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An_253789 posted:
I have rejected "anti-psychotics" because I have never been psychotic. I have racing thoughts, sleep only 3-4 hours a nights with help from klonopin, valium, ambien, Xanax or anything I have been prescribed. Nothing works. I was on Seroquel, slept like a baby, but put on 40 lbs. I am now being taken off trileptal and left on ONLY 200 mg of lamictal with valium to sleep. I am COMPLETELY falling apart. I cry all the time and am so aggressive, I could rip someone's head off. I cannot function, go for a walk or even do the dishes. I want to try LATUDA or GEODON for sleep and racing thoughts, I don't care if they are anti-psychotics or not. I am DESPARATE. I want my old life back! Please help me.
Joseph F Goldberg, MD responded:
Dear An,

That Latuda, Seroquel or Geodon were first studied in schizophrenia (and hence are called antipsychotics) is no more relevant to whether they also have mood value than the fact that Depakote or Tegretol were first studied in epilepsy and are therefore called antiepileptics...means nothing in terms of their possible mood value. Latuda is FDA-approved as an antidepressant for bipolar I disorder, though it has no data in mania (but presumably should work there as no dopamine-blocking drug has ever been shown not to treat mania). It appears to be weight-neutral. Geodon is FDA-approved to treat mania but has 2 negative placebo-controlled trials in bipolar depression, and thought it too seems weight-neutral, there is no evidence that it helps depression.

Dr. G.
gingerladypet replied to Joseph F Goldberg, MD's response:
Dr. - at this point (and for many years) I have had no real depression. It's the lack of sleep & racing thoughts that are my problems. I take 100 mg of lamictal but I seem only to get irritable and aggressive if I increase it. I need a slight kick of an antipsychotic at night to get a good night's sleep, then , if I find any depression, Wellbutrin was advised, as it has no weight gain properties. But, at this point, I am concerned with just sleeping and mood stabilizing. Trileptal has worked well for years as a mood stabilizer, at 900mg, which may have to be tweaked depending on what the Geodon does. If I stay on the Trileptal and the 100 mg of lamictal, IS GEODON A GOOD CHOICE AS AN ANTIPSYCHOTIC FOR SLEEP??? BTW, THANKS ALOT!
Joseph F Goldberg, MD replied to gingerladypet's response:
Dear Ginger, Rather than think of individual symptoms piecemeal, think of the constellation that forms a syndrome to gauge if a medicine would be helpful. If racing thoughts and sleeplessness are part of an incompletely resolved manic episode, Geodon is an appropriate FDA-approved treatment for mania. Sometimes a sleep aid such as Ambien or lunesta can also be useful add-on until the full antimanic effects of an antimanic drug become evident. Dr G

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Joseph F. Goldberg, MD, is a Clinical Professor of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. He also maintains a private prac...More

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