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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by pretty_paints on May 17, 2005, at 14:46:23
Hi
I have been on Rispiridone, Zyprexa, Seroquel and Abilify.
The next alternative might be Clozapine. The thing is though, HOW BAD IS THE WEIGHT GAIN?
Is it comparable to that of Zyprexa or worse?
I've heard stories stories stories of people going from a size 8 to a size 20 (UK sizes). Is this true or hearsay?
I was 48kg when I started. I went up to 61kg (an increase of 13kg) when I went on both Remeron and Zyprexa together. Now I'm on Remeron and Abilify I've gone down to about 57kg.
Will Clozapine cause me to gain MUCH more weight than these other meds?
I am seriously stressed out coz none of these stupid meds seem to be working well enough for me to have a life.
Please reply if you have any info :(
Posted by Maxime on May 17, 2005, at 16:35:23
In reply to Weight gain - but is Clozapine my last shot?, posted by pretty_paints on May 17, 2005, at 14:46:23
((( Pretty Paints ))) So good to see you again!
The weight gain from Clozapine is similiar to the weight gain from Zyprexa. I have a friend who has taken both.
Do you have an official DX yet?
Have you tried any of the older anti-psychotics like chlorpromazine?
I will see if I can find any information on weight gain and Clozapine.
Love,
Maxime> Hi
>
> I have been on Rispiridone, Zyprexa, Seroquel and Abilify.
>
> The next alternative might be Clozapine. The thing is though, HOW BAD IS THE WEIGHT GAIN?
>
> Is it comparable to that of Zyprexa or worse?
>
> I've heard stories stories stories of people going from a size 8 to a size 20 (UK sizes). Is this true or hearsay?
>
> I was 48kg when I started. I went up to 61kg (an increase of 13kg) when I went on both Remeron and Zyprexa together. Now I'm on Remeron and Abilify I've gone down to about 57kg.
>
> Will Clozapine cause me to gain MUCH more weight than these other meds?
>
> I am seriously stressed out coz none of these stupid meds seem to be working well enough for me to have a life.
>
> Please reply if you have any info :(
Posted by Maxime on May 17, 2005, at 16:48:54
In reply to Re: Weight gain - but is Clozapine my last shot? » pretty_paints, posted by Maxime on May 17, 2005, at 16:35:23
Hi Pretty Paints. I found the article below for you. I already that if you combine Seroquel with Clozapine that you can lose weight (weight gained by anti-psychotics). Also clozapine can cause type Diabetes just like Zyprexa so it would be important to try and keep your weight down. Hope this article gives you some hope.
Hugs,
MaximeAntipsychotic-Induced Weight Gain: A Newsmaker Interview With David Henderson, MD
Medscape Medical News 2004. © 2004 Medscape
Robert Kennedy
Feb. 13, 2004 (Sydney) — Editor's Note: Weight gain and diabetes in patients treated with antipsychotic agents is gaining more recognition as a serious problem in this population. Medscape also recently published a news article for CME credit on this topic (Joint Panel Urges Increased Surveillance for Adverse Effects of Antipsychotic Drugs, available at http://www.medscape.com/viewarticle/467951).
To discuss the latest research in this area, Medscape's Robert Kennedy interviewed David C. Henderson, MD, here at the International Congress of Biological Psychiatry. Dr. Henderson is associate director of the Schizophrenia Program at Massachusetts General Hospital and assistant professor of psychiatry at Harvard Medical School, both in Boston.
Medscape: You presented a number of studies at this meeting pertaining to weight gain and antipsychotic medications. Why did you choose this area to study?Dr. Henderson: The issue regarding weight gain and glucose metabolism is an important one that we began looking at 10 years ago when we opened a clozapine clinic and found some of the patients were putting on a lot of weight as well as developing diabetes. As a result, we set out not only to monitor these patients for these problems but to also develop interventions to reverse and to prevent these problems.
Medscape: A number of the major antipsychotics have associated weight gain and glucose issues. When you design the studies, do you design it from a pharmacologic point of view or patient care perspective?Dr. Henderson: We recognized that some drugs were worse than others and we chose to focus on those drugs, in particular clozapine, because it is a drug reserved for the treatment-resistant population. The drug is the most effective drug in that population so a lot of the work has been with that drug. We also recognize that olanzapine caused similar problems in weight, lipid metabolism, and glucose metabolism so we focused on this drug as well.
Medscape: You presented a study about sibutramine. Can you discuss it?Dr. Henderson: Sibutramine is [Food and Drug Administration]–approved weight loss agent that goes under the brand name of Meridia. It works with the serotonin system that is designed for weight loss and has been examined in long-term studies of up to one year. We chose to do this because it is our general feeling that exercise and behavioral weight programs are not going to be effective in this population because they entail taking drugs that impair satiety and cause sedation. It is unrealistic to expect that behavioral changes are going to reverse these problems.
We studied sibutramine in the study that we presented with olanzapine-treated patients who gained a significant amount of weight. It is a 12-week study in conjunction with a behavioral nutrition program and we found that patients did lose weight with this drug. It was statistically significant and their weight was reduced. Their [body mass index] went down and their waist circumference went down as well. It appeared to be an effective agent for weight loss in olanzapine-treated patients without any major side effects.
Medscape: You also presented a study with aripiprazole. Can you discuss this one as well?Dr. Henderson: Aripiprazole is the newest atypical antipsychotic agent. We decided to add aripiprazole to clozapine-treated patients. Initially, we hypothesized that we would see some improvement in psychopathology, but also because the drug is more activating, we thought we would see some improvement in activity level. We were surprised to find out that patients lost a significant amount of weight (up to 10 pounds, some patients even more), and more striking was a reduction in lipids, particularly the triglyceride levels came down dramatically in a majority of patients.
It is important to note that this is a six-week, open-label, 10-patient study, and you would need a larger sample to continue to confirm the data. When looking at other data that we had in other weight-loss studies with clozapine, where we could get patients to lose some weight, the results were not this dramatic and we did not find any significant change in lipids as we did in the aripiprazole study. This represents something that needs to be studied further in placebo-controlled trials, but it raises some interesting questions mechanistically.... It can be a clinically useful intervention for clozapine patients that are at a high risk for medical disorders because of the drug.
Medscape: Were the results a surprise to you?Dr. Henderson: The weight loss and the lipid findings were extremely surprising.
Medscape: You were initially looking for reduction in symptomatology?Dr. Henderson: We were looking for reductions in psychotic symptoms, maybe some improvement in depression symptoms, but not weight loss.
Medscape: I know it is a small study, but the findings are dramatic. How are the patients reacting?Dr. Henderson: When patients participate in a drug trial, they want to come off the drug when the study is completed and they are usually happy that the study is over. But for this study, the majority of patients (8 out of 10) absolutely demanded to be continued on the drug. Overall they felt better, partly to the decrease in sedation, they were more active, they were more social, and overall the quality of life was significantly better for them. In that study we continued eight patients with the combination of medications and they continued to state what the drug does for them and how it makes them feel better.
Dr. Henderson receives research funding from the National Institute of Health, Janssen Pharmaceutica, Bristol-Myers Squibb and Lilly.Reviewed by Gary D. Vogin, MD
Robert Kennedy is site editor/program director of Medscape Psychiatry & Mental Health.
Posted by ed_uk on May 17, 2005, at 17:48:19
In reply to Weight gain - but is Clozapine my last shot?, posted by pretty_paints on May 17, 2005, at 14:46:23
Hi Katie!
It's nice to see you again :-) I'm sorry things have been bad lately.
>Weight gain
>Is it comparable to that of Zyprexa or worse?Similar to Zyprexa, possibly slightly worse.
>Will Clozapine cause me to gain MUCH more weight than these other meds?
I very much doubt it. If you can handle the weight gain from Remeron and Zyprexa you can probably handle anything!
We'll always be here for you :-)
Love Ed xxx
Posted by Phillipa on May 17, 2005, at 18:32:09
In reply to Re: Weight gain - but is Clozapine my last shot? » pretty_paints, posted by ed_uk on May 17, 2005, at 17:48:19
Pretty Paints! I'm glad to see you're back. Why not stick around for awhile. How is the CBT going? Fondly, Phillipa
Posted by med_empowered on May 17, 2005, at 21:50:17
In reply to Re: Weight gain - but is Clozapine my last shot?, posted by Phillipa on May 17, 2005, at 18:32:09
Hey! I don't wanna rain on your parade, but are you **sure** clozapine is the way to go? I mean, if you **must** take an anti-psychotic, and your only choices now would be clozpine or an old drug, like Mellaril or something, I'd say go for the clozapine. But...clozapine is some rough stuff. I've known a few people on it. In addition to the blood tests, you have the weight gain potential. There's sometimes drooling (I've seen it ...not pretty). There's **dense** sedation (I had a friend who would fall asleep in the middle of a card game) and, of course, there is the unusually large risk of drug-induced seizures. In fact, one of the people I knew who took it was given Depakote specifically to prevent clozapine-induced seizures. He didn't have any seizures...but the combined effect made him kinda stupid. Plus, clozapine doesn't play well with other drugs, even ones commonly used for schizophrenia/schizoaffective/bipolar. Benzodiazepenes, for instance, are very, very rarely used with clozapine b/c of some freaky side effect (I wanna say some sort of liver thing, but I'm not sure). BUT clozapine has helped many people live happier, healthier, more fulfilling lives...I'm just trying to point out that anti-psychotics in general, and clozapine in particular, are still pretty hardcore meds in terms of side-effects. Good luck!
Posted by pupperpop on May 17, 2005, at 23:22:32
In reply to Weight gain - but is Clozapine my last shot?, posted by pretty_paints on May 17, 2005, at 14:46:23
I hope you find this helpful:
I was on clozapine for two years and gained about 35kg. I have experience with Geodon, Abilify, and Zyprexa. In my case, the rate of weight gain was similar to Zyprexa.
Clozapine will probably make you gain more weight than on any other atypical, except for Zyprexa. The amount of weight gain varies from person to person, but for me it did not stop until I was off the clozapine.
Posted by xbunny on May 18, 2005, at 11:30:55
In reply to Weight gain - but is Clozapine my last shot?, posted by pretty_paints on May 17, 2005, at 14:46:23
> Hi
>
> I have been on Rispiridone, Zyprexa, Seroquel and Abilify.
>
> The next alternative might be Clozapine.I couldnt tell you about clozapine weight gain, but before trying clozapine, which is a pain to take cos the regular blood work, I would try one of the older antipsychotics. Theres also zotepine and amisulpride to try from the atypical group. Bunny
Posted by TomG on May 18, 2005, at 14:02:35
In reply to Re: Weight gain - but is Clozapine my last shot?, posted by xbunny on May 18, 2005, at 11:30:55
I would definately second the motion to try Amisulpride (Solian) especially if you are in the UK. I think you are.
I want to try it really bad if my current trial of Seroquel fails, but unfortunately it is not prescribed in the U.S.
It can be very good for negative symptoms of schizophrenia (I can identify with all of them) at low dose and effective for positive symptoms (I have no positive symptoms) at a medium to high dose.
I keep asking my pee-doc every meeting if he's heard of it and he writes it down then never mentions it again until I bring it up. I think I'm about to make yet another doctor change. But.....
ask your doctor about Amisulpride. I think alot of people here have found it to be a good addition.
This is the end of the thread.
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