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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by JonW on July 26, 2002, at 14:12:10
Hi,
I'm taking Geodon right now and I think I love it (I'm bipolar so it's too soon to tell yet)... anyway, I'm concerned about tardive dyskinesia. What exactly is it like to have symptoms of TD? Every so often a particular muscle group will twitch and cause my legs, arms, hands, or trunk to move. It's nothing major, but I'm concerned because I don't know what TD is... ARE THESE SIDE-EFFECTS ANYTHING I SHOULD WORRY ABOUT?
Thanks,
Jon
Posted by oracle on July 26, 2002, at 14:41:13
In reply to Tardive dyskinesia help?!, posted by JonW on July 26, 2002, at 14:12:10
Every so often a particular muscle group will twitch and cause my legs, arms, hands, or trunk to move
You should call your doc about this so he/she can
advise you
Posted by Mr Beev on July 26, 2002, at 16:30:49
In reply to Re: Tardive dyskinesia help?!, posted by oracle on July 26, 2002, at 14:41:13
I second oracle's suggestion that you talk to your doctor, for this can indeed be a very serious condition. I have even seen TD referred to as "parkinsonism", so I suppose there is a dopamine connexion.
As I recall, the longer one takes the medications that induce such effects, the great the chance they will remain permanent! Some people recover immediately upon cessation of the offending meds, others can take months. It is a myth that the (so-called) antipsychotics are the only psychotropics that can cause such troubles.
Be wary of your doctor's repsonse, should you decide to contact him/her: I have heard of doctors prescribing medications that merely mask the symptoms. I do not know if there are meds that can truly stamp out the problem at the root.
Best wishes,
Mr Beev
Posted by JonW on July 26, 2002, at 18:35:11
In reply to Re: Tardive dyskinesia help?!, posted by Mr Beev on July 26, 2002, at 16:30:49
Thanks for the advice guys... I just got off the phone with my pdoc and she believes they're myoclonic jerks as geodon is somewhat serotonergic. That makes sense to me. In any event she lowered my doseage because of another side-effect I'm having and maybe that will reduce this problem as well. It's really not an issue, but I just wanted to be sure of that.
Thanks again,
Jon
Posted by Ritch on July 26, 2002, at 19:30:32
In reply to Tardive dyskinesia help?!, posted by JonW on July 26, 2002, at 14:12:10
> Hi,
>
> I'm taking Geodon right now and I think I love it (I'm bipolar so it's too soon to tell yet)... anyway, I'm concerned about tardive dyskinesia. What exactly is it like to have symptoms of TD? Every so often a particular muscle group will twitch and cause my legs, arms, hands, or trunk to move. It's nothing major, but I'm concerned because I don't know what TD is... ARE THESE SIDE-EFFECTS ANYTHING I SHOULD WORRY ABOUT?
>
> Thanks,
> Jon
Hi Jon,You need to tell your doctor about what *exactly* is occuring. If the Geodon is causing this it could be extra-pyramidal symptoms (EPS) not tardive dyskinesia. TD is something more likely to develop after taking antipsychotics for extended periods and generally isn't reversible. EPS is a short term phenomenon that fades away when the antipsychotic is discontinued. However EPS syndromes may be masked by continuing to take the antipsychotic that is triggering them (along with anticholinergics to combat the symptoms such as Benadryl or Cogentin). Pronounced EPS symptoms with even small doses of antipsychotics may be predictive of future TD if they aren't discontinued after a time. I have always been sensitive to EPS (I am bipolar, too). Depending on the antipsychotic used, the EPS symptoms can vary considerably. Haldol made me immediately restless (I couldn't sit still-I had to shuffle about), then the next day I got a severe back spasm and couldn't stand or walk (had to take big doses of diazepam to relieve the spasms). Stelazine caused my tongue, jaw, and neck to spasm and I had to go to the ER. I didn't have that much trouble with low doses of Mellaril (thioridazine) or Thorazine (chlorpromazine). The newer ones can cause troubles too. Seroquel caused my posture to change and Risperdal made it feel like somebody was turning 'off and on' my ability to walk when I was walking (I would periodically feel a "freeze" for a second or so during my gait). I am not trying to scare you on purpose, that's just my experience with them. Most of this stuff faded after I stopped them (and I have been on and off the things for years). Just make sure to tell your doc what is going on. Geodon might not be the right one for you.
Mitch
Posted by LostBoyinNC1 on July 27, 2002, at 21:20:21
In reply to Tardive dyskinesia help?!, posted by JonW on July 26, 2002, at 14:12:10
> Hi,
>
> I'm taking Geodon right now and I think I love it (I'm bipolar so it's too soon to tell yet)... anyway, I'm concerned about tardive dyskinesia. What exactly is it like to have symptoms of TD? Every so often a particular muscle group will twitch and cause my legs, arms, hands, or trunk to move. It's nothing major, but I'm concerned because I don't know what TD is... ARE THESE SIDE-EFFECTS ANYTHING I SHOULD WORRY ABOUT?
>
> Thanks,
> Jon
those little twitches are bad news. Make sure you tell your Pdoc about that. Thats from the dopamine blockade your getting from Geodon. Here is what you could do:1) Take high dose natural vitamin E daily as a way to keep your nerves healthy. And when I mean high dose vitamin E, I mean high dose. As in 1500-2000 mg IU a day. There is info here in the tips and tricks on vitamin E for TD prevention.
2) Tell your Pdoc about those little muscle pops and twitches ( do you happen to have a numb tongue from Geodon by any chance) and ask him if an anti-cholinergic (parkinsons) drug taken simultaneously would be a wise idea. Some psychiatrists prescribe a parkinsons med with an anti-psychotic as a form of prophylaxis against EPS and movement disorders. This was a much more common practice in the old days when typical anti-psychotics was all they had. However it can still be done with the newer atypicals like Geodon. Cogentin and Artane are the two most common anti-EPS drugs.
Also, if your dx is bipolar why are you using an anti-psychotic as your main med? Why not a mood stabilizer? Mood stabilizers are much safer neurologically and are the drugs of choice for bipolar. If I was bipolar, Id be on a mood stabilizer not an atypical anti-psychotic, unless I was psychotic.
Posted by geno on July 28, 2002, at 12:45:19
In reply to Re: Tardive dyskinesia help?! » JonW, posted by Ritch on July 26, 2002, at 19:30:32
from what i gather, from all of the aphycotics, seroquel causes the least side effects of td or esp. Esp at low doses, which at 50mg helps me sleep great, and no side effects,except for am sedation. BUT the good thing with seroquel i like unlike zyprexa, is its half life is only 7-8 hrs after taking it, so by the next day afternoon, your not dragging butt all day.
geno
Posted by LostBoyinNC1 on July 28, 2002, at 15:35:08
In reply to Re: Tardive dyskinesia help?!, posted by geno on July 28, 2002, at 12:45:19
> from what i gather, from all of the aphycotics, seroquel causes the least side effects of td or esp. Esp at low doses, which at 50mg helps me sleep great, and no side effects,except for am sedation. BUT the good thing with seroquel i like unlike zyprexa, is its half life is only 7-8 hrs after taking it, so by the next day afternoon, your not dragging butt all day.
> genoActually Clozapine is the atypical anti-psychotic least likely to cause TD. There are no reported cases of TD as far as I know. Clozapine can still cause EPS however, but not TD. Clozapine is the safest atypical at least when it comes to movement disorder risks. However Clozapine has other difficult side effects unrelated to movement disorders and its generally only used for refractory schizophrenics.
Posted by JonW on July 29, 2002, at 14:02:24
In reply to Re: Tardive dyskinesia help?!, posted by LostBoyinNC1 on July 27, 2002, at 21:20:21
> those little twitches are bad news. Make sure you tell your Pdoc about that. Thats from the dopamine blockade your getting from Geodon. Here is what you could do:
Hi lostboy, thanks for the advice. Actually, I'm also weaning off of Nardil right now and since my last reduction of the dose of Nardil my myoclonic jerks have gone away and I was able to increase my dose of Geodon to what I was taking before without a problem. I had the jerks before starting the Geodon but they got worse when I added the Geodon so I thought it was responsible for them. I'm so happy this is not the case because I absolutely love this drug! I also wrote Dr. Goldberg on this problem to get his opinion and he said that myoclonic jerks are a very common side-effect of Nardil.
> 2) Tell your Pdoc about those little muscle pops and twitches ( do you happen to have a numb tongue from Geodon by any chance) and ask him if
No numb tongue.
> Also, if your dx is bipolar why are you using an anti-psychotic as your main med? Why not a mood stabilizer? Mood stabilizers are much safer neurologically and are the drugs of choice for bipolar. If I was bipolar, Id be on a mood stabilizer not an atypical anti-psychotic, unless I was psychotic.
If you were bipolar you'd want to be on a drug that works :)
Actually, the atypicals are very commonly used by experienced pdocs in bipolar disorder. In europe, they're the first line agents. I also take depakote and neurontin and have been on several other classic mood stabilizers but they have been of little or no help. I hope to be able to discontinue my depakote and neurontin and see if I can tolerate moclobemide for my social phobia. Bipolar disorder is a hellish disease and I wouldn't wish it on anyone, so please think twice before discouraging anyone with this disorder from trying drugs that have the potential to give them a life.
Anyway thanks for your input :)
Jon
Posted by LostBoyinNC1 on July 29, 2002, at 17:33:59
In reply to Re: Tardive dyskinesia help?! » LostBoyinNC1, posted by JonW on July 29, 2002, at 14:02:24
> > those little twitches are bad news. Make sure you tell your Pdoc about that. Thats from the dopamine blockade your getting from Geodon. Here is what you could do:
>
> Hi lostboy, thanks for the advice. Actually, I'm also weaning off of Nardil right now and since my last reduction of the dose of Nardil my myoclonic jerks have gone away and I was able to increase my dose of Geodon to what I was taking before without a problem. I had the jerks before starting the Geodon but they got worse when I added the Geodon so I thought it was responsible for them. I'm so happy this is not the case because I absolutely love this drug! I also wrote Dr. Goldberg on this problem to get his opinion and he said that myoclonic jerks are a very common side-effect of Nardil.OK...yes twitches are a side effect of MAOIs and on MAOIs are nothing to be concerned about. I didnt know you were on the Nardil.
>
> > 2) Tell your Pdoc about those little muscle pops and twitches ( do you happen to have a numb tongue from Geodon by any chance) and ask him if
>
> No numb tongue.Thats good. I always get a numb tongue on these atypicals and my Pdoc says that bad. I know it feels bad too.
>
> > Also, if your dx is bipolar why are you using an anti-psychotic as your main med? Why not a mood stabilizer? Mood stabilizers are much safer neurologically and are the drugs of choice for bipolar. If I was bipolar, Id be on a mood stabilizer not an atypical anti-psychotic, unless I was psychotic.
>
> If you were bipolar you'd want to be on a drug that works :)
>
> Actually, the atypicals are very commonly used by experienced pdocs in bipolar disorder. In europe, they're the first line agents. I also take depakote and neurontin and have been on several other classic mood stabilizers but they have been of little or no help. I hope to be able to discontinue my depakote and neurontin and see if I can tolerate moclobemide for my social phobia. Bipolar disorder is a hellish disease and I wouldn't wish it on anyone, so please think twice before discouraging anyone with this disorder from trying drugs that have the potential to give them a life.Yeah, I know. In the USA Zyprexa is formally FDA approved for mania in bipolar disorder. It seems many Pdocs are just switching over to atypicals to treat bipolars. I dont know if I agree with that, but to each his own. Bipolar is certainly a different illness than unipolar major depression or an anxiety disorder. Bipolars tend to have higher dopamine levels than depressives I read.
Still, if it was me and I was bipolar Id be trying mood stabilizers first and foremost and if that didnt work then Id do the atypical thing.
Posted by Ritch on July 29, 2002, at 22:17:54
In reply to Re: Tardive dyskinesia help?! » LostBoyinNC1, posted by JonW on July 29, 2002, at 14:02:24
>............I hope to be able to discontinue my depakote and neurontin and see if I can tolerate moclobemide for my social phobia.
Jon,
I am just wondering.. when are you going to start your moclobemide? I am on Depakote+Klonopin+Effexor. If I could swap the Effexor for moclobemide (at a low dose-leaving in the depakote and clonazepam) with less side effects and better response for SA symptoms, *with* less chances of hypomania I would bug the crap out of my pdoc about getting it imported (with a prescription). Are you in Canada?
Mitch
Posted by JonW on July 30, 2002, at 5:52:34
In reply to Moclobemide question » JonW, posted by Ritch on July 29, 2002, at 22:17:54
Hi Mitch,
Moclobemide is the drug I've always gone back to but never waited beyond 4 weeks (even though I had no side-effects). I've been impatient, and only recently have been able to get myself to give drugs their full trial. Anyway I plan to give moclobemide a 12 week trial. Dr. Liebowitz says moclobemide is not as potent as other drugs, but I'm bipolar and "brittle" so that may work out just fine for me. It certainly has enough positive clinical trials to get excited about and warrants a full test drive.
In about a week I stop Nardil completely, so I should be starting moclobemide in about 3 weeks. Every day seems like a week when you're waiting to start a drug, though... Anyhow, please feel free to email me at jonw1978usa@yahoo.com if you have "other" questions you can't discuss on this board about moclobemide.
Good Luck,
Jonp.s. I live in the USA
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