Posted by mindevolution on February 3, 2007, at 4:13:50
In reply to Re: Atypicals for anxiety?))yxibow » mindevolution, posted by yxibow on February 3, 2007, at 0:17:15
> > On the other hand I questioned you about some of the generalisations you made about the suicide risk for unmedicated people with schizophrenia, and you have not backed up any of your generalisations at all.
> I can attempt to back that up and argue with journals, but the fact is that for acute suicidality in schizophreniform disorders or for that matter in any disorder, an antipsychotic ranks up there with Lithium in its capability to stop a person from harming themselves in a 72 hour or 14 day hold if it is warranted that the patient cannot yet handle release. The latter is more rare and often consumers are tossed back into the community and their illnesses come right back and something awful happens, or they become part of the walking wounded homeless, untreated, all too visible in a certain city near where I live.
i really think you are the one succumbing to generalisations without any evidence that they hold true. I can cite many studies that show that akathisia from antipsychotics can induce suidicality, can you show me one that shows that the risk of suicide in schizophrenic patients never treated with antipsychotics is higher than AP treated patients?
> I can also back up a study in the BJP that did an extensive study of TD in Zyprexa vs Haldol and came up with an average rate of 2.66% and a yearly average of 0.52% http://bjp.rcpsych.org/cgi/content/abstract/174/1/23good point, however, did you notice that that was a summary and the test did not focus on D2 receptor occupancy? realistically to accurately compare the eps potential of two antipsychotics the doses of each have to produce the same level of dopamine blockade. this and most tests do not make such a comparison rendering the vast majority of head to head comparisons irrelevant.
so if I want antipsychotic A, although I like the term neuroleptic which I notice you used, to come out ahead of antipsychotic B, all I have to do is make sure the dose of A produces less D2 occupancy than antipsychotic B. this creates endless amounts of research that proves absolutely nothing, which is why I referred you to a study that compared antipsychotics with similar D2 occupancies. Once the doses were truly comparable, there was no noticeable difference between them.
If we extrapolate further, Seroquel has an even lower potential of TD.
In the study I cited they explained that at the doses used in the trial D2 occupancy was less than 80% meaning that eps was not induced. With a large enough dose of seroquel 80% D2 occupancy is achieved and voila eps.I challenge you to produce a report showing d2 occupancy of 80%+ without eps, it can't be done!
every single antipsychotic, atypical or otherwise, can create d2 occupancy of 80% and induce the same eps as each other. just because seroquel is dosed at amounts that create less than 80% d2 occupancy does not make it a safer AP. All APs are dangerous, and equally so with a truly comparable dose. some just have some nice extra bonuses like diabetes or agranulocytosis thrown in for good measure.
> There also was another study recently that compared all atypicals and found that the rate of TD was around 2% give or take, which is a lot better than most of the typicals that preceded them. Yes, there was a study, the CATIE study that said that the effectiveness was not very different, but where's the humanity? Agents like Zyprexa and Seroquel, with all their unfortunate lipid profile issues, have far less EPS than the phenothiazines and others that were compared with.
are you sure they compared doses properly with the same d2 occupancy, I doubt it very much, if you can show me one that does a proper head to head I would be interested in reading it. when we compare this 1mg dose of olanzapine with 10mg of haloperidol, it creates less eps and TD. it isn't really a proper comparison. what would happen if we compaired 20mg olanzapine with 0.5mg haloperidol? unfortunately this is how most AP trials are conducted which in my opinion doesn't prove a thing.
> I agree with the model of informed consent -- don't get me wrong, I had a psychiatrist in college who I did not like, frankly I think she just hated people who read the PDR and happened also to be male. (I'm not a misogynist, this just seemed to be a sense that I got that as sole controlled substance provider -- nurse practitioners could provide other substances, college mental health was ran as her own fiefdom.) And yes, I was offered olanzapine even though I knew of the possibility, however small, that TD could occur and I was not at that level of anxiety. And I didn't take it.btw what about if this happened to you if you decided to use olanzapine for anxiety:
http://www.akathisiasupport.org/akathisia5/nwh-akathisia-usen3.pdf
> This doctor was also a benzophobe and before I knew well about the dangers of quitting cold turkey, I quit Tranxene only to have scalp muscle spasms. I was given back only half the dose. If I was not poo-pood by the paltry student urgent care clinic (and this is a top tier University in the US with a medical school of shining reputation), I would not have ongoing spasms today.If I knew then what I know now I would have gone to the off-campus doctor they were all too happy to consolidate to an on campus doctor and an on-campus therapist (who I respected much and got along with unlike the doctor) and gotten my Tranxene back at its level until it could have been properly reduced.
sorry to hear that.
> I would have to somewhat disagree -- I think that combining first line choices with therapy would work better, but you're entitled to your opinion. If more "harsh" medications are needed, however one wants to describe that, it should also be under informed consent. MDD doesn't respond very well just to therapy alone, it is a consuming disorder, I can tell you.ok well let's agree to disagree on that one.
> Well I can think of a number of benzodiazepines that could work and possibly some other AEDs, that's true. I never said antipsychotics are a first line defense, except in some complex bipolar cases when there is a clear line that mania is occurring, and sure, even then lithium and other choices are available but don't always work.
APs are as serious and damaging as it gets, are you sure if you were the doctor you wouldn't try something less toxic like clonidine, propranolol, or even methodone?
> I think they should be given as much information as they need to make their decisions.
agreed.
>But it goes further as we have a rubber stamp and out the door model of health care in the US.
particularly when applied to mental health care.
> > One idea of mine is to have a central register of drug toxicity, so that every medication is given a toxicity rating for its recommended dose range out of 1000 based on independent government (not drug company) sponsored trials. Patients and doctors can both refer to the register as one way of objectively identifying the relative risks of medication alternatives.
> However paltry it is, there is an adverse reporting system in the US in the Stage IV (marketing) of a medication and some drugs have been pulled because of numerous reported cases.true.
> Well every substance out there that has a CAS number is given an MSDS rating actually. We know the LD50
i didn't know that existed. LD50 of Polonium 210: estimated at 10 (inhaled) to 50 (ingested) nanograms in humans makes this one of the most toxic substances known. One gram in theory could poison 100 million people of which 50 million would die!
are there LD50s for psychopharmaceuticals?
> in rats and mice and sometimes dogs -- mice may seem miniscule but they serve a valuable purpose as a number of their responses to medication mimic a human response. Would you really want to be a lab mice in the first stage of drug trials for toxicity before it is given to "healthy" humans in Stage I?
nope, underlined.
> The government does sponsor drug trials to the tune of millions of dollars a year, they can be looked up on government web sites at the NIH, etc. But like it or lump it, sans advertising, it takes millions of dollars to produce the "right" compound, and that money can't come from thin air.
ok, but can't the government say "you want this drug approved, give us 20million, and we will conduct independent testing for you". there is no loss to the company, they would have still had to pay for the research, except now the trial is government controlled and much more independent.
> I mean I could rant that the US could spend more money on education and health care than on military forays, but we would get into an Iraq argument and everyone has a different opinion (I support the troops, but I think there has been great mismanagement to say an understatement, of things.)
let's leave that argument for another thread.
me
poster:mindevolution
thread:728141
URL: http://www.dr-bob.org/babble/20070201/msgs/729268.html