Clozapine
July 22nd, 2009
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Clozapine is a powerful antipsychotic drug. I was prescribed clozapine to contain my psychotic delusions when I was in hospital.
Clozapine is generally prescribed after other antipsychotic drugs have failed. This could be because of side-effects, or because it’s not working, etc. In my case I started on olanzapine, then I was put on risperidone, and finally I was put on clozapine which I’ve been on since (at the time of writing).
The clozapine had an almost immediate effect; say two weeks and getting stronger from there). For me it meant that I was bumped out of my euphoric bubble and was forced to face reality again. I clearly remember thinking “something isn’t right”, but it still took me a long time (years) to figure out what was real and what wasn’t. That was without doubt the hardest part.
The thing is that everything seems to make perfect sense when you’re delusional (courtesy of the chemicals in your brain who start), and even after all the treatment I still sometimes wonder what the hell happened.
It raises a lot of questions that’s for sure. For example:
- What’s real?
- What thoughts are mine?
- What thoughts can I trust?
- What’s my purpose?
- Why am I here?
- Does God exist?
If you find yourself stuck with those questions, ask yourself this one instead: “What can I do to turn this around?“. That’s a far more powerful question to ask yourself, and it will help you through. Also a good idea is to answer those questions while you’re feeling good, so that when you don’t feel so good you have some answers ready. Otherwise you’ll just end up running around in circles for a long time like me. 
History
Clozapine was created in 1971, but wasn’t always the wonderdrug that it is now. In 1975 the manufacturer withdrew it from the market because of the severe side-effects. In 1989, after studies showed clozapine was the best antipsychotic drug around, the FDA approved it again.
Blood tests
Users of clozapine also have to take regular (every four weeks in my case) blood tests to make sure that the white blood cell level is still okay (a possible side-effect of clozapine is the reduction of white bloodcells). White blood cells are very important of course so it’s important not to miss any tests.
I’ve come to know the staff of the medlabs quite well over the years.
Side-effects
There are several possible side-effects with clozapine; here are the ones I experienced:
- Drooling while sleeping (there are special pillow covers for this – no longer an issue)
- Weight gain (always feeling hungry and gained 20 kgs in no time – the fast food restaurant within walking distance from the hospital didn’t help of course – hmmm comfy food)
- Thirty minutes after taking clozapine I fall asleep
- Initially I slept for 10-11 hours, then gradually back to 10, and now down to 9 1/2 (any less and I don’t feel too good the next day – this also requires a bit of planning for waking up at the right time)
- Sleep really deeply (I don’t wake up for anything)
- Wake up groggy (used to take 30 minutes to properly wake up, now I’m much more alert)
- No dreams for years (except for the odd one)
- Brain fog during the day (hard to focus/concentrate – now much better)
There is also medication to treat some of the side-effects (like drooling), but that medication can then have side-effects of its own. Doh! Strange concept really. For me the drooling stopped when the dosage was reduced far enough.
Tip:
Don’t drink heaps of water before going to bed (say 2 hours). I’ve had to be rescued from being stuck inside the wardrobe several times by my wife in the middle of the night as I had absolutely no idea where I was (and more importantly where the toilet was).
Whether you like clozapine or not, I think it’s absolutely incredible that it works at all. I simply can not imagine what my life would have been like without it, and I think it’s something to be thankful for (side-effects or not). In other words; it does the job – eventually.
Dosage
Clozapine is generally reduced in small steps, so it may take a while to get back off it.
I started out on 300 mg, and I’m now on 87.5 mg (at the time of writing).
The dosage itself can have a big effect on how you feel and function. Every time my dosage was reduced I felt clearer in my mind, or was able to get up earlier, and even write clearer articles (starting earlier this year). So in many ways your thinking changes.
There are no hard guidelines for when to reduce clozapine, so the doctors generally try and get an idea of the state of your mind. When the more logical thinking returns and your handling it well, they might reduce it further, etc. If you’re thoughts are still chaotic then you’re likely to stay on your current dosage a bit longer. This has happened to me several times, and it’s no big deal. Good things take time, and there’s no need to rush these things.
I generally know when I’m ready for another reduction (able to handle the current dosage, and feeling good, etc), and will then ask them for it.
More information
Your doctor should have informational pamphlets about clozapine; best to start there.
For additional information check out the Wikipedia/Clozapine page. Their research on clozapine is very extensive (albeit a little bit more technical).
If you can talk to people who are also on clozapine then try and exchange experiences with them; you might both learn something new.
Posted in Mental Illness
