Posted by SLS on April 2, 2004, at 17:46:34
In reply to Re: A question on APs » SLS, posted by judy1 on April 2, 2004, at 10:31:21
Hi Judy.
> Did the literature you read make you feel confident that the research was done correctly?
No.
> I know you've read enough scientific articles to question who is behind the funding, the role of placebos, etc.- if you feel that the studies proved that cycling off and on atypicals was detrimental then I accept those findings.
At this point, I would still want to scrutinize the evidence or rationale for this contention. I really don't know what to make of it, but I did see it in more than one place. However, I have witnessed the misinterpretation of a single faulty investigation of a drug (modafinil) being embraced and passed along as a putative and established fact, most often in the absence of citation.
> (I know something similar was found with lithium, but i've also read studies that disproved that).
Did that involve its discontinuation and subsequent non-response once it was restarted? I think the term given to this speculative phenomenon was "lithium discontinuation induced lithium refractoriness". Robert Post and his collegues at the NIMH suggested this about 10 years ago. I believe that it is possible, despite more recent assurances to the contrary.
> My side-effects can be quite frightening to me on atypicals- not just weight gain (although that is difficult for someone prone to bulimia); it's the dystonia that scares me, the possibility of permanancy.
I do recall how severe your reactions have been to APs in general, but I thought you had found one that you tolerated well. Yes, I would be scared to death. I have been taking Abilify 10mg for the last year. I have experienced no abnormal movements at all. Because of the seriousness of my condition, I eventually came to feel that the risk versus benefit of using atypical APs continuously was acceptable. I would have no problem taking Zyprexa long term. However, it is very possible that you are a member of a very small minority of people who would develop TD while using these newer drugs. EPS of one type or another has been reported with all of them. Actually, you might be a candidate for using clozapine (Clozaril). It is usually reserved for more stubborn cases because one needs to go for biweekly blood tests to screen for agranulocyctosis. However, it is actually used sometimes to treat TD. The risk of TD with clozapine is considered to be the lowest, although many would argue that quetiapine (Seroquel) has near zero liability.
I would not feel comfortable either encouraging you or discouraging you to use an AP as long-term maintenance therapy. Because the ramifications of making such a decision are so weighty, I just wanted to draw your attention to a potentially critical issue regarding TD and episodic use of APs. I have also seen it suggested by some that the mere appearance of dystonic EPS early in treatment is a prognosticator of the eventual development of TD. Yet, others have cast doubt upon this contention as well. It is hard to know who's right and who's wrong. I hope I haven't upset you. I just want to see you well.
:-)
- Scott
poster:SLS
thread:330972
URL: http://www.dr-bob.org/babble/20040402/msgs/331870.html