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Dr. Bob is Robert Hsiung, MD,
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Posted by linkadge on November 30, 2004, at 10:31:32
In reply to drug-induced illness, posted by lostforwards on November 30, 2004, at 8:25:33
Antipsychotics are powerful drugs, there is nobody doubting that. When initiating any medication it is necessary to weigh the pro's and cons.
What these stupid antipsychiatry sites fail to do, is offer any viable treatment options.
It's one thing to blow a whistle, and another thing to lend a helping hand.Linkadge
Posted by JACJ on November 30, 2004, at 10:40:06
In reply to Re: drug-induced illness, posted by linkadge on November 30, 2004, at 10:31:32
I agree with you Link. As I sit here my heart is breaking and tears are in my eyes. I was subjected to three AP's for about 2 years. I was never told about any side effects. There is nothing I can do about it now but just to let others know that other methods should be used.
So, does the brain go back to normal after coming off the drug? I am guessing that it depends how long you have been on the drug.
Posted by JACJ on November 30, 2004, at 10:43:43
In reply to Re: drug-induced illness, posted by JACJ on November 30, 2004, at 10:40:06
Does damage happen to everyone? I have so many questions about this article. Can someone tell me what dysphoria is? Can personal disorders stay with you after coming off the drug forver? Is the structure of the brain changed indefinately once coming off them?
Posted by ed_uk on November 30, 2004, at 10:50:54
In reply to Re: drug-induced illness » lostforwards, posted by Larry Hoover on November 30, 2004, at 10:10:32
Hello...
After my own dire experience with AP-induced akathisia and dystonia I will be forever 'in awe' of the toxicity of APs.
Although it is clear that dyskinesia may occur in the absence of neuroleptics, it is important not to forget that TD can occur in non-psychotic patients prescribed dopamine antagonists. I have no doubt in my mind that APs can cause TD.
The use of anti-emetic dopamine antagonists to treat non-psychiatric problems provides an example of what I am saying. Metoclopramide for example......
Metoclopramide-induced tardive dyskinesia in an infant.
Mejia NI, Jankovic J.
Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA.
We describe a 1-year-old girl who developed orofaciolingual stereotypy at age 2 months after a 17-day treatment with metoclopramide for gastroesophageal reflux. The stereotypy, documented by sequential videos, persisted for at least 9 months after the drug was discontinued. This patient represents the first documented case of tardive dyskinesia in an infant. We also review previous reports of tardive dyskinesia in children.
J Pediatr. 1992 Dec;121(6):983-5. Related Articles, Links
Tardive dyskinesia associated with use of metoclopramide in a child.Putnam PE, Orenstein SR, Wessel HB, Stowe RM.
Department of Pediatrics, Children's Hospital of Pittsburgh, PA 15213.
Tardive dyskinesia is a chronic, often permanent, movement disorder that has been reported in elderly patients receiving metoclopramide. We describe an 8-year-old boy with tardive dyskinesia that developed when he received metoclopramide as part of therapy for gastroesophageal reflux and erosive esophagitis.
Metoclopramide-associated tardive dyskinesia in hemodialysis patients with diabetes mellitus. Two case reports.Sewell DD, Yoshinobu BH, Caligiuri MP, Jeste DV.
University of California, San Diego.
Metoclopramide, a drug used almost exclusively for medical indications, is a dopamine (D-2) receptor blocker and has been reported to cause extrapyramidal side effects. We present two case reports of hemodialysis patients who were treated with metoclopramide for diabetic gastroparesis. Within 12 months of beginning treatment, both patients developed persistent tardive dyskinesia. These cases highlight the fact that some patients who benefit from metoclopramide may also have a relatively high risk of developing persistent tardive dyskinesia. The consultation-liaison psychiatrist can play an important role in the education of the medical staff regarding metoclopramide-induced tardive dyskinesia.
Arch Fam Med. 1992 Nov;1(2):271-8. Related Articles, Links
Metoclopramide-associated tardive dyskinesia. An analysis of 67 cases.Sewell DD, Jeste DV.
Department of Psychiatry, University of California, San Diego.
OBJECTIVE: To summarize information regarding the frequency, risk factors, clinical characteristics, treatment, and course of metoclopramide hydrochloride-associated tardive dyskinesia obtained from an analysis of 67 case reports. DATA SOURCES: All the case reports of metoclopramide-associated tardive dyskinesia involving human patients in the literature in English obtained by using Index Medicus and Med-Search. The indexing terms used were as follows: metoclopramide, tardive dyskinesia, dyskinesia, parkinsonism, and extrapyramidal side effects. STUDY SELECTION: For a patient to be included, the main published research criteria had to be met based on the information provided. These criteria included exposure to metoclopramide for at least 30 days before the onset of dyskinesia. Fifty-two patients met these criteria. DATA EXTRACTION: One author independently extracted the data. DATA SYNTHESIS: The incidence and prevalence of tardive dyskinesia associated with metoclopramide have not been well studied. The mean (+/- SD) length of treatment with metoclopramide before the onset of symptoms was 20 +/- 15 months. The most common location of the dyskinetic movements was the face (28 [60%] of 47) followed by the tongue (21 [45%] of 47). In 15 (71%) of 21 patients on whom long-term follow-up was provided, the symptoms were still present 6 months or more after discontinuation of metoclopramide. CONCLUSION: Persistent tardive dyskinesia is a serious potential side effect associated with metoclopramide treatment.
Ed.
Posted by ed_uk on November 30, 2004, at 11:07:48
In reply to Re: drug-induced illness, posted by ed_uk on November 30, 2004, at 10:50:54
Hi Jacj,
Breggins views are very extreme. Not everyone is damaged by APs by any means. Breggin constantly attacks psychiatric drugs but he doesn't provide us with any evidence of the efficacy of the treatments which he suggests as an alternative. He is 'on a mission' to demonstrate the toxicity of all psych drugs.
I very much doubt that you have been damaged by taking Zyprexa etc. It is much less likely to cause TD than older APs like Haldol. I as said before, if you don't have TD now- you never will do!
Dysphoria is a term which refers to mental distress- negative emotions such as feeling depressed, anxious or irritable.
Ed.
Posted by Larry Hoover on November 30, 2004, at 11:15:43
In reply to Re: drug-induced illness, posted by JACJ on November 30, 2004, at 10:18:04
> Very Interesting research. Do you think one should get MRI, etc. after comming off the drugs? Part of me wants to find out what damage has been done, if any?
I don't know that anyone has even come up with an adequate model of what brain dysfunction is associated with dyskinesia. Even if the MRI showed something, what then?
Current theory is that there is an oxidative stress effect of neuroleptic medication, and that may lead to some sort of damage that produces dyskinesia. For that reason, trials of e.g. the antioxidant vitamin E have been done. The benefit is probably there, but it is mild. Interestingly, I see that these trials only used one form of vitamin E, alpha-tocopherol, whereas it is gamma-tocopherol that is thought to be most neuroprotective. For that reason, I suggest that a trial of "mixed tocopherols", or a vitamin E product that specifically lists gamma-tocopherol on the ingredients, might be in order.
Lar
Posted by linkadge on November 30, 2004, at 11:23:23
In reply to Re: drug-induced illness » JACJ, posted by Larry Hoover on November 30, 2004, at 11:15:43
Divalproex and lithium can also be used to prevent TD in neurolecptic treated patients.
Linkadge
Posted by JACJ on November 30, 2004, at 11:24:54
In reply to Re: drug-induced illness » JACJ, posted by Larry Hoover on November 30, 2004, at 11:15:43
You asked me what then if I found something out. There is nothing I can do but I would rather know and make the doctor's responsible. It just blows my mind that people are put on AP's for sleeping, etc. I know someone who took Vit. E and did report some progress. Are there any meds being developed for TD? I know there is a research group at Yale conducting some research. I will see if I can find anything.
Posted by Larry Hoover on November 30, 2004, at 11:27:35
In reply to Re: drug-induced illness, posted by ed_uk on November 30, 2004, at 10:50:54
> Hello...
>
> After my own dire experience with AP-induced akathisia and dystonia I will be forever 'in awe' of the toxicity of APs.
>
> Although it is clear that dyskinesia may occur in the absence of neuroleptics, it is important not to forget that TD can occur in non-psychotic patients prescribed dopamine antagonists. I have no doubt in my mind that APs can cause TD.
>
> The use of anti-emetic dopamine antagonists to treat non-psychiatric problems provides an example of what I am saying. Metoclopramide for example......I didn't mean my presentation of naturalistic data to be used to detract from awareness of the toxic effects of neuroleptics, or other dopaminergic meds. It's a part of the context that is seldom considered, and most seldom by the anti-med movement, I would assume.
I hold to a diathesis stressor model of dyskinesia. A person may be genetically vulnerable to the development of dyskinesia (the diathesis), but it requires some external agent acting on the individual (the stressor) for that genetic vulnerability to be revealed. That is true even for schizophrenics not exposed to medication. What the stressor might be in those cases is not clear, but immune function due to viral illness is one potential variable. Antioxidant status is another.
In the case of the pediatric dyskinesias as by metoclopramide, it is clear that the drug is the stressor involved. However, as it is not a general effect of that particular drug when used in infants, one must distinguish the effect as one arising from diathesis, i.e. due to genetic predisposition.
It makes me sad that anyone would be treated with e.g. a neuroleptic without full informed consent of the potential consequences, but e.g. psychosis might make such informed consent moot. I don't mean to distract into the ethics of treatment in those situations, though.
Lar
Posted by JACJ on November 30, 2004, at 11:29:56
In reply to Re: drug-induced illness, posted by ed_uk on November 30, 2004, at 11:07:48
> Hi Jacj,
>
> Breggins views are very extreme. Not everyone is damaged by APs by any means. Breggin constantly attacks psychiatric drugs but he doesn't provide us with any evidence of the efficacy of the treatments which he suggests as an alternative. He is 'on a mission' to demonstrate the toxicity of all psych drugs.
>
> I very much doubt that you have been damaged by taking Zyprexa etc. It is much less likely to cause TD than older APs like Haldol. I as said before, if you don't have TD now- you never will do!
>
> Dysphoria is a term which refers to mental distress- negative emotions such as feeling depressed, anxious or irritable.
>
> Ed.
>
>
Hi Ed,
I do agree that Breggin views are extreme but he makes great points. I would like to see some validity to his research. Have you seen any research that clearly states AP's cause long term/permanent disorders after the w/d of the drug? Again, thanks for the reassurance. Many symptoms I have now are a direct result of coming off the cocktail of drugs I was on. I can tell the difference. I just hope to get on with my life. It is so hard to let this go. I just feel violated. Why are drugs the first line of treatment instead of therapy, etc? I do believe that people do need drug therapy but I was just a normal person with some anxeity and depression and I got into this mess.Thanks for listening. :)
Posted by ed_uk on November 30, 2004, at 11:34:45
In reply to Re: drug-induced illness » ed_uk, posted by Larry Hoover on November 30, 2004, at 11:27:35
> I didn't mean my presentation of naturalistic data to be used to detract from awareness of the toxic effects of neuroleptics, or other dopaminergic meds.
Hi Larry, I know you didn't. I just wanted to make the point that APs can have serious side effects for some people.
Regards,
Ed.
Posted by ed_uk on November 30, 2004, at 11:41:56
In reply to Re: drug-induced illness » ed_uk, posted by Larry Hoover on November 30, 2004, at 11:27:35
Have you seen these?
Neurol India. 2002 Dec;50(4):473-5. Related Articles, Links
Lithium - induced tardive dystonia.
Chakrabarti S, Chand PK.
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh - 160012, India. medinst@pgi.chd.nic.in
Tardive dystonia is an uncommon form of chronic dystonia, which usually develops on exposure to neuroleptics. Tardive dystonia (Tdt) following lithium therapy has not been previously reported. The case of 38 year old man with bipolar affective disorder who developed tardive dystonia while on maintenance lithium treatment is described. Presentation of Tdt in this patient was fairly characteristic although there was no suggestion of recent neuroleptic exposure. Tdt known to have poor treatment response, responded very well to clozapine, a novel anti-psychotic, in this case. To conclude, Tdt may develop on exposure to drugs other than neuroleptics. An adequate trial to clozapine can prove to be a useful treatment option.
J Clin Psychiatry. 1996 Jan;57(1):22-8. Related Articles, Links
A cross-sectional study of parkinsonism and tardive dyskinesia in lithium-treated affective disordered patients.Ghadirian AM, Annable L, Belanger MC, Chouinard G.
Allan Memorial Institute, Royal Victoria Hospital, Montreal, Quebec, Canada.
BACKGROUND: The purpose of this study was to investigate the prevalence of extrapyramidal symptoms (EPS) and tardive dyskinesia (TD) in affective disordered patients treated with lithium and to study the association of these symptoms with medication and other factors. METHODS: This cross-sectional study was carried out in all consenting outpatients attending an affective disorders clinic in a psychiatric hospital. The study sample consisted of 130 stable outpatients: 110 with bipolar disorder, 18 with unipolar (major) depression, and 2 with atypical affective disorder. At the time of evaluation, 110 patients were receiving lithium, 37 in combination with antidepressants and 19 with neuroleptics, and 40 had a history of neuroleptic treatment during the previous 6 months. The patients were assessed with the Extrapyramidal Symptom Rating Scale (ESRS) for parkinsonism, akathisia, dystonia, and TD. The prevalence of these symptoms was calculated for all patients and by current lithium and neuroleptic intake. Multiple linear regression analysis was used to investigate the relationship between the ESRS subscale scores and gender, age, diagnosis, and medication type. RESULTS: The prevalence of tremor was 20.8%; hypokinetic parkinsonism, 7.7%; akathisia, 4.6%; dystonia, 3.8%; and TD, 9.2%. Tremor was associated with lithium and neuroleptic intake; hypokinesia was associated with neuroleptic treatment and age; and TD was associated with neuroleptic, lithium, and tricyclic intake and age. Seven of 51 patients taking lithium but without a history of neuroleptic treatment during the previous 6 months presented symptoms of TD. CONCLUSION: The combination of lithium and neuroleptics was associated with a high prevalence of EPS. The presence of TD in lithium-treated patients not treated with neuroleptics for at least 6 months is consistent with the hypothesis that lithium may exacerbate the vulnerability of affective disordered patients to dyskinesias.
Regards,
Ed.
Posted by ed_uk on November 30, 2004, at 11:49:45
In reply to Re: drug-induced illness, posted by JACJ on November 30, 2004, at 11:29:56
Hi Jack?? Not sure if that's your name! :-)
You could try looking up some of the references at the end of Breggins article. You could look them up on PubMed.
Which symptoms do you have at the moment that you think are due to your previous medication?
In the UK at least, you have to wait at least a year to see a psychologist on the National Health Service. In contrast, meds are readily available.
Regards,
Ed.
Posted by JACJ on November 30, 2004, at 12:25:19
In reply to Re: drug-induced illness » JACJ, posted by ed_uk on November 30, 2004, at 11:49:45
Hi Ed,
Why does it take so long to see a therapist? Is there not enough medical personnel there? That is ashame.Let's see. I am expereincing muscle twitches which are very coming off the benzos. My mucles would twitch day and night and now only do it once in a while. I see a flare up in them when I drink caffiene or get stressed. I was so scared when first leanring about symptoms cause I read twitches are the start of TD but one has to be very careful b/c not all twithces are TD related. The nerves to the muscles are hyperexcitable, which leads to tremors, tics, jerks, spasms and twitching, and jumping at the smallest stimulus. I got some twitches in the face but only a couple of times and that was at the beginning of my w/d.
I am also having some obsessive thoughts and anxiety. It is worse than normal and I know that is due to the drug w/d b/c the thoughts are irrational and I never had that before the drugs. I also have fear which is something I can't describe. It is the type of fear one feels watching a horror film or getting a fright. it is fear that can't be controlled and leads to a downward spiral of thoughts. This has decresed alot but is still there sometimes. it is brought on by reading too much. (negative readings) It is also brought on by watching negative shows like those animal abuse shows or documentaries about abuse, neglect etc. I sue to be able to watch them but not now.
My CNS is in such a fragile state and I have to give it time to heal. Healing in drug w/d and healing is not linear and takes time. Healing is quite slow.
Posted by lostforwards on November 30, 2004, at 12:43:52
In reply to Re: drug-induced illness » ed_uk, posted by Larry Hoover on November 30, 2004, at 11:27:35
Stress makes a lot of sense. I was off APs for over a year, and when I was really stress I started to get twitching at the corner of my mouth. I also had some odd behaviours before anyway, like when I was REALLY stressed I would spin stuff. When they put me on the AP again, while stressed I started getting more symptoms of dyskinesia as well as dystonia. I was only on the meds the first time for 2 weeks.
When I went on an even higher dose a month later after being off, I had other symptoms. Like once my left leg collapsed while I was using the bathroom, I developed sterotypies, and I don't think this was Tardive dementia, but I didn't look people in the eye, and I'd sway one way or the other.
Actually...when I missed sleep for a night my body was suck leaning way over one side. Usually missing a night of sleep makes me "manic". I don't know what that leaning stuff was all about.
Nor do I know what compulsively spinning things especially when someone was around me, or not looking people in the face are.
ALL were revealed with the stress of the antipsychotic + environmental stress.
Posted by lostforwards on November 30, 2004, at 12:48:12
In reply to Re: drug-induced illness, posted by ed_uk on November 30, 2004, at 9:50:22
Thanks for for the info. Tardive dysmentia's a new term for me.
Posted by ed_uk on November 30, 2004, at 13:02:57
In reply to Re: drug-induced illness, posted by JACJ on November 30, 2004, at 12:25:19
Hi Jacj,
It sounds like your symptoms are due to benzodiazepine withdrawal. I think it's very unlikely that any of your symptoms are related to the APs that you took. I think you took Ativan, is that right? Did you taper slowly? How long is it since you last took the benzo?
Regards,
Ed.
Posted by lostforwards on November 30, 2004, at 13:17:15
In reply to Re: drug-induced illness » lostforwards, posted by ed_uk on November 30, 2004, at 9:24:57
That's pretty interesting. Tardive dysmentia? Never heard of that before. The breggin paper lists it as just terminology - that it's no different than tardive dementia. What you've described though seems a lot like what I was getting at.
thanks.
Posted by lostforwards on November 30, 2004, at 13:28:07
In reply to Re: drug-induced illness, posted by linkadge on November 30, 2004, at 10:31:32
No, usually exclusively antipsychiatry sites don't offer any treatment options. Some people in antipsychiatry are opposed to all treatments, including psychosocial if you can believe it.
There are other treatment options you just have to look to other sources.
Posted by JACJ on November 30, 2004, at 13:53:28
In reply to Re: drug-induced illness.. to JACJ, posted by ed_uk on November 30, 2004, at 13:02:57
> Hi Jacj,
>
> It sounds like your symptoms are due to benzodiazepine withdrawal. I think it's very unlikely that any of your symptoms are related to the APs that you took. I think you took Ativan, is that right? Did you taper slowly? How long is it since you last took the benzo?
>
> Regards,
> Ed.
Hi Ed,
I did everything wrong when tapering. I tapered 3 mgs of Ativan in a month and then 3 weeks later I tapered 80 mgs of Geodon in 3 weeks. The geodon masked somme of the w/d symptoms. About 2 days later coming off the Geodon my symptoms were full blown. I have been off of Ativan for 8 months now.
Posted by linkadge on November 30, 2004, at 14:31:56
In reply to Re: drug-induced illness... to Link, posted by ed_uk on November 30, 2004, at 11:41:56
I agree with the results but not the conclusion of the studies. Lithium is the most neuroprotective substance we have. I'm not sure what the mechanism of this might be but I can only make a proposition.
Perhaps in people who are predisposed to TD might have a irregulation in dopamine/glutamate that when unmedicated it beeing slowly compensated for
by the brain's own mecanisms. When a glutamate stabalizer is introduced, the brains own mechanisms become supressed and the TD surfaces full force.I've read some studies that show lithium can reduce neuroleptic induced alterations in limbic and substantia niagra (sp.) glutamate activity.
A lot of schitsoprenics drink coffee which might ofset some of the neurolecptic induced movement disorders. Caffiene is protective in a mouse model of PD and TD.
Linkadge
Posted by linkadge on November 30, 2004, at 14:33:59
In reply to Re: drug-induced illness » linkadge, posted by lostforwards on November 30, 2004, at 13:28:07
It is pathetic that we have to make such steps back like this.
The biggest problem, is that people with schitsophrenia can be paranoid and highly susptitious. When a site like this comes on
and starts refering to these drugs in such terms
we take huge steps back in treatment.
Linkadge
Posted by lostforwards on November 30, 2004, at 14:44:20
In reply to Re: drug-induced illness » ed_uk, posted by Larry Hoover on November 30, 2004, at 11:27:35
I already posted a reply describing some of the dyskinesia and dystonia I had as well as a bunch of weird behaviours and mannerisms.
do you have any idea why I would react to stress with bizzare behaviours like those I've mentioned?
Posted by lostforwards on November 30, 2004, at 14:45:38
In reply to Re: drug-induced illness, posted by lostforwards on November 30, 2004, at 14:44:20
Posted by ed_uk on November 30, 2004, at 14:53:32
In reply to For: Larrry Hoover, or anyone with an explanation (nm), posted by lostforwards on November 30, 2004, at 14:45:38
Hi Jacj! :-)
Rapidly tapering from a benzo makes the withdrawal symptoms more intense in the short term (ie. while you are tapering) but doesn't make any difference in the long term. Please don't worry about the way that you tapered.
I understand that you don't want to take any more medication in order to relieve your withdrawal symptoms. Even so, it could be useful to know about some of the options that are available. To give an example, low doses of propranolol (Inderal) can be used to reduce tremor eg. 10mg three times a day. Propranolol is a beta-blocker.
Perhaps psychological treatment could also be helpful. Have you ever seen a psychologist?
Regards,
Ed.
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