Posted by med_empowered on November 4, 2005, at 22:04:17
In reply to Haldol experiences? » med_empowered, posted by yesac on November 4, 2005, at 14:25:57
hi! I dont know enough about lithium+AP combos to give you a really good answer...if you read the Haldol package insert (you can find it online) and PDR-type stuff about Haldol, there should a warning about the Lithium+Haldol combo, and the problems it can cause...in addition, if you google it, you'll find case studies. Apparently, in some cases the combo has proven disastrous (very bad, very permanent brain damage...lithium+AP also seems to boost the risk of NMS) and in others...no one really knows. Since some people end up with such pronounced, permanent brain damage, its possible that long-term use of lithium+AP could lead to more subtle brain damage in a larger number of people. I've only seen case studies on the old antipsychotics, especially Haldol...my guess is that it could happen with the atypicals, but there would be lots of variables (like, what atypical is being used, dosages, other drugs, duration of treatment, etc. etc.)
I can understand your desperation but...to me at least, the risks just seem so great. Plus, Haldol really isn't a great drug. Its popular in institutions because it makes people shut up and cause less trouble, but it isn't exactly an "empowering" drug...its not something thats going to help you reach your full potential or anything. It really is a "dumb drug" in the truest sense of the term.
As for what you can try next...I don't really know what to say. Phenytoin (Dilantin) isn't exactly the anticonvulsant of choice for bipolar, but it has been studied a bit, and it seems that it works well for **some** people--cognitive impairment can be a problem, but with adequate control of dosing, this might not be a problem. Plus, its cheap--its been around since the 30s. Maybe ditching antipsychotics altogether could work...Depakote+Lithium might be a good combo for you, or maybe Tegretol could be part of a mix (it doesn't play well with other drugs, and blood tests are necessary but it does seem a bit more potent mg per mg than Trileptal, and some people swear by it). I don't know how well they'd work for day-to-day, minor agitation and rapid-cycling, but some benzos are pretty good for mood control...Ativan and Klonopin can help a good bit, even at more extreme manic heights of bipolar...they compare pretty well to short-term use of Haldol in those situations, with far fewer side effects ("additcion" isn't really THAT big a problem with benzos).
The only med I could really think of off the top of my head that might be affordable and helpful would be Surmontil. Its kind of a Clozapine-ish tricyclic; it tends to be soothing, and may have some (minor) antipsychotic activity (it doesn't seem to get rid of acute psychosis, but there may be some mild D2 blockade, as well as some action at other dopamine receptors). I would imagine there's a generic, since its been around forever. Combining that with Depakote or Tegretol might be good; that sort of combo could cut the edge off intense depression or intense mania and also provide a bit more stability for more subtle mood shifts.
Anyway, I'm not a big fan of APs in general, especially for mood disorders..I'm *definitely* not enthusiastic about anyone taking Haldol. If you *must* take an antipsychotic (old-school), it seems like Trilafon (perphenazine) would be the way to go...less EPS/Akathisia than Haldol, and a bit more sedation. I think Molindone, Mellaril, and Loxapine are also a bit better than Haldol or Thorazine in terms of side-effects (that's really not saying much, though). If you do opt to take an AP of any sort, I think you'd probably be better off avoiding Lithium just in case (I'd hate to be the person who discovers that the atypicals+lithium=brain damage), but that's really your decision to make.
poster:med_empowered
thread:574968
URL: http://www.dr-bob.org/babble/20051031/msgs/575536.html