Living with Bipolar Disorder: Changing Antipsychotic Medication

Rochdalestu

Medication Explained: Olanzapine 💊

So, I’m currently on 750mg of Quetiapine daily for my Bipolar Mania. It’s been with me since before Christmas and now I’m fed up with it. So I saw my Psychiatrist and we started off by stopping the Mirtazapine I was on. Antidepressants can worsen mania in Bipolar is the long and short of it from what I was told. Then we started to increase the Quetiapine. I was on 300mg at night and 100mg in morn (I think? Too lazy to check it so will update later if wrong), and I gradually worked up to the current dosage of 750mg. I take 500 mg at bedtime and then I take 250mg each morning. You would think that would wipe me out wouldn’t you?? Nooooo, I’m just staring at the ceiling. Taking the nighttime meds at 9pm, it’s 3am at the earliest/latest (depends how you look at it) that I drift off. I’m normally awake at 4am or 5am if I’m actually getting some sleep. Sometimes I just don’t sleep whatever. So I’m deceasing the night dose to 400mg, and then this Monday coming (17/07/23), I’ll be starting the Olanzapine.

Just to give you a bit of context, my Psychiatrist doesn’t like to prescribe Benzodiazepines whatsoever. However, my Practitioner said that I was the first person who they knew of to be prescribed any. The last four weeks I have been on 1mg Lorazepam too. I may have slurred my speech a little and appeared a tad docile, but it didn’t help for sleep or the mania.

Background of Olanzapine

Olanzapine is a thienobenzodiazepine classified as an atypical or second-generation antipsychotic agent. The second-generation antipsychotics were introduces in the 90s and quickly gained traction due to their impressive efficacy, reduced risk for extrapyramidal side effects and reduced susceptibility to drug-drug interactions. Olanzapine very closely resembles Clozapine and only differs by two additional methyl groups and the absence of a chloride group. It was discovered by scientists at Eli Lilly

Administration

Olanzapine was initially used orally and intramuscularly for the chronic treatment of schizophrenia in patients over 13 years old and other psychiatric disorders such as bipolar disorder including mixed or manic episodes.

Olanzapine is also indicated, in combination with lithium or valproate for the short-term treatment of acute manic or mixed episodes associated with bipolar disorder in adults. Furthermore, in combination with Fluoxetine, it improves the treatment of episodes of depression associated with bipolar disorder.

Mechanics of Action

The effect of olanzapine in the Dopamine D2 receptor is reported to produce the positive effects of this drug such as a decrease in hallucinations, delusions, disorganised speech, thought, and behaviour. On the other hand, its effect on the serotonin 5HT2A receptor prevents the onset of anhedonia (inability to feel pleasure), flat affect (showing no emotion), avolition (inability to initiate and/or pursue goal activities), and poor attention.

Based on the specific mechanism of action, Olanzapine presents a higher affinity for the Dopamine D2 receptor when compared to the rest of the Dopamine receptor isotypes. This characteristic significantly reduces the presence of side effects.

The activity of olanzapine is achieved by the antagonism of multiple neuronal receptors including the Dopamine receptor D1, D2, D3 and D4 in the brain, the Serotonin receptors 5HT2A, 5HT2C, 5HT3 and 5HT6, the alpha-1 adrenergic receptor, the histamine receptor H1 and multiple muscarinic receptors.

As aforementioned, olanzapine presents a wide profile of targets, however, its antagonistic effect towards the Dopamine D2 receptor in the mesolimbic pathway is key as it blocks Dopamine from having a potential action at the post-synaptic receptor. The binding of Olanzapine to the Dopamine D2 receptors is easily dissociable and hence, it allows for a certain degree of dopamine neurotransmission.

It’s been reported that you can become irritable and agitated with taking Olanzapine initially. You can get very short tempered. Well, come on, if we’ve got this far then we already know all about the ‘Bipolar Rollercoaster’ we’re riding day in, day out! I hate being Bipolar, it’s absolutely amazing! 😜

19 thoughts on “Living with Bipolar Disorder: Changing Antipsychotic Medication”

  1. Antidepressants can indeed sometime worsen mania generally, not only in Bipolar, which is the typical. In some cases of OCD and severe depression, these manic or hypomanic episodes might be connected to factors like medication side effects, exacerbation of anxiety disorders, mood swings, comorbidities etc. When I had related episodes at first I was feeling like I could do anything, so happy, but later I was extremely dipressed, but yet with so much unnecessary energy. I can’t sleep good either even when I’m good. I have it from my childhood. And yes, I have asked, I don’t have bipolar😅and btw don’t let me started about fluoxetine, it exacerbated everything for me for Gods sake😅😅, but your new atypical antipsychotic looks great in comparison to other medicines. Does it fit you well?

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  2. We have a unhealthy appetite for naming, categorising and segregating ourselves for one another. Giving an illness a name doesn’t mean that the body recognises it. We seem to be like an amoeba and trying to separate ourselves to make our ailments subjective and objective. I have embraced my ‘illness’ and accepted it, I feel a lot better for it. I have a different pattern of behaviours than most. Sleep for example, I have been 11 days without. My personality is a disorder though isn’t it?! 😂 you are you, I am me, we’re individually unique yet fundamentally identical. If we were to sit with our relative health professionals for a few hours and we were able to try to explain how things are living with what we do (we are the experts) then it would be beneficial for both. But it’s something that seldom happens and we are branded as what they think we are. Bipolar, depression, anxiety, schizophrenia et al will still be as prevalent today in 20 years or more time if we aren’t given any opportunity to talk about it and listened to. My opinion anyway

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  3. Regards to the Olazapine, it’s a slow process but I don’t know if it’s responsible for the mania subsiding or if it’s a natural process of the bipolar. I’m not hungry but then I have a meal and I can’t stop eating. I’m not sleeping great but it’s apparently a good sleep aid of label. Not too much for me. I’m reading up about atypical antipsychotics and the more I do I see how they have limited success but carry some serious serious side effects. I’m told that If I stopped my medication (I’m on lithium too) I would be at risk of extreme things blah blah. I think it’s the medication that will do me more harm than the bipolar in the long run

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  4. The important thing is to find what fits better for you. I know everything can have side effects, but in my opinion you see what medicine give you the most benefits with the less side effects and then U take it. U will have side effects either way, I have too. U could have manic episodes also either way, I don’t believe these specific pills made mania worst. I believe in disorders like these you have to take something, it can help a little bit or more. Of course I’m talking about the right medication for you.

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  5. Moreover could U be better without medication at all? For me I could be without but I couldn’t have a quality of life. In exacerbations I was extremely bad. Of course now I still have issues and disorders but I can manage it so much better with the right professional, medication and most of all with my personal effort too.

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  6. Absolutely. These medications aren’t a cure for this illness. They’re merely a remedy to keep it manageable. When you think how severe bipolar is for example, you have to have something that can contend with the bipolar, meaning that it will be heavy duty. If you think of it as a crowd of people at a party and the medication arrives and then sees a friend in the crowd, as it goes to them, others move out the way, creating a ripple effect of imbalance just like in the body. To make an omelette you have to crack a few eggs

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  7. That’s why I tell you I can only imagine about bipolar. I know about mental health struggles but they say bipolar are one of the most difficult, so I really admire your attitude. It must indeed be extremely difficult. I really wish every day U find the strength to move on.

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  8. I’m not sure what would happen Medication free. I was on 750mg Quetiapine and at the time I had to finish work, been told that I most probably won’t be well enough to work again (I’m 40), and now I am on Olazapine and I’m still struggling with shit, lithium and Olazapine are making the days manageable but I still feel the impact of the mania and depression. I have self harmed before and I feel that Im told without medication that I would be a danger to myself. Also as I’m under psychiatric care If I refused medication I would probably be detained under the mental health act on advise of my health care professionals

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  9. Although I’m not a therapist, I strongly suggest U To always take your medication. I’m sure U feel bad but it will be so much worst without. We are not talking about an easy condition. If this meditation is not good for U, could U try something else with ur doctor? I was experiment with mine until we found the most appropriate medication for me. Still with side affects but there are no comparison with my older non appropriate medication that made all more difficult and with the non medication at all.

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  10. For me I cant work or do every day things without any medication. Even if depression is out of picture, OCD can’t be stopped just alone. I do my exercises but we are talking about nearly existing without medication. U will be in danger even for your life so yes U have to take something (the right one thing).

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  11. I always do take my meds. You are right about talking with the psychiatrist and that’s exactly what I try to do. I am constantly reading and researching the medication and I said that the Quetiapine wasn’t working properly and then they upped the dose gradually to the max and then they changed it to the olanzapine. From what I have read and understood, there’s no real fundamental difference between the antipsychotics other than the atypical ones having less side effects than typical. I believe it’s about finding the right one to make you function. It’s the same with antidepressants, I responded really well to Mirtazapine but Sertraline was horrendous for me.

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  12. Absolutely. At the end of the day we need to do what is right for us and not be concerned about what the next person would do. True perfection has to be imperfect doesn’t it

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  13. Sertraline was mediocre for me but with serious side effects so it wasn’t worth it. You can tell to your daughter what U read what to believe about the medicines and let you guide U. I did exactly this and we discuss about these issues. The non typical antipsychotics have indeed less side effects, I think they are better considering the side effects. If U Want to try smt typical, I believe the quantity must be smaller cause of the many side effects.

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  16. I had 3 epileptic type seizures on sertraline as I had Tramadol too. To this day it’s not been found out why but I think it’s serotonin Syndrome but I’ll never know. Sertraline made me feel similar to being on ecstasy initially then I just felt terrible. I’ve got a blog about how it works. Im not sure if they still prescribe the typical antipsychotics anymore because of the pyramidal side effects. At the end of the day it’s about taking one day at a time and if it’s not broke then don’t try to fix it. I’m just hoping that I can have more input on my thoughts with the health professionals. I’m starting psychotherapy on Monday so I’ll see what happens

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  18. Thank you 🙏 I will be given fluoxetine when I have depressive phase as it’s effective in combination with olanzapine. Fingers crossed that if I do have it it works out for me.

    I wish you all the best too and I have enjoyed chatting with you tonight. I hope you have a very pleasant weekend

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