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Geodon vs Risperdol: New Washington State Policy July 3, 2011

Posted by Crazy Mermaid in Uncategorized.
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Washington State just introduced a new policy regarding psychotropic medication for people with mental illnesses. This policy covers those people with mental illness who are without private insurance. The new policy is that psychiatrists are forced to put patients on older psychotropic drugs with more side effects because the newer drugs are prohibitively more expensive. At a time of severe budget cuts, quality of life can’t legally play into a psychiatrist’s decision on which medication to prescribe. But it should.

Geodon and Risperidone

While I understand that there are a finite number of dollars available to treat patients without private insurance who have a mental illness, there should be a quality of life cost to consider in addition to the apparent financial cost when the decision is made regarding which medication to put a patient on.

A perfect example of this is the use of Risperidone, a generic form of Risperdol, versus the newer drug, Geodon. Geodon was developed as an alternative to Risperidone. It minimizes the number of side effects mentally ill patients have to put up with in order to be relatively symptom-free while being properly medicated.

While at the mental hospital, I was started on Risperidone, the less expensive drug. The side effects I experienced on Risperidone included extremely slow, fuzzy thinking (like my brain was in a fog and made of mush), loss of libido, lethargy lasting an hour or two after I woke up, and a tremendous increase in my appetite (and subsequent weight gain), as well as a multitude of other smaller side effects including fine motor skill problems. The bad news is that the net effect was a poorer quality of life than I had without the drug. The good news was that the voices were less prevalent.

When I was released from Fairfax Mental Hospital, my new psychiatrist brought to my attention Geodon as an alternative to Risperdone.  He discussed the side effects of Risperidone versus Geodon, a newer generation of drugs with fewer side effects. The minute he had the opportunity to provide a better drug, he did it. Right then, we decided to wean me off the Risperidone (around $200 per month) and onto Geodon (around $700 per month). I was shocked at the price of Geodon, but my insurance picked up the majority of the cost. In effect, my health insurance allowed me to purchase a higher quality of life.

The problem with hearing voices, besides the obvious interruption of thought processes, is the fear that the voices might become overwhelming and permanent, driving me into a total eclipse of my personality and core being, unable to function in the world. That’s what medication keeps at bay.

The difference in quality of life between these two drugs can’t be emphasized enough. With Geodon, a person will be much higher functioning. Geodon will be the difference between someone being able to hold down a job and someone who has to stay cooped up in their room all day. The cost of recidivism because of the less tolerable side effects should be taken into account when a policy of “generic first” is implemented, but it isn’t.

Mentally ill people will be functioning at a lower level on Risperidone. They will have more health problems because of the tendency of Risperidone to cause weight gain. Their thinking will be fuzzy, their coordination will be affected. Their libido will be erased entirely.  And there’s a good chance they’ll stop taking their medication when they get fed up with the side effects.  The more severe cases will end up in a mental hospital, costing the taxpayer tens of thousands of dollars (see my blog about how expensive a mental hospital stay is).  Or jail (also at tens of thousands of dollars per year). Or with drug and alcohol problems from self-medicating. So much for the cost-saving idea.

In short, I understand the new policy is due to budget cuts, but the initial monetary gains on paper need to be balanced against the quality of life as a medicated person and the reality of life as an unmedicated mentally ill person. In a perfect world, psychiatrists would be able to choose the best drug for their patients, with no regard for costs. Risperidone would lose every time if this were the case. Unfortunately for those people without private insurance, if they seek treatment, they will be stuck on the drug with more side effects and with a poorer quality of life.  These are all additional costs that I wish the new policy would consider when choosing the appropriate drug.  But it’s too late. They’ve already made their choice.

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Comments»

1. willfindhope - July 3, 2011

I agree that quality of life for the patient should be considered when making policies regarding what medication should be used. However, not everyone may have the same reactions on Risperdal, even if it is a medication that did not work well for you. For others it may work well without side effects that are too bothersome. It’s interesting that you regard Risperdal as an ‘older’ antipsychotic, here in Australia it’s still regarded as one of the newer ones along with medications such as Zyprexa, Seroquel etc. while medications such as Haldol and Largactil are the ‘older’ ones. Geodon is a medication that is not actually available here in Australia (yet?).

Crazy Mermaid - July 7, 2011

It’s interesting you would mention Haldol. When the voices came back in full force (after I had been home from the mental hospital for only a few days), my psychiatrist told me I had to go on Haldol or return to the mental hospital. It worked quickly to eliminate the voices, but the cost was tremendous. Besides all of the physical side effects, that powerful drug made me desperate to commit suicide. I honestly don’t know which is worse: the horrible voices or the terrible side effects. Next time I will choose going back to the mental hospital rather than go back on Haldol. (Note: This was before Risperdol got up to therapeutic doses in my system).

2. moodybpgirl - July 7, 2011

God, who makes these decisions?! I went through hell trying to get Medicaid to cover my Pristiq. (Can’t you just take a first generation anti-depressant that comes in a generic form? Uh… no. I can’t. It’s an entirely different kind of medication that works entirely differently.) I guess they’re thinking “Hey, why would poor people need to feel healthy? It’s not like they’re going to contribute anything valuable to society.”

3. lunasunshine - July 8, 2011

MA here in Pennsylvania is supposed to provide care for the “Medically Needy”. Bipolar Disorder qualifies because it requires a lot of med checks, therapies, and medicine in order to maintain balance and live a productive, happy life. Except, MA likes to mess with people and suddenly cut benefits for no reason. I went on MA in the first place because I was low income and couldn’t pay for my medications. They cut my prescription coverage because I “made too much money”. I was working a part-time, minimum wage job with two dependents in my household. How the hell could they figure I was making too much money? Do they have any idea what these psych meds cost?!

No. They don’t. And they won’t even consider for a second the consequences of their actions. It’s between shelling out a little cash for some meds versus picking up the tab for a hospital stay. That’s just bad business, honestly, if they want to look at it from that perspective. And that’s all they want to see it from. Because we are not people to them. We are burdens. I bet, if they had their way, they would have us all eliminated for being low-income and having a mood disorder.

Jackass politicians.

moodybpgirl - July 11, 2011

Absolutely. Proactive mental health care will always be an ounce of prevention for a pound of cure. Why that’s such a difficult concept to grasp I’ll never understand.

4. Catherine - July 10, 2011

No medication regime should be determined by government edict. America is a global disgrase in mendical care. But that said, note that Geodon can have more tardive dyskinesia side effects, more muscle-related stiffness, and it has a side effect of weight gain.

All meds are problematic, and the choices are so personal.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001070/

Love your blog — thanks for writing!

Crazy Mermaid - July 11, 2011

Actually, Geodon makes many people (including me) LOSE weight. That’s one of the other reasons my psychiatrist and I decided to switch from Risperdol. But it can also cause weight gain. Go figure.

5. Catherine - July 10, 2011

Um, lots of typos in that post… you can delete it!

6. Armando - August 20, 2011

I too switched from risperdal to geodon three years ago in 2009 and I also switched to geodon because of the weightgain. I can’t say geodon worked wonders for me and I weigh more on geodon than while on risperdal. But now I can stay awake (I couldn’t stay awake while on risperdal so I tried provigil/modafinil to stay awake) and now while on geodon I wear size “L” (large) shirts rather than size “XL” (extra large) shirts. Pants stayed the same. Geodon is more expensive but my insurance pays for it, same as it did for risperdal and provigil, but now I’m only on geodon. Also was prescribed hydrochlorothiazide for blood pressure and lost six pounds going back to almost the same weight I had while I was on risperdal.

Armando - August 20, 2011

I forgot to mention I workout a lot. But yes, side effects lessened now that I’m on geodon.

Crazy Mermaid - August 21, 2011

That’s great!


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