My main concern is given the repeated need of hospitalization that stoping the drug will just lead them back to hospital.
It will. With a sort of slow inevitability at times. This is a major problem with psychiatric patients and which is why so much of my clientèle, on admission, is already known to me from past admissions. The usual cycle is for the patient to self-discontinue the medication because either (
a) side effect burden; (
b) various barriers to access from insurance coverage to transportation to having a poor memory to take the medication every day; but of the greatest relevance here (
c) taking the medication, then feeling that one is "alright" or even "cured," and then having the idea that the medication is no longer needed. What usually happens is that after taking the medication the patient will feel the same, if not better (due to side effects abating and possibly a bit of rebound mania) but will not have serious symptoms for a totally unknown period of time ranging from days to months. During this time it is very easy to self-deceive into believing that one can go without the medication, but the future episodes lurk in the future and will strike, at uncertain times and circumstances unknowable, sometimes in the future.
I don't think it'll cause long term damage.
In terms of mentation, it will not, i.e. if you feel your mind is cloudy, this will go away; often times it will go away as the mind and body get used to the medication, sometimes a medication change is in order. The most serious concern with olanzapine is long term and involves metabolic issues, weight gain, diabetes, etc. This is mitigated by modifiable lifestyle changes such as diet and exercise. If you are not obese it is probably not a concern. Apart from this, like most psychiatric medications, it is quite safe; and carries significantly less risk of motor problems, etc. than many other antipsychotics.
I took olanzapine and I feel amphetamines now just fine.
Whether this is a good idea, though, is questionable; as they have opposing actions and the OLZ is being taken for good reason.
I think your doctor should have plenty of options of drugs you can try to replace olanzapine with so you can stay stable without feeling flat. But until then I'd really suggest you keep taking it because if you want to be the one who gets to call the shots and get the meds you feel help you the last thing you want is a bipolar episode so they can call the shots on what you get.
This is sound advice. Discontinuing medication leads to a downward spiral of rehospitalization and will eventually land you in a facility like mine for the long term and severely impaired which is not somewhere that you want to be. In the long term, your mind will
not be permanently fried in any way by taking olanzapine, however, coming off and on medications, and the subsequent episodes, each time you go through the cycle it will get worse. Psychotic or manic episodes, even if they stop, have lasting effects on the brain and psyche and tend to get worse over time. This is more the case for schizophrenics but is valid for bipolar patients too, each episode will be harder to treat than the last, generally speaking, and will, by virtue of that alone, lead to longer hospitalizations, as will non-compliance in general as clinicians will have concerns about compliance and safety in the community.
If this happens long enough not only might you wind up in a long-term facility but you might wind up with some sort of court-ordered outpatient treatment. I don't know how this works in the U.K. but it is more or less the same wherever you go, if I have a patient who is on court-mandated treatment who does not take medication as directed or show up for appointments, I only need to make a few phone call and fax some documents with a few signatures and they will be brought in handcuffed but law enforcement. The court can also mandate you to take long acting injectable medications, given once ever 2-4 weeks or in the case of some of the newer medications, at even longer intervals, there does exist a long-term injectable version of Zyprexa (and Abilify, these are fairly recent; beforehand, we were limited to older drugs like haloperidol and fluphenazine.)
This is actually not a bad thing, plenty of people do it voluntarily, it allows you not to be bothered with taking pills and keeps a more steady level of the medication in your blood, although some don't like it as it can be fairly heavily sedating in the beginning and for obvious reasons the dose isn't easily titrated, but there are well-known and well-designed protocols to change from oral to long-term injectables.
Olanzapine may or may not be the best drug for you; you may or may not need an atypical or typical neuroleptic along with mood stabilizers, but I would strongly suggest that you
not make these decisions around "I can't get high anymore," this is a pretty bad reason, not only because getting high without medication puts you at substantial risk but because it is possible that you will be able to enjoy (some) recreational drugs (with some limits) afterwards; I have always advised my clients
not to do this but have also always oriented my practice towards harm reduction and honesty in the case of those who chose otherwise; I cannot unfortunately say the same for all clinicians (some do drug-testing, and can similarly do so by court order as above, and incarcerate the person until they provide a sample; I never agreed to do so even when I got pressure from the courts and State to do so for a variety of reasons, I felt it damaging to the provider-patient relationship and also to encourage patients to do more dangerous drugs like synthetic cannabinoids and so on to evade the tests; I made it clear to my patients that I would not make a call just because they were using but only due to behavioral issues or non-compliance with medication or appointments.)
But regardless, leave the recreational drugs out of the equation; discuss options, of which there are many, with your doctor, who will likely present you with at least a few alternatives if you are emphatic on not taking the Zyprexa, assuming it's his intention to even keep you on it long-term. Generally, without getting the courts involved, it is a give-and-take and a collaborative relationship of selecting a treatment regimen that is the best for the person in question, from multiple different dimensions, including therapeutic effect, side effects, cost/insurance coverage (in your case as I am given to understand a case still needs to be made with the NHS in order to cover more new and expensive medications, to make this case we have to document that you have had poor response to, or intolerable/dangerous side effects from, more affordable alternatives), etc.
So really, with all the medications out there, and all the possible combinations, there is something that will fit. Don't underestimate the importance of other treatments; cognitive-behavioral therapy (CBT) is very helpful for a very wide range of conditions and it is designed to help you better understand patterns of thought and action that lead to problems, internal and external alike, other forms of supportive therapy can be helpful too. ECT is not really in the picture for you now in all probability but should you get into a really severe state of either mania or depression, it is out there, and can be very helpful.
This post or any of my communications do not constitute professional advice nor do they establish a professional relationship of any kind; I make no claim to any specific professional credentials; in person consultation is essential for any medical, psychological, substance-related or harm reduction decisions. While peer support an advice can be helpful, any content posted online, regardless of it's source, cannot, by it's very nature, substitute for an in-person relationship with a clinician who has had the opportunity to take your history in the larger context and provide professional advice with all these factors, and others, taken into account.
