Posted by yxibow on December 31, 2005, at 1:06:14
In reply to I'm scared of Antipsychotics., posted by med_empowered on December 29, 2005, at 22:02:18
> hi! I'm glad this guy doesn't have (noticeable) tardive dyskinesia. But..why was he on chlorpromazine at age 5? That strikes me as a sort of medical child abuse.
Perhaps... we didn't know then.
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> From what I understand, the first cases of TD popped up around 1957. Apparently they paid more attention to this problem in Europe than in the US (US doctors also seemed to use higher doses of neuroleptics than European ones).Yes, cases started to appear.
From what I understand, the APA data was "processed" in such a way that the numbers don't reflect the actual incidence--if you look at more minor cases of TD, the number for 5years could be more like 30%, and the numbers for "long-term" treatment could be over 50%.This perhaps is for a lifetime use of Haloperidol in those most susceptible to tardive dyskinesia, something we unfortunately still don't completely understand and even with novel antipsychotics the jury is still out.
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> Newer antipsychotics seem to be better. It seems like the data is strongest on Zyprexa, which apparently causes TD at a rate of about .5-1%/year.Yes, that is about correct... you will not be able to read the abstract unless your university subscribes to it, but the British Journal of Psychiatry had a study of olanzapine vs haloperidol (The British Journal of Psychiatry 174: 23-30 (1999)) and concluded that "the one-year risk was 0.52% with olanzapine (n = 513) and 7.45% with haloperidol (n = 114)".
That's much better than Haldol, but think about it: the way atypicals are being sprayed on everyone, for everything (sleep, anxiety, OCD, depression, Bipolar, Boredline Personality Disorder, etc.) we could still be looking at a whole lot of new cases of TD, since the number of patients being treated with neuroleptics is being greatly increased.
This is possible -- on the other hand if my aunt was on an atypical for BP-II during her downswings, maybe she would still be alive. Its a tradeoff -- I agree, they shouldn't be used by people who are not familiar with all their effects. They should only be prescribed by psychopharmacologists.
Think about it this way: there are about 2 million schizophrenics in the US. The vast majority of these people are medicated, or will take medication for a good while before discontinuing treatment. Even if only 1/8 of them--250,000--complete a year of treatment with an atypical antipsychotic, there will still be about 1,250 new cases of TD **per year** of exposure to the drug. And that's if you use low-end numbers (to take into account the patients who stop taking meds) for patients and the low-end rate for development of TD.But think about the number of people not with negative symptoms and introversiveness, but with positive symptoms and paranoid agitation. Is it really worth the risk on society to have a paranoid schizophrenic with a gun (how so easy to get in this country) walk into a crowded building and rant and start shooting? Or worse, the recent tragedy of a mentally ill patient on a return flight from Central America being "taken down" by Federal Marshals because he was off his medication?
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> Its important to realize that, the first time around, TD was kind of denied. Doctors said it was infrequent for movement disorders to be permanent, the meds were safe, blah blah blah.From the experts on movement disorders who have studied this for decades, such as the Wirshings, movement disorders fall into three categories basically: 30% remit completely over time, 30% dont get worse, and the remaining third do unfortunately worsen.
Also, APs have other risks, like the often-fatal Neuroleptic Malignancy Syndrome. I read one estimate that puts the number of fatalities due to this "rare" syndrome at about 100,000 worldwide since Thorazine was introduced. Think about it: 100,000 people dead.
I'm not sure which journal that came from, but even if 100,000 people were killed, which is an awful tragedy, take a look at what that would be compared to the entire world population: 1.54 thousandth of a percent. Plus, there are a lot of signs leading up to NMS that, I agree, patients put into the right hands of the right doctors would be able to reverse this condition.
Benzos, on the other hand, have hardly killed anyone. They may be "addictive," but they dont cause fatal reactions and overdoses are rarely fatal.
I would agree with that one statement to a degree.. benzodiazepines are probably the safest psychiatric medication that has been invented. The LD50 vary; some are safer than others but it can be estimated that the fatal dosage is far greater than any prescribed amount. Respiratory depression is the major problem. Flumazenil can be administered.
So, compare and contrast: docs hesitate to RX benzos, the "bad" drugs, b/c they might be "addictive"...
Well, I prefer to call them habituating rather than addictive. And some people, just like those genetically predisposed to alcoholism, may exceed than line of habituating into abuse and addictiveness, finding underground sources and faked prescriptions.
but they'll hand out super-expensive drugs that can cause TD and NMS.
Every drug has a side effect. If aspirin were released by Bayer this year it probably wouldnt pass the FDA.
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> Personally, I think neuroleptics should be considered controlled substances. They may not be "addictive" in the conventional sense, but the risks inherent in neuroleptic treatment call for more stringent monitoring of dosing and prescribing habits of doctors.I think that is the "all doctors are idiots" concept. As said before, I fully believe that neuroleptics should be prescribed by those who are fully knowledged in their usage, psychopharmacologists. There is recent controversy that novel antipsychotics such as Zyprexa and Seroquel perform no better than old drugs like chlorpromazine and the like and have nasty diabetes potential if not monitored -- but there's one thing missing from that argument, and that is the quality of life beyond the "sanity", the EPS and TD nature. If one were to extrapolate the BJP study of Zyprexa, one could estimate that Seroquel might even be 1/4% per year or even less. The jury is still out.
I think every day what if, as I take Seroquel -- but even though I have some unusual EPS, mostly mild -- I have to weigh it against the factor of the rare disorder (non-psychotic) for which it is partially benefitting. Sure, I experience blunting of affect. I wish I was the person I was in college. But we look future forward, I can't change time or why what happened to me did. I can only say that after 4 years, my somatiform disorder is far less prevalent in my mind than it was before when I had to wear sunglasses in clubs from the sheer distraction of strobe lights.
I don't know how long I will have to take the Seroquel, or the other medications I take. But I have to move forward with my life eventually. If for some that means they prefer pure psychodynamic talk therapy to medicine or a combination of the both, then be so for them. But just remember the high rate of suicide in schizophrenic, schizoaffective, and bipolar patients and the emotional burden that places on their family.
2005 holds so far no antipsychotic that will not 100% not produce TD, save for Clozaril which is nearly but not 100% (there have been a few doubtful cases) and has all sorts of unpleasant side effects that can render a patient socially reclusive. There are exciting drugs in the pipeline, though they probably wont be released until 2007 or beyond. May the future hold a brighter day for the whole schizophreniform spectrum, which consumes more than $2 billion alone in just the United States.
poster:yxibow
thread:593085
URL: http://www.dr-bob.org/babble/20051221/msgs/593660.html