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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 11 to 35 of 44. Go back in thread:
Posted by Chloe on December 27, 2001, at 21:11:32
In reply to Re: Cam:antipsychotic question » Chloe, posted by Cam W. on December 27, 2001, at 20:44:17
Cam,
I have been off of Mellaril for 4 or more years because I was developing tongue movements. After about a year, the tongue movements settled down so it only come back with an anxiety producing situation, or activating meds like Celexa. Seems strange an SSRI would cause the same mouth movements as an AAP.
My Pdoc is wondering if I just have an "oversensitive" tongue and mouth since the d/c of Mellaril. Does this sound plausible? That agents that might touch on dopamine would *reactivate* an already irritable tongue? And maybe Seroquel won't cause additional *permanent* damage? The damage is already done?BTW, I was on Clozeril for about 3 month several years ago. I had a wonderful response to it. Best I think I have every functioned. My emotional pain for once, was really being managed. But my WBC bottomed out. Very upsetting.
I think I am going to wait on this Melatonin "cure" for the moment. It seems like it might add more problems at the moment.
Thanks so much Cam.
Chloe- I haven't heard of using melatonin successfully for EPS or TD. I have seen vitamin E used successfully...once. The Seroquel™ (quetiapine), while it may not stop these movements, will, in all probability, not worsen them (unless, by stopping the Mellaril™ - thioridazine - "unmasks" more severe tardive symptoms). I have never seen Seroquel cause any kind of EPS symptoms (let alone TD), but then again, I seldom see Seroquel used as a sole agent.
>
> The worse case of TD that I had ever seen (the person could not even keep a hat of their head) was basically "cured" using Clozaril™ (clozapine). It did take over 8 months for the effects to kick in, but now this person is riding a bike, and if you did know that this person had TD, you couldn't tell. The transformation was absolutely amazing.
>
> I have heard a similar story with Zyprexa™ (olanzapine), but I have personally only seen the unmasking of Orap™ (pimozide) induced TD with Zyprexa. This could be due to the short time that the person was taking the Zyprexa before stopping it.
>
> - Cam
Posted by Cam W. on December 27, 2001, at 23:14:49
In reply to Re: Cam:antipsychotic question » Cam W., posted by Chloe on December 27, 2001, at 21:11:32
Chloe - Yes, unfortunately the damage is done. The good news is that it is highly unlikely that Seroquel will add any more problems. It is thought that the loose binding of dopamine-D2 receptors by the atypical antipsychotics (like Seroquel), rather than the irreversible binding of dopamine-D2 receptors to the traditional antipsychotics (like Mellaril) helps to avoid EPS and TD.
With the atypicals, at any one time the D2 receptors are less than 79% blocked. Above this level is when one starts seeing EPS symptoms (and ultimately TD symptoms). I think that I read somewhere that with most of the atypicals you can obtain greater than 80% blockage of D2 receptors if you raise the dose high enough (Risperdal™ [risperidone] >6mg; Zyprexa™ [olanzapine] >35mg - approximately), except with Clozaril™ (clozapine) and Seroquel. I am fairly sure that they have tried, but have been unable to get Seroquel to block the D2 receptors at a level greater than 80%.
Yeah, SSRIs do seem to exacerbate TD and can even cause EPS in a minority of people. I don't really know why. It could be because when you increase serotonergic tone, you (in a roundabout way) decrease dopaminergic transmission. This is just a guess, though.
As for the use of Clozaril, has your doc ever considered a rechallenge, with a close watch on your blood cells? I have seen a few rechallenges where the second time around there has been no blood problems (so far). The downside to the cases that I know about is that the docs are a little jumpy about Clozaril rechallenges and keep the people on weekly blood tests forever (so far). That can be a real pain (where I wouldn't put a window).
- Cam
Posted by Chloe on December 28, 2001, at 9:31:41
In reply to Re: Cam:antipsychotic question » Chloe, posted by Cam W. on December 27, 2001, at 23:14:49
Cam,
That info is so helpful and reassuring. Especially when you throw in the statistics! I am also glad Seroquel seems to even "more" safe in that it doesn't seem to bind over 80% at any dose.
> > Chloe - Yes, unfortunately the damage is done. The good news is that it is highly unlikely that Seroquel will add any more problems. It is thought that the loose binding of dopamine-D2 receptors by the atypical antipsychotics (like Seroquel), rather than the irreversible binding of dopamine-D2 receptors to the traditional antipsychotics (like Mellaril) helps to avoid EPS and TD.> > With the atypicals, at any one time the D2 receptors are less than 79% blocked. Above this level is when one starts seeing EPS symptoms (and ultimately TD symptoms). I think that I read somewhere that with most of the atypicals you can obtain greater than 80% blockage of D2 receptors if you raise the dose high enough (Risperdal™ [risperidone] >6mg; Zyprexa™ [olanzapine] >35mg - approximately), except with Clozaril™ (clozapine) and Seroquel. I am fairly sure that they have tried, but have been unable to get Seroquel to block the D2 receptors at a level greater than 80%.
> > Yeah, SSRIs do seem to exacerbate TD and can even cause EPS in a minority of people. I don't really know why. It could be because when you increase serotonergic tone, you (in a roundabout way) decrease dopaminergic transmission. This is just a guess, though.
> > As for the use of Clozaril, has your doc ever considered a rechallenge, with a close watch on your blood cells? I have seen a few rechallenges where the second time around there has been no blood problems (so far). The downside to the cases that I know about is that the docs are a little jumpy about Clozaril rechallenges and keep the people on weekly blood tests forever (so far). That can be a real pain (where I wouldn't put a window).In terms of a rechallenge, I am under the impression that it is illegal to take Clozaril again after one has had agranulocytosis. Is my info incorrect? Perhaps it's allowed in Cananda, but not here in the US? Or my pdoc is just too scared! But I don't think so.
After two days of Seroquel, my thinking is really clearing up and I am feeling a bit better. I think I am just going to have to accept my tongue movements and get on with my life. It is quite reassuring that it shouldn't get worse. Unfortunately, this tongue stuff was created a long time ago.
Thank you so much, again, Cam. It is such a gift that you are willing to share your expertise and experience with us. Happy 2002!
Chloe
Posted by janejj on December 28, 2001, at 10:43:05
In reply to Re: Paranoia and Dopamine CamW or anyone ? » janejj, posted by Cam W. on December 27, 2001, at 13:09:59
Hi Cam,
Thankyou for your reply ! How are those philosophy books going !?
OK I suspect then that it is the Wellbutrin. Perhaps just exacebating what was already there! Although its very specific paranoia, just that i think people are staring at me when i go shopping at the mall. I hate those places !!!
Janejj
Jane - My holidays are going well; as well as they can for a secular humanist-type of guy. Santa sent a pile of philosophy books (I think he/she thinks that I am collecting too much information about psychopharmacology without internalizing it (ie. collecting the knowledge, but not integrating it into wisdom). Guess I gotta become more selective in what I learn, and finally realize that I can't know it all! (Sure Santa, wanna bet!)
>
> Anyway, I have seen someone who did develop paranoid ideation about 3 or 4 weeks after starting Wellbutrin™ (bupropion). I had seen this person in outside the clinic (at a mall) and he/she had said that they were feeling very "anxious and jittery". Since it was about three weeks into therapy, I had chalked it up to start-up side effects. I told this person to hang on and these would go away.
>
> I went back to work and had a conversation with the therapist about this individual and she gave a call. I guess this person had deteriorated and the therapist went to the apartment. This person had progressed to the point where the neighbors were plotting to "get them" (the whole family). This person was sent to hospital for a couple of days, the Wellbutrin was stopped, and the ideation faded.
>
> It should be noted that this person had been taking Haldol™ (haloperidol) for a number of years, and had a few breakthrough psychotic episodes (usually delusions, rather than overt paranoia, though). This person had experienced paranoia during the occasional cocaine binge (which was denied, at this time - also, had previously told me that coke wasn't a favorite escape because of the paranoia). Also, this person had been known to occationally binge on other recreational chemicals, but had never mentioned (to me) of any paranoia.
>
> The pdoc, therapist, and I had chalked up the paranoia to either extreme agitation &/or nervousness. In any case, whatever had caused the paranoia, it did resolve within a couple of days of stopping the Wellbutrin. I do believe that I had read somewhere that Wellbutrin had caused paranoid ideation in a person taking Wellbutrin, but I cannot remember the particulars.
>
> I hope that this is of some help. - Cam
Posted by Willow on December 28, 2001, at 16:32:24
In reply to CamW, posted by janejj on December 28, 2001, at 10:43:05
Posted by IsoM on December 28, 2001, at 17:03:50
In reply to What is EPS? (nm), posted by Willow on December 28, 2001, at 16:32:24
It means extrapyramidal symptoms - muscle disturbances & movements such as restlessness, tremors, & muscle stiffness that are side effects of some antipsychotic medications. They're generally more common with older medications than the newer ones.
Posted by Cam W. on December 28, 2001, at 18:02:44
In reply to Re: What is EPS? » Willow, posted by IsoM on December 28, 2001, at 17:03:50
> It means extrapyramidal symptoms - muscle disturbances & movements such as restlessness, tremors, & muscle stiffness that are side effects of some antipsychotic medications. They're generally more common with older medications than the newer ones.
....or Edmonton Police Service (damn, busted again).
Willow - EPS can be treated with anticholinergic drugs (which many times cause more perturbing side effects than some EPS), like Cogentin™ (benztropine), Artane™ (trihexyphenidyl), Kemadrin™ (procyclidine), Disipal™ (orphenadrine),
Akineton™ (biperiden), and Parsitan™ (ethoproprazine). I have listed them in order of most commonly used to least commonly used in our area.All have good points and bad points. Doses are highly individualized. Some people taking high doses of older antipsychotics don't need any or small doses (1mg of Cogentin daily), but I have seen someone taking 1mg of Haldol a day need 2mg of Cogentin three times daily. It's all how one's body is affected by D2 blockade.
- Cam
Posted by Willow on December 28, 2001, at 22:15:13
In reply to Re: What is EPS? - Willow, posted by Cam W. on December 28, 2001, at 18:02:44
EPS can be treated with anticholinergic drugs (which many times cause more perturbing side effects than some EPS), like Cogentin™ (benztropine), Artane™ (trihexyphenidyl), Kemadrin™ (procyclidine), Disipal™ (orphenadrine),
> Akineton™ (biperiden), and Parsitan™ (ethoproprazine). I have listed them in order of most commonly used to least commonly used in our area.So EPS is the constant movement of legs and arms that my father has? And if so, his doctor hasn't tried him on any of these meds, is there a reason for this?
The effexor gives me muscle twitches and sudden jerks. I've been reassured by the doctors that this isn't related to the TD in anyway. Are they correct? Is it safe to say that they aren't related to EPS either?
Chloe
If you're still here I have a question for you regarding the TD, more so the tongue. Do you ever get an irrating tickle running along a nerve in your tongue? I've just always wondered what this is.
Answers just lead to more questions.
Willow
Posted by Willow on December 28, 2001, at 22:16:42
In reply to Re: What is EPS? - Willow, posted by Cam W. on December 28, 2001, at 18:02:44
> ....or Edmonton Police Service (damn, busted again).Now what would the Edmonton Police Service want with you?
Wondering Willow
Posted by Cam W. on December 28, 2001, at 23:58:52
In reply to EPS Cam, posted by Willow on December 28, 2001, at 22:16:42
>
> > ....or Edmonton Police Service (damn, busted again).
>
> Now what would the Edmonton Police Service want with you?
>
> Wondering WillowWillow - Just hangin' with my homeys on the drug squad. =^P
Posted by Cam W. on December 29, 2001, at 0:11:19
In reply to Re: What is EPS? » Cam W., posted by Willow on December 28, 2001, at 22:15:13
Willow - There are several reasons that your father hasn't been given these drugs. First and foremost, I believe that your dad has tardive dyskinesia (TD), and these meds do little in the way of stopping those movements. The anticholinergics I mentioned are usually used for the extrapyramidal movements and muscle pains associated with EPS.
Secondly, these drugs cause a fair bit of cognitive impairment in the elderly population, especially those prone to Alzheimers, which anticholinergics with significantly worsen. They actually use anticholinesterase inhibitors for Alzheimers patients, which increase acetylcholine concentrations in the body. Blocking acetylcholine receptors would significantly enhance Alzheimers symptoms.
Also, anticholinergics can cause hallucinations in people who are more sensitive to their effects, and they cause lovely side effects like extreme dry mouth, sedation, urinary flow problems, and coordination problems (leading to falls). These side effects are most pronounced in the elderly.
Muscle twitches probably aren't EPS, although some people have reportedly got EPS symptoms from SSRIs and Effexor. It isn't that common. I believe that muscle aches and pains are an early sign. Your doc can do a simple test to determine if you do have EPS (I doubt it, though).
- Cam
> The effexor gives me muscle twitches and sudden jerks. I've been reassured by the doctors that this isn't related to the TD in anyway. Are they correct? Is it safe to say that they aren't related to EPS either?
Posted by Chloe on December 29, 2001, at 9:45:56
In reply to Re: What is EPS? » Cam W., posted by Willow on December 28, 2001, at 22:15:13
> >Do you ever get an irrating tickle running along a nerve in your tongue? I've just always wondered what this is.
Willow,
I have never experienced an irritating tickle. My tongue can get awfully sore and irritated at the tip where is rubs back and forth on my lower teeth. But no nerve problems. That is an interesting one. Does your father experience this?
> > Answers just lead to more questions.Isnt that the truth!
Best,
chloe
Posted by Willow on December 29, 2001, at 15:16:06
In reply to Re: What is EPS? » Willow, posted by Chloe on December 29, 2001, at 9:45:56
Chloe
I asked my dad if he has any problems besides the obvious with the TD because of the tongue movements. He said that just his neck gets sore. The scariest part of it is that he often swallows down the wrong tube and chokes.
Fortunately the zyprexa doesn't give him such a dry mouth and the need to gozzle water isn't as strong. Now this may also be because he substituted his beer for Ativan, he claims the no-name brands don't help the same way.
The question regarding the tickle was for myself. Thankfully it is very infrequent but quite obtrusive as it has wakened me from my sleep which not much can. I've also on separate occassions lost all sense of smell and taste. The taste came back to parts of my tongue in portions, the back first. I don't know if this is related to the tickle.
But from this experience I do believe that these senses affect our mood. Whenever I notice it fading I make a point to eat strong foods and sniff strong odours to try and revive it and to give my mood a kick start.
I do hope your holidays are going well!
BEST WISHES
Willow
Posted by Chloe on December 29, 2001, at 15:55:59
In reply to TD » Chloe, posted by Willow on December 29, 2001, at 15:16:06
Hi Willow,
I am glad your dad is better on Zyprexa and avoiding beer! The inability to swallow stuff is very scary for me. I felt I might have had that when I took Geodon. All foods just seemed so dry, and I had such a hard time forcing down my throat. It was strange, because I did not experience dry mouth with Geodon. So I was too scared to continue with that med.Your tongue phenomenon sounds uncomfortable. Esp. if it's waking you from a sound sleep. Are you taking any antipsychotics? Do you think this is some form of TD that I am unfamilar with? I wonder if it's neurological in some way. In that you are losing sensation, and taste, and then it will return with strong smell. Have you talked to an MD about this? Does it worry you?
I am barely holding it together with the addition of Seroquel. I find it doesn't work as well as the traditional antipsychotics, and I do get exaggerated tongue wiggling/teeth clenching, which is very annoying. But I guess it's better than being "crazy", ie, angry, distorted thinking, paranoid, anxious all the time. But I am still extremely depressed. I just wish there were a cure for what I got. But I really don't have much hope. Esp. when all meds seem to be giving me major side effects. I am *trying* to stay upbeat as possible. I hate to drag people arouond me down with my lousy mood!
Thanks for the holiday good wishes. Same to you.
Chloe
>
> I asked my dad if he has any problems besides the obvious with the TD because of the tongue movements. He said that just his neck gets sore. The scariest part of it is that he often swallows down the wrong tube and chokes.
>
> Fortunately the zyprexa doesn't give him such a dry mouth and the need to gozzle water isn't as strong. Now this may also be because he substituted his beer for Ativan, he claims the no-name brands don't help the same way.
>
> The question regarding the tickle was for myself. Thankfully it is very infrequent but quite obtrusive as it has wakened me from my sleep which not much can. I've also on separate occassions lost all sense of smell and taste. The taste came back to parts of my tongue in portions, the back first. I don't know if this is related to the tickle.
>
> But from this experience I do believe that these senses affect our mood. Whenever I notice it fading I make a point to eat strong foods and sniff strong odours to try and revive it and to give my mood a kick start.
>
> I do hope your holidays are going well!
>
> BEST WISHES
> Willow
Posted by OldSchool on December 30, 2001, at 11:59:48
In reply to What is EPS? (nm), posted by Willow on December 28, 2001, at 16:32:24
I was recently diagnosed with EPS this past fall. Im still battling it actually. It occurred after I took low dose Seroquel for slightly over one a month, just 50 mg!. I was adding the seroquel to an SSRI for "augmentation" for refractory depression...didnt help in fact it made me feel more depressed. After I went off the Seroquel, my muscles got super sore and tight feeling and my tongue got real numb. I felt super weak, but my mood wasnt affected that much. I also had mild weakness on my right side. I also had a lot of small muscle twitches at rest, "twitch, twitch, twitch."
It feels like a very mild, sustained muscle contraction all over my body, with a numb tongue.
I went to my family doctor and he quickly informed me I was suffering from side effects of the Seroquel and he told me to contact my psychiatrist immediately, which I did. I then went and saw my psychiatrist, who informed me after doing some tests that my right side was mildly weak. He told me I had EPS, and that EPS oftentimes affects one side of the body more than the other.
Right now Im just waiting things out to see if things will go back to normal on its own. Its gotten a bit better but the EPS is still there. Only thing Ive tried so far that helps it is OTC Benadryl. Its also started affecting my breathing some I hate to say, like my chest gets tight, all my muscles get tight. Tongue is numb a lot. I cant open my mouth as far as I used to before all this EPS started.
The best way to deal with EPS is to never get it in the first place. When it comes to neuroleptic induced movement disorders, prevention is the best cure. That means avoid taking anti-psychotics unless you are bona fide psychotic or manic. Dont use atypical anti-psychotics for things that oftentimes are a integral part of severe depression like anxiety, insomnia, agitation, irritability and "rumination."
Use anti-psychotics for what they were originally intended for...psychosis. IE; schizophrenia or manic psychosis.
I have kind of come to the conclusion on my own that for people whose primary dx is a mood disorder and if they have psychotic symptoms the best thing might be old fashioned bilateral ECT. Or maybe bifrontal ECT. Instead of anti-psychotics plus antidepressants. Because with ECT there is no danger of movement disorders. Id trade some memory loss for this EPS crap anyday.
In short, if your problem is primarily a severe mood disorder, you might be better off getting shocked than taking anti-psychotics.
Here is a link that describes EPS from the Merck manual website:
http://www.merck.com/pubs/mmanual/section14/chapter179/179d.htm
Old School
Posted by Chloe on December 30, 2001, at 18:05:35
In reply to Re: What is EPS?, posted by OldSchool on December 30, 2001, at 11:59:48
I am just emerging from an agitated phycotic depression that was helped with the last resort Seroquel.
But now I read Old School's story about Seroquel and EPS and I am scared out of my mind. I have jaw clenching and tongue wiggling and my tongue has some pretty bad sores on it. I don't know what from...From all the repetitive rubbing or is it from the increased dry mouth from the Seroquel?
I am barely coping, and today day 5 on 50-100mgs Seroquel, I was able to go out with a friend and not go into a psychotic rage.But now I am so scared to remain on Seroquel. Having my tongue to tense and numb(?) and wiggly and clenching is awful. I can't get in touch with a pdoc till wednesday. What am I supposed to do? I think I will have bigtime rebound craziness if I just go off. I am so suicidal. NOTHING I take really helps that much, and all meds that do help, like lithium or AP's give me such bad side effects. I just want to throw in the towel. The pain is just so unbearable. And now, a med that was marginally workinig looks like it could permanently impair me. God, I guess I don't even care if I get impaired at this piont.
What is am I supposed to do if I need a major tranquilizer like an AP, but I shouldn't take them? Anyone know? God, how do I hang on?
> I was recently diagnosed with EPS this past fall. Im still battling it actually. It occurred after I took low dose Seroquel for slightly over one a month, just 50 mg!. I was adding the seroquel to an SSRI for "augmentation" for refractory depression...didnt help in fact it made me feel more depressed. After I went off the Seroquel, my muscles got super sore and tight feeling and my tongue got real numb. I felt super weak, but my mood wasnt affected that much. I also had mild weakness on my right side. I also had a lot of small muscle twitches at rest, "twitch, twitch, twitch."
>
> It feels like a very mild, sustained muscle contraction all over my body, with a numb tongue.
>
> I went to my family doctor and he quickly informed me I was suffering from side effects of the Seroquel and he told me to contact my psychiatrist immediately, which I did. I then went and saw my psychiatrist, who informed me after doing some tests that my right side was mildly weak. He told me I had EPS, and that EPS oftentimes affects one side of the body more than the other.
>
> Right now Im just waiting things out to see if things will go back to normal on its own. Its gotten a bit better but the EPS is still there. Only thing Ive tried so far that helps it is OTC Benadryl. Its also started affecting my breathing some I hate to say, like my chest gets tight, all my muscles get tight. Tongue is numb a lot. I cant open my mouth as far as I used to before all this EPS started.
>
> The best way to deal with EPS is to never get it in the first place. When it comes to neuroleptic induced movement disorders, prevention is the best cure. That means avoid taking anti-psychotics unless you are bona fide psychotic or manic. Dont use atypical anti-psychotics for things that oftentimes are a integral part of severe depression like anxiety, insomnia, agitation, irritability and "rumination."
>
> Use anti-psychotics for what they were originally intended for...psychosis. IE; schizophrenia or manic psychosis.
>
> I have kind of come to the conclusion on my own that for people whose primary dx is a mood disorder and if they have psychotic symptoms the best thing might be old fashioned bilateral ECT. Or maybe bifrontal ECT. Instead of anti-psychotics plus antidepressants. Because with ECT there is no danger of movement disorders. Id trade some memory loss for this EPS crap anyday.
>
> In short, if your problem is primarily a severe mood disorder, you might be better off getting shocked than taking anti-psychotics.
>
> Here is a link that describes EPS from the Merck manual website:
>
> http://www.merck.com/pubs/mmanual/section14/chapter179/179d.htm
>
> Old School
Posted by gregg on December 31, 2001, at 10:41:32
In reply to Paranoia and Dopamine CamW or anyone ?, posted by janejj on December 26, 2001, at 23:29:50
Jane,
If you read the prescibing info on the manufacturer's web site you will find a paragraph that says Wellbutrin can cause/exacerbate psychosis.
Personally, I only know one person who has used Wellbutrin to treat the depression component of depression with psychotic features. When used alone, the Wellbutrin caused a dramatic worsenning of the psychosis (paranoid delusions). When an anti-psychotic (Risperdal) was added to the 300mg of Wellbutrin, however, the psychosis completely disappeared. While this is only one case, it does suggest that caution may be warranted in using Wellbutrin without an AP if there is a history of psychosis.
gregg
PS Has anyone else seen "A Beautiful Mind"? Great film!
> Hello everyone,
> Hope you had a good holiday !
>
> Ok i'm wondering if Wellbutrin can induce paranoia ? Is it connected to too much Dopamine ?
>
> Thankyou,
>
> jane
Posted by gregg on December 31, 2001, at 10:52:07
In reply to Re: Cam:antipsychotic question » Chloe, posted by Cam W. on December 27, 2001, at 20:44:17
Cam,
I noticed that you say in a couple of your posts that you seldom see Seroquel used as a sole agent. I was wondering why that is. Is Seroquel not as effective as other APs (like Risperdal or Zyprexa) in treating psychosis? It would be a shame if a med with such a benign side-effect profile was a dud in treating the condition it is intended for! I am particularly interested in how effective you have found Seroquel to be in treating the psychosis in depression with psychotic features?
Thanks,
Gregg> Chloe - I haven't heard of using melatonin successfully for EPS or TD. I have seen vitamin E used successfully...once. The Seroquel™ (quetiapine), while it may not stop these movements, will, in all probability, not worsen them (unless, by stopping the Mellaril™ - thioridazine - "unmasks" more severe tardive symptoms). I have never seen Seroquel cause any kind of EPS symptoms (let alone TD), but then again, I seldom see Seroquel used as a sole agent.
>
> The worse case of TD that I had ever seen (the person could not even keep a hat of their head) was basically "cured" using Clozaril™ (clozapine). It did take over 8 months for the effects to kick in, but now this person is riding a bike, and if you did know that this person had TD, you couldn't tell. The transformation was absolutely amazing.
>
> I have heard a similar story with Zyprexa™ (olanzapine), but I have personally only seen the unmasking of Orap™ (pimozide) induced TD with Zyprexa. This could be due to the short time that the person was taking the Zyprexa before stopping it.
>
> - Cam
Posted by Willow on December 31, 2001, at 15:35:27
In reply to Re: EPS, what to do???, posted by Chloe on December 30, 2001, at 18:05:35
> But now I read Old School's story about Seroquel and EPS and I am scared out of my mind. I have jaw clenching and tongue wiggling and my tongue has some pretty bad sores on it. I don't know what from...From all the repetitive rubbing or is it from the increased dry mouth from the Seroquel?
Chloe you mentioned both jaw clenching and sores on your tongue. At night you may have actually injured your tongue with the clenching. Talking to your dentist or doctor and they may be able to give you ideas on how to speed the recovery. I find flossing helps, don't know why but it seems to speed recovery and mouthwash.
>
>I can't get in touch with a pdoc till wednesday. What am I supposed to do? I think I will have bigtime rebound craziness if I just go off. I am so suicidal. NOTHING I take really helps that much, and all meds that do help, like lithium or AP's give me such bad side effects. I just want to throw in the towel. The pain is just so unbearable. And now, a med that was marginally workinig looks like it could permanently impair me. God, I guess I don't even care if I get impaired at this piont.Chloe we are all individuals. Our symptoms may have similarities but how they affect and impair us differ. I believe that our mental health takes precedence, because it affects our identity and ability to think. At the present time I don't let what "MAY" happen affect me, because it may not and there are bigger issues for me to deal with now.
Hang in there! Write down your main concerns and bring them to your doctor's appointment.
Keep in touch ...
Whispering Willow
Posted by jimmygold70 on January 1, 2002, at 2:11:46
In reply to Re: Cam:antipsychotic question, posted by Chloe on December 27, 2001, at 17:18:57
> I HAVE to be on an AP for the at least a few months or much longer. I already have MILD vermicular movements of the tongue from long term use of Melleril several years ago.
That happens - Extrapirmaidal Symptoms
> A well know pharmacologist that was consulted said I should go back on a typical AP and take 10 mgs of Melatonin to conteract tongue movements.
I haven't heard of this
> This was too scary for me, so I opted to go with the more safe AP, seroquel(much less effective, though!).
Try any atypical atipsychotic - Risperdal, Zyprexa, Seroquel or Geodon. There is no reason to presume that a sufficient dose of any of these could be less effective than Melleril for paranoid ideation.
> Do you think the seroquel could turn my mild tongue movements into TD?
No.
> And is there any merit to the use of Melatonin? The RDA for TD prevention in this pdocs mind is 10 mgs. This seems like a very high dose, and possibly depressogic, I would persume.
Very sedating, I presume. Try benztropine (BENZTROP MES, COGENTIN) for that.
> Do you have any thoughts on this???
>
> TIA
> Chloe
Posted by Chloe on January 1, 2002, at 17:44:52
In reply to Re: Cam:antipsychotic question, posted by jimmygold70 on January 1, 2002, at 2:11:46
Thanks for answering my questions. Since my pdoc is out of town I have been using 50 mgs doses of benadryl for the clenching (it doesn't help with the tongue movements at all). Do you think cogentin work better than benadryl for EPS?
I really feel that being on Seroquel is not such a good idea for me. The EPS is significant, and I have terrible tongue sores all around my tongue (ouch!) and on one cheek, an achy, clicking jaw, and trouble swallowing food. The paranoia is less, but the physical symptoms are hell.
There must be something better than this!At least the Mellaril didn't give me EPS, but I am sure in time I would develop more advanced TD.
Is there any other way to manage paranioa and distorted thinking without AP's??? Are there any other major tranquilizers that don't block dopamine???Thanks again
Chloe> > I HAVE to be on an AP for the at least a few months or much longer. I already have MILD vermicular movements of the tongue from long term use of Melleril several years ago.
>
> That happens - Extrapirmaidal Symptoms
>
> > A well know pharmacologist that was consulted said I should go back on a typical AP and take 10 mgs of Melatonin to conteract tongue movements.
>
> I haven't heard of this
>
> > This was too scary for me, so I opted to go with the more safe AP, seroquel(much less effective, though!).
>
> Try any atypical atipsychotic - Risperdal, Zyprexa, Seroquel or Geodon. There is no reason to presume that a sufficient dose of any of these could be less effective than Melleril for paranoid ideation.
>
> > Do you think the seroquel could turn my mild tongue movements into TD?
>
> No.
>
> > And is there any merit to the use of Melatonin? The RDA for TD prevention in this pdocs mind is 10 mgs. This seems like a very high dose, and possibly depressogic, I would persume.
>
> Very sedating, I presume. Try benztropine (BENZTROP MES, COGENTIN) for that.
>
> > Do you have any thoughts on this???
> >
> > TIA
> > Chloe
Posted by Chloe on January 1, 2002, at 17:55:30
In reply to ... what to do??? » Chloe, posted by Willow on December 31, 2001, at 15:35:27
Hi Willow,
You are so right that what happens to one person may not happen to another. It seems that I can get scared out of me witts about these AP meds. Especailly since I had to stop antipsychotics in the late 1990's because of emerging TD. So I guess I am really edgy about trying them in any form again since I have permanent damage already. Though I know this new breed of AP's are safer. But God, do I have some major side effects...I am desperately waiting for a psychpharm consult. I hope the guy will get back to me this week. I really need a better approach to managing my illness, I think...The EPS is all I focus on now, not the paranoia. I wonder if this really is an improvement! I did get some special kanker sore rinse. It has helped a little. Now my sores are white, instead of red! But I think I just make them worse again while I sleep. So I am just trying to keep hope alive that something better is out there for me!
Thanks again Willow. Hope you had a happy new years day.
Chloe
Posted by jimmygold70 on January 1, 2002, at 17:56:40
In reply to Re: Cam:antipsychotic question » jimmygold70, posted by Chloe on January 1, 2002, at 17:44:52
> I really feel that being on Seroquel is not such a good idea for me. The EPS is significant, and I have terrible tongue sores all around my tongue (ouch!) and on one cheek, an achy, clicking jaw, and trouble swallowing food. The paranoia is less, but the physical symptoms are hell.
> There must be something better than this!I know they use risperdal to treat TD ! The best treatment for TD is to increase the dose of the AP you take. Since Risperdal is less likely to cause TD than the typical ones, I would recommend you to try this. There is no well documented uses for sqroquel concerning paranoid ideation. The fact it works for paranoid schizophrenia doesn't imply it is good for paranoid ideation as well.
> At least the Mellaril didn't give me EPS, but I am sure in time I would develop more advanced TD.
> Is there any other way to manage paranioa and distorted thinking without AP's??? Are there any other major tranquilizers that don't block dopamine???No. The definition of a major tranquilizer that it should block D2 receptors. I would stick to an antipsychotic with well proven history of treating paranoid ideation - i.e. Risperdal. Play with the dose of risperdal + Benadryl/cogentin. Zyprexa is also an option. Yes, SSRIs might help too. I would combine high dose Paxil with whatever antipsychotic you take. It might bring more favorable results. Just my intuition.
Jimmy
Posted by OldSchool on January 1, 2002, at 18:05:11
In reply to Re: Cam:antipsychotic question » jimmygold70, posted by Chloe on January 1, 2002, at 17:44:52
> Thanks for answering my questions. Since my pdoc is out of town I have been using 50 mgs doses of benadryl for the clenching (it doesn't help with the tongue movements at all). Do you think cogentin work better than benadryl for EPS?
>
> I really feel that being on Seroquel is not such a good idea for me. The EPS is significant, and I have terrible tongue sores all around my tongue (ouch!) and on one cheek, an achy, clicking jaw, and trouble swallowing food. The paranoia is less, but the physical symptoms are hell.
> There must be something better than this!
>
> At least the Mellaril didn't give me EPS, but I am sure in time I would develop more advanced TD.
> Is there any other way to manage paranioa and distorted thinking without AP's??? Are there any other major tranquilizers that don't block dopamine???
>
> Thanks again
> Chloe
>
Bilateral ECT has powerful dual antidepressant/anti-psychotic properties, without creating the movement disorder problems of anti-psychotic drugs. Side effects? Memory loss.Old School
Posted by Cam W. on January 1, 2002, at 18:16:38
In reply to Re: Cam:antipsychotic question, posted by gregg on December 31, 2001, at 10:52:07
Gregg - I have seen Seroquel™ (quetiapine) added to both atypical and psychotic depressions, with varying degrees of success. Sometimes it added too much excess drowsiness, sometimes did nothing at all, and sometimes brought people "back to the world of the living and functioning." As I have only seen relatively few cases Seroquel used in depression (10 to 20 cases), and the fact that I no longer work closely with the psychiatrists, I am not as privy to a lot of the pdoc decisions as I used to be.
The problem with Seroquel monotherapy is that the drug works like a charm when used alone in a hospital setting. Many (probably most) psychiatrists and hospital clinical pharmacists will, and do, disagree with me on the next point.
"I" feel that when the hospital boys (and girls) are able to stabilize someone with psychosis (usually schizophrenia or schizoaffective disorder) on Seroquel, seeming all thought processes clear up, and functioning dramatically improves. The problems seem to start when the person loses the relative sanctity, safety, and security of the psych ward. The person, more often than not, is place back in the community (ie. thrown back to the wolves), back to the same environment, with the same associated stresses, that help to promote the most recent psychotic break. "I" believe it is this environment, with it's past memories, that overwhelm the activity of the Seroquel, and contribute to another relapse.
Perhaps the reason for this is that Seroquel just doen't have enough D2 receptor blocking ability. Perhaps there is a lower range of consistent block that is required before environmental stressors can again overwhelm the brain, and psychosis rears it's ugly head.
The reason I like seeing Seroquel used with other atypicals is that one can usally get away with lower doses of the others. This is important, especially when reaching doses of 6mg/day of Risperdal™ (risperidone) and 30mg/day (or so) of Zyprexa™ (olanzapine), in which cases the risk of EPS becomes significantly greater.
While I have no scientific evidence of the above (which is probably why the pdocs won't listen to me on this issue - but I got 'em thinkin'), I have read a study showing that using Seroquel and Clozaril™ (clozapine) together, it seems (in this small study) that those who used both drugs in combination, as opposed to using Clozaril alone, gain less weight, while having as good or better control of the psychosis.
I wish the dumbass drug companies (there go a few more job opportunities < sigh >) would drops their egos (and some of their potential profits) to try combinations like this, to see if we can get combinations of drugs (not just antipsychotics) that will maximize efficacy, while minimizing adverse effects.
Cam (stepping down off his soapbox, shaking the clouds from his hair, and going off to check the want ads, again)
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