ultimately be shown that Geodon, like all the other medications in this category, does a reasonable job as a maintenance medication in bipolar disorder. It is also unclear whether Geodon has specific antidepressant qualities, such as those found in Seroquel (quetiapine).
Geodon is unique among this class of medications because it does not have the same risks of weight gain or changes in glucose and lipid metabolism that accompany all of the other medications in this class. When it was released initially by the manufacturer, there was a lot of concern about a potential effect on cardiac rhythms. Most of the drugs in this class carry some similar risks, but it was thought that Geodon might have a higher risk than the others. However, after a number of years in clinical use, this has not turned out to be the case. A doctor will typically order an EKG (heart rhythm test) before prescribing Geodon, because of these concerns.
Most patients take Geodon two times each day. For bipolar disorder, your prescriber is likely to start you on a low dose, such as 20 mg twice a day, and then increase your dose by every few days or weeks to maximum doses of 80 or 100 mg twice a day. (If you have low blood pressure, poor liver function, or are elderly or in a weakened condition, your prescriber may ramp up the dose even more slowly.) The maximum dose listed by the manufacturer is 80 mg twice per day, but prescribers may use more sometimes depending on the clinical situation. As always, follow your prescriber’s advice and instructions.
In my practice, Geodon is often a second or third choice medication if there has been poor response to other atypicals – or if weight gain or glucose or lipid problems are significant. If a patient is at high risk of diabetes or already has diabetes or poor lipid profiles (high cholesterol, for example) Geodon might be a first choice. There are few studies with Geodon in children and teens, so I use it less frequently in those populations. Many people find Geodon to be a well tolerated medication, without the weight gain problems, although it can be pretty sedating, especially at first.
Geodon is generally not used in individuals with pre-existing cardiac rhythm abnormalities or significant heart disease. There are also a number of other medications, including over-the-counter (OTC) and some natural or herbal products that can cause similar changes in the heart’s electrical circuits, so the doctor must carefully review all of a patient’s other medications and over-the-counter products before prescribing Geodon. The prescriber should also be clear with a patient on Geodon that they must let her know before starting any new medications or over-the-counter products.
Like other atypical antipsychotics, Geodon has the potential of producing negative side effects, including the following:
Unlike most other atypical antipsychotics, Geodon does not increase levels of the reproductive hormone Prolactin. Many other atypical agents do increase this hormone, which can affect menstrual cycles.
For more about Geodon, visit Pfizer’s Geodon page.
If you’ve taken any form of Geodon for bipolar disorder or are a doctor who has prescribed it, please share your experiences, insights, and observations.
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I have taken a number of the atypicals, with not so great results (side effects). I recently changed to Geodon, and it’s been frustrating getting to the right dose that doesn’t include being over sleepy or having horrible akasthisia. It’s not as severe as the akasthisia I experienced on Abilify, but close. I’m still in the process of tweaking the dose, but I’m happy that I don’t have the massive carb cravings anymore. I’m hoping this is going to be “the” atypical that does if for me *crosses fingers*
Decreasing your dosage will decrease akathisia symptoms. Also, you might try taking Geodon all at once in the evening with food which would help alleviate the daytime drowsiness. Keep tweaking, eventually you will find your therapeutic level. Here’s to hoping that Geodon works for you.
I’ve been taking Geodon since February of this year(2008)&haven’t experienced any of the bad side effects that others have reported. The only thing I can complain about is trouble remembering the words I need for things, but that could be due to other meds I take as well. I did notice that it’s greatly decreased the amount&frequency of aural hallucinations I have-they’re not “cured”, but the meds have helped. I now have the aural hallucinations more frequently only if I let myself brood or get stressed out by others’ behavior towards me. Also I have lost a great deal of weight which was great because every drug I’ve been on since I was first diagnosed with bipolar at 19(I’m 40 now.)has usually put about 20lbs. on me because of the carb cravings. I have a heart murmur&had an EKG done before taking Geodon&I’m doing fine. I would definitely recommend looking at the drug company website&also know that the manufacturer has a program for those of us who can’t afford it without help-it’s not as expensive as Abilify-but it’s still spendy.
I’ve been on Geodon since 2001. I went on it after I gained ten pounds in one week on Risperdal. I went through hell getting the dosage right, but I also found that if I take the entire dosage at night with food I am okay. One thing you should know about Geodon is that quite often reducing the dosage actually increases the side effects. I had to go on a higher dosage to get rid of the sleepiness. I haven’t changed the dosage in seven years. For me, it has been a miracle drug.
DO NOT TAKE GEODON! I was on it for three months - until I developed a heart murmer and was unable to sleep for days on end. I now take benztropine to counter the side effects of Geodon. My tongue is swollen, I have trouble swallowing, I can no longer regulate my body temperature, I slur my speach, my memory has deteriorated and I generally feel bad. Geodon is one dangerous medicine.
Hi, Will
I appreciate your contribution to the discussion. I think many medications used to treat bipolar have some pretty weird side effects, sometimes very serious ones, that you never see in the manufacturer’s list of “possible side effects.”
Telling people not to take Geodon, because of your experience with it, however, seems a little drastic to me. I once had a serious reaction after taking Alleve that sent me to the hospital with anaphylaxis. That doesn’t mean that the millions of people who use Alleve for treating their pain should stop taking it. It just means that I can’t take it.
I did not have any problems on it - in fact, I actually lost weight and started sleeping (of course, I lost the weight because I had no appetite). Coming off of it though was a different story.
I’ve taken Geodon for about three months and initially the dose was too high — I had racing thoughts, anxiety, couldn’t settle down. Now I’m taking 40mg and it seems to work okay. It doesn’t work as well as Seroquel did, but I gained so much weight, I had to switch. I have lost weight since I’ve been on Geodon. I think I still have some tweaking to do, but the side effects are dry mouth, shaking hands,poor memory,poor concentration…
hi i have been taking geodon for a little over 3 years now. i was originally on 80mg twice a day and over the course of these years have worked my way down to 20mg twice a day. i know better than to quit cold turkey-have done it with other meds and the results werent good. i plan to eventually get off these pills all together. i hope to offer hope to those of you who wish to do the same.
I have been taking Geodon 40mg at night for Bipolar I depression with mixed states. I tolerate the drug well but I see that it is usually given twice daily. I also had taken it all at night because I thought it would help my severe insomnia. Sometimes I feel that it makes me drowsy and other times I feel it amps me up; one other peculiar side effect is that in the morning my speech is slurred as if I have marbles in my mouth and my neck is a bit stiff. For this I have taken 25 mg benedryl. I am still not sure how to best take it. Any comments or suggestions?? I also take Trazadone 150mg. for insomnia/depression and Diazepam (Valium)10 mg for anxiety all at bedtime. Thanks!
Has anyone heard of auditory hallucinations being present with bi-polar disorder?
Thank you!
Hi, Kelley–
Yes, when my wife is cycling into mania, she experiences auditory hallucinations as a part of the psychosis. She’ll pass people in the street and believes they say things to her when they’re not even saying anything.
I have Bipolar, mostly mania.I started Geodon at 160 mg a day. Intolerable side affects so I had the doctor go to the lowest 20 mg a day. I ended up in the hospital again.Was released on 160mg a day, I again had the doctor lower me to 80 mg. I still felt terribly screwed up when taking 80 mg a day. The knock you out side affect, was awful and I was pacing, cognitive thinking problems, bad depression,totally off kilter. I had my doctor slowley lower the dosage down 60 mg still felt yucky, now I am at 40 mg a day. I take it before bedtime with food and I finally feel completely normal and am symptom free. I am so greatful I stuck with this medicine. I dont have any side affects now and I feel like myself before I got bipolar disorder. 1 pill a day no other meds. I am working, no problems at all with side affects or Bipolar disorder now that I am on the right dose.It was hell to get to this point but, I believe it is all atributed to exacting the dosage. It takes quite awhile to get it just right but when you do you will realize what a Godsend this medicine is.
Our 16yr old daughter has been on geodon(20mg) with seroquel(100mg) daily for the past two weeks. First week she woke up with her jaw dislocated on both sides and as of date she mumbles as though she has marbles in her mouth. Her doctor (although he is very aware of what is happening)wants her to continue with it so she can sleep and be sedated while her cyclic mania passes (caused by her menstrual cycle)
Are these symptoms normal or is she being overdosed???
I did not think you were suppose to take geodon and seroquel together. I am on seroque now and am being switched to geodon because of the weight gain.
I have started geodon 40 mg at nite b/c I was on Seroquel and I gained weight and was starving all the time so I told my doctor I was not willing to deal with that. So far it has been great. Will the sedating effects at night decrease?
I’ve just started taking geodon about one and a half weeks ago. I’ve already noticed some bennefits to my bipolar II disorder. I am starting to socialize more and my thoughts have started to slow down a little (good thing). The sedation was rough the first few days, but as I only take 80mg in the evening it wasn’t to bad, and the sedation lessened day by day. Now I seem to also have a little more energy (not much, but it is noticable).I hope it helps even more, but if it doesn’t that’s ok because it is helping. Dusty.
My daughter who is 27 years old is taking 40mg of Geodon and 20mg of Lexapro in evening with food as directed by her doctor. Her original diagnosis 9 months ago was bipolar with schizophrenia, then changed to schizoaffective. Her complaint was for this diagnosis was negative thoughts, hearing voices in her mind only, anxiety and racing thoughts. She has not suffered from this continuously, only once before while in junior high and starting again last year. She has never be suicidal. She would like to evenually get off this medication since it is so sedating. Her doctor is wanting her to be on this medication for a full year to a year and a half then look at weaning off to see if she can. My question is what will the easiest way to wean off these medications? I’ve on websites how difficult it is and was wondering if anyone has found a successful way to do this?
I have Bipolar II disorder and I have been taking Geodon for about 2 weeks. I previously tried it but it was so sedating and my new doctor said it was not just the Geodon - but the combination. Also I was taking a very high dose - 160mgs all at night.
Now I just take 80mgs at night with food. It has been incredible - I love it. It has really virtually eliminated my depression. I’ve begun to lose the weight I gained with Seroquel. I was very sleepy in the morning for the first week but that has passed. I have more energy, I actually talk to people at work, I’m not constantly thinking negatively anymore. It really has almost been miraculous. I definitely think it’s worth a try for people suffering with Bipolar Depression.
My daughter is on Depakote 1000mg and Abilify 10mg and struggles with the weight gain, (She had previously been on Seroquel four months ago) which seems to have accelerated with the recent increase in dose of Depakote. I’m considering asking her MD to change the Depakote to carbamazepine and abilify to geodon. Are they compatible together? I don’t want her to try lamictal due to severe rash associated with it. And she tried Topamax only for two days and immediately had cognitive and memory problems. Stopped it immediately.
I have been taking Geodon and Seroquel for 3 years now. At first from switching from Risperdal to Geodon I experienced weightloss. Now that ive been on Geodon and Seroquel for so long i gained 70 lbs. I also have blood sugar issues. I’m trying to ask my doctor if I should stop using Seroquel and lower the dosage of Geodon. I am currently taking 40mg. of Geodon daily,in the am. and pm. Has anyone had withdraw symptoms from lowering the dosage of Geodon?
Carrollton, from what I have heard it is easier to get off the medication earlier. In my experience I was able to get off Zyprexa after taking it for 6 months, however I had another episode and was placed on Geodon. I have found Geodon to be very effective at a low dose (I take 20 mg in the morning and 40 mg at night). Higher doses seem to increase the side effects, especially drowsiness, at least for me.
To Stacy and Carrollton, the biggest concern with lowering doses of Geodon is what it does to you heart rhythms. Lowering doses quickly can be dangerous, so work with your doctor on lowering them slowly.
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