Wednesday, January 16, 2008

Symbyax, the miracle pill

In psychiatry most medications take a while to work. It's not uncommon to have to wait 7 to 10 to 14 days until you see some relief of symptoms, especially when it comes to depression. One of the most impressive meds that are available is Symbyax, Symbyax is actually a combination of Prozac and Zyprexa, both Lilly drugs. It is out with an indication for bipolar depression, which is often a complicated disorder to treat. What has been awesome abouth this medication is that people often find significangt relief from their depressive symptoms in as little as 24 to 72 hours! I have had some of the most dramatic benefits in spme of my most depressed and overwhelmed patients, one of whom I saw tonight.

I like to compare Symbyax to a rueben sandwich. a rueben sandwich has components that individually I don't like and yet it is deliciious when it's put together as one package. Not that I don't like Prozac or Zyprexa, but I have had patients that have been on Prozac without benefit and Zyprexa without benefit, but in combination it works great.

A couple of cautions need to be considered with Symbyax, however. Any time you add an antidepresssant to someone with bipolar it is important to watch for manic activation. Generally the Zyprexa protects against it but the antidressant can still cause and increase in anger, mood swings and make things worse over all.

Another problem is sedation and weight gain with the Zyprexa. The problem with weight gain is that the more overweight a person is, the more risk for diabetes. There have been two case reports (of tens of thousands who have been on this medication) of patients developing a severe diabetic reaction (ketoacidosis) upon starting the medication with no wieght gain. This is highly unusual, however, but still very concerning. Sometmes, moreso in males than females, there is some weight gain and then it plateaus at an ok level. The risk of weight gain seems to be about 18%, so 82% probability it won't happen. If there is too much weight gain, this medication may need to scrapped, or, if it is important to continue the medication, there are other medications that can be used to offset the increase in appetite such as Topamax or Symmetrel.

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