Zyprexa: Weight, Appetite among others

So I am having some serious problems since starting Zyprexa last summer. I'm trying to handle myself but its just getting to be very difficult.



The hardest parts of this are as follows:

• Increased appetite, particularly junk food, sugary stuff, stuff with lots of carbs. These appetites have been addictive in effect. Particularly psychologically.
• Decreased self-image
• Difficulties with certain movements where there was none before

The hard part is I am extremely out of shape. I used to ride bike regularly for 45 miles a week and had great health. I am worried now that I am heading down a dark road. My pdoc warned that these meds can cause diabetes. The pdoc at the ward did not seem to be concerned about my blood work though.

The hard parts for me is trying to motivate myself to do anything. If it involves commitment especially, finding motivation to move forward is extremely difficult. I don't know how to approach eating healthier and lifestyle changes and preparing for the difficulty of dropping unhealthy foods and snacks.

The pdocs want me to stay on Zyprexa cause they said its a pretty strong AP for psychotic symptoms. But I feel my quality is still being affected. I know I could ask for metformin, but I know that working on fixing this is more than just throwing another med into the cocktail.

Anyone have any advice to breaking this difficult medication/lifestyle/exercise related issue? Dealing with motivational problems and pushing forward?

Olanzapine or zyprexa made me gain 85lbs in 9 months before I was switched to abilify. where it took awhile to stop consuming large quantities of sugary and deep fried greasy items. But I lost it all and then some I was 285lbs and now I am 155lbs.

But I understand where your coming from. Do u have a GP? Can you ask them to do blood work for you?

I complained and complained that I was so lethargic and tired that I was sleeping 16hours a day. Now I get 8hours I might get more depending on if I can go back to sleep...

No matter how hard I tried to exercise I just kept gaining. My pdoc put me on a drug that was suppose to help with weight loss I forget it’s name (I feel stupid right now), but that’s what helped with the initial weight loss.

Maybe asked to be switched to abilify?

Have they even determined you need a medicine that strong, there will always be some breakthrough symptoms in the beginning regardless, it’s common for ward pdocs to use something strong and then for you to change after when you can no longer tolerate it. Abilify is ok for weight but latuda and Geodon have been proven better. Latuda is one of the newest meds and seems to work for most everyone. You are right about adding* metformin, it’s hard to get and adding one more med with its own side effects is a pain.

Honestly, I never really made any headway trying to diet on APs. It was kind of ok on aripiprazole, though I did still gain a few kilos. Being really strict with healthy eating halted the weight gain, but I never really lost it.

However, olanzapine (and quetiapine) are a whole ‘nother ball game!! I seriously could not cope with the raging hunger all of the time; my brain literally screaming at me that I was starving and I absolutely had to eat. Even to the point where my stomach was hurting so much and I knew that I couldn’t possibly be hungry. I tried eating healthy things, but they did not hit the craving for junk food so I’d end up eating the junk food too. Honestly, I think the craving for junk food is a way to compensate for the APs causing low dopamine, because only junk food, a ridiculous amount of junk food, could get my brain to quieten down a bit.

So, no, I couldn’t lose weight on olanzapine. And trying to limit weight gain was a constant battle with struggling willpower and a feeling of futility. And that’s not even factoring in how lazy and unmotivated APs make me, to the point of SI because I seriously HATE living like that. Sleeping 16+ hours a day and then wanting to sit in a chair and not move a muscle the time that you are awake is not conducive to weight loss, or having a meaningful life...

All that being said, I did find the effects on apathy and appetite were dose dependent with all APs. As Sometimes said, you may not need to be on olanzapine, or at that dose. Often they start high and then aren’t very good at coming back down on them like they should. Everything is a balancing act though. A lower dose or a different AP to lose weight may mean that you have to learn to live with more symptoms. Hopefully the psychosis team that you are going to will give you therapy etc to learn to cope with that better. The only way to cope with voices etc without drugging them into non-existence is to realise that you have the ability to choose how to respond to them. Most people react without thought, but with practise you can choose to respond in a conscious way rather than react without thought. Voices can say all kinds of awful ****, but that doesn’t have to affect you negatively. I’m not saying that you, or anyone else, are choosing to be distressed by them because it’s a natural reaction, but that you can learn to choose not to let it upset you. Learning skills like that is really the only way that I can ever see people learn to deal with these experiences without using meds to obliterate them (which isn’t even possible for most people).

As has been mentioned, there is the option of metformin, but that also has its own issues, and at least here in the UK, Drs won’t really prescribe it outside of type 2 diabetes. Another option, which is available OTC in the UK, but idk about elsewhere, are so-called fat binding tablets. They bind to the fat that you eat so that it isn’t absorbed and it passes out the other side. Not to get graphic, but steatorrhoea is NOT pleasant! It’s not a side effect, but the necessary consequence of the drug doing its job. It also has the added psychological benefit of being so unpleasant that most people try to cut down the fat that they eat so as to minimise the steatorrhoea. So like a double weight loss strategy. It’s not something I’ve tried, but it may be an option.

*Willow*

I'm actually on both Zyprexa and Abilify at once. I have to go to a GP at some point soon to get a medical certificate for my drivers license renewal, so I can request blood work then.

I agree. I've thought about Latuda or Geodon...maybe after some therapy and skill building with CBT I can request a med change and/or lower dose.

Are you still on APs or not anymore?

Yes, I totally relate with the ravenous hunger with olanzapine. At first it was okay on lower doses cause before that I had absolutely no appetite and if anything I was not eating as I should have been. Makes sense that the compensation could be cause of low dopamine….

Thankfully I don't get as tired on olanzapine. I still sleep 10-12 hours, but its so much better than the 14-16 hours on risperidone. I feel like Abilify made things better with energy during that day though. So I feel like I can focus at least enough to get through the day. Aside from apathy and lack of motivation, though.

The ward pdoc did take me to 30mg of Abilify and dropped me back to 15mg. Then later on another pdoc raised me to 15mg of olanzapine. I hope to drop back at some point. I don't want to sledgehammer a nail at the cost of quality of life. I am in and out with my feelings about the psychosis treatment team but I hope it will help. I've managed to be less afraid of the voices with reassigning my feelings about them and watching some videos of others dealing with them. So perhaps with therapy and this I can work through it. Perhaps they can help with my paranoia problems too. Those I feel really affect me badly. Like lately I am feeling like people on the board here are out to get me. and its hard to kick these feelings. Like I am being monitored with scrutinizing levels of surveillance. I realise its likely not true, but it does ramp my anxiety up. I've thought about vanishing more than once cause of it....

I will consider things and when I meet the pdoc next month I will figure out if I want to try metformin if they are willing to. That other fat binding tablet sounds horrible That sounds miserable. No way...lol.

I gained 30+ lbs on zyprexa. I did okay at 10 and 15 but once it was raised to 20 I lost all control. I binged on junk food. Ate bowls of cereal at a time. It was awful. Otherwise I never would have switched because I liked Zyprexa.
The only advice I have is to talk to your pdoc about your concerns. With Zyprexa it isn’t about vanity weight. It’s about your health especially when you take into consideration the diabetes aspect.
I really like latuda. I lost everything and then some. I feel good on it and it keeps my psychosis at bay. Maybe it’s time to try something else?

Schizoaffective, PTSD, Anxiety

That sounds like a good plan, though they do have their own issues too. But I definitely think that working on your emotional regulation skills will make a massive difference in your ability to cope, to then play around with meds.

Other than 11 months in 2016-17 when I was forced to take meds in hospital, I've been off APs since the end of 2013

lol Well, people do buy it... I think everyone wants a magic pill that will make them lose weight without any/much diet or exercise, so they must be willing to put up with the steatorrhoea somehow

*Willow*

Why are you on two antipsychotics? Are you tapering off one of them?

Do you really want to take metformin? I know people who take it for type 2 diabetes, who are not overweight. The side effects are nasty. Diet and physical activity will probably help you a lot more (even psychologically) than adding another medication.

Hmm, yeah. I see the pdoc next month. I hope things work out. Its a different one from the last time. Guess we will see.

I agree with everything you say. and that is fantastic you are able to not need the APs! I hope one day I can do the same. With enough therapy and time. I'm not looking to obliterate the symptoms, I'm looking to properly cope with them. I'd rather cope with them off APs than stay on them and have unpleasant side effects. I strongly feel that long term AP use isn't good for the body and mind.

Well I was in the hospital and the ward pdoc put me on Abilify in addition to Zyprexa. Later on the pdoc at the polyclinic was going to keep me on them. He wants to eliminate the positive symptoms completely....I will see with the pdoc at the psychosis polyclinic if they're willing to work with me in a more therapeutic approach rather than all medication.

I agree with you on the meds. Part of me wants to try it but I know every med comes with drawbacks. As it is I'm on enough meds as it is.

It's interesting to me that you used the word "need".

This is off topic, and I keep being reminded that PC isn't a place for intellectual discussion, but it made me think about when taking a psych med is a 'need', and when it is a 'choice'.

If that's the definition of need, then I have never 'needed' to take medication, for anything, ever. I have chosen to try meds to help me cope with certain experiences in the past, and now I choose not to take meds that don't help and give me more things to deal with.

Anyway, that's jmo, and it's off-topic so I will stop rambling now.

*Willow*

I'm sorry. I worry sometimes if I upset you a lot. I don't know. Sometimes I have poor choice of words or don't think. I don't know. I'm sorry...

No need to be sorry in my eyes I have been following this thread after I commented earlier and have read every single persons text. Sorry is for when you hurt someone think for a minute did you hurt willow, in any shape or form?

I choose to take meds as well but I ultimately at one time needed them and went without for two weeks because pdoc cut me off cold turkey and left me almost for dead. It was her fault that I withdrawled from Effexor worst feelings ever. I hated her for that...

There is needs, wants and desires. Choice is wrapped up all in each of them. Say then choose to need or choose to want or the choose to desire. You have it in the bag.

There’s absolutely no need to be sorry. You didn’t remotely upset me. I said that your post was “interesting” because it provoked a philosophical debate in my mind about needs vs wants, and the choices we do and don’t make. I enjoy being intellectually stimulated. I also have this thing about word choice and word meaning that bores everyone else to tears, but I find it interesting why we, unconsciously a lot of the time, choose one word over another. Anyway, there’s certainly no need to apologise.

What concerns me though is that you said you worry that you upset me “a lot”. Why is that? Is it me specifically, or everyone on here?? I can’t think of anything you’ve ever posted that has upset me, and I can’t see why you thought I was upset from what I posted, but I hope that you will stop worrying about it from now on

*Willow*

Okay, that makes sense... Yeah, I agree about word choice, it is interesting...I used to be a lot more into this stuff back during my college days. Understanding where you're coming from with that makes sense to me.

I don't know or understand why....except that I have felt like you've been after me. Like, out to get me, sabotage me, etc. I don't know why. Just this really intense fear. And its been going on for a while... I just wanna cry. Only now did it occur to me that this may not be...logical in foundation. I'm terrified. Idk why.

I’m going to preface this by saying that what you have just written hasn’t hurt me in any way. I’m not remotely threatened by what you said because I know that it has no basis of truth in my reality. Ok, so I’m not taking it personally that you feel this way. As far as I’m concerned, it’s just part and parcel of interacting with the type of posters on this particular forum.

I do want to point out that I come here to try to help people, if I can. I don’t always succeed, and I may sometimes get things wrong and put my foot in it. But I find it very satisfying to be able to support people through difficult times.

I’d like to think that if an outsider examined our posts, they wouldn’t see any evidence of what you fear. Perhaps, if it doesn’t breach your privacy, you could get your wife and/or partner to do that, if you feel that would be helpful? I’d be open to feedback if they came up with anything that I might be inadvertently doing because I’d hate to be doing anything to fuel these feelings. I’d like to think that I’ve tried to support you since you’ve joined.

I’m wondering if this fear is coming from the same kind of place as the fear you’ve expressed before about worrying that you don’t belong here, that we don’t want you posting here? Perhaps the idea that I might genuinely want to try to help you is incompatible with your low self esteem - you don’t feel that you ‘deserve’ care and support, and so I must have some kind of ulterior motive?? Idk, I’m just hypothesising... I do think it’s worth examining though, whether it’s just me you believe this about, or others here too.

Anyway, I have to run some errands now, and then go to choir rehearsal, so I won’t be able to check back in until late tonight. (Just in case you might think I’m annoyed, or ignoring you, or something.)

*Willow*

Hey, I wanted to thank you for the insight. I'm grateful you aren't upset at me. I may take till some time tomorrow to reply. I'm getting ready to leave for Oulu later tonight... and I need a little time to wrap my head around what's going on. A day or so. I'm so sorry again for this. In addition to this, fortunately (or unfortunately at the same time) other insights came after and I'm just struggling with them as well. Very stressful.

I’m sorry that you’re struggling

There’s really no need to keep apologising though. From my perspective, I worked in MH for a long time and so I know that splitting is quite common, and so it didn’t hurt my feelings at all. I just think it’s something to try be mindful of, and even try to see what might trigger it, if possible.

So I’m perfectly happy to consider the matter resolved, but I’m also equally happy to discuss things further if you need to. It sounds like whatever insights you’ve had have been distressing, so I’m here if you want to talk about them further at any point.

Anyway, I hope that you have a lovely trip away. All the best

*Willow*

Thank you. I ended up having to skip last night's bus to Oulu cause I was feeling extremely sick. I think it was a mix of things throughout the day and add in my stomach problems I get that contributed to me feeling horrible. So I'm up today and feeling a lot better after some much needed sleep...and so today I'll be taking the afternoon bus up to Oulu.

I appreciate you being willing to help despite my symptoms. I'm not totally sure where things went in the wrong direction. I've always seen you as insightful and intellectual in how you post on here, and at some point I may have misinterpreted that you were using it against me in perhaps some ulterior motive as you mentioned? What you said about my thoughts of not belonging or being allowed to post here make more sense the more I think about it. Like you and others were trying to get me to leave and vanish. For some reason I have thought people do have some vendetta against me. It has taken a lot of courage and strength on my part to be open here about what's going on in my head. Even then as I type this, I feel like you and others will use it against me. I still struggle to accept there *is* a problem like now that more than one pdoc at the ward and polyclinic have said I have. I feel like I should just leave these forums cause it cannot even be possible. That's the push/pull I have in my head regularly regarding trying to come to terms with this.

I'm curious what you meant by splitting? I know it's a symptom related to borderline personality disorder, and such. I get that black and white thinking a lot in the past; and maybe thinking you were on a course plotting against me was a form of all or nothing thinking? I wonder if it's that plus paranoia. The reason I ask is I am generally good at recognizing splitting behaviours in myself, and I recognise them for what they are. That ability to differentiate splitting has saved me from many potentially heartbreaking arguments with people close to me where I chose logic and analysis over blind emotional all or nothing thinking. What caught me off guard this time is I didn't even realise what was going on with you until yesterday's encounter on here. Then it cascaded into me realising my thoughts about others here was also likely the same situation. The whole thing sent me into a nervous breakdown yesterday, trying to comprehend what happened, in addition to feeling sick already.

Thank you again. For pointing out what was happening to me after I was open about stuff yesterday. Telling me it had no basis of truth in your reality made me realise it was not truth for me either because you weren't trying to get me to leave or anything. I still struggle with the thoughts but I am trying to work through it. Like, I feel like others are watching me close here and waiting to attack. Its distressing.

I'm concerned that you are over medicated. Sometimes medication can psychotic symptoms, especially if they cause drowsiness. It is like being in perpetual stage one sleep, when (hynopompic and hypnagogic) hallucinations can occur. People commonly mistake this for psychosis, which is sometimes evident in the roll-call threads. I also have to point out that stopping a medication will initially increase psychotic symptoms. They will wane once the body adjusts. Usually florid psychosis won't develop until weeks later.

Are you on any benzodiazepines as well? These can also cause psychotic symptoms. It is well known in psychiatry to avoid them in people who are acutely psychotic.

Being able to function and live life is essential for recovery. Being a walking pharmacy isn't. I believe it is important to find the right balance so you can live, not survive and be disabled by terrible medication side effects.

When I was dealing with psychosis, I took one medication only, which was Zyprexa. It took a while to adjust to the sedation and hunger, but it really worked for me. I only took 5 mg, which didn't eliminate all the 'positive' symptoms. No medication has ever done that for me. I doubt it does for anyone. Years later I still get symptoms for time to time.

I hope I don't sound like I am preaching. My intent is to inform you.

No, you don't sound like you are preaching. Thank you for your information.

I agree with you to a certain extent on the medication. I'm on a total of 7 meds. And one PRN. It is a lot, yes. But its 2 meds for my hormone replacement therapy, 1 for essential tremor (which I had before APs), 2 antipsychotics, 1 mood stabilizer, and 1 antidepressant. Then the PRN is diazepam.

Are you able to cite sources for the symptoms imposed by benzos? I did a little research and found it to be a rare occurrence. None of my pdocs have ever shown concern towards that med either. If it was lets say, a stimulant medication like Adderall or Ritalin, I know those can definitely cause psychosis in patients. But I'm on neither. If SP sees this, I'd be curious of your input on this too.

I know a few others on the boards here have also been/are on two APs as well. I do not want to stay on two APs, but I know right now it helps me stay stable. The ward pdoc adding Abilify did bring me out of psychosis. I still have some symptoms semi-regularly (voices, paranoia, etc), but its not like when I was in the ward. After getting specialized therapy for this at the psychosis polyclinic for a while, I want to request to go off at least the Zyprexa, as it is has the most unpleasant side effects of any of my meds. Otherwise, all that aside, I am actually feeling quite good overall. My mood for the most part is very good, my depression is under control, no erratic mood swings. Subtract Zyprexa I do not see any reason to switch or discontinue other meds as my mental health is quite good outside the stuff I mentioned above.