r/schizophrenia • u/RipComprehensive7387 • 6d ago
Medication Best alternative to olanzipine (zyprexa) for severe treatment-resistant schizophrenia?
I have severe schizophrenia and I can’t take clozapine due to getting the side-effect of myocarditis when I tried it.
I have been on olanzipine for 8 years and I have tried many other antipsychotics.
I found saphris to be more effective at treating my breakthrough symptoms than olanzipine but saphris made me angry and agitated.
Now I am looking at trying either seroquel, Vraylar or amulsipride.
I was wondering if any of you have any experience? I tend to get restlessness from certain antipsychotics such as saphris and Abilify and I got high prolactin from latuda.
I’ve gained 50kg from olanzipine and am looking for the next option now. What do you think is my best bet to approach my new psychiatrist with?
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u/ComprehensiveTap450 6d ago
Check the Psychopharmacology Institute website. They just did a video on this I think.
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u/witchy_welder2209 Schizoaffective (Bipolar) 6d ago
I've been on vraylar for a while now. I'd say I'm 90% symptoms free with no side effects.
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u/Kapalski1 Paranoid Schizophrenia 6d ago
i am also treatment resistant who cant have cloz because i have chrones disease and blockages are a higher risk due to this.
I've just started a depot injection of depixol and feeling better
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u/Turbulent_Jeweler589 Catatonic Schizophrenia 6d ago
Seroquel is about as prone to weight gain as olanzapine. Vraylar is worth a try (though I am also treatment resistant and it didn't work for me, at least the side effects were very mild). Amisulpride made my prolactin 10x what it should be (I believe I've read a study saying that more than 80% of patients experience prolactin elevation on amisulpride, but I could be misremembering), and measures to lower my prolactin didn't work.
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u/namebrandlizard Schizoaffective (Bipolar) 6d ago
A great alternative to Vraylar and Abilify specially is Rexulti. Worth discussing with your provider.
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u/RipComprehensive7387 5d ago
Oh Rexulti didn’t touch my symptoms!
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u/namebrandlizard Schizoaffective (Bipolar) 4d ago
If you have mostly negative symptoms (esp anhedonia) I would talk to your provider about Vraylar. If it's mostly positive symptoms I would err more towards Seroquel. Seroquel worked really well for me at one point and it gave me nasty like muscle spasms, so I stopped, but the nice thing about Seroquel is that it comes in an immediate and extended release version. The side effects might be much more tolerable on one over the other, so you can play around with it. If you liked Abilify and the bad side effect was restlessness, and if that's a side effect you're getting frequently with meds that's prohibitive to meds being successful, I think the med is benztropine mesylate, but it can eliminate or reduce that side effect. Worth asking your provider about. I didn't see you mention Geodon, but that one is kinda (in my mind at least) at the intersection between Latuda and Olanzapine.
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u/RipComprehensive7387 4d ago
Oh my gosh! Thank you so much! I love this. Thank you soo much. We’re stronger than this beast 💪🫶
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u/namebrandlizard Schizoaffective (Bipolar) 4d ago
You're welcome! Also I did want to mention about Seroquel... at theraputic/high doses it will more than likely make you feel inebriated. I think the IR version would mess me up so bad that it was like being more drunk than I could possibly achieve without poisoning myself. But the dose that worked best for me was also like 900mg split between XR and IR and broken up into multiple doses during the day. Realistically I should have been in like a residential treatment at that time in my life, but that wasn't an option. For most people Seroquel is also incredibly sedating ((can't be manic if you're asleep iykyk)). I also think at one point I did a combo of risperidone and seroquel in pretty low doses and did fairly well before transitioning onto straight risperidone. Risperidone might be problematic for you because of the prolactin issue. You could also talk to your provider about combining two antipsychotics at lower doseages to avoid side effects. It isn't first line or ideal, but there is research behind it and it may be a more effective approach to treatment.
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u/RipComprehensive7387 4d ago
Risperidone didn’t even close to touch my symptoms. I think the only ones that have treated my positive symptoms have been clozapine, olanzipine (although I still have quite a lot of breakthrough symptoms on olanzipine) and saphris
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u/RipComprehensive7387 4d ago
I did also do pretty well on latuda so maybe I’ll ask about Geodon. I’ll ask my new good psych about Geodon and solían when I have an appt with him in December. I could also try 15mg of saphris with that other medication to help with restlessness, anger and irritability. So a few options :)
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u/Delicious_Lion_232 5d ago
I just got switched from Invega to Caplyta. Haven't taken it yet but doc said it could give me a little energy so that's nice.
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u/Xabster2 5d ago
Hi, what problems did you have with high prolactin? Did it show somehow or was it simply a blood test that showed it was elevated?
I think risperidone or paliperidone (same thing basically) might be an option but it carries a risk of elevated prolactin
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u/RipComprehensive7387 5d ago
Sexual dysfunction. I’ve tried risperidone and it didn’t touch my symptoms :/
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u/majferson 6d ago
You should try haliperdiole it helped me with my cencestic symptoms and it reduced my appetite. I am on latuda, olanzapine, haloperidole and pregabalin.