Posted by mindevolution on February 3, 2007, at 18:30:45
In reply to Re: Atypicals for anxiety?))yxibow » mindevolution, posted by yxibow on February 3, 2007, at 12:36:57
>> 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'm not interested in this argument about akathisia any more. Its a phenomenon of every neuroleptic, it is a manageable EPS, and if it becomes an issue, a less potent neuroleptic should be tried. There are so many other types of EPS, that while this one may seem nasty, its predictable. That's all we can really say about a class of drugs that is an unfortunate necessity.
well i disagree, I think there is a growing body of evidence to suggest that akathisia can be shown to induce suicidal and violent behaviour in otherwise calm and peaceful patients. when a drug can potentially turn a calm patient with no history of violence, into a violent one via akathisia which is extreme anxiety, then I think there is cause for alarm, and it represents a significant threat not only to the patient, to any persons who checked the patient in against their will for help, to his doctor who administers the medication, and to the public as well. Historically I believe the patient is blamed for the violence rather than the medication, although the tide is turning, particularly with the same problem occuring with ssri ADs.
>>> 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/174/1/23
>> good 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.
> I know about D2 occupancy rate, the difference is that haloperidol occupies it at nearly 100% and doesn't let go, and while Seroquel and Zyprexa may also occupy it at a fairly substantial rate, they do let go, many times more in an interval than Haldol does.look here is a chart regarding recommended AP doses:
http://www.npi.ucla.edu/ssg/antipsychotic.htmhaldol occupies 80% d2 at about 3mg from memory yet its max dose is up to 40mg! risperdal occupies 80% d2 at 6mg but max dose is only 8mg. here see the charts here: http://italia.medscape.com/viewarticle/457516_4
and here: http://www.chovil.com/dopamine7.htmlso if we compared max haldol dose to max risperdal dose, risperdal wins as the "safer" AP every time. it is the same across all the "atypicals" vis a vis "typicals" with max doses of the atypicals just enough to induce serious eps if required by the docs, while the max dose of the typicals is way way way over the eps threshold.
just because the new recommended doses of "atypicals" are lower so that eps is not triggered as often doesn't make them safer it is only the illusion of safety. this way they can market new drugs and make 50 times as much money from patents.
in fact from the chart here: http://www.chovil.com/charts.html
one can conclude that for the same level of d2 occupancy, haloperidol will induce the least potential for adverse effects, due to its relatively lower effect on all other receptors. in essence because haloperidol focuses on the d2 receptor, it is the cleanest AP. that is to say that at a properly comparable dose of haloperidol is likely to be as effective with less side effects.
so I would like to see a study that compares 3mg haloperidol to 6mg of risperidone to 18mg of olanzapine to make a fair comparison. although I can guarantee you won't find such a study, instead what you will find is that most studies focus on doses of 10mg and even 20mg of haloperidol used as the typical benchmark for "typical" antipsychotic comparisons!>> http://www.akathisiasupport.org/akathisia5/nwh-akathisia-usen3.pdf
> Sorry -- maybe a nice support for people with akathisia, but I don't argue with websites that look amateurish, don't subscribe to HON or have other health credos to back up. Its why I don't get into Ashton discussions.
it wasn't the website that I was referencing, it was the quite clearly legitimate released medical record of an individual patient that shows that akathisia can literally be torture. would you blame that guy if he committed suicide or assaulted his psychiatrist or anyone else after suffering like that?
>>> 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 fail to see where methadone is going to help a bipolar suicidal patient but we can ignore this red herring. Clonidine and propranolol are nice adjunctives to help EPS, they don't do a whole lot by themselves except in certain situations like clonidine for child hyperactivity. Propranolol masks the anxiety but does not take it away like benzodiazepines. Its good for essential tremor and drug induced tremor.methodone produces a sense of well being and is a cns depressant, are you sure you don't see how it may be used in such a patient to induce a pleasant tranquillisation rather than potentially inducing eps, including akathisia, or even nms? clonidine and propranolol and benzos could also be used to reduce anxiety and induce a calm and peaceful state in the patient and have no where near the risks of AP use. yet AP use is the first line med of choice by psychiatrists in psyche wards for everything from anxiety to suicidal ideation or even sleep disorders, and in a suicidal patient eps might just be the thing to make them go through with it.
>>> 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!
> Yes, did you not read the news of the Russian who was poisoned in London ? It takes a lot of nuclear reactor activity to create Polonium and dispersal is quite another story, but it is still an unsolved case.I knew it was a radioactive substance but didn't take note of exactly what it was, was it Polonium 210?
>> 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.
> But government controlled or company controlled its not a third party. To really have one you would need something like commonwealth countries have, a crown corporation.well with government controlled trials, the direct bias from the drug companies is removed, which would be a major step forward in the drug approval process. I agree with you, in the long run the more indepedent the testing process is the better for consumers and doctors alike and any vehicle to achieve a greater independence should be encouraged.
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URL: http://www.dr-bob.org/babble/20070201/msgs/729429.html