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BDD Moderators: Keif’ Richards | negrogesic
Antipsychotics and Opioids
- Thread starter evo4ever
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Don't have personal experience with antipsychotics but i would assume they reduce opioid euphoria.
Nor can I imagine anyone wanting to take them together. But for grins sake, assume someone had been taking Geodon for schizoprenia, was on a stable dose and doing well, I suspect that the euphoria would be present (and welcome). Best I recall there is zero affinity for the opioid receptors, but given how all the circuitry reciprocally affect things like the opioid network, it may not be straight forward. Why we are on the subject--how do salvia lipids such as salvinorin A which appears to be a bad-assed opioid (kappa) receptor agonist produce psychedelic experiences. I know that some academics want to call them dissociative but I aint buying.
I'm asking this because my Psychiatrist wants to put me on Olanzapine to try and get some of my most troublesome BPD symptoms under control. I'm also a chronic pain sufferer too and I'm prescribed Oxycodone 120mg daily (30mg QDS) and Pregabalin 300mg daily (100mg TDS).
If I were in your shoes, I'd try it. Worst case you have to discontinue the Olanzapine and maybe endure a few days of increased pain. Untreated bipolar symptoms can be distressing at best--especially the god awful depressive and mixed phases--and at worst, full blown episodes that can have tragic, even fatal endings. In the end, it's a risk/benefit analysis. I'd take the risk. Besides the Pregabalin which is essentially useless for bipolar, what other meds are you taking? I ask only because there may be some other options available to you.
I haven't got Bipolar I've got Borderline Personality Disorder with comorbid Major Depressive Disorder and Generalised Anxiety Disorder. The Pregabalin is for my chronic neuropathy and Generalised Anxiety Disorder. I'm also on Mirtazapine 45mg for my Major Depressive Disorder.
My bad--read as BMD, not BPD. Mirtazapine is a good med, one I take myself, and a pretty damn good sleeper that goes underutilized. Figured the gabapentin was for pain, but has been used for bipolar with lousy results. I'd still try it--back in the day, we'd often prescibe small amts of haldol for the same reason. Do you think it helps with the anxiety--shortage of good meds that are not SSRI's or highly addictive benzos....
Yeah I think Pregabalin is quite effective for anxiety, it's also good for insomnia too imo. I do get the occasional benzo when things get really bad incase I shift into a uncontrollable violent emotional state 
. I can feel happy, sad, cheerful, aggressive, violent, and many more emotions in one day, sometimes even within a few hours thanks to my BPD.
. I can feel happy, sad, cheerful, aggressive, violent, and many more emotions in one day, sometimes even within a few hours thanks to my BPD.
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I read some case report about heroin addicts going into spontaneous withdrawal like symptoms after taking olanzapine (without reducing their normal opiate intake).
I've experienced such symptoms before after taking a high dose of olanzapine while being opioid dependant, although I would say it felt more like side effects from the drug that were similar but not the same as opioid withdrawal. Dosing opioids did relieve the symptoms, though... (mostly RLS)
I've experienced such symptoms before after taking a high dose of olanzapine while being opioid dependant, although I would say it felt more like side effects from the drug that were similar but not the same as opioid withdrawal. Dosing opioids did relieve the symptoms, though... (mostly RLS)
- Joined
- Jul 21, 2002
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- 12,052
Olanzapine doesn't seem called for based on what you've described but I don't have all the info so who knows.
That said, antipsychotics should generally avoided unless they are absolutely necessary. Especially a pretty heavy duty one like olanzapine.
Personality disorders are tricky to treat, and antipsychotics are a pretty controversial pharmacotherapy for treating them. Personality disorders themselves are controversial.
Here is a decent sized study that evaluated olanzapine's efficacy in treating borderline personality disorder that came up short.
Olanzapine for the treatment of borderline personality disorder: variable dose 12-week randomised double-blind placebo-controlled study - PubMed
Individuals treated with olanzapine and placebo showed significant but not statistically different improvements on overall symptoms of borderline personality disorder. The types of adverse events observed with olanzapine treatment appeared similar to those observed previously in adult populations.
pubmed.ncbi.nlm.nih.gov
Of course olanzapine can be used for treatment resistant depression in certain cases so again who knows what your history looks like.
Personaly i feel antipsychotics are over used and I believe in time this will be consensus on this. But then again, you might very well benefit from them.
Olanzapine doesn't seem called for based on what you've described but I don't have all the info so who knows.
That said, antipsychotics should generally avoided unless they are absolutely necessary. Especially a pretty heavy duty one like olanzapine.
Personality disorders are tricky to treat, and antipsychotics are a pretty controversial pharmacotherapy for treating them. Personality disorders themselves are controversial.
Here is a decent sized study that evaluated olanzapine's efficacy in treating borderline personality disorder that came up short.
Olanzapine for the treatment of borderline personality disorder: variable dose 12-week randomised double-blind placebo-controlled study - PubMed
Individuals treated with olanzapine and placebo showed significant but not statistically different improvements on overall symptoms of borderline personality disorder. The types of adverse events observed with olanzapine treatment appeared similar to those observed previously in adult populations.
Of course olanzapine can be used for treatment resistant depression in certain cases so again who knows what your history looks like.
Personaly i feel antipsychotics are over used and I believe in time this will be consensus on this. But then again, you might very well benefit from them.
Yeah the main treatment for BPD is Dialectical Behavioural Therapy but you can treat BPD symptomatically with medication as well if some of the symptoms become particularly severe and chronic. Theres been multiple clinical trials treating BPD symptoms with antipsychotics over the years with some positive results but it's highly individualized and antipsychotics might not be suitable for everyone. The most promising antipsychotic for BPD is Olanzapine followed by Quetiapine. The reason why personality disorders are controversial is because they're hard to diagnose but they do exist clinically speaking!
I am not surprised that the results were meh. Hell most trials, even those that reach a p<0.05 generally have a mild impact on the illness. I also agree, and don't get me standing on a soapbox that antipsychotics are over-prescribed and even mixed as in a dab of this a dob of that, usually based on the prescriber's "experience" ie, shorthand for I havent a fucking clue but lets try it anyway, sure there some receptors we haven't bombed.... I get especially incensed when kids are involved. Sure you're gonna be an anhedonic robot, but that will teach you for acting out. But I also know a great adolescent and kiddy shrink who has cases where she is convinced the AP's are indicated. And just going on experience that a) BPD is ego-dystonic beyond belief, and that a low dose trial is worth a shot. Used to call Haldol "personality glue" for the effect seen on internal state regulation.Olanzapine doesn't seem called for based on what you've described but I don't have all the info so who knows.
That said, antipsychotics should generally avoided unless they are absolutely necessary. Especially a pretty heavy duty one like olanzapine.
Personality disorders are tricky to treat, and antipsychotics are a pretty controversial pharmacotherapy for treating them. Personality disorders themselves are controversial.
Here is a decent sized study that evaluated olanzapine's efficacy in treating borderline personality disorder that came up short.
Olanzapine for the treatment of borderline personality disorder: variable dose 12-week randomised double-blind placebo-controlled study - PubMed
Individuals treated with olanzapine and placebo showed significant but not statistically different improvements on overall symptoms of borderline personality disorder. The types of adverse events observed with olanzapine treatment appeared similar to those observed previously in adult populations.
Of course olanzapine can be used for treatment resistant depression in certain cases so again who knows what your history looks like.
Personaly i feel antipsychotics are over used and I believe in time this will be consensus on this. But then again, you might very well benefit from them.