US Brand Name: Zyprexa
A link here will take you to the official website for the drug.
Other Brand Names: Dozic (Colombia)
Olansek (Austria; Belgium; Bulgaria; Czech Republic; Denmark; Finland; France; Germany; Greece; Hungary; Ireland; Italy; Netherlands; Norway; Poland; Portugal; Russia; Slovenia; Spain; Sweden; Switzerland; Turkey; United Kingdom), although this brand name is going out of fashion in most European countries.
Zyprexa Velotab (Austria; Belgium; Bulgaria; Czech Republic; Denmark; Finland; France; Germany; Greece; Hungary; Ireland; Italy; Netherlands; Norway; Poland; Portugal; Russia; Slovenia; Spain; Sweden; Switzerland; Turkey; United Kingdom)
Zyprexa Zydis (New Zealand)
Зипрекса / Zyprexa (In areas where the Cyrillic alphabet is in use, such as Russia)
זיפרקסה / Zyprexa (Israel)
オランザピン / Zyprexa (Japan)
Generic Name: olanzapine
What is Zyprexa: Zyprexa is an Antipsychotic, specifically an atypical antipsychotic
Read up on these sections if you haven’t done so already, because they cover a lot of information about multiple medications that I’m not going to repeat on many pages. I’m just autistic that way about not repeating myself.
Other Forms: Orally disintegrating tablets (Zydis), intramuscular injection. Mixed with Prozac (fluoxetine) to form Symbyax.
What are the FDA Approved Uses of Zyprexa. Zyprexa is approved to treat:
Schizophrenia (two-year double-blind study vs. Haldol (haloperidol)) – approved September 1996.
Bipolar mania (47-week double-blind clinical trial vs. Depakote (divalproex sodium)) – approved 10 July 2003 for acute bipolar mania. Those are what I mean by a freaking clinical trials and follow-up studies! None of that 6 to 8-week comparison with a placebo bullshit that everyone else does.
On 14 January 2004 Zyprexa joined lithium as only the second medication with approval to treat chronic (that is long-term) bipolar mania. Lithium and Zyprexa (olanzapine) are currently the only drugs specifically approved for long-term treatment of bipolar disorder. All the others are approved only for short-term treatments. And while those of us in the bipolar spectrum have to keep taking meds forever, many of the anticonvulsants don’t have the same long-term consequences of either drug with long-term approval. Funny that.
Zyprexa is also approved to be used in combination with lithium and Depakote (divalproex sodium) to treat bipolar mania.
What are Some of the Off-Label Uses of Zyprexa. Additionally Zyprexa is also prescribed to treat:
Panic & anxiety.
Borderline personality disorder.
Management of cancer pain (augmenting opiate treatment).
PTSD: no better than placebo in a small double-blind study, but in a larger open-label study it did well.
Autism. You know, using children 5 to 10 years old as human guinea pigs to drug them into submission. Zyprexa was used in this study to make them more compliant because the metric used, the CPRS Autism Factor score, rates things like anger, uncooperativeness and hyperactivity. Give a child 5 to 10mg a day of Zyprexa and they sure as hell aren’t going to be doing much of anything. Why the hell don’t these parents just go see Uncle Doctor Arnie to work with their kids’ strengths instead of against the kids’ weaknesses?
Body dysmorphic disorder.
Glossodynia (burning tongue).
Obsessive-Compulsive disorder (OCD) (augmenting an SSRI).
Masturbatory guilt (sorry, the case report isn’t online, but I might post a scan of it one day).
Alcoholism (no more effective than placebo in this study).
Treating tardive dysdinesia.
Treatment-resistant (refractory) major depressive disorder This is one of several studies where Zyprexa was augmenting Prozac (fluoxetine), which ultimately lead to the creation of Symbyax. But combining Zyprexa with any antidepressant in the real world tends to work, as you’ll see in the next one. It’s just a matter of finding the right cocktail for you.
Despite Zyprexa’s (and other atypical antipsychotic’s) outrageous cost, one Lilly-based study concludes that it’s still cheaper to augment antidepressants than it is to pay for less-than-effective monotherapy.
Click on the links to see the various trials, studies and case reports for approved and off-label uses.
Zyprexa’s pros and cons:
Pros: There is no better medication if you or a loved one are in some kind of mental health crisis! Seriously, if someone is flipping out due to schizophrenia, some form of bipolar mania or several other flip-outs, Zyprexa (olanzapine) is just the thing to calm them the hell down right now and let them think straight about long-term treatment options. Maybe it will be part of their long-term med cocktail, maybe not, but until you can think straight in the first place, you can’t make any long-term decisions. Fast-acting and effective, it’s great to have in the medicine cabinet for bipolar emergencies. When combined with the right antidepressant, it could be just the thing to conquer that treatment-resistant depression that nothing else will deal with.
Cons: Along with Effexor (venlafaxine) and Depakote (divalproex sodium) this is a med that everyone loves to hate. You’ll gain five pounds (two kilograms) just by filling the prescription. You’ll sleep 10-16 hours a day. You won’t care about anything. You might come down with type 2 diabetes. But all of these things are probably going to be issues if you take Zyprexa (olanzapine) at medium-to-high dosages for a long time. Except for the sleeping and not caring, you’ll feel like that the first time you take the med, but those eventually wear off. Usually.
Side Effects of Zyprexa (olanzapine)
Even though it’s class action lawsuit city with Zyprexa (olanzapine) and other atypical antipsychotics these days because of their side effects, the side effects really aren’t that bad! But if you’re into that sort of thing, we have a page to help you find a lawyer.
For tips on how to cope with these side effects, please see our side effects page. The only proven med-based solution I’ve found to date for Zyprexa (olanzapine) and weight gain is Axid (nizatidine). Everything I have to help lose weight on Zyprexa on the side effects pages.
In addition to the usual short-term side effects for atypical antipsychotics
Zyprexa’s Typical Side Effects: Headache, nausea, dry mouth, sleepiness or insomnia, diarrhea or constipation, not giving a damn about anything (a.k.a. the zombification effect), loss of libido and a host of other sexual dysfunctions. Most, if not all of these will go away in a couple of weeks. Except for the excessive sleepiness (up to 16 hours a day!), which could hang around for as long as you take Zyprexa. The sexual dysfunctions could also stick around if you’re taking a high enough dosage of Zyprexa. What Zyprexa is absolutely notorious for is weight gain. Almost everyone who takes Zyprexa gains a significant amount of weight – on average 7% of their initial body weight, or about 20 pounds (9 kilos). Zyprexa is a potential triple threat when it comes to weight gain, as it could slow your metabolism, may make you want to sleep 10 or more hours a day, and often make you want to eat more. And since it hits the H1 histamine receptor, it’s going to make you crave carbohydrates like there’s no tomorrow, so good luck sticking to that Atkins diet. But, hey, at least it’s the goddamn med’s fault and not any lack of willpower on your part.
These aren’t all the side effects possible, just the most popular ones.
Zyprexa’s Not So Common Side Effects: Diabetes. Accidental injury. Tremor. Irregular heart beat. Like any antipsychotic there is a slight, but real risk for extrapyramidal symptoms (EPS), tardive dyskenesia, and neuroleptic malignant syndrome (NMS). Please see the page on these risks. Zyprexa (olanzapine) tests as having one of the lowest risks for EPS and TD and has been used to treat people with TD. Everyone is also flipping out over pancreatitis, when 64 people out of the thousands taking Zyprexa (olanzapine) developed pancreatitis through 2003. But don’t let that stop anyone from filing lawsuits.
These may or may not happen to you don’t, so don’t be surprised one way or the other.
Zypexa’s Freaky Rare Side Effects: Getting intoxicated from water (score!) and getting hung over with no previous intoxicating effects (bummers!). Fecal incontinence. Priapism (i.e. the never-ending hard-on) from an overdose along with Neurontin and at a high dosage all by itself. There have been other reports of this freaky rare side effect when mixing Zyprexa with other meds, including lithium. Kids, don’t try this at home as a Viagra substitute. Although who can honestly resist the temptation of being constantly drunk, hard and taking a dump whether you want to or not? Zyprexa is a med for manly men.
Zyprexa’s Suicide Risk: The use of Zyprexa (olanzapine) has had a few documented suicide attempts. But all psychiatric and neurological meds have a potential suicide risk. It actually tests rather well as a suicide preventative, and in that respect its use far outweighs any suicide risk.
Interesting Stuff Your Doctor Probably Won’t Tell You: Smoking clears Zyprexa (olanzapine) out of your system 40% faster. While Lilly doesn’t recommend a dosage adjustment for smokers, I wouldn’t be surprised if smokers ultimately need either higher dosages than non-smokers, or at least a modification in dosage scheduling. That smokers need a difference in Zyprexa (olanzapine) dosage isn’t surprising. This drug is metabolized by two enzymes, CYP2D6 and CYP1A2, and it’s the second that nicotine induces. That is, when you smoke you get your liver to pump up the volume of certain enzymes. Most meds inhibit the action of enzymes as they get greedy with them, so that’s why you often have to reduce the dosages when you mix drugs in a cocktail.
Also men clear it out 30% faster than women. As usual, women always take longer to do anything.
The only differences found in ethnicity is with Japanese patients, where they seem to get twice as much out of Zyprexa than the rest of the population.
And, as is typical with these crazy meds, the med has a half-life that is 1.5 times longer in those over 65 than those who aren’t.
Putting it all together, all things being equal as the economists like to say, a non-smoking elderly Japanese woman may require a dosage of one-sixth that of a smoking hakujin male under 65.
Because it works your liver pretty hard and needs two enzymes for metabolism, there are going to be plenty of drug-drug interactions. Check with your pharmacist and double-check at my preferred Drug-Drug Interactions site if you’re taking any other medications, either prescription or over-the-counter. I’d also recommend an annual liver function panel, just to make sure your liver is always up to snuff.
Zyprexa’s Dosage and How to Take Zyprexa:
For bipolar mania Lilly recommends starting at 10-15mg of Zyprexa once a day. If no improvement is seen go up to by 5mg a day to a maximum of 20mg a day.
All I can say is, unless you’re seriously flipped out that is way too high to start.
Sure, if you’re in a hospital or otherwise getting some kind of 24/7 care and barely know where you are, then start at 10mg of Zyprexa a day. But if you got yourself to the doctor, you know what day of the week it is and you haven’t maxed out your credit cards, I suggest starting at 2.5mg of Zyprexa a day. Especially if you’re taking other meds to treat the bipolar disorder.
I’m really not a big fan of antipsychotics as monotherapy for bipolar disorder. Unless you’re unable to tolerate any anticonvulsant, I think Zyprexa (olanzapine) and the other atypicals are best reserved as crisis meds and as add-ons. While there are people for whom Zyprexa (olanzapine) will be the medication to treat their bipolar disorder in the long run. But the main reason these meds are getting a big push to treat bipolar disorder right now is just to pad the pharmaceutical companies’ bottom lines. Lithium and anticonvulsants are less expensive and, except for lithium’s issues with hypothyrodism, have fewer long-term issues.
For schizophrenia the recommended dosage starts with 5-10mg of Zyprexa a day with a target dosage of 10mg a day. You can go up to 15mg of Zyprexa a day after a week, but the clinical trials show that 10mg a day is the usual effective maintenance dosage.
I don’t know squat about schizophrenia, so I’m not going to argue with them.
For panic / anxiety – 2.5mg of Zyprexa a night should do it. but this is something you and your doctor will really have to work out. There just isn’t enough published literature on its use for panic and anxiety, unfortunately.
I suggest an annual or semi-annual liver function panel, depending on the dosage, just to make sure your liver is always OK and to catch any major problems before they get out of hand.
How Long Zyprexa Takes to Work: Fast. Really fast. You should start feeling better the next day. OK, the next day “better” could be relative in that you may not give a rat’s ass about anything at all, and that might be just too weird. But within a week, sometimes two, the zombie effect goes away and you have really calmed the hell down and can think straight. Unless you have a really nasty reaction to this med, there isn’t a better drug on the US market for getting your head straight and letting you think clearly about things. You may not be able to get out of bed for most of the day, but if things were bad enough that you needed Zyprexa (olanzapine), then you need that bed rest, and don’t let anyone else, especially yourself, try to convince you otherwise. So take some sick leave and start considering your treatment options. There are plenty of other meds out there for whatever you might have.
How to Stop Taking Zyprexa: Your doctor should be recommending that you reduce your dosage of Zyprexa by 5mg a day every six days if you need to discontinue Zyprexa. Making it a week is just easier to remember. For more information, please see the page on how to safely stop taking these crazy meds. You can stop cold turkey if it’s an emergency, but I wouldn’t recommend doing that without a doctor’s supervision. The major problem with stopping antipsychotics is a sudden return of your symptoms.
So if you’re at 15mg a day you take 10mg a day next week, 5mg a day the week after that and then you’re done.
Chances Zyprexa Will Work and How Zyprexa Compares to Other Meds: Odds of it working for all forms of schizophrenia – excellent. Even people with refractory / treatment-resistant schizophrenia have a good chance of responding to Zyprexa. Works well and works fast.
Odds of it working for bipolar mania – also excellent. Zyprexa (olanzapine) and Keppra (levetiracetam) are the two best meds for stopping out-of-control mania RIGHT NOW. While I think Zyprexa (olanzapine) is best suited as a crisis med and an add-on for bipolar disorder, I’m not too big on antipsychotics as monotherapy (i.e. the only med you take) for bipolar disorder, it does alone to stabilize a lot of people. If anticonvulsants don’t do it for you, Zyprexa can be your med in the long run.
Odds of it working for panic / anxiety disorders – good. Antipsychotics aren’t front-line meds for panic / anxiety but they work well for some forms of the disorders. Zyprexa (olanzapine) might be a sledgehammer to a fly approach for panic / anxiety, but only you and your doctor have an idea of how panicked / anxious you are.
Odds of it working for depression – Really good. As a stand-alone med for depression it can work but not very often. But when you mix it with an antidepressant for treatment-resistant major depressive disorder no other atypical antipsychotic works as well as Zyprexa (olanzapine) at pulling people out of the abyss of endless days and nights of laying in a bed of dirty, rumpled sheets staring at the walls and ceiling waiting, waiting, waiting for someone to just come in and kill you to finally put an end to it.
Now for the details as to how I arrived at the above odds. Mostly it’s from anecdotal evidence gathered from various online support groups I monitor, user ratings and comments at Remedy Find, experiences people send to me via e-mail and summaries of efficacy from the books in the references at the end of this page. Additionally there are these trials and studies from the PI sheet and that I found through Pub Med:
For schizophrenia two six-week clinical trials were completed and one 12-month trial was started but not finished. What? Not finished? What’s that about? It’s about the people in the placebo group getting progressively crazier while the people taking Zyprexa (olanzapine) were getting significantly better, so the trial was halted and everybody got Zyprexa. Anyway, in the two placebo-controlled six-week trials 1mg a day proved to be worthless for schizophrenia, and 15mg a day didn’t do much better than 10mg a day. At 10mg a day people started to think more clearly. Here it is in more detail.
The following metrics were used:
Brief Psychiatric Rating Scale (BPRS), a multi-item inventory of general psychopathology traditionally used to evaluate the effects of drug treatment in schizophrenia. The BPRS psychosis cluster (conceptual disorganization, hallucinatory behavior, suspiciousness, and unusual thought content) is considered a particularly useful subset for assessing actively psychotic schizophrenic patients. It’s like the MMPI of crazy.
Clinical Global Impression (CGI), reflects the impression of a skilled observer, fully familiar with the manifestations of schizophrenia, about the overall clinical state of the patient. In other words, how loony your doctor thinks you are.
The Positive and Negative Syndrome Scale (PANSS) a 30-item rating instrument evaluating the presence/absence and severity of positive, negative and general psychopathology of schizophrenia. The scale was developed from the BPRS and includes other symptoms, such as aggression, thought disturbance, and depression. This is a much more accurate test, if standardized tests are your thing, of insanity.
Scale for the Assessment of Negative Symptoms (SANS). This is a relatively new test looking at an axis of five “negative” symptoms: affect flattening (i.e. you talk like I do), alogia (periods of speechlessness, in other words you still talk, or not talk, like I do), avolition-apathy (i.e. not giving a shit before you were put on antipsychotics), anhedonia-asociality (nothing is pleasurable, you don’t like people, i.e. you’re a natural born goth) and attentional impairment (huh? What did you say?). If this is the scale of negative symptoms what the fuck is the corresponding “positive” assessment? Oh, hallucinations, delusions, formal thought disorder, and bizarre or disorganized behavior.
In a 6 week, placebo-controlled trial of 149 people involving two fixed Zyprexa (olanzapine) doses of 1 and 10 mg/day taken once a day, Zyprexa (olanzapine) at 10 mg/day (but not at 1 mg/day), was superior to placebo on the PANSS total score (also on the extracted BPRS total), on the BPRS psychosis cluster, on the PANSS Negative subscale, and on CGI Severity. As much as I like lower dosages, I will admit that 1mg a day is pretty useless for schizophrenia according to this trial, as well as the anecdotal evidence of most people in the real world. But it’s pretty all or nothing here, either 1mg or 10mg a day. Nothing in between.
In a 6 week, placebo-controlled trial of 253 people involving three fixed dose ranges of Zyprexa (olanzapine), either 2.5 to 7.5mg a day, 7.5 to 12.5mg a day or 12.5mg to 17.5mg a day, all taken once a day regardless of what the dosage was, the two highest Zyprexa (olanzapine dose groups) (actual mean doses of 12 and 16 mg/day, respectively) were superior to placebo on BPRS total score, BPRS psychosis cluster, and CGI severity score; the highest Zyprexa (olanzapine) dose group was superior to placebo on the SANS. There was no clear advantage for the high dose group over the medium dose group. In other words, 10-12.5mg a day works just as well as a higher dosage for many people.
As usual, there are no hard numbers in the PI sheet for what is considered “superior” to placebo on these various tests.
In a longer-term trial, 326 adult outpatients who remained stable on Zyprexa (olanzapine) during open label treatment for at least 8 weeks were randomized to continuation on their current Zyprexa (olanzapine) doses (ranging from 10-20 mg/day) or to placebo. The follow-up period to observe patients for relapse, defined in terms of increases in BPRS positive symptoms or hospitalization, was planned for 12 months, however, criteria were met for stopping the trial early due to an excess of placebo relapses compared to Zyprexa (olanzapine) relapses, and Zyprexa (olanzapine) was superior to placebo on time to relapse, the primary outcome for this study. Thus, Zyprexa (olanzapine) was more effective than placebo at maintaining efficacy in patients stabilized for approximately 8 weeks and followed for an observation period of up to 8 months. So there’s definitely no placebo effect over the long run, but really guys, you think you could have given them Haldol or something instead of a placebo so they wouldn’t have gone nuts?
I’m not too happy with the bipolar trials. They were smaller (67 and 115 people) and a lot shorter (three and four weeks). So the people in the experimental group took between 5 and 20mg (!) a day and got some vague improvement on the Young Mania Rating Scale . Whoopee shit. You score 0-60 on all of 11 items assessing irritability, disruptive/aggressive behavior, sleep, elevated mood, speech, increased activity, sexual interest, language/thought disorder, thought content, appearance, and insight. Basically if you didn’t have the bipolar diagnosis already the test would be fairly pointless in trying to figure out if you bipolar, schizophrenic, obsessive-compulsive, schizoaffective or even ADHD. Even some people in particular parts of the autistic spectrum who aren’t bipolar would score well on it. Try taking it during a bout of severe depression, you may not have any self-esteem, sexual interest or least of all elevated mood and activity, but everything else could be really out of whack and you could get hit with a bipolar 2 diagnosis even if you aren’t really bipolar 2.
Independent studies and trials will use more and better metrics than just the YMRS. These will include some or all of the ones listed for schizophrenia as well as:
The Hamilton Rating Scale For Depression (HAM-D) – 21 questions where your doctor determines how much your life sucks.
Beck Depression Inventory (BDI) – Another 21 questions where you give your opinion on how much your life sucks.
The Montgomery-Asberg Depression Rating Scale (MADRS) – For doctors too busy to ask the 21 questions on the HAM-D. No shit.
The Manic State Rating Scale (MSRS) – 26 behaviors, scored on frequency and intensity. Covers dysphoric and euphoric manias. There’s less cross-over with ADD/ADHD than the YMRS and as someone who has lived long-term manias and has been around plenty of people in dysphoric and euphoric manias, this is a much better indicator of mania. Does OK as far as standardized go in covering mixed states.
Still, I have absolutely no doubts whatsoever about Zyprexa’s effectiveness as an anti-manic. None at all. It’s one of the most effective anti-manic meds on the market. I just question the small, short trials using one test to get the high initial dosages they recommend. The other thing is the short duration of the trials. In the short run, all sorts of non-med approaches will actually work to bring someone down from a manic high for a day or a week. That’s why Bach Flower Remedies or that Serenity crap appear to work in the short term. It’s part of the reason why so many of us fall into the trap of thinking we can deal with our illness without meds, or with dangerously bogus “treatments.”
Let’s see how Zyprexa (olanzapine) stacks up against other meds. Keep in mind who sponsors the study, as it will tends to make the results more favorable for the med in question (on average 3.6 times more likely, according to a Yale study).
First for schizophrenia:
Zyprexa vs. Geodon. I don’t know whose money was behind this study. It doesn’t really matter, as they tested as equally effective! Geodon (ziprasadone) just managed to come out ahead because its side effects didn’t suck as much. From other published data and anecdotal evidence, I can agree with that. For most people Geodon’s side effects do suck less than Zyprexa’s.
Zyprexa vs. Solian. Solian (amisulpride) is a standard antipsychotic available in the UK, Europe, and parts of Asia. It is similar in action to Orap (pimozide). It looks like the money for this study was from Lorex-Synthelabo, the manufacturer of Solian. Both meds test as equally effective, but the side effects published in the abstract suck somewhat less for Solian. However, this bit at the end of the abstract is puzzling. “The side-effect profile of the two drugs differed.” Well, duh, we expect that. But you leave it out there in a significant way.
Zyprexa vs. Prolixin. Prolixin (fluphenazine) is one of the older standard antipsychotics. This Lilly-conducted test showed Zyprexa to be more effective and the side effects sucked less (really, weight gain vs. EPS and extreme agitation, which sucks less to you?). Against such an old med the results aren’t surprising.
Zyprexa vs. Haldol vs. placebo. This Lilly-conducted study pitted the intramuscular injections against each other to see how they worked for people who were really in crisis. The results were that the Haldol (haloperidol) is marginally more effective, but not significantly so, but sucks a hell of a lot more. Despite this being a Lilly study, I don’t think there is a better crisis medication on the market than Zyprexa.
Zyprexa vs. Clozaril. This appears to have been an independent study pitting Zyprexa (olanzapine) against Clozaril (clozapine) for treatment-resistant schizophrenia. It looks as if higher than normal dosages of Zyprexa (up to 25mg a day) is just as barely effective as the Clozaril while sucking less. Either way you’ll get fat and be subject to diabetes, but you probably won’t get EPS or TD with either. Plus with the Zyprexa you need the weekly blood work. I’d just recommend a semi-annual blood panel for liver function at dosages that high.
Zyprexa vs. Haldol. This two-year, independent-looking study has Zyprexa going up against the tried and true standard antipsychotic Haldol (haloperidol) for people who have had their first psychotic episode. Zyprexa tested as more effective and sucking less (more weight gain vs. less EPS, less tremor and less extreme agitation). More importantly the people would stay on Zyprexa more consistently than they would Haldol (haloperidol).
Zyprexa vs. Risperdal. This independent-looking study has Zyprexa testing as superior to Risperdal (risperidone) after 30 weeks. Nothing in the abstract about the dosages used.
Zyprexa vs. Risperdal vs. Clozaril vs. Haldol. This decent sized, 14-week study was sponsored by NIMH (with each of the drug companies chipping in the meds). The results – Zyprexa is the superior atypical antipsychotic, but it all depends on the form of schizophrenia being presented. They’re all better than Haldol (haloperidol) as long as you’re more concerned about effect and all the non-weight gain side effects.
Zyprexa vs. Risperdal. In this Janssen-sponsored study, 2-6mg a day of Risperdal (risperidone) tests as working as well as (slightly better at some things, not quite as good at others) and sucking less than 5-20mg a day of Zyprexa after only eight weeks. See what I mean about when the manufacturer sponsors the study it often comes out in their favor?
Zyprexa + glycine vs. Risperdal + glycine. This small study indicates that adding high dosages of the amino acid glycine to either Zyprexa (olanzapine) or Risperdal (risperidone) can help with treatment-resistant schizophrenia. It’s something to discuss with your doctor before making the switch to Clozaril (clozapine).
ECT + Risperdal or Zyprexa vs. Risperdal or Zyprexa alone for treatment-resistant schizophrenia. Hey, now we’re really getting down to what is going to suck less, ECT or Clozaril (clozapine). In this study, ECT combined with either Risperdal (risperidone) or Zyprexa (olanzapine) didn’t work that much better and didn’t really sucks less. So you’d probably want to try the glycine treatment mentioned above first, but it that pans out, there are treatment options.
Seroquel vs. Zyprexa vs. Risperdal vs. Serdolect vs. Haldol vs. Placebo. Antipsychotic cage match! Five drugs enter, …and five drugs leave. Unfamiliar to US readers would be Serdolect (sertindole), a European atypical antipsychotic that is unlikely to be introduced to the US market. It’s been withdrawn from the UK market and is admitted by Lundbeck to be a med of last resort. Anyway, the results of this analysis of multiple studies involving over 2,400 people with schizophrenia show Risperdal (risperidone) and Zyprexa (olanzapine) to be more effective than Haldol (haloperidol) when it comes to all of schizophrenia’s symptoms, while Seroquel (quetiapine fumarate) and Serdolect (sertindole) are just as effective. When it comes to the negative symptoms, though, Seroquel (quetiapine fumarate) tested as less effective Haldol while Risperdal and Zyprexa continue to be more effective. As usual Risperdal had the greatest risk of EPS. Surprisingly the wonder drug Placebo didn’t do too badly in some of the studies.
Zyprexa vs. Risperdal vs. Seroquel vs. Clozaril – Straight from the trenches of a state psychiatric hospital in Louisiana, where people get anticonvulsants, antidepressants, benzodiazepines and anything else that makes the real world a messy place to treat the mentally interesting. 100 people staying on average a year in the hospital. The results – Zyprexa (olanzapine) had a slight edge over Risperdal (risperidone). Yet when you came down to the people with hard-core refractory disorders, nothing beat Clozaril (clozapine). Zyprexa was still the better drug to try first, but sometimes you have to just give in to conventional reality and go with the Clozaril.
Now for bipolar disorder:
Zyprexa vs. Depakote. This 47-week, Lilly-conducted study had 251 people take either a flexible dosage of 5-20mg a day of Zyprexa (olanzapine) or whatever their blood levels indicated for Depakote (divalproex sodium) in the range of 500-2,500mg a day. It took an average of only two weeks to calm the hell down for those taking Zyprexa, compared to two months for those taking Depakote (divalproex sodium). Otherwise the Zyprexa was a bit more effective, but sucked a lot more.
Zyprexa vs. Depakote. A smaller, shorter study than the one above had similar results. Zyprexa was somewhat more effective, but sucked a lot more. How much more? One person died due to complications from diabetes. Ouch.
Zyprexa vs. Risperdal vs. lithium. A small, short study sponsored by Janssen for bipolar and schizoaffective disorders. 0.25 to 7mg a day of Risperdal (risperidone) against 7.5 to 17.5mg a day of Zyprexa (olanzapine) against 600 to 900mg a day of lithium. All meds were equally effective and equally sucky during the short period of the study. In 1998 dollars the Risperdal (risperidone) cost half as much as the Zyprexa at the dosages used, and that would still hold true today. I note that one of the doctors conducting the study is Dr. Sanjay Gupta of Olean hospital, not to be confused with CNN’s Dr. Sanjay Gupta. This Dr. Gupta is doing some fascinating work, though.
As an add-on for mixed-states and/or ultradian rapid cycling. While Depakote (divalproex sodium) is the best med for either, and Topamax (topiramate) is incredible in its own right for some forms of ultradian rapid cycling, if you don’t get along with either, or you experience break-through symptoms while during your normal therapy with either med, Zyprexa (olanzapine) is an awesome emergency add-on medication for mixed states and/or ultradian rapid cycling.
Seroquel vs. Risperdal vs. Zyprexa vs. Geodon to augment antidepressants for treatment-resistant depression Another antipsychotic cage match! 49 people who have ridden a total of 76 horsies on the med-go-round. Here are the results – Zyprexa (olanzapine) is the clear winner with a 57% response rate, followed by Risperdal (risperidone) with 50%, Seroquel (quetiapine fumarate) with 33% and bringing up the rear in a real shock to me, Geodon (ziprasidone) with only 10%. So if your doctor wants to try Zyprexa (olanzapine) combined with an antidepressant first to bring you out of the abyss, don’t fret the weight thing. Which sucks less, what you’re going through now or a few extra pounds?
How Zyprexa Works In Your Brain: Like all Novel / Atypical Antipsychotics, Zyprexa (olanzapine) is a selective antagonist (i.e. it gets in the way of) for key serotonin (5HT2A/2C Ki=4 and 11 nM), muscarinic (M1-5 Ki=1.9-25 nM), and dopamine (D1-4 Ki=11-31 nM), receptors. It also blocks the action of histamine (H1 Ki=7 nM), and adrenergic (a1 Ki=19 nM) receptors. It also binds weakly (in that you may or may work this way for you) to GABAA, BZD, and b adrenergic receptors (Ki >10 µM).
So, what does that mean in English? Well excessive dopamine in certain parts of the brain is one popular hypothesis behind the symptoms of schizophrenia. There’s also evidence that working on the muscarinic receptors makes a big difference as well. The effects of the other receptors on schizophrenia are less well known. While GABA is currently undergoing a lot of study for schizophrenia, that’s the realm of anticonvulsants.
For bipolar disorder, anyone who lives in Bipolarland can tell you about getting manic from having their brain soak in serotonin for too long from an SSRI. Or perhaps the same thing happened from too long of a soak in norepinephrine and dopamine from Wellbutrin. There’s even evidence that the muscarinic receptors play a role in bipolar disorder as well.
If my unfortunate and quite accidental experience with a mushroom that had a bit too much muscarine is any indicator, I’ll go along with the hypothesis that muscarinic receptors play a big role in bipolar disorder.
Basically Zyprexa (olanzapine) is going to deal with more neurotransmitter receptors than any of the other popular atypical antipsychotics. Only Clozaril (clozapine) deals with more. That’s probably why Zyprexa (olanzapine) is effective for things like refractory schizophrenia of all forms and helping to control the nastier aspects of bipolar disorder like mixed states, rapid and sometimes ultradian rapid cycling.
Zyprexa’s Half-Life: An average of 30 hours in a range of 21 to 54 hours.
Days to Reach a Steady State: About one week.
Comments: My suggestion for a bipolar diagnosis is once you start thinking straight, save the Zyprexa (olanzapine) for if and when you really flip out again. I think that most everyone who lives in the part of Bipolarland where they experience out-of-control manias, either euphoric or dysphoric, should have a prescription for an atypical antipsychotic of some kind. Only experience is going to tell you which, if any of them, you get along with best. But if you haven’t tried any of the others, honestly, Zyprexa (olanzapine) is your best bet for a calm-you-the-hell-down-in-a-crisis med there is on the US market. The section on how it works in your brain explains why.
I liked it in that I could think much more clearly than when I was first taking Risperdal (risperidone) in the early days of my mental meltdown, and I stayed in bed a lot so I wasn’t going to do anything bad. Of course, I just stayed in bed all day long, day after day for a couple weeks. At a dosage of 2.5mg a day. But I’m lousy at clearing meds that use the CYP2D6 enzyme, so that was as much my issue as Zyprexa’s. And maybe there is something to what I’ve been told about being the reincarnation of a comedian from Meiji-era Japan (see Interesting Things Your Doctor Won’t Tell You).
When I was in the locked ward of a psychiatric hospital I met a couple of people who had been taking Zyprexa (olanzapine) for two weeks to deal with delusional thinking. It was doing them wonders. Sure, it took two weeks for them to get to the point where they could get out of bed often enough and for long enough to go on supervised walks outside of the locked ward and participate in the group activities, but look at it this way, it only took two weeks for them to stop thinking the totally batshit crazy thoughts all the time that landed them in the locked ward of a psychiatric hospital! That is pretty damn miraculous in my book. And, yes, they were eating more than twice as much as I was each meal, but there may be something you can do about that. I’m looking into Zyprexa-specific strategies for med-induced weight gain and will put them up on the weight-gain side effects page when I find out more about it. So far the only med that mixes well with Zyprexa, weight gain and flipping out is Axid. I have all the information published about it that I could find up on the page.
Hey, look at this. A survey of German psychiatrists – what antipsychotics would you take or give to your family? 51.9% (or 28 out of the 54 who met the survey’s standards) put Zyprexa as their first-line med if they or a family member started to flip out.
So is Zyprexa (olanzapine) a good long-term med for you? That depends. Obviously if nothing else works and Zyprexa does, it’s the best long-term med for you and you just have to find a way to deal with the weight gain and potential threat of diabetes. Regular testing for diabetes and doing what you can in the way of exercise and other tips I have on the weight-gain side effects page is all you can do for now. Plus eat lots of cinnamon. I’ll have more on this on a page specific for the diabetes threat, but it looks like a quarter teaspoon a day of cinnamon can help regulate blood sugar and cholesterol levels.
You can always try another novel/atypical antipsychotic whose side effects don’t suck as much. Abilify (aripiprazole) and Geodon (ziprasidone HCl) are the two usually tried in place of Zyprexa (olanzapine) as they rarely, if ever, cause weight gain and it’s a coin-toss about Geodon (ziprasidone HCl) and sedation. Just don’t go begging your doctor for another med because of lack of specific side effects, as that is a sucker’s game. Every med has some side effect that sucks a lot of ass. In any event, if some other med doesn’t work out for you, you can always come back to Zypexa. Like most of the atypical antipsychotics, it’s very forgiving that way.
Zyprexa (olanzapine) is probably the most studied novel/atypical antipsychotic when it comes to the atypical antipsychotic-antidepressant cocktail to treat bipolar depression and refractory major depressive disorder (I found sixty studies on humans and rats). It has been paired with Prozac (fluoxetine) to create Symbyax, the only medication specifically approved to treat bipolar depression. While most often paired with an SSRI of some kind. But really folks, any antipsychotic, standard or novel, paired with any antidepressant, modern or old fashioned, is going to produce this synergistic effect. The concept goes back to the early 1980s with the introduction of Etrafon / Triavil (amitriptyline hydrochloride & perphenazine), a blend of the tricyclic antidepressant Elavil and the standard antipsychotic Trilafon. It’s all a matter of finding the right combination of antipsychotic & antidepressant that works for you, if you need something incredibly potent to deal with the blackest of depressions.