Posted by yxibow on July 23, 2008, at 1:06:04
In reply to Re: i think i have TD from Clozapine, posted by bleauberry on July 22, 2008, at 20:13:11
> I still have drooling in my sleep after being off of zyprexa a couple years. And a slight eye twitch. And trembling during movements of exercise, such as doing a push-up.
It is a very hard thing to view -- and you may be right, you may have these things because of Zyprexa, just as I still have stiffness. But there is a strong theory in psychiatry that causality is not necessarily causation.
That is while x was taken or procedure x was done or one felt in x way at a certain time, y may not be 100% of the reason or relation to x.
Also these things may take a very long time to remit or may remit very quickly. It depends on the person, genetics, unforseeable consequences that have never been seen yet in the general population, and other factors.
> Hey, I don't think it is realistic for any of us to enter the world of powerful psychiatric drugs and come out of it the same way we went in. That is probably most especially true with antipsychotics. I'm not sure you can point the finger at clozapine because you've been on a bunch of others and high doses to boot. Things were probably already in the works but didn't elevate to the level of noticing them a lot until it was clozapine's turn to join in.
>
> Or it could be side effects that will go away after being off clozapine for a while.
>
> In any case, I hope your doctors are trying to think of ways to get you off the antipsychotic merry-go-round and do some other stuff. If destined to stay on them though, hey, I saw at pubmed where refractory patients were improved with a combination of Risperdal and Zyprexa.
>
> Antipsychotics and TD. Length of time and size of dose.Partially. And also very different whether a person has an affective (mood) disorder or a disorder that has psychotic features (schizophrenia -- not schizoaffective, and some forms of bipolar that are more complicated than an affective disorder).
Basically it is now known that old line antipsychotics can produce TD up to 25% a year for an unknown length of time, but a number of them are far less potent than that.
Also it is generally accepted that atypicals as a conglomerate will produce TD possibly about 5% a year for an unknown length of time, with Risperdal being the only one with a proven number of cases at the moment. Seroquel and Zyprexa are probably 0.25% to 0.5%. Clozaril is unique that it has never been truly shown to produce TD for those who have never taken or have not taken many antipsychotics. In fact it improves TD in patients.
Also those with schizophreniform disorders for reasons not quite understood can have choreiform movements that mimic TD but are actually not TD, but a part of the way the brain works in those individuals.
People with affective disorders, such as myself are much more sensitive to APs, although that varies wildly. A number of BP I/II people live lives stabilized on APs.
Also TD, unlike TDy (Tardive Dystonia) remits at least 30% of the time if not more, remains the same in 30% of cases, and unfortunately for reasons not quite understood becomes worse in 30% of the cases. However, though some forms of TDy may not remit except for 10% of the cases, there are far more palliatives for TDy than TD.
Unfortunately some people do still need APs -- it becomes a "merrygoround" too when people do not stay on their medications even though there is some undesirable side effect which can be mitigated. Dropping one cold can cause unknown consequences but at least withdrawal dyskinesia, that I am sure of as I have experienced it at least once.
I wish we were at a stage in schizophrenia, more than 50 years after Thorazine, that we had medications that did not produce TD. To this date, clozapine is the closest we have, and a "gold standard", with many side effects that Jeroen has experienced -- drooling being one many people experience besides somnolence. There are receptors still in the experimental stage, sigmoid, etc.
There will come a time when this doesn't happen to many people but it may take a number of years, just like other frontiers that have a long way to be explored. For better or worse, we are still in the "middle ages" of psychiatry. Medication works for a number of disorders without a lot of side effects, and unfortunately for many, there are consequences.
Ultimately, it is, is the condition better worth living with without treatment, or does the benefits outweigh the risk. This is the case with all medicine. Hard choices. Very hard choices when you feel alone in a corner. I don't like to carry a flag that bears that or turn my disorder into the only thing that is myself, which is a place that people fall into in secondary depression due to a complex case, but I do feel alone a lot of the times because I have a very rare disorder.
-- Jay
poster:yxibow
thread:841207
URL: http://www.dr-bob.org/babble/20080718/msgs/841559.html