u/Agile-Ad-2831

Hi all! I am about to start Caplyta 21 mg as the only SGA not yet tried. What works for me is either Lybalvi or Zyprexa as monotherapy or a combo of medium-dose Geodon and low-dose Seroquel for sleep as polypharmacy.

However, both Zyprexa and Seroquel cause extreme hunger, and Zepbound/Mounjaro helps only a little. The hunger is so bad that it wakes me up in the middle of the night, and I need to eat to quell the pangs and fall back asleep.

I consume about 3000 calories, all good, healthy food, mostly homemade, versatile, high in protein and fiber, etc., but way too much. I do not have metabolic syndrome and exercise a good amount, but the hunger is just crushing.

Other SGAs didn't work. Lithium and anticonvulsants didn't work. Thorazine worked, but gave such bad EPS that my psychiatrist decided not to try any more FGA, since I have a very strong propensity for EPS, and FGAs are notorious for that.

The only remaining SGA not tried yet is Caplyta. The hope is that it might work, replace Lybalvi, and remove this dreadful hunger so that I can eat normally again.

But has it worked for anyone whose natural tendency is more towards an elevated than a low mood? I have had really severe depression episodes, but overall, I tend towards an elevated mood and insomnia more than towards depression, and I know that Caplyta is primarily for Bipolar Depression. Has it worked for anyone with a profile like mine, i.e., a propensity for mood elevation?

Hello! I have a well-managed Bipolar I with Psychotic features, and I take Lybalvi, in its smallest dose, as monotherapy. Everything else has been tried and either didn't work, or was intolerable, or both. Lybalvi causes extreme, painful, spastic hunger in me, including at night – I usually wake up at around 2 AM from Nighttime Eating Syndrome and have to eat a substantial amount of food before I can go back to sleep. Otherwise, hunger keeps me awake. I typically eat plain Greek yogurt with blueberries, or homemade chia/flaxseed pudding made with milked almonds and raspberries, on better nights. On worse nights, I need more food than that.

In general, I eat a really, really, really good diet – mostly homemade, fiber-rich, protein-rich, versatile, with lots of healthy fats (fish, avocados, EVOO), whole grain slow-cooking cereals, beans/lentils/peas soups with leafy greens, fermented dairy, eat the rainbow, drink fat-free bone broth daily, and all the rest of that. My only processed food choice is dairy-based protein shakes from time to time. I do not have any cravings, rarely eat sweets, and when I do, eat a little, never do what is called "emotional eating" or eating out of boredom, never use food to fill an emotional void (nor do I ever feel it) or provide comfort in a difficult situation, but boy, do I suffer from painful, spastic, imperative, punishing physical hunger. In other words, my problem is hunger in my stomach, the feeling of hunger pangs, rather than being messed up in the head. I know for a fact that Olanzapine in Lybalvi causes it, because when I tried, say, Thorazine, which doesn't lead to weight gain, nighttime eating syndrome immediately stopped, and there was no hunger, but I couldn't tolerate even the tiniest doses of Thorazine because it caused antipsychotic-induced movement disorders (EPS).

Because I am often painfully hungry, I end up eating too much of good food. And calories in - calories out work against me, because I cannot exercise nonstop, either.

At 55, I am otherwise generally healthy, with no joint pain, no hormonal symptoms of menopause (still spotting on Mirena, as I have been since 2004 when it was first inserted), BP ~105/65, normal lipids, normal liver enzymes, normal blood sugar, and am physically active – strength, cardio, flexibility – with a good amount of muscle mass. I do have somewhat elevated fasting insulin, but it has been coming down since first measured in 2022. I also have sleep apnea in the REM stage, but it is fully treated with BiPAP with a very low AHI. I am extremely lucky to have such a good baseline BP (before weight gain, it was 90/60) and a skeleton in a really good state - my 35-year-old physical medicine physician assistant looked at my MRI and said he would have wanted my bones. DEXA scans show bone density above the 90th percentile.

However, from Olanzapine in recent years and, alas, other weight-gaining psychothropic drugs in the past that ultimately hadn't helped me but left their mark in terms of weight gain, I weigh about 230 lbs, being 5'5''. I am on Zepbound, and it helped, together with starting an exercise program four years ago, to bring my weight down from a HW of 276, but then the weight loss stalled, and I believe it is because Zepbound does NOT fully offset the hunger caused by Olanzapine. It only offsets it partially.

I tried wakefulness-promoting agents for an unrelated issue of hypersomnolence, and they virtually erased my appetite while on Lybalvi, being much more effective than Zepbound in that sense. However, I couldn't sustain them long-term for a wide variety of reasons (different reasons for different waking agents).

I am now offered a Gastric Sleeve by the same clinic that prescribes Zepbound. My psychiatrist and I are worried about:

1. Will I still feel hungry after the gastric sleeve because of the problem with Olanzapine-induced hunger? Olanzapine disrupts signals from the stomach to the brain. The signals do not report satiety when they should. Will this problem stay with me after surgery? If it will, the surgery seems pointless and just a bag of dangerous side effects.

2. Will my 5 mg of Olanzapine from Lybalvi 5/10 continue to be enough to keep me stable, or will malabsorption of nutrients also include malabsorption of Lybalvi, leading to needing higher doses? That would also be an undesirable outcome.

Thanks in advance for the answers and reports from the trenches.