Posted by SLS on March 16, 2002, at 9:11:01
In reply to Re: A case of Seroquel induced TD, posted by OldSchool on March 15, 2002, at 19:00:20
Hi OS.
> Scott, I don't exactly agree with your ideas about atypicals and EPS. The bottom line is that ANY anti-psychotic can produce EPS. Even Clozapine.
I think we are in complete agreement here with regard to those drugs that are currently marketed.
> While it may or may not be true that atypicals are safer than typicals, atypicals are still not exactly the safest drugs in the world to take.
Neither is penicillin.
> I believe this is especially true if you are not floridly psychotic, as in schizophrenic or manic psychotic. I don't care if it is a "weak D2 binder" or whatever. If the drug antagonizes d2 receptors it can cause EPS...period.
Well, I would not feel comfortable making such a statement. Some neuroleptic antipsychotics are selective as to which regions of the brain they act. For example, aripiprazole (Abilitat) blocks D2 receptors in areas of the brain suspected to be involved in schizophrenia (prefrontal cortex), but not in those regions involved with movement, i.e. nigrostriatal dopamine pathways. In addition, some of the newer drugs being investigated bind to D2 receptors, but only momentarily. They hop-on and then hop-off. It is thought that perhaps no one receptor "believes" it is being blocked, although it is sure that it is not being stimulated. If the receptor doesn't perceive a change in its environment or function, it doesn't send a message to the neuron's nucleus asking it to synthesize more receptors.
> All anti-psychotics can cause these problems.
So far, it looks that way.
> The drug companies claim "their atypical is safest"
Surely, one of them must be.
I don't know if any drug company claims that their neuroleptic antipsychotics are without the risk of producing EPS. I'm pretty sure that none do. Each neuroleptic is distributed with an FDA-approved pamphlet known as a package insert or label. Every bottle. I'm sure your pharmacist will give you one if you ask. It would be quicker, though, to look through the Physician's Desk Reference (PDR), in which you will find for each drug a reproduction of the information found on the package insert. To the best of my knowledge, they all state in black-and-white the percentage of subjects that developed EPS while taking the drug.
> but in the end its all BS because all of them can cause EPS and even TD. Ive tried Zyprexa, Risperdal and Seroquel all at low doses and everyone of them gave me EPS equally.
Unfortunately, you are not alone. There are a bunch of people here who are equally prone to the development of EPS when using low dosages of atypical neuroleptics.
I am curious though. I haven't followed your posts (nor anyone else's lately) so as to know what illness you are treating with antipsychotics. How long ago were you first treated with an antipsychotic? Which one(s)? I'm sure you understand the reason I ask this. If you were treated with one of the older typical neuroleptics prior to your exposure to the atypicals and prior to the the emergence of EPS, then your case could not be included in an investigation to examine the potential for any of the atypicals to produce EPS.
> Every atypical I have tried gave me these symptoms. I dont believe these BS claims that atypical anti-psychotics are safe.
> Because I dont believe they are safe.
Safe. Safer. Safest.
The latter two words can be established through observation, since the drugs being compared represent a frame of reference. The first word is a judgment. What are the parameters you use to judge drugs as being safe or unsafe? I'm not sure I would judge these drugs as being safe. I am a bit afraid of them. However, many doctors with years of real-life experience treating real-life people do judge them as being safe - safe enough to justify their use.
> Plus on top of this all the atypicals are bad about raising blood sugar. Zyprexa has been implicated in quite a few cases of diabetes.
This is true. Is their any clear evidence that the causation of these things are not secondary to the weight-gain these drugs produce? I don't know. If it is, then perhaps steps can be taken to avoid it.
> Hell its even being admitted by mainstream psychiatry that plain old SSRIs can cause EPS in a minority of people taking them.
Yeah, I was going to bring that up. I'm glad you did. Like I said, even penicillin is not without the risk of fatal reactions. I have been well aware of the risk of SSRI-induced EPS for a number of years, including the possible emergence of suicidality due to the induction of akathisia. It is my belief that Prozac has caused some people to commit suicide. Still, I might decide to start taking Celexa next month to treat a severe and treatment-resistent bipolar depression. Do you think I should? Are SSRIs safe? Are they safe enough for me to try?
Risk versus benefit.
Is there no degree of severity of illness for which it is worth the established and quantized risk to treat? I know a few schizophrenics and members of their immediate families whom think there is.
What about depression? For me, I thought it was worth the risk. I've tried three so far. Unfortunately, though they produced an improvement of my depression, they also produced cognitive side effects that forced me to stop taking them.
> Can the BS...all atypical anti-psychotics can cause EPS equally.
How did you go about coming to this conclusion?
> Except for maybe Clozapine, which I have never taken and cannot discuss. I do know Clozapine is considered to be extremely safe when it comes to movement disorders, but Im skeptical of even that.
I am glad to see that your judgment of clozapine is not without objectivity.
> Finally, the best way to get rid of EPS is bilateral ECT.
I didn't know that (no sarcasm). I'd like to know more about it.
- Scott
poster:SLS
thread:97844
URL: http://www.dr-bob.org/babble/20020313/msgs/98289.html