Olanzapine and Quietapine for Bipolar

[Lullabycrickets23]

Hello everyone!
I am the partner of someone with Bipolar and psychosis. After a section in 2018 DP has been fairly stable without major relapse.
Now DP and s going through a worsening crisis and CMHT has been useless and actually put them at higher risk or relapsing.
we consulted a private psychiatrist and recommended incorporating a low dose of Quietapine to the usual Olanzapine + Fluoexetine. This would be to calm DP and ease the severe anxiety they experience and that leads to alcohol or Weed misuse.
I am worried that the GP won’t prescribe the combination as it is generally not recommended for the cholesterol profile and weight gain.
Does anyone has experience of this combination and can shed a light if it would be useful?
The psychiatrist also plans to change the antidepressants as ut might be the one not working anymore, but first would try this combination.
Just looking for experience with a double antipsychotic really.
thanks

I thought it was kind of one or the other, with olanzapine being the stronger of the two. There might be some here on both tho x

Yeah I thought that too and it seems to be the general consensus. So that’s why ai am not sure of what the benefits are are if they outweigh the risks.

Quietiapine is often used as a booster for other antipsychotics, so it doesn’t seem like a weird combination to me (not a clinician but have experience in MH)

I don’t take that combination, but I do take two antipsychotics— quetiapine and prochlerperazine—for bipolar. I take 3000mg of quetiapine. That’s not a typo! They both help me with depression and psychosis. I don’t have highs anymore. I also take three other medications for depression. They do have to monitor people on two antipsychotics, especially with the possibilities of heart problems. It took me years to find the right combination and I still get depressed, but not as badly as before.

I can’t comment on Olanzapine+Quietapine but I am on Olanzapine+Aripiprazole (alongside an antidepressant and mood stabiliser) and it’s kept me stable since I started them a year and a half ago. The Olanzapine is a low dose, they were transitioning me to Aripiprazole for a clinical trial but I had a few issues when they tried reducing the Olanzapine and I was never able to switch fully. Best of luck with it all, I hope they are able to stabilise them.

Hi OP, sorry to hear that your partner is having another relapse. I have bipolar and a lot of experience with both anti psychotics and mood stabilisers. I would disagree with both yours and PP opinion about one or the other. I am currently on Lithium and Quetiapine and it's a great combination. I was very reluctant to be on more than one mood stabiliser or anti psychotic but sometimes it is necessary to get episodes under control. It can also help ease the unwanted side affects if you are on two. Also your concern about weight gain, Olanzapine is far far more of a weight gained than Quetiapine so I doubt that adding Quetiapine would impact. I love Quetiapine it's an absolutely brilliant drug. All the best