Low Dose Antipsychotics – Do They Help?

I am very medication-reactive. Not so much with the positive effects, but I can almost guarantee you I’ll get all the side effects.I get every side effect for antidepressants, every side effect for antipsychotics and every side effect for pretty much anything else.

And sometimes, just for good measure, I’ll get side effects that doctors say “aren’t possible”. They are my favorite. And those overractions are often on the lowest known effective dose of the medication.

But if you add a low dose, lower than thought effective, of an antipsychotic, can this be helpful?

I Overreact to Even Small Doses of Antipsychotics

Antipsychotics have some of the worst side effect profiles around (if you ask me, and well, you’re here, so you kind of did). While antipsychotics are entirely appropriate in the treatment of many disorders and even a miracle for some people, that doesn’t mean it’s all rainbows and lollipops. [push]The years spent trying out antipsychotics have been some of the worse years of my life physically, and often mentally.[/push]

And the reason why is because not only do I not find them overly helpful or effective, but I also find they are absolutely hellish is live through. Typically, on antipsychotics I wants to eat my weight in ice cream every day and that is when I’m not sleeping, which is most of the time. I swear, I don’t remember huge chunks of time because I just slept through them. And yes, I could complain about other things like tremors and weight gain as well. And other things like body temperature dysregulation. And the list goes on. Antipsychotics in effective doses suck for me.

But Antipsychotics Are So In

Antipsychotics are all the rage. Everyone gets them prescribed for everything. And as I mentioned over at Breaking Bipolar, Seroquel is the highest grossing psychotropic medication (that means it beat out every antidepressant) and antipsychotics in general are the highest-grossing class of medications pulling in $14.6 billion in 2009. (My mouth hangs open every time I read that.)[pull]Nevertheless, I’m not a fan of trend-following.[/pull]

And there is some good science behind why antipsychotics are being more frequently prescribed. Antipsychotics can help for intractable depression, mania as well as their traditional use in schizophrenia.

I Refuse to Take Antipsychotics

So last year, after gaining more weight and being hungry 25 hours a day I simply refuse to take another antipsychotic at all. In any combination. No More.

Um, except a tiny dose of Zyprexa. 1.25mg to be exact. That’s half of the lowest available dose. It’s pretty much all I can handle of the stuff.

My Doctor Was Sure The Low Dose Zyprexa Did Nothing

My doctor back in the US was pretty sure it was doing nothing and when I finally saw my old doctor here he was sure it was doing nothing so I stopped taking it. I like to try to do what the doctor says mainly because they don’t like it when you don’t. Listening to them and giving their advice a chance is how you build rapport.

And my guess is everyone in the room saw this coming: I started feeling like crap.

OK. Low Dose Zyprexa Might Be Doing Something

The change in mood was really notable. Often mood changes are so gradual they are hard to see, but not this one. From manageable to unmanageable in a day-and-a-half. I then met with another doctor to get official word to go back on it. Basically I wanted to see if it was likely I was having a psychosomatic reaction. She seemed to think not, so last night I took a dose.

Low Dose Antipsychotics Good for Stabilization?

When I met with this new doctor (another long story, she’s a resident) she said that low dose antipsychotics are typically good at stabilization, not so good as antidepressants, for that you need a higher dose, but good for all that rapid-cycling business. That’s just the opinion of one doctor, but I thought I’d share.

low dose antipsychoticsSee, a Low Dose Isn’t So Low When You’re On 23 Other Meds

See, I’m on 6 other meds besides Zyprexa. And there are these interaction things. No one can really say what the interactions are per se, as the combo is too complex, but obviously there are some. So it’s quite possible that 1.25mg in my system is like 2.5mg or 5mg in someone else’s system. No one really knows.

And sure enough, I do feel better today. It does feel a little easier to hack away at projects and try to get work. I don’t feel quite so crushingly sad. It’s really a nice change.

So, Jump On the Low Dose Antipsychotic Bandwagon?

Obviously, I can’t say what someone should or should not do so I’m not going to even try. I will say though that some people do use low doses of drugs, particularly antipsychotics, quite successfully. Sometimes it’s for sleep and sometimes it’s for mood, but sometimes it works. Antipsychotics sometimes “turn up” other medication. It’s the suspected reason why the Zyprexa/Celexa combo works so well. The small amount of Zyprexa increases the efficacy of the Celexa. Of course, that is partially supposition.

But if you’re like me, and have tried antipsychotics but can’t stand the side effects, perhaps you might want to try a low dose combo route. If your doctor was always pushing the dose (which they usually do) you’ve likely never given the low dose a chance to work. It’s at least worth a conversation with your psychiatrist.

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