Posted by linkadge on February 11, 2007, at 20:06:15
In reply to Re: low dose risperdal -- linkadge, posted by munificentexegete on February 11, 2007, at 18:53:18
>true, however, most people will come into >contact with these drugs on an involuntary basis >at some point in their life such as in the >foster care system, in a nursing homes, and even >in the teen screen process.
I don't agree with using medications in such ways.
>on a voluntary basis, with proper elucidation of >the true risks, meaning proper independent long >term studies, I agree with you. but that sounds >like an alternative universe to the one we >currently live in.
Well, thats what boards like this are for. I agree that doctors don't educate patients fully about the risks of the drugs they push. I was not made aware about some of the side effects of drugs which harmed me.
>yes, it is an established medical and legal fact >that all antipsychotics typical and atypical >cause EPS including TD.No. It is an established fact that they *can* cause TD and EPS. Like I said before, if they caused TD and EPS in everybody who took them, then I would have got TD or EPS from them which I didn't.
>sad isn't it when many studies conclude the risk >of suicide is higher with an AD than without.It is difficult to say, because many of the studies which concluded an increased risk of suicide were short term studies. It is not clear how they affect the rate of suicide in the long term.
>however, everyone is exposed to the risk of >developing serious neurological damage with >these drugs. it is about calculating the >probablities given the size of the dose and the >length of treatment.
That sounds fair.
>well if it isn't a disease, then that means it >isn't a medical issue doesn't it?Regardless of wheather it is a medical issue, it is a problem. For many people with this "manifestation", there is little apparent other way to improve symptoms. Even if it isn't a medical disease, if a medicine can aid in the treatment, and is justified in its risks, then it makes sense to take it.
>for example EPS is generally thought to be a >dopamine receptor issue, so they compare a dose >of new antipsychotic that induces a dopamine >block of 50%, to a dose of old antipsychotic >that blocks 80%+ of dopamine.Yes. Atypicals have less binding to dopamine receptors that typical antipsychotics. They also bind more loosely to the receptor.
>although as a side note much EPS could also be >due to anticholinesterase activity hence why >atropine is often a successful treatment for >things like dystonias.I had no idea that antipsychotics had binding to cholinsterase.
>However, you were exposed to a risk of >developing TD. That risk is exacerbated by >increased doses and the total amount of >risperidone injested.True.
>actually you have almost certainly incurred >brain decay from the risperidone, although you >have not yet incurred enough damage for the >damage to be obvious.Not necessarily. The side effects from many medications are not always linear. Damage occurs when the drug ofsets natural chemistry so much that dammage occurs. The brain is able to deal with a variety of toxins so long as they don't acumulate to high enough doses. Like bacteria. Your body can deal with germs so long as the they are not at too high a level, and you won't get sick.
The progression of TD may also depend on things like antioxidant enzyme status. Nutritional status. Level of neuroprotective growth factors etc. The level of the growth factor BDNF, is often related to the development of brain dammage after the administration of neurotoxins.
>As has been established, every milligram of >antipsychotic causes progressive irreversible >neurological damage, in the same way that a >neurological disease would cause if say you had >Parkinson's disease.
I don't think that has been established. If it has, you would be able to easily present me with data that specifically shows that all antipsychotics induce brain damamge at *all* doses (including low doses).
>every milligram injested causes neurological >damage,
There is absolutely no data to support that claim. That is like saying that valproate damamges the liver at all doses, which is not true. Yes, valproate can dammage the liver, but many people take high doses of valproate for long periods of time without any evidence of liver damamge.
>if overtime the total amount of >risperidone >injested by a patient from the time they first >start taking the medication is more than say >100mg, that would be taking 2mg for 50 days, >there may be a 0.05% chance that neurological >decay caused by the risperidone displays as TD.
It does't work that way. Like I said before, the brain is able to deal with toxic agents quite well, so long as the dose is low, and its defences are high. Dammage only occurs when the system is overwhelmed.
Think of it this way. There are pesticides which are anticholinsterase inhibitors. They raise levels of acetycholine so high that the result is neurological dammage. But, low doses of anticholinsterase inhibitors are in many foods you eat. Green tea inhibits acetycholinsterase. Yet green tea is highly neuroprotective. So you cannot say that acetycholinsterase inhibition causes dose dependant neurotoxicity.
>with cumulative dose of 300mg, say 2 mg for 150 >days the risk of TD may be 3%, and so on. 3% is >a very high probablity given the seriousness of >TD for only consuming 300mg, but that is the >risk I have seen from some studies of >risperidone in the elderly.
I don't think it works that way. Show me one study that concludes that the occurance of TD is related to cumulative drug ingested, and not maximum daily dose.
>well if psychosis is not a disease it falls >outside the ambit of the medical profession, as >a result medical intervention can never be >justified on an involuntary basis.
I never agree with the use of these drugs on an involtentary basis.
>on a voluntary basis, by contrast, a person >should be free to pursue as many different >treatment alternatives, for whatever non disease >they have, as they desire.
While there may not be direct proof that schizophrenia is a medical illness, there is no proof that it is not a medical illness.
>what problem are we talking about precisely, a >disease, or something else?It doesn't matter. People need solutions.
Linakdge
poster:linkadge
thread:730044
URL: http://www.dr-bob.org/babble/20070207/msgs/731943.html