Posted by SLS on March 20, 2001, at 7:44:50
In reply to Re: ADVICE PLEASE-Want to try Geodon, but TD risk? » SLS, posted by steve on March 20, 2001, at 1:02:04
Steve,
> Isn't it sad that doctors don't tell you this, and that pharma companies aren't forced to label their "APDs" as neurotoxic?
Well, I don't think there is sufficient evidence yet to even use the word "putative" to describe as neurodegenative the acknowledged and usually irreversible side effects of neuroleptic antipsychotics. Tardive dyskinesias, tardive dystonias, and tardive akathisia are recognized as severe consequences of treatment with APs in a sizeable percentage of people (I don't know the statistics).
Severe schizophrenia is a hideous derangement of humanity. I deem it unacceptable to withhold an almost magically effective treatment that brings these people back into our world of coherency. (I don't think it would serve schizophrenia well to begin an esoteric debate regarding the coherency of the world at this point). I also deem it unacceptable to withhold information from everyone concerned and unconcerned regarding the full nature of the possible severe reactions that can occur. Likewise, it would irresponsible not to describe the remedial treatments available to address them. For those who must make a decision, it becomes a risk/consequence versus benefit judgment. Unfortunately, I am unaware of treatments that are more efficacious than the neuroleptic antipsychotics, the atypicals probably representing acceptably effective treatment.
The problem: If not these drugs, than which?
What treatments do you think deserve consideration?
Temorary solution?: Begin a prophylactic treatment simultaneously with the initiation of the antipsychotic to minimize or prevent tardive dyskinesia. From what I have encountered in the medical literature, the issue of neurotoxic processes are being intensively studied from the perspective of both pure neuroscience research and clinical application to specific medical conditions including Alzheimer's Dementia, Parkinson's Disease, Huntington's Chorea, schizophrenia, and "recreational" drugs like methamphetamine. It might not be too far off that this type of temporary solution becomes applicable.
What do you think?
One thought I had is to reduce the rate at which neurons synthesize dopamine, since this might be a primary pathway toward the evolution of neurotoxic substances. MAO inhibitors like selegiline? Dopamine agonists like bromocriptine or Mirapex? COMT inhibitors? With an antipsychotic on board, perhaps any potential for these drugs to be psychotogenic would be greatly reduced or made nul. I would be curious to learn if combining an atypical neuroleptic with relatively low affinity for DA receptors with a DA agonist produces psychosis or exacerbates schizoid symptoms. I would be curious to see what Mirapex would do, only because it seems to be the focus of much study as a substance which prevents neurotoxic damage. My concern here is that Mirapex might carry a greater liability than the other DA agonists to produce psychosis because it stimulates D3 receptors in brain structures above the striatum that might be involved in producing positive schizophrenic symptoms. The stimulation of D3 receptors would not be countered because neuroleptic antipsychotics can't block them. I don't know enough at this point about all of the locations of D3 receptors and their contribution to schizoid or otherwise psychotic conditions.
- Scott
poster:SLS
thread:56412
URL: http://www.dr-bob.org/babble/20010319/msgs/56962.html