Differences between Anti-Psychotics: Quetiapine, Olanzapine, Clozapine
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- čas přidán 26. 06. 2024
- This video explores the differences between anti-psychotics, specifically Quetiapine, Olanzapine, and Clozapine.
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The video discusses the differences between antipsychotics: quetiapine (Seroquel), olanzapine (Zyprexa), and clozapine (Clozaril). Quetiapine is approved for schizophrenia, bipolar disorder, and as an adjunct for depression. It is considered a "jack of all trades, master of none" and is useful for Parkinson's psychosis due to its low risk of extrapyramidal side effects. However, it has significant sedation, weight gain, and orthostatic hypotension side effects. The next difference between antipsychotics brings us to Olanzapine is one of the most effective antipsychotics, just below clozapine, but with significant weight gain and metabolic complications. It is effective for mood disorders and acute agitation, and smoking significantly impacts its levels. Anti-psychotic differences are notable in Clozapine, as it is the gold standard for treatment-resistant schizophrenia and reducing suicide risk. Despite its superior efficacy, it has serious side effects like agranulocytosis, myocarditis, constipation, and hypersalivation, requiring strict monitoring. However, it is cost-effective and provides improved outcomes, leading to the conclusion that it is underutilized, but patient adherence and understanding of adverse effects are crucial.
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#psychiatry #psychopharmacology #pmhnp
0:00 Give Up
0:20 Quetiapine
5:45 Olanzapine
11:24 Clozapine Commercial
11:43 Clozapine
Thank you so much for this! I couldn't sleep, still can't, and the doc told me to just pop quetiapine. Not a word of information for off-label use. Reading reviews it's extremely addicting, to the point where you can't sleep without it, and people who've then gotten hooked on it for a few months develop involuntary mouth movements. It's scary. I had a shit job and anxiety - a conversation with my best friend solved half my problems (for a few days) - surely there's more to treating mental "disorders" than literally just drugs. Gosh. I'm so glad I caught this in time!
Your channel is underrated! This is great material.
You got a subscribe just for the Keanu Reeves level of casual yet effortless approach to pharmacokinetics. As soon as I mention specific CYPs, I see life leave people’s eyes and they become just a bored smile politely waiting for me to finish.
Thank you 🙏 great vid I’m glad I found it
Brilliant.my daughter lives independently,works voluntarily ,has friends,relationships.yet pre clozapine she had severe schizophrenia .I have another daughter with schizophrenia been on abilify,no good,seroquel, as well and. Little more than a sleep aid. Please listen mental health, daughter not a lot better, I feel hopeless,as they are so against clozapine
great job as always! keep them coming :))
Aw I thought my phone randomly started playing the postal service. I was excited
Amazing video, would love video like this covering other SGAs like dones and pips/rip!!!
Will be done some day!
im watching ALLLLLLL your videos :)
Very well spoken, you really have to listen because you talk pretty fast. Learning.
Lol to the ad 😂 this is such a good video!
- 🐻❄️
Quetiapine has ALL the binding affinities, like antipsychotics generally, but hydroxyzine, which doesn't get much press, has a similar H1:D2 binding ratio, and is used for sleep and anxiety at the drop of a hat. Central histamine antagonism/inverse agonism is enough by itself to warrant caution in applications like sleep induction even without the D2 antagonism or concerns about muscarinic receptors. NTs that make you be awake and conscious and stop having you be asleep and unconscious ought, in most cases, some might say, to be allowed to do their thing. It may not be as bad to use for insomnia as benzodiazepines, but that's faint praise. Inducing sleep by necessity requires fairly powerful agents.
I appreciate your nuance because it seems like it is not rare for prescribers to take positions like "this class of drug bad, I'll never use it," or "this drug exhibits sufficient efficacy, I'll always use it." Not prescribing n-methyl-α-methylphenylethylamine like you said in your ADHD video gets a pass because good luck getting anyone's insurance to cover it anyway.
what would switching from seroquel to olanzapine do?
i like the anti histamine effect of Seroquel for allergies
I have taken both Zyprexa and Seroquel. The Zyprexa caused a ton of weight gain, and it created ridiculous hyperlipidemia. So, I switched to Seroquel. I have been on Seroquel for about 25 years in total. It has been the best atypical antipsychotic for me. The only other atypical that worked well was Saphris. But, I had to stop taking the sublingual medication because it created nasty blisters under my tongue. But, I'm back on Seroquel. I will probably take this drug for the rest of my days.
Thanks!
Wow thank you! Keep on the lookout, hoping some good new stuff coming out soon 😇
Clozapine worked for me
Thank God 💪
🙏
Zyprexa (Olanzapine) "Thienobenzodiazepine"
-Ontario,Canada
Please talk about capylyta. Your videos helping me understanding a lot in my Psych rotation. You are amazing teacher.
I like the remix of such great heights intro
I wish you would have talked about how some drugs are newer versions of older drugs. For example, Olanzapine (newer) is derived from Clozapine (older) and has less risk of agranulocytosis and therefore decreased need for blood monitoring.
Olanzapine is not a patch on clozapine.
Blood monitoring for my pharmacies clozapine patients is a bane on their existence. I feel so bad for them, but clozapine is a last option here so they've exhausted all their options
Newer versions is not the best term because that implies they act in similar ways, and clozapine and olanzapine have numerous differences. The correct thing to say is that olazapine is a second generation antipsych while clozapine is a first. And yes, with second gens there are less incidences of those side effects mentioned. And yes, clozapine is usually a last resort option these days for treatment resistent schizo bc it is that powerful albeit with numerous side effects
@@Jakey4000 😮
I'm stunned at how well you explain to my idiot peanut brain and I can understand it. Thanks mate.
At last they declared to me that I was becoming dangerous and that they should lock me up in a madhouse if I did not hold my tongue. Then such grief took possession of my soul that my heart was wrung, and I felt as though I were dying; and then . . . then I awoke.
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The one they will take. I feel that so much. It’s hard as a ND to want to take them. It flatlines me which really sucks. Let alone remembering to take it on time.
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Postal service beat in the background?!? I love this already
www.psycho.farm/post/give-up-and-pre-occupied-attachment
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Rolling For Ontario,Canada
16:02 Clozapine is an AGONIST at M4, whereas it is an ANTAGONIST at M1, M2, M3 and M5.
Hey I absolutely love your videos they're insane. Hope you get into medical teaching as well. Do you think you could cover antidepressants in general like SSRIs vs NDRIs vs SNRIs vs MAOis vs tricyclics?
Nobody knows what the 'farm will harvest
* projecting that @@PsychoFarm will do an SSRI vs. SNRI video *
@@Mikielma1 Make an offering to Demeter, the goddess of Harvest
Patent perspective ORLANZAPINE over everything.. Even haloperidol
Apiroprazole is manic hell. And I had to take another med to stop the restless legs and muscle spasms with it. Also felt like I was on speed.
Just about to try quetiapine
Update quetiapine made me do nothing but eat and sleep.
what about vaping ? does that have same 1a2 concern?
In rehab, we used to call it the "Seroquel Shuffle". We would all go take our night meds at the same time and it would basically turn you into a drunk, munchie ridden, zombie. Good times.
😂
Can you do a video on TCAs? Clomipramine and others
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These drugs are shit if you are thinking of starting them, don't. Look up Tardve Dyskesia.
Been seroquel for 20 years plus taking 400 mg and have uncontrollable gagging and retching. Amantidine works with eps.
Why do these meds take so long to work in the beginning?
when all else fails , when do they suggest ECT?
The initial dose of Quetiapine is intense. I can see why it might be abused recreationally.
No different than Thorazine, Thioridazine, Stelazine and low dose Haldol. They are major tranquilizers after all. I prefer the done antipsychotics.
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The + sign next to the receptors name what does it mean?
The plus sign means it hits that receptor.
Hello! What is your opinion on the combination of venlafaxine 150 mg, onzapine 2.5 mg and lyrica 150 mg? I have borderline disorder and severe depression and anxiety...I have the impression that onzapine is helping me. Does onzapine reduce the effects of venlax and can it affect memory? Tnx
was on 150mg venlafaxine and 5mg olanzapine got detox purposes, worked well
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Olanzapine decreases brain in monkeys. But I don't know about it effects on memory.
Also antipsychotics have side effects like tardive dyskinesia, involuntary movements if you take them long enough.
Major concerns on olanzapine is diabetes, cholesterol and weight gain
Wd you care to share how long have you been taking it for and how you manage its side affects. Wil b grateful for your response
Can u talk about newer antipsychotic cariprazine
he'll probably talk about vraylar once he makes a video about abilify and rexulti.
Cariprazine is interesting. The half-life of its metabolite (one of them) is much longer than the parent molecule. That metabolite also has a far greater binding affinity for D3 receptors. Without writing an essay, let me just say that 1.5 mg daily of Vraylar (Cariprazine) is ideal, but you likely won't see huge benefits for some time. After a steady state is reached (6 half lives) of the D3 loving metabolite (months), you might see some D2 binding side effects (because the metabolites of the parent compound start competing to be hepatically metabolized later on) which are generally mild EPS.
@@medicinally is this theoretical or have u seen it happened??
@@summer7529 In my patients, yes 1.5 mg Cariprazine daily has shown good outcomes, but it takes patience.
@@medicinally how many months patience.
And say a person with schizoaffective is on 80-100mg once a day geodon and 1000 mg divalproex and 100mg quetiapine nocte.
Is cariprazine 1.5 dose capable of taking the the load of 100mg zeodon. Talking dose equivalent in terms of preventing relapse.
I feel like I am dying none of the new or old meds is helping me I am bipolar 2 diagnose a 13 it has just gotten worst with the time I feel is better being death I had tried everything I can't use antidepressants they elevate my mania my ocd and ptsd I get in rotating episodes of ptsd depression anxiety ocd mania I am suffering from hardcore insomnia I studied pharmacy tech I've been even in caplyta it gives me migraines I was used as a lab rat for Ect it made everything worse in my life no body seems to help my kidney apparently is in a bad condition I am screaming for help I am trying to go fasting 36 hrs for growth hormones idk what else to do shrooms going to pluto maybe to find the fkn cure to this hell that I am living in i feel like a clown and also if i don't take seroquel I won't sleep for weeks
Try walking. It doesn't do any harm. But it was go to drug for anxiety and depression in the old times. Probably it helps because it mild EMDR therapy. Maybe you wouldn't feel any better. It's really mild medication. But what you have to lose? It's good exercise
800mg would knock me out so bad 😅 idk how people can take that much
If you're talking about seroquel then the higher the dose the less sedating it seems to be once a certain amount of tolerance is built from what I'v read from peoples experiences. Of course it's still sedating but not feeling like you stayed awake for 2 days.
I was on 800 milligrams of Seroquel immediate release. Yes, you build up a tolerance but you never get used to the sluggishness. I hated that more than Haldol personally.
Why is it bad for sleep? I haven’t yet stumbled upon a single pure antihistamine that doesn’t either 1 give me a severe headache 2 hits quickly and leaves quickly.
The side effects suck I’m so fat now that I have money enough to have food at home BUT it hits super fast, like 1 hour max. But like, most importantly it doesn’t make me feel angry the way pure antihistamines do.
Yes you get a bit of restless leg if you have a high ssri dose together with it but like I can’t imagine that I’d have a functional sleep schedule with something like Propiomazine or Promethazine or something.
I have really bad insomnia in part because of vyvanse which I very literally cannot function at all without or even at a lower dose
So if anyone has any recommendations for long term sleep treatment that isn’t quetiapine PLEASE tell me. Anything. (I’ve tried amitryptiline, I’m on the Z drugs, I’ve tried mianserin and mirtazepine, I’ve tried every antidepressant. Any antidepressant that’s more sedative fucks w my life during the day)
CBD oil 👌. Zopiclone seems popular but dependence forming. B6 supplementation but watch out for hypervitamin toxicity tingly feet.
i have really bad insomnia too, i was put on seroquel for sleep while i was in the psych ward bc not even lorazepam knocked me out 😭 other psychs have warned against it but i have tried everything else for sleep and it is the oNLY thing that has allowed me to have consistent sleep for the first time in years.. so im curious just how bad the adverse effects really are bc it is the most effective sedative ive tried
A bicycle+cannabis indica.
Why so negative on seroquel for sleep? I have a very smart attending who uses it on inpatient all the time at low doses
bc that’s lazy medicine. educating on better sleep hygiene is better. cbt is better. at the end of the day, there’s long term effects to antipsychotic. it changes brain chemistry so unless they have indication for that or they’re open to having brain changes, that is lazy.
@@KAFaye-nk5tl that has truth but also fully generalizable against medicine for sleep. When you have 20 inpatients, you are going to want to make sure they sleep and quickly since you only have 3-7 days on average. why not seroquel is the question, when you aren't even hitting d2 at those doses
It's not meant to be used for insomnia. It's highly sedating and that is the only reason psychiatrists use it for sleep. That's why.. instead of prescribing proper insomnia meds. It's cheap psychotherapy and very negligent given the side effects. I was on 800 mgs for Mania. It's terrible. Imo
@@chrispbacon1188 it's nasty stuff indeed..trust me..I have experience..
@@justinebourke9449 yes, it is. I've been on everything. From Thorazine, Stelazine, Zyprexa to Latuda and Abilify. Finally put on Geodon. Works wonders but it turned me Diabetic. My glucose was perfect before I started it. I just can't stand this situation.
I have heard horrible things about Zyprexa
Thoughts on clonazepam taken with olanzapine?
I was on olanzapine and Clonazepam. In my experience, olanzapine is pretty sedating. Though it didn't really help my anxiety. Clonazepam did. Some psychiatrists argue that benzos aren't necessary when being treated with pine atypicals. Especially Quetiapine, Clozapine and Olanzapine. Depends on your diagnosis and your doctor.
I heard horror stories about withdrawal from benzodiazapines. Person awake after coma with epilepsy and disability.
How bad are the anticholinergic effects between 600 mgs of Quetiapine and 10 mg of Olanzapine? The efficacy seems to be equal, but I'm wondering which would cause more memory loss.
From my experience pretty rough with the pine atypicals. IMO two pines together makes it much worse. The dones are way better. Risperidone and ziprasidone etc. Plus your doses are pretty high. Especially being pines. I've only experienced memory loss through benzos. Though like I said, you are on heavy doses. I was on 4 mgs of Risperidone with 800 mgs of Quetiapine. Wasn't pretty. You don't want to mix two pines. A pine and done yes if it's severe. Not two pines. Watch your sugar and weight gain.
@@chrispbacon1188 I don't mean that I take them both. I mean if you only took either 600 mg Quetiapine or 10 mg Olanzapine. Both hit around the same percentage of D2 receptors at these dosages. That being said, I've been told that my memory loss is not through Quetiapine, with the argument being that I have no other anticholinergic effects like constipation, urinary retention, tachycardia or anything else.
@@chrispbacon1188 I also barely gained any weight. And the weight I gained, probably like 2 kgs, I lost it pretty quickly too. I just cut out eating candy and that was it.
I was prescribed 30 mg of olanzapine....is it too much?
I am afraid to develop diabetes with it.
Seems like it. I thought 20mg was the maximum dose for zyprexa.
@@dereks1848I agree. I used to take olazapine at the max 20mg. Now I can actually be able to sleep without it. Mind you am 38 years old and am awaiting a psychological evaluation to check my cognitive memory. (Been forgetting things as of late)
Curious why you wouldn't recommend Seroquel for sleep or baby bear as you so eloquently put it lol. Is it because you believe the medication has more side effects than worth as a mild sedative?
You got it!
Seroquel is very dangerous to have prescribed for sleep and there as much better alternatives that poison almost killed me and I was initially given it as a sleep.
I was in a chemical straitjacket. I was a zombie for 24 hours a day, sleeping incredibly long. When I finally got out of bed, it was a struggle to get to the kitchen.
And then what happens on Seroquel is that it freezes your muscles and shuts your muscle system down. So, it's really hard to walk. And when I did walk I had no control over my ability to stop walking, so I walked into walls.
Olanzapine is good, least adverse effects of any bipolar med I’ve taken. You didn’t mention that Olanzapine is considered first line for post partum psychosis? Or is that an off label use that my hospital embraced. It doesn’t pass through to breastmilk as much as other Antipsychotics apparently. I don’t think most clinicians grasp the receptor-activity-at-different-doses because I’ve never met one that actually wanted to titrate up. “Lowest effective dose” was the mantra. We-ell if the patient can sleep it’s all good? All day as well as all night. Maybe. Seroquel is awful awful awful, it’s all they want to give out of the hospital (when not breastfeeding). And is just a histamine coma, can’t move, except to eat like a grazing baleen whale. Clozapine I’ve heard good things (from psychiatry), haven’t tried.
You didn’t include Mirtazapine. For different dx I suppose. Almost indistinguishable to me, somewhere between seroquel and olanzapine in sedation. And notably inhibits my swallowing though I’ve never read that in the side effects.
Oh and they all seem to come with GI hypomobility which is a welcome sideeffect to IBS-D comorbid patients but not to postpartum patients 😂
The hunger I felt on olanzapine was insane. It was like a black hole in my stomach. I was like a golden retriever or something I just couldn’t not eat. No matter how much I ate or how calorie dense or how much volume I just. Never ever felt satisfied it was like it took away my inability to feel satisfied food wise
Remeron is very interesting, especially when given in the "California Rocket Fuel" combination. Its mechanism of action is very neat, "Mirtazapine is in a group of tetracyclic antidepressants (TeCA). Mirtazapine inhibits the central presynaptic alpha-2-adrenergic receptors, which causes an increased release of serotonin and norepinephrine. Mirtazapine is also sometimes called a noradrenergic and specific serotonergic antidepressant (NaSSA). Noradrenaline is known to have an activating effect on the sympathetic nervous system, explaining the general increase in activity and increased metabolism seen with mirtazapine. It also acts as a potent antagonist of H1 histamine receptors (producing a sedating, calming effect) and 5-HT2A, 5-HT2C, and 5-HT3 serotonin receptors." www.ncbi.nlm.nih.gov/books/NBK519059/
This must be why my psychs have been so hesitant to add Mirtazipine to my Quetiapine in the last times mentioning it! (This was two different psychs through times) -- interesting info
We can use the clozapine quetiapine
My friend use daily quetiapine 100 mg tab but they can clozapine 100mg in place of the quetiqpine
Please give me answer is
Absolute rubbish drugs 😒
lil peep
Huh?
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Every single one of these videos is like a repeat of some sort of strange sales pitch, and none of you can nail down or explain exactly how these medications or neurotoxins are supposed to help somebody other than dumming them down
talk a little faster bro. ADHD meds.
sounds like a personal issue.