Is Zyprexa a Long-term Treatment for Me?
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Q:  Is Zyprexa a Long-term Treatment for Me?

Dr. Phelps

I have BP II. My medications are: Lamictal - 300 mg, Zyprexa - 7.5 mg, Wellbutrin - 200 mg, and .5 mg Klonopin as needed.  Doctor agreed to taper down Zyprexa as it was not thought to be a long-term med in the plan - was placed in plan after hypomanic after SSRI Celexa (subscribed by psychiatric nurse practioner who did not believe I have BP).  I really wanted the change as I have gained 50 lbs while on Zypexa.  Dr. instructed that I was to taper Zyprexa to .5 mg for one month, and 2.5 mg the following month.  Had a slight hypomania followed by a crash into depression while on .5 mg.  Just after starting the 2.5 mg taper realized that something was wrong (suicide thoughts, severe anxiety, missing work, etc.)

Immediately went to see my Dr. She returned me to the 7.5 mg dose of Zyprexa.  The improvement in my depression was almost  unbelievable.  Took the Zyprexa before bed and woke up fealing 100% better.

My question:  is Zyprexa a long-term treatment for BP II and would you consider continuing it long-term based on what I have written?

Thanks -- Ask the Doctor is a real blessing to me.

Dear Terry -- 
Because Wellbutrin is still in there, an antidepressant, I think it may take a while to determine whether lamictal alone might hold your symptoms under control. You'd have to taper the Wellbutrin very slowly, just as you were doing with the Zyprexa, and then try tapering the Zyprexa again -- this time without Wellbutrin around. The hope would be that Wellbutrin may have made you "need" Zyprexa by contributing to the potential for manic-side symptoms (just as Celexa did), and that without it, perhaps you wouldn't "need" the Zyprexa anymore. That's all theory of course but needs to be considered before you conclude you're "stuck" on Zyprexa. If you were indeed "stuck" that way, check out the teeny smidgin of information on Zyprexa Zydis allowing those who've gained on Zyprexa to turn around and lose it while still on Zyprexa (huh?
check it out). 

Of course all of this theory must be discussed with your doctor for her impressions and so that the two of you can make a plan together. Good luck with that. 

Dr. Phelps 

Published August, 2005


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