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Suffering through sleepless nights. On olanzapine 5 mg. Is there any alternate medicine to get cured?

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Psychiatrist
Practicing since : 2003
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Hi Doctor

I was a normal guy, some 10 years before , I got into very suspicious behaviour all of sudden and lost sleep since I felt there was some thing controlling me with electronic devices ( I used feel certain part of muscule vibrating without any reasons, as if some external force striking it , it was not within the body , usually at night times , that sudden force of stricking pulse was distrubing my sleep , i lost lot of sleep and started feeling my thoughts where controlled , watching lot of TV , Started talking to myself internally inside mind , not externally , i know it is normal to talk to oneself , but it became excess. Then i was becoming a abnormal , i was taken normal physician who gave a alprozalam , and later the physician suggest to take to psychiatirist clinic i was diagnosed for Schizopernia .
I am on Olanzapine 5 mg (Oleanz) for past 9 years,

i have stopped going for followup check up , i have put on lot of weight. I sleep a lot . no physical acitivity , feel procasination , feel very tired . I am married for last 6 years and working for a IT company , we dont have children . I want to get rid of olanzapine due to many reasons, yes it is helping me sleep , more than 12 Hours, but I want to get on with life ,i want to be successful in my work not procastinate and feel lazzy @ work, i have ED ,sexual problems, my cholestrol levels are high. All these factors led me to stop taking it for day or two , but I go into insomania , dont feel tried awake for more than a day or so ,also the scalp feels tight in some regions. I know , i am not doing right thing by stopping to take it , but i am forced to. Is there any alternative to stop taking olanzapine? . How long should i be on the medication ? is there a end to it or is it I need to take life long ? Or is there any low effect alternative to it ?

Posted Sun, 18 Nov 2012 in Mental Health
 
 
Answered by Dr. Jonas Sundarakumar 32 minutes later
Hello and welcome to Healthcare Magic. Thanks for your query.

After going through your clinical history, I'm convinced that your diagnosis is correct, more specifically it is "Paranoid Schizophrenia".

I will certainly guide and help you regarding your problems with Olanzapine. But before that, I would like to have the following clarifications regarding your medication:

1) Were you on a higher dose of Olanzapine initially? If so, for how long? And how long are you being maintained on 5mg?

2) In the last 9 years of taking medication, have you suffered from any relapse of your psychotic symptoms at any point of time? (If you have had any relapses, was it due to stopping medication?)

3) How long have you been having these symptoms of tiredness and lethargy, procastrination, decreased motivation, etc.?

Please get back to me with these clarifications and we shall take it forward.

Regards,
- Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by
 
Follow-up: Suffering through sleepless nights. On olanzapine 5 mg. Is there any alternate medicine to get cured? 10 hours later
Hi Doctor

Please find my reply

1) Were you on a higher dose of Olanzapine initially? If so, for how long? And how long are you being maintained on 5mg?
Intially it was 15 mg 0-0-1 at night times, Dupalac for Constipation.


2) In the last 9 years of taking medication, have you suffered from any relapse of your psychotic symptoms at any point of time? (If you have had any relapses, was it due to stopping medication?)
As far as I am aware , never had relapse. When I tried to stop the medicine, i was not getting sleep for two or more days or feeling of that lack of sleep made me feel somewhat awkard the next day, jet lag etc , then I had to switch back to same medicine.


3) How long have you been having these symptoms of tiredness and lethargy, procastrination, decreased motivation, etc.?
From the day i started it , but now a days I Have managed to cope with it , sometimes i feel refreshed , but most of the time feel very sleepy , if dont get up in the morning , i continue to sleep till 11,12 clock afternoon also, usually on leave days.

Also I forgot to mention , sometime i find it difficult to concentrate on what others are saying , mind tends to wander , some time even language fluency is impacted.
 
 
Answered by Dr. Jonas Sundarakumar 12 hours later
Hello again and thanks for the detailed reply.

Most of your side effects like weight gain, excesive sleep and sexual dysfunction are unfortunately due to Olanzapine. It is an effective anti-psychotic medication, but with some troublesome side effects. In fact, among the different anti-psychotic medication, Olanzapine has a high risk for weight gain and sedation is also a troublesome side effect for many people.

Now, it's a good thing that you have not had any relapses so far and are maintaining well on a low dose of anti-psychotic. You also seem to be free of any psychotic symptoms now and are reasonably well-functioning. However, it is still not advisable to suddenly stop your medication.

Since you are having multiple side effects of the medication, my advise to you would be to change over to another anti-psychotic medication without these side effects. Now, suddenly stopping Olanzapine and changing over to another medication is not also good, since there may be withdrawal symptoms such as insomnia, anxiety, etc. as well as a risk for relapse.

So, my advise to you would be to first gradually decrease the Olanzapine while gradually substituting it with another medication without these side effects.

Aripiprazole (Arip MT) is an effective anti-psychotic medication with very few side effects - especially it does not have sexual side effects and weight gain.

So, you can decrease the Olanzapine to 2.5mg and simultaneously start Arip MT 10mg. After 1 month of this combination, you can completely stop Olanzapine and increase the dose of Arip MT to 15mg.

While decreasing the dose of Olanzapine, you may have mild sleep disturbances for a few days (that is why I'm advising you to gradually reduce the dosage) - you can manage this by strictly following regular sleep timings and proper sleep habits. In case, the insomnia is severe or persisting, then you may need short term medication to help you tide over this problem.

You also need to consult a physician to tackle your hyper-cholesterolemia. In addition, regular physical exercise (at least 20 minutes a day) and diet control are also essential.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by
 
Follow-up: Suffering through sleepless nights. On olanzapine 5 mg. Is there any alternate medicine to get cured? 2 hours later
Thanks Doctor. Sure will follow the prescription. How long should I continue this medicine ? or I need to take it continous ? Also I have noticed , suppose I study , i tend to forgot it very soon and I have to reread again , is this normal ? and also some time while speaking , i tend to forget words in flow , i mean not free flowing (Language fluency) ? But it is not that very bad . To be XXXXXXX my writing is better than speaking. Is this side effects of the medicine ? , I see my colleagues speaking very fluently and feel that I am missing something.
 
 
Answered by Dr. Jonas Sundarakumar 5 hours later
Hello again,

The duration of treatment varies according to the severity of the illness, course of the illness, risk factors for relapse, the person's current social and occupational situation, etc. So, there is no single rule for everyone.

Now, in your case, you have not had any relapses and a low dose of anti-psychotic is sufficient to maintain you symptom-free. So, your risk for relapse is "comparatively" low. But still, we can never be sure that you won't get a relapse when you stop the medication. See, you have recently got married, you have responsibility of work, you may later on have some more responsibilities like children, etc. - so, with all these responsibilities, is it worth taking a risk (even if it may be small)?

Right now, I would advise you to first change over to Aripiprazole, stabilize your self completely for a while and then we can think about reducing the dose at a later time. Once your side effects decrease and you become more comfortable with the new medication, then I think, you won't mind taking a small dose of the medication, just to be on the safer side.

Regarding your other problems, mild concentration difficulties can be a side effect of the medication, but forgetting things after reading is not abnormal. To improve your speaking fluency, you should not only improve your language skills but also your self-confidence...

Best wishes,
Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by
 
Follow-up: Suffering through sleepless nights. On olanzapine 5 mg. Is there any alternate medicine to get cured? 39 minutes later
Thanks Doctor.
 
 
Answered by Dr. Jonas Sundarakumar 1 hour later
You're welcome. Wish you all the best.

You can contact me for any advise in the future at:
WWW.WWWW.WW
Please close this query and leave a review if you are happy with my answers.

Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by
 
Follow-up: Suffering through sleepless nights. On olanzapine 5 mg. Is there any alternate medicine to get cured? 13 hours later
Hi Doctor

Yesterday I purchased Arip MT 10 mg and took it in night along with 2.5 mg Oleanz , I felt vomiting sensation , also vomitted once this morning. Is it too early , should I continue taking and vomiting sensation will come down ? or should I take some other medicine to counteract it ?

Regards,
XXXXXXX
 
 
Answered by Dr. Jonas Sundarakumar 45 minutes later
Hi XXXXXXX XXXXXXX

I'm not sure if the vomiting sensation is due to Arip MT. Even if so, it should subside very soon and so I think it's advisable to continue the medication. If the sensation is persisting and troubling, then you can take a tablet called Pan-D, to counteract it. Tonight you can reduce the dose to 5 mg (1/2 tablet). After taking 5 mg for 1 week, you can increase it to 10mg.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by
 
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