Not sure what to do?

Diagnosed Sz or Sza
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I’ve had 3 episodes of psychosis. The first lasted 2 weeks, the second 6 weeks and the last one about 12 weeks. The last one was dreadful, full of voices, delusions and hallucinations. The first episode happened after stress and drug use. Which then likely triggered schizophrenia. The second episode came after stress with no drug use and the last one involved the use of cocaine. Both relapses happened when off of antipsychotics. Both times I made it for about 5 months off of Olanzapine. Before the last one I was on 5mg Olanzapine for about 2 years and felt very normal on that dose. After I relapsed I was put on 15mg Olanzapine. That was 2 years ago and I have now worked my way down to 7.5mg and have no symptoms except for the odd unusual thought.

I currently have slight side effects which are a complete lack of labido and the other one is that I am less athletic then I was when on 5mg Olanzapine. I have been exercising for a year and can only run at 10 minutes per mile. Although I can run 5 miles. So my fitness isn’t dreadful but it gets me down it’s not as good as it should be.

As far as I see it, I have 3 options. 1 stay as I am. I should mention that I work full time, have a social life and see my son regularly. But again lack the drive to pursue women how I did before the last episode. 2 risk going down to 5mg Olanzapine and possibly relapse. I tried 5mg on Saturday and woke up feeling very different and wasn’t sure if I heard a voice. I was anxious though. Think I could have also been having withdrawals. 3 I have been thinking of trying Brexipiprazole.

What I am aiming for is an improvement in labido and better results with physical fitness and strength training.

Any advice would be really appreciated! As this is playing on my mind. My life isn’t bad but it’s just missing that drive. Appreciate your thoughts just wondering if I should play it safe or risk becoming unwell for more!

Also sorry for the long post. And thank you again for any input!

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On antipsychotics your best bet for libido and athletic performance is abilify

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Tried Aripiprazole when I first became unwell in 2020. When I was on 15mg I could barely get out of bed. Think things got a little better when I got down to 10mg and then progressively better as I was tapered completely off antipsychotics.

Scared to try it again as worried it will make me weak again.

Maybe things would be different this time though?

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Idk something else might have been going on. Id try it again and frankly if it doesnt work for you to switch to newer ap.

What I mean by something else going on was that you first started taking aps so maybe it was difficult to adjust. Idk.

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Thank you for your help. Yeah I have been wondering myself if it could be different this time. If it didn’t work hopefully I could go back on Olanzapine and settle for life as it is now. Which actually isn’t to bad, just trying for a full life!

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You dont have to settle for less theres better meds than olanzapine

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I have been more stable since I gave up trying to create an outcome and just take the meds as prescribed

Much pain was caused for me thinking I could cut this or that out or improve something else

Truth is many side effects can subside after time as I found with clozapine

I said no to clozapine for years as I thought it would be like Olanzapine but I was wrong and that was a mistake

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I feel quite well on Olanzapine and it’s all I’ve ever known really… but would be good to be on something that is better for my health long term.

What other antipsychotics are there that are good for labido, athleticism and low weight gain?

See my psychiatrist on the 29th of this month so hopefully he will have some ideas!

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Yeah definitely see what you’re saying with that. Sometimes best to accept things as they are as it can always be worse!

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Most if them arnt amazing for those things but lots are better than olanzapine.

Abilify

Rexulti

Latuda

Geodon

Vraylar

Cobenfy

Are all new and improved in those areas

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My brain took a hammering for years trying to tweak stuff all the time

I know they like the patient to be involved in the decision making

But they should have been a bit more forceful earlier on to stop the cycle

They did not force the clozapine issue since my last hospital stay

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I have a lot to lose at the moment. Working full time for a council do landscaping. Good wage, pension and sick pay. Definitely don’t want to go mental again and lose it all! I’ve made a lot of progress since my last episode. And have found that with each one everything just gets harder and harder and the symptoms get worse. So you just end up going backwards

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I am working full time also

Had my own landscaping business for quite a few years

It’s a good job but my health these days means I am remote working in IT

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Thanks for that information… I’ve asked about Rexulti with my psychiatrist and just waiting to hear back if they proscribe it in my area.

I’m in the UK so Cobenfy isn’t available at the moment but will hopefully be this year.

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Im on Rexulti

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I’m hoping to be able to give it a try myself. How do you find it affects you physically with exercise and weight gain?

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Weight gain is minimal but if you eat excess calories on it daily then the skys the limit. You wont gain against the laws of physics like with olanzapine though.

For athletic performance its better than the paliperidone i took before but im also 42 years old now so im kinda past my prime.

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I’m 43 now so getting past it physically myself. But making the best of what I can!

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[Antipsychotic medications differ significantly in their propensity to cause weight gain and metabolic disturbances. While many second-generation antipsychotics (SGAs) are associated with weight gain, options exist with lower risk, and proactive lifestyle changes can mitigate this effect.

Weight Gain Liability Profile (Highest to Lowest)

High Risk: Clozapine (Clozaril), Olanzapine (Zyprexa).

Moderate Risk: Quetiapine (Seroquel), Risperidone (Risperdal), Iloperidone (Fanapt).

Low to Weight Neutral: Aripiprazole (Abilify), Ziprasidone (Geodon), Lurasidone (Latuda), Cariprazine (Vraylar), Molindone]–NIH

[Antipsychotic Comparison Chart Antipsychotic Risk of Weight Gain Typical Metabolic Impact:

Clozapine Very High Significant Weight Gain (up to 30+ kg)

Olanzapine Very High High Weight Gain (avg 4.2–7.4 kg)

Quetiapine Moderate/High Moderate-High Gain

Risperidone Moderate Moderate Gain

Asenapine Low/Moderate Generally Mild

Paliperidone Moderate Similar to Risperidone

Aripiprazole Low/Minimal Minimal Gain (0.5–0.9 kg)

Cariprazine Low Minimal/Low

Lurasidone Very Low/Neutral Weight Neutral/Minimal

Ziprasidone Very Low/Neutral Weight Neutral/Minimal

Haloperidol Low (FGA) Usually Weight Neutral]-AI Overview

[Key Findings on Weight Gain Liability Highest Risk:

Clozapine and olanzapine consistently show the most severe weight gain, often resulting in >7% increase from baseline body weight.

Lowest Risk: Lurasidone, ziprasidone, and aripiprazole are frequently recommended for patients at risk of metabolic complications.

Timing: The highest rate of weight gain occurs in the first 3 months of treatment, but it can continue for 1–4 years.

Dose Response: Most antipsychotics show a dose-dependent relationship, where higher doses increase the risk of weight gain. National Institutes of Health (.gov) National Institutes of Health (.gov)

Exercise and Behavioral Management Effectiveness of Exercise: While exercise is generally beneficial, studies have shown that exercise interventions (e.g., walking, strengthening) alone often fail to significantly reduce body weight or BMI in patients already experiencing significant weight gain from antipsychotics.

Combined Approach: A combination of nutritional counseling and cognitive behavioral therapy (CBT) has been shown to be more effective in preventing and reversing weight gain.

Management Strategies: Switching to a lower-risk antipsychotic (e.g., from olanzapine to aripiprazole) is often more effective for weight loss than lifestyle interventions alone.

Metformin Use: Pharmacological intervention, particularly metformin, has strong evidence for reversing or stopping antipsychotic-induced weight gain.]–AI Overview

@Luke83

I view this data as general guidance, but keep in mind that we all react differently to these meds, so there’s still trial and error.

I’ve been taking Seroquel 600mgs/day for years, and I’ve lost about 100lbs over the last 5 years. I limit sugar, carbs and fat, and I eat high protein and fiber. I also ride a stationary bike about 2-3 times per week. As for motivation, I think action leads to motivation. You just have to do it, regardless of how you feel. It’s not easy, but it’s also not impossible.

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Thank you for this…

I should add I don’t lack motivation or effort as have been running between 3 and 4 times per week for the last year and have also been lifting weights for about 3 months. So have been doing between 6 and 7 exercise sessions a week :sweat_smile: have taken this week off as fed up to be honest. More just disappointed with the lack of progress as well

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