Why olanzapine?

[stringbean]

just wondered if anyone can offer me any advice?

My psychiatrist has been trying to help alleviate some of the symptoms of OCD.

I have tried clomipramine 175mg which i am still taking but he also decided to add a mood stabilizer and was put on lamotrigine, but I had a reaction and had to come off it.

At my last visit he explained that he wanted to add a small amount of olanzapine at 2.5mg he explained that this would act similar to the lamotrigine.

I am concerned as he said that i do not have any other psychiatric illness than OCD and a few neuroses but nothing more than that! If this is the case why would he prescribe this drug as this is for bipolar and other illness.

 

[Daniel E.]

Re: why olanzapine?

The treatment protocols for OCD specify that adding an antipsychotic med to one's existing medications can be helpful for OCD. And often, if not always, the only way to know is to try.

For example, I was sooner or later put on a dose of Risperdal when taking Prozac and Luvox, etc. I wasn't on it for long because of side effects.

And if you've seen the commercials lately for Abilify, they were trying to market that antipsychotic for depression. So the term antipsychotic may be a misnomer in some sense.

 

[David Baxter PhD]

Definitely. The so-called "atypical antipsychotics" are used at lower doses to treat or augment the treatment of many other conditions or disorders, including anxiety disorders, depression, OCD, insomnia, etc. Some of the drugs in that family are known to have antiobsessional properties.

And the dose your doctor has prescribed is well below the dose usually used for treatment of schizophrenia or bipolar disorder.

 

[AmZ]

I'm taking Olanzapine and don't have bi-polar or schizophrenia.
I am taking it as a short term thing whilst my other medications are being added/adjusted and is to help me with anxiety.

 

[Daniel E.]

Regarding why antipsychotics may be helpful for OCD:

In patients with obsessive-compulsive disorder (OCD), structural and volumetric abnormalities have been identified by up-to-date neuroimaging techniques both in the prefrontal region and in the basal ganglia (striatum, thalamus, amygdala). The dysfunction of these regions also has been proved by neuroimaging techniques. These alterations can be described as dopaminergic hyperfunction in the prefrontal cortex and serotonergic hypofunction in the basal ganglia. The dysfunction of the so-called 'cortico-striato-thalamic' loops is strongly linked to the symptoms of OCD, where the dopamine is the most dominant neurotransmitter. The ascending serotonergic projections from the raphe nuclei restrain and control the function of these loops. Thus, when serotonergic hypofunction is present, the predominantly dopaminergic loops became overactive, which has been confirmed by neuroimaging techniques and by neurocognitive tests as well. The linkage of the two predominant neurotransmitter systems affected in OCD can be the reason for the fact that SSRIs have limited success in the treatment of OCD symptoms. In recent international, multicentric studies, the treatment of SSRI non-responder subgroup of OCD patients were supplemented by antipsychotics with dopaminergic activity. Many studies have confirmed the beneficial effect of these antidopaminergic substances on the hyperactive cortico-striato-thalamic loops in OCD. The investigation of these dysfunctional loops is also connected to the genetic background of OCD, because some of the candidate gene regions of OCD are coding proteins of the dopamine synthesis (for example: COMT). In this paper, we present a detailed overview of these relationships based on recent findings of OCD research.

[New approach to obsessive-compulsive disorder: do... [Psychiatr Hung. 2007] - PubMed result

 

[stringbean]

Thank you all for your replies.
I am happy that i asked and had such informative repsonses.

Can i ask one more thing, i have been on 2.5mg for two weeks and not noticed any real benefits, does this take time to work? i.e. i know it stems the anxiety but when do the mood stabilzing effects work?

 

[David Baxter PhD]

Can i ask one more thing, i have been on 2.5mg for two weeks and not noticed any real benefits, does this take time to work? i.e. i know it stems the anxiety but when do the mood stabilzing effects work?

It may take a few weeks or several weeks. Rather like when you start taking SSRIs.

 

[stringbean]

Thank you so much. I was a little confused as my Dr said they would work straight away but think he must have meant the anti anxiety properties. I thought it was to good to be true!

---------- Post added July 21st, 2011 at 03:31 PM ---------- Previous post was July 20th, 2011 at 04:44 PM ----------

Thank you again

 

[stringbean]

dear all, thank you again, i have now been back to my Dr for follow up!
The clomipramime has been prescribed for Ocd and the olanzapine as a mood stabiliser/ depression.

I explained that the intrustive thoughts were still there and still not feeling ok!
Therefore he wants me to see a psyhcologist for intrusive thoughts and up 5mg of olanzapine.

Is this still a low dose? should i be worried?

 

[David Baxter PhD]

Yes it still a low dose.

It sounds like your doctor knows what s/he is doing, stringbean. Good luck.

 

[stringbean]

Thanks Dr Baxter.

 

[AmZ]

When do you take the Olanzapine? (Which time of the day?).

I was on 20mg (10mg in morning and 10mg a 4pm) for anxiety/depression. The doctor warned me that it can make you quote drowsy and sleepy, maybe this would be a problem for you depending on the work you do or driving, etc?

 

[stringbean]

well now on day four of 5mg, should i be getting the mood stabilising effect yet? as i still feel terrible!

 

[David Baxter PhD]

What does "feel terrible" mean, stringbean?

 

[stringbean]

well here i am again for advice.

I have now been on 5mg of olanzapine for two weeks and feeling a lot better but then for the past two days i have felt at times, jittery and unable to focus and the old feeling of panic that i am going to go mad and lose control.
the question is this standard with this medicine or has it stopped working, I am worried that although i felt so much better to start now back to the way i felt before i started taking it. Not sure i can fight anymore

 

[David Baxter PhD]

No medication can (or should) completely eliminate anxiety, stringbean. The goal of taking medication is to make it more manageable. Then you need to add in self-management skills (e.g., cognitive reframing, as in CBT) and figure out what is triggering the anxiety.

 

[stringbean]

Re: anyone on olanzapine, advice needed

Thanks Dr Baxter, it wasnt so much anxiety it was waves of despair, one moment i would think, I am going to be ok then the next felt despair.

I have only been on this dose 15 days and wondered if this was standard pattern.
first few days didnt feel much different then 6 days alot better then two bad days as above.

I spoke to my Drs secretary and she advised via him that i should keep on this dose and see him in three weeks.
Do I take it from there that this is quite common with this drug when given for ocd related anxiety and depression to take a while for it to stabilize and its quite common to fluctuate at this stage in the regime??

Sorry i am on here again but dont really know who to ask and where to turn

 

[David Baxter PhD]

It's common with any medication of this type, stringbean. They all take time to work. And in the meantime you will have good days and not so good days.

 

[stringbean]

sorry back again with a few questions
I had been on olanzapine for five weeks and had meeting with my Dr last week. I found that for the first two weeks i didnt notice any improvement then for two weeks felt really much better then the last week felt not so good again therefore when i went back to my Dr we decided to stop it as i was finding it hard to concentrate. BUT after three days was feeling really bad and obsessing about meds and in a right state and had to speak to my Dr and he said i was obviously missing the mood stablising element of the drug and that i should re take it.
I have now been on it for two days but still feel rubbish, will it get better, will I get better

 

[David Baxter PhD]

It should get better, stringbean, but of course if it doesn't in a few days to a week go back to your doctor and let him/her know. There are always alternatives to any drug.