Misc Will I get withdrawals from Olanzapine switching straight to Aripiprazole?

[UK Warrior]

Hi everyone, today when I collected my monthly prescription my Olanzapine 7.5MG was not there, I looked at the repeat prescription and it said "Patient has been changed from olanzapine to aripiprazole and citalopram.

The strength of the aripiprazole is 5MG and the citalopram 10MG.

I am worried that I may get withdrawal symptoms from the olanzapine, or where I am switching straight to another antipsychotic will I be OK?

 

[ShulginsReincarnation]

Hi everyone, today when I collected my monthly prescription my Olanzapine 7.5MG was not there, I looked at the repeat prescription and it said "Patient has been changed from olanzapine to aripiprazole and citalopram.

The strength of the aripiprazole is 5MG and the citalopram 10MG.

I am worried that I may get withdrawal symptoms from the olanzapine, or where I am switching straight to another antipsychotic will I be OK?

Well, I am sure you have figured it out by now, but for anyone who is finding this through the search engine function; it should be fine. Care to share your experience though?

 

[UK Warrior]

Well, I am sure you have figured it out by now, but for anyone who is finding this through the search engine function; it should be fine. Care to share your experience though?

Well, I don't feel as sedated as the olanzapine made me, but this is making me feel bad anxiety and I am finding it very hard to sleep. For the past 2 nights I have been laying in bed until 5AM before I am getting to sleep.
I don't know if this is Olanzapine withdrawal, or the new antipsychotic though.

 

[ShulginsReincarnation]

The olanzapine has a stronger action as an antagonist at the D2 and 5HT2A receptor sites thus it will be more sedating based on this fact alone. Aripiprazole has a really interesting mechanism of action, but (without going into that in great detail) it acts as a partial antagonist at the D2 receptor as opposed to olanzapine which is a full agonist. And, as for the 5HT2A receptor antagonism, olanzapine is 35 times more potent. So, these will be the two primary things resulting in the insomnia you are experiencing now. Combine that with the fact that some people (such as myself) are extremely sensitive to SSRIs like citalopram, and as a result we experience insomnia from this medicine alone. I am not sure that you are taking it as well now as was indicated in the above, but if so then this may be exacerbating the issue you are having at present. Oh, and let me not forget olanzapine is also an a1 receptor antagonist as well as an H1 receptor antagonist which aripiprazole is neither. So, yes, LOTS of sedating things going on with olanzapine that aripiprazole lacks in.

All in all, if you do not experience your sleep cycle returning to normal in the next two weeks or so I would bring it up with the psychiatrist that is treating you. Hopefully they are decent enough to make appropriate adjustments if necessary. Most psychiatrists (not Psych NPs; they are usually useless for the most part in my experience) are pretty good with med adjustments though. Just let them know what's going on and they should work with you.

 

[daturetard]

Well, I don't feel as sedated as the olanzapine made me, but this is making me feel bad anxiety and I am finding it very hard to sleep. For the past 2 nights I have been laying in bed until 5AM before I am getting to sleep.
I don't know if this is Olanzapine withdrawal, or the new antipsychotic though.

Insomnia is definitely something that would be medically referred to as discontinuation syndrome. Normal people who don't do word alchemy would say withdrawal. Did you sleep fine on olanzapine?

 

[UK Warrior]

Insomnia is definitely something that would be medically referred to as discontinuation syndrome. Normal people who don't do word alchemy would say withdrawal. Did you sleep fine on olanzapine?

I thought it could be down to withdrawal/discontinuation syndrome.
Olanzapine helped me sleep all the way through the night.

I have a weird symptom today though, I think the aripiprozole may be starting to work- It feels like I have took a very low dose of MDMA. I am getting slight rushes across my skin, feel very talkative and have a great feeling inside.

I will keep an eye on this though, as i did read in the pamphlet this can happen and be some sort of syndrome?

 

[Keif' Richards]

I'm totally fine with this question being asked. I do feel that this is a question best asked of your doctor though. Bluelight exists essentially due to politics and morality. Drug use has been treated as a moral failing and politics have entrenched this sentiment deep into the foundations of medicine/science. We exist because people cannot get straight answers from their providers regarding addiction, recreational drug use, withdrawal etc. A question like this is pretty straightforward though. I would expect your psychiatrist or even your pharmacist to have a solid answer for you.

 

[ShulginsReincarnation]

I thought it could be down to withdrawal/discontinuation syndrome.
Olanzapine helped me sleep all the way through the night.

I have a weird symptom today though, I think the aripiprozole may be starting to work- It feels like I have took a very low dose of MDMA. I am getting slight rushes across my skin, feel very talkative and have a great feeling inside.

I will keep an eye on this though, as i did read in the pamphlet this can happen and be some sort of syndrome?

Yes, serotonin syndrome due to too much serotonin in the synaptic cleft for too long. It is due to combination of aripiprizole and the SSRI drug you have most likely. Monitor it closely and if it becomes uncomfortable then seek medical attention as it can be dangerous if not treated and is severe. A more rare side effect, but possible.

 

[UK Warrior]

Yes, serotonin syndrome due to too much serotonin in the synaptic cleft for too long. It is due to combination of aripiprizole and the SSRI drug you have most likely. Monitor it closely and if it becomes uncomfortable then seek medical attention as it can be dangerous if not treated and is severe. A more rare side effect, but possible.

I see, thanks for your explanation.

I haven't taken the SSRI for two days as my consultant psychiatrist told me they could make my BPD worse, as they have in the past.

My meds were changed without my knowledge, I only knew when I collected the repeat prescription.

Is it possible it can occur with just the aripiprazole? I feel quite nice to be honest, just a very mild feeling but am content, it is nice.

 

[ShulginsReincarnation]

I see, thanks for your explanation.

I haven't taken the SSRI for two days as my consultant psychiatrist told me they could make my BPD worse, as they have in the past.

My meds were changed without my knowledge, I only knew when I collected the repeat prescription.

Is it possible it can occur with just the aripiprazole? I feel quite nice to be honest, just a very mild feeling but am content, it is nice.

The feeling you are getting is not quite serotonin syndrome related, but rather a somewhat unique combination of neurons re-regulating their activity as a result of the olanzapine withdrawal and the effects of the aripiprazole. I find aripiprazole fascinating due to its mechanism(s) of action to be quite honest, and its a rather ingenious pharmaceutical when used appropriately. There is another similar drug I have yet to investigate (though I have forgotten the name,) but outside of these two newer atypical antipsychotics there have not been many great options for treatment of certain sets of mental disorders that have been developed thus far. Its a very promising class of pharmaceuticals and I cannot wait to see where it leads, but to get to answering your question now (apologies for side-tracking.)

The olanzapine was strongly blocking dopamine’s action at the D2 receptors, and now you have discontinued it abruptly so a rebound effect is being experienced. Plus, being that aripiprazole acts as a partial agonist at D2 receptors which means it is also boosting the dopaminergic activity that is already in overdrive. This is likely what is causing talkativeness and the mild euphoria you feel. It should be an almost stimulant like effect from this aspect of your situation.

Both olanzapine and aripiprazole affect the serotonin receptors, but in a different way. Olanzapine is a strong antagonist at 5HT2A and 5HT2C receptors which would contribute to the increase in energy/boosted mood you may feel due to the withdrawal. Aripiprazole affects the 5HT1A receptors as a partial agonist which should be giving a mild feeling of anxiety relief similar to MDMA (feeling of melting as some may describe it.) The effect at 5HT2 receptors is weaker than olanzapine, so it only slightly blocks the effects of withdrawal here which somewhat mediates the aforementioned rebound effects relative to 5HT2A receptor re-regulation. Collectively this could elicit an empathogenic effect or a feeling of being more connected with others and/or animals for example.

MDMA primarily increases serotonin release and, to a lesser extent, dopamine and norepinephrine. The combination of dopaminergic rebound from olanzapine withdrawal and aripiprazole’s partial agonist activity at serotonin and dopamine receptors could mimic mild MDMA effects, such as euphoria, increased energy, and a sense of well-being.

So, in summary, the overlap between dopamine and serotonin system modulations by aripiprazole and the rebound effects from olanzapine withdrawal likely explain the MDMA-like feelings. These effects highlight the importance of gradual medication changes to avoid such unintended and potentially destabilizing experiences.

Honestly, whoever switched the meds this rapidly was doing a somewhat poor job as a psychiatrist, but I figure it was an honest mistake. Psychiatrists are often overworked and stressed due to the demands of the job they hold, but that should be no excuse. However, I myself sometimes slip up as I did earlier this evening when discussing pharmacology in a group setting. But, seeing as I was the most educated person in the room regarding such at that point in time there was no uproar. However, I know I made the mistake myself so I will take note, correct my mistake internally, and if it comes up again remember my fault. This is how most people operate, and as I said before: the psychiatrist will likely work with you if your mood doesn’t stabilize in about two weeks or so as your brain adjusts to the rapid shift in medications. Try not to make any major decisions until this time; that is the best advice I have at this time for you considering your current situation.

Hope all works out well for you once things settle!!

P.S. I am exhausted after having gotten only 4 hours of sleep last night and still being awake now due to writing an essay with supporting evidence backing my opinion on why drugs should be legalized and regulated for the sake of both the lives of both drug users and society as a collective which I just got done presenting to a group and having a lengthy discussion thereafter. I hope you will understand if there are any minor errors in grammar or repetitions of facts as I was having some difficulty with linear thinking at points during my explaining the above, though I hope I did correct the mistakes when I reviewed everything. Thank you for your patience with me on this matter; it is greatly appreciated

 

[ShulginsReincarnation]

I'm totally fine with this question being asked. I do feel that this is a question best asked of your doctor though. Bluelight exists essentially due to politics and morality. Drug use has been treated as a moral failing and politics have entrenched this sentiment deep into the foundations of medicine/science. We exist because people cannot get straight answers from their providers regarding addiction, recreational drug use, withdrawal etc. A question like this is pretty straightforward though. I would expect your psychiatrist or even your pharmacist to have a solid answer for you.

Maybe, or maybe not. I often times seem to have more sophisticated knowledge than many medical professionals I have met in the field of psychiatry and addiction psychology regarding questions such as these. I do entirely understand where you are coming from, and in a perfect world I would agree. However, I did my best to answer the question based on my intricate knowledge of this particular field of study (coupled with some first hand experience dealing with similar right now with a loved one interestingly enough.) If OP would like to present my answer to their psychiatrist or pharmacist for review they may feel free, but anyone with a sophisticated knowledge of psychiatry/addiction medicine should be capable of grasping my interpretation of what OP is experiencing. If they have any rebuttals I would love to hear them because I really doubt any doctor would be able to provide much better of an explanation than I just did to be quite frank.

P.S. I didn't see your comment in the other thread until just now; I think maybe I am speaking too much on pharmacology in these replies. Headed to the neuroscience/pharmacology section from now on until I figure out how to answer questions more appropriately in these situations. Thanks again though for the advice!

 

[UK Warrior]

I'm totally fine with this question being asked. I do feel that this is a question best asked of your doctor though. Bluelight exists essentially due to politics and morality. Drug use has been treated as a moral failing and politics have entrenched this sentiment deep into the foundations of medicine/science. We exist because people cannot get straight answers from their providers regarding addiction, recreational drug use, withdrawal etc. A question like this is pretty straightforward though. I would expect your psychiatrist or even your pharmacist to have a solid answer for you.

I do apologise here, most of my questions are regarding addiction and recreational use, I just knew that bluelight was a great resource and I would likely get a helpful answer for it.

I did already ask my pharmacist when I got the medication, and was just told the potential side effects of Aripiprazole, they was unsure when I asked about stopping the olanzapine so could not give me an answer.

Regarding my psychiatrist, I am in the UK and go through a primary care centre and only see my psychiatrist every 3 months for review. Unfortunately if I phone the primary care centre I just get through to a receptionist who can take your queries, then pass them on to the psychiatrist-thats if they deem them to be important enough to even go to them.
I once waited two weeks to hear back on the phone in a question regarding my olanzapine.

I just understood bluelight to be a great resource for all sorts of drugs, and where I was expecting too and am experiencing a withdrawal wanted to speak to people on here.

Again, I do apologise if its not what bluelight is for, and I hope this comes across the right way as text can sometimes seem blunt.

 

[UK Warrior]

The feeling you are getting is not quite serotonin syndrome related, but rather a somewhat unique combination of neurons re-regulating their activity as a result of the olanzapine withdrawal and the effects of the aripiprazole. I find aripiprazole fascinating due to its mechanism(s) of action to be quite honest, and its a rather ingenious pharmaceutical when used appropriately. There is another similar drug I have yet to investigate (though I have forgotten the name,) but outside of these two newer atypical antipsychotics there have not been many great options for treatment of certain sets of mental disorders that have been developed thus far. Its a very promising class of pharmaceuticals and I cannot wait to see where it leads, but to get to answering your question now (apologies for side-tracking.)

The olanzapine was strongly blocking dopamine’s action at the D2 receptors, and now you have discontinued it abruptly so a rebound effect is being experienced. Plus, being that aripiprazole acts as a partial agonist at D2 receptors which means it is also boosting the dopaminergic activity that is already in overdrive. This is likely what is causing talkativeness and the mild euphoria you feel. It should be an almost stimulant like effect from this aspect of your situation.

Both olanzapine and aripiprazole affect the serotonin receptors, but in a different way. Olanzapine is a strong antagonist at 5HT2A and 5HT2C receptors which would contribute to the increase in energy/boosted mood you may feel due to the withdrawal. Aripiprazole affects the 5HT1A receptors as a partial agonist which should be giving a mild feeling of anxiety relief similar to MDMA (feeling of melting as some may describe it.) The effect at 5HT2 receptors is weaker than olanzapine, so it only slightly blocks the effects of withdrawal here which somewhat mediates the aforementioned rebound effects relative to 5HT2A receptor re-regulation. Collectively this could elicit an empathogenic effect or a feeling of being more connected with others and/or animals for example.

MDMA primarily increases serotonin release and, to a lesser extent, dopamine and norepinephrine. The combination of dopaminergic rebound from olanzapine withdrawal and aripiprazole’s partial agonist activity at serotonin and dopamine receptors could mimic mild MDMA effects, such as euphoria, increased energy, and a sense of well-being.

So, in summary, the overlap between dopamine and serotonin system modulations by aripiprazole and the rebound effects from olanzapine withdrawal likely explain the MDMA-like feelings. These effects highlight the importance of gradual medication changes to avoid such unintended and potentially destabilizing experiences.

Honestly, whoever switched the meds this rapidly was doing a somewhat poor job as a psychiatrist, but I figure it was an honest mistake. Psychiatrists are often overworked and stressed due to the demands of the job they hold, but that should be no excuse. However, I myself sometimes slip up as I did earlier this evening when discussing pharmacology in a group setting. But, seeing as I was the most educated person in the room regarding such at that point in time there was no uproar. However, I know I made the mistake myself so I will take note, correct my mistake internally, and if it comes up again remember my fault. This is how most people operate, and as I said before: the psychiatrist will likely work with you if your mood doesn’t stabilize in about two weeks or so as your brain adjusts to the rapid shift in medications. Try not to make any major decisions until this time; that is the best advice I have at this time for you considering your current situation.

Hope all works out well for you once things settle!!

P.S. I am exhausted after having gotten only 4 hours of sleep last night and still being awake now due to writing an essay with supporting evidence backing my opinion on why drugs should be legalized and regulated for the sake of both the lives of both drug users and society as a collective which I just got done presenting to a group and having a lengthy discussion thereafter. I hope you will understand if there are any minor errors in grammar or repetitions of facts as I was having some difficulty with linear thinking at points during my explaining the above, though I hope I did correct the mistakes when I reviewed everything. Thank you for your patience with me on this matter; it is greatly appreciated

I see, I am glad I am not imagining the feeling and it is indeed related to my medication switch. You say aripiprazole is rather ingenious, does this mean it will likely treat my bi-polar and related depression better than the olanzapine? The olanzapine stopped my manic episodes but made me not really want to do anything. However I felt stable.

Yes, I guess the feeling can be described as kind of melting. It is nice, I wont lie.

I agree it was poor to be switched like this, especially without my knowledge or consent. I last saw my psychiatrist around a month ago and explained about my depression, and was told they may lower my olanzapine and add an antidepressant which I consented too.
I didn't realise they would change the antipsychotic though, especially feeling stable on it for 2 years.
I understand they may well be overworked as you say though.

Thank you, I hope things work out too

No need to explain yourself, you have really helped me with your answers!

 

[ShulginsReincarnation]

You say aripiprazole is rather ingenious, does this mean it will likely treat my bi-polar and related depression better than the olanzapine? The olanzapine stopped my manic episodes but made me not really want to do anything. However I felt stable.

Yes, the aripiprazole could definitely help with the bipolar and related depression better than olanzapine which would only function as you described. If for whatever reason the aripiprazole does not work on its own, then adjunct medications such as an antidepressant (likely of a different class of drug than citalopram in your specific case; atypical antidepressants such as mirtazapine or bupropion come to mind here as they have less chance of worsening the bipolar disorder) or another form of mood stabilizer (such as valproate, lamotrigine, or lithium) can be added.

Aripiprazole was originally designed to be used as a secondary medication rather than a primary treatment option from what I was taught, but the use of aripiprazole on its own for the treatment of certain mental illnesses such as bipolar disorder once certain symptoms are brought under control with antipsychotics (usually olanzapine these days) seems to be growing in popularity with psychiatrists. The results are usually favorable in the cases I have seen thus far which is great news! However individual results may vary depending on a person's biochemistry, so it is always best to be open and communicate well with your psychiatrist regarding any concerns you may have as soon as they occur

I am very glad that I have helped you get the answers you were seeking. If you need anything else, I will be around these forums regularly now so feel free to reach out.