Clozapine for psychosis

[Bhj]

Hi. I’ve been told by my psychiatrist today that starting on clozapine is an option as I’ve tried 3 different anti psychotics which have not had an effect on my paranoid delusions. I’ve been told this is usually only used when other anti psychotics haven’t worked. Anyone had any success stories with clozapine after others have failed?

I went on Clozapine for a few months last year and it did get me out of a difficult period. The titration is very slow and so it did take quite a while to reach a therapeutic dose as it can make you neutropenic. There was also lots of blood tests. You are also only given a weeks supply at a time and only from a particular pharmacy (mine was a hospital pharmacy). I'm glad I took it as it did help, but I didn't want to take it long term as I found my thought process slowed considerably and also struggled to wake up in the night for my children. If you have any questions please ask. Good luck with whatever you decide to do.

Thank you for your reply. That’s helpful to know. I’m a bit worried about the slowing down thought process bit as I had that when I was on risperidone which was also very numbing. Did you feel any emotions while you were taking it? He also said I would have to stay in hospital when I first start taking it, was this the same for you? And if so how long did you have to stay in for?

The important thing to remember is that all the medications effect people in different ways, so you may not experience the slowing down of the thought process that I did. Where I live, you can commence clozapine therapy in the community, but means daily visits from a specialist team. At the time I was quite unwell, I had a 9 month old daughter so started it in the Mother and Baby mental health unit. I was there about 3 months.
For me it was a last resort, it was pretty much the only antipsychotic I hadn't tried. Has he suggested any other options?

He said I had 3 options which is to either stay on lurasidone a while longer as they changed the dose 3 weeks ago to the highest dose or I can try amilspride which can have a lot of side effects or the clozapine. Over the last 3 years I have been on risperidone, aripiprizole and lurasidone and have also had cbt. I told him I’d like to stay on lurasidone till after Christmas as I haven’t had any bad side effects and don’t want to start something else before and not be able to act enthusiastic about Christmas for the kids. I just don’t know what to do next, the truth is I don’t believe I’m Ill and the more anti psychotics I take that don’t work just seem to reinforce that belief each time.

Have you considered being reviewed by another Psychiatrist? You are able to request this. They may have fresh ideas to try. There are so many other antipsychotics available. I really would only take clozapine as a last resort. But obviously your consultant knows the whole situation. Perhaps a review with someone else might help with your queries about diagnosis? Do you feel safe at the moment? Have you got CPN support?

Yes I was referred to the early intervention team 3 years ago June just gone when it all started. The thing is they usually only see people for 3 years and that was up in June so I don’t know whether they just want to hurry the process up a bit to get me off their caseload. It’s probably not but it sort of feels that way. That’s a good idea to ask to speak to one of the other psychiatrists and see if they have any other suggestions. Thank you for your reply.

Am I right in thinking that you haven't tried Quetiapine or Olanzapine? Quetiapine has been a lifesaver for me.

I know someone on Clozapine and he has had a lot of side effects and the weight gain has been bad. However, it's really helped his symptoms.