Expert: Ivan Goldberg, M.D. - 3/22/2010

Question
Hi Dr. Goldberg,
I have a question regarding managing Zyprexa side-effects. I have been through all other AAP's except Geodon and they all gave me EPS symptoms except Zyprexa. My current side-effects are mild dystonia (I can live with it and yes I have tried cogentin, benadryl doesn't work), memory problems and vision problems. Now I say I won't take cogentin because it causes more vision problems and more memory issues and they are much worse, my dystonia is mild enough compared to the Akathisia and TD I experienced on the other meds. My vision is so screwy that sometimes I feel like I am looking out of a bubble and like things are changing shape or size. I have horrible difficulty driving at night and I really want to do something. My pdoc said there is nothing but switching to Geodon which will most likely give me severe eps. The memory loss thing is frustrating me and causing my anxiety to go up. Is there any thing that can be done? I am also on lithium (1.0 blood level at 1800mg) and Lamictal (200mg/day). Apparently I need to be on an antipsychotic as I get symptoms that are mildly psychotic without one. I say mildly because I am aware that something isn't right. Any advice is appreciated. Is there a chance I can come off an AAP some day since I get psychotic off of it even with 2 mood stabilizers? My pdoc said some day but I am wondering if he just said that to prevent me from getting upset.

Answer
Hi Kevin . . .

It is not easy for psychiatrists, or anyone else for that matter,m to predict what will or will not happen in the future. I have had some patients who required antipsychotic medications for many years, but who eventually were able to discontinue them without a return of the psychotic symptoms of bipolar disorder. I have also seen more than a few patients who did best when their psychotic symptoms were treated with clozapine. While this drug requires frequent blood tests, many people find it easier to take than drugs such as Zyprexa and geodon.

Best regards . . .

Ivan
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