Posted by yxibow on May 4, 2006, at 0:05:38
In reply to Re: Yxibow Q » UgottaHaveHOPE, posted by ed_uk on May 3, 2006, at 12:01:24
> Hi
>
> I'm not Yxibow but the highest dose someone should take depends on several factors....
>
> 1. Can they afford it?
> 2. Can they tolerate the side effects?
> 3. Is a higher dose actually necessary?
>
> EdWell I'm not going to disclose my insurance policy although it happens to be a certain PPO. It doesn't matter how many pills of Seroquel you take, the copayment is exactly the same.
The side effects of drowsiness I will agree are a problem I am trying to mitigate at the moment.
Is the higher dose necessary? If anxiety relief is being provided at a modest dose, then no. I am a firm believer in the lowest dose that provides the most benefit and as low as possible of EPS and other side effects of any, new, or old generation antipsychotic.
Do I think Seroquel should be used for pure anxiety? Not really necessarily -- controlled and monitored use of a moderate dose of something like Valium could be just as affective for GAD. Or Luvox or Paxil. But there may be some reason why the person's doctor prefers to use Seroquel or thinks the treatment is better.
I take it for an awfully complex somatiform disorder, but only because I need to suppress the type of dopamine that Seroquel provides because I have about the rarest disorder on the planet that makes my vision brighter and damn annoying. And I suppose the serotonergic profile of Seroquel might do something for me also. I take a high (1100 at the moment) dose of it although I've been on other doses at other times. But I'm on polypharmacy anyway, its rather complicated.
I think that Ed is hedging on the study that came out not that long ago, CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness ). But not all of the reports are out yet. Furthermore, although for some people with Schizophreniform disorders may benefit in terms of drug effectiveness just as well on old line antipsychotics, is their quality of life really the same? I think there was a cursory glance over things which lead people to think, oh, perphenazine works just as well as the more expensive Seroquel, why bother with the cost. And I think that's a dangerous view towards things -- yes, it is true we do not know the full possibilities of TD with the newest atypical antipsychotics but we certainly know the likelihood with old generation ones and they're not good. There was a fairly large study of Zyprexa a while back in the British Journal of Psychiatry which concluded at best 1/2% per year give or take. One can probably interpret that even less for Seroquel. And Haldol, perphenazine, Prolixin -- as much as 30% in some studies.That's the quality of life issues that are missing from the study that I find cursory -- that you can just dose up with old line drugs and mask all the akathisia with Cogentin and its just the same. Sure, Zyprexa carries a non zero risk of Type II Diabetes, and I continue to be monitored on Seroquel (which has a less problematic lipid profile than Zyprexa) although I am on a fairly rigorous exercise program now and my cholesterol dropped 64 points. But the EPS and lifetime side effects are so much lower. Cost is an issue, I agree -- it costs over $2 billion to treat Schizophrenia in this country alone. But I think its money well worth spent if it gives even a small number of those patients a greater outlook on life and maybe even a return to some productivity.
-- Jay
poster:yxibow
thread:639400
URL: http://www.dr-bob.org/babble/20060429/msgs/639832.html