![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 15 to 39 of 50. Go back in thread:
Posted by ed_uk on December 11, 2004, at 17:35:36
In reply to TO ED UK, posted by Jeroen on December 11, 2004, at 17:08:44
Hello Jeroen,
I'm glad you replied!
I think you really need a neurologist to diagnose your eye condition. Your psychiatrist probably won't have much experience in diagnosing neurological problems.
The problem with Zyprexa is that it can cause tardive dyskinesia. I think that it would be a good idea to ask your psychiatrist about Clozaril. I know that you are worried that Clozaril might cause too much drowsiness but if you started with a very low dose and increased gradually you might not have a problem. The drowsiness caused by Clozaril usually decreases after you have been taking it for a while.
Best Wishes,
Ed.
Posted by ed_uk on December 11, 2004, at 17:37:43
In reply to Re: Jeroen, posted by ed_uk on December 11, 2004, at 17:35:36
Jeroen, what does your psychiatrist think is wrong with your eye?
Posted by Jeroen on December 11, 2004, at 17:37:50
In reply to Re: IM AFFRAID TO TRY CLOZARIL!!! » Jeroen, posted by TomG on December 11, 2004, at 17:34:01
dont talk about the freaking geodon... OH PLEASE,, the first 2 days i felt REALLY GOOD but then the nightmare for me started and isnt over yet
i felt something is wrong about that drug...
Posted by Jeroen on December 11, 2004, at 17:41:14
In reply to Re: Jeroen, posted by ed_uk on December 11, 2004, at 17:37:43
a muscle from my eye causing these abnormal movements, he sais its very rare but it appears to exist, my neurologists sais it will go away but its been 3 months now.. my psychiatric doctor sais nothing can be done on it, and that it aint bleherospasm
another doctor sais it can only be that blaherospams so im getting nuts
Posted by ed_uk on December 11, 2004, at 17:43:33
In reply to TO ED UK, posted by Jeroen on December 11, 2004, at 17:08:44
Hello! :-)
Geodon has very little antihistamine effect. It causes sedation via a different mechanism.
Are you well at the moment?
Regards,
Ed.PS. I think we need more people with schizophrenia on psycho-babble because we have lots of people with mood and anxiety disorders but not many with schizophrenia.
Posted by ed_uk on December 11, 2004, at 17:46:14
In reply to Re: Jeroen, posted by Jeroen on December 11, 2004, at 17:41:14
Hello Jeroen,
I think you need to make another appointment with the neurologist. Will you make another appointmant?
Best Wishes,
Ed.
Posted by Jeroen on December 11, 2004, at 17:55:49
In reply to Re: Jeroen » Jeroen, posted by ed_uk on December 11, 2004, at 17:46:14
yes,, can Zeldox gave me eye damage? i experience light sensivity, i didnt had this before
Posted by TomG on December 11, 2004, at 17:58:54
In reply to Re: To Tom, posted by ed_uk on December 11, 2004, at 17:43:33
Ed,
Geodon does in fact cause sedation through the H1 histamine receptor. If you go to the online product insert at http://www.pfizer.com/download/uspi_geodon.pdf you will see that the somnolence observed with Geodon is thought to be from antagonism of H1 histamine receptor. Also check out this article which goes more in depth about sedation and AP's. http://www.psychiatrist.com/pcc/pccpdf/v06s02/v06s0201.pdf
But you may be right the sedation I'm experiencing might be via another mechanism but no research I've read points any other direction. But, I have to try something else. I'm OK on Geodon though. Its great for deep depression, anxiety, cognition, confusion, paranoia. The sedation I'm having is mimicking some negative symptoms of schizophrenia like anhedonia, amotivation, avolition. I know these symptoms are caused by the sedation and not a reemergence of symptoms from the disease itself. I'm about to seek out another AP, so if nothing else works I'll always have Geodon to fall back on. It has been a miracle drug for many of my main symptoms.
Posted by ed_uk on December 11, 2004, at 19:25:34
In reply to Re: To Tom » ed_uk, posted by TomG on December 11, 2004, at 17:58:54
Tom,
Although it is a possibility, I still think that it is unlikely that your sedation is caused by H1 antagonism. You are on a low dose of Geodon and it is a weak antihistamine. Pfizer does not say that sedation is always caused by H1 antagonism, they just suggest that it might be in some cases. Your sedation could be due 5-HT2a antagonism.
Regards,
Ed.
Posted by ed_uk on December 11, 2004, at 19:31:07
In reply to Re: To Tom » ed_uk, posted by TomG on December 11, 2004, at 17:58:54
It sounds like you've really benefited from Geodon. Are you thinking of trying Abilify?
Ed.
Posted by TomG on December 11, 2004, at 21:07:20
In reply to Re: To Tom, posted by ed_uk on December 11, 2004, at 19:31:07
Well Ed, my doctor always asks me when we start talking about this sort of thing, "Why does it matter?". I agree with him that trying to guess what mechanism the sedation is caused by is sort of useless. I do know that my sedation didn't start until about two months into taking Geodon. I experienced *no* sedation during the first two months except a little each night after I would take it. I also tried Provigil and it had absolutely no effect on the sleepiness whatsoever. So, you may be right the sedation may be caused by 5ht2a antagonism, but theres not a whole lot I can do about that. I may be benefitting from the 5ht2a antagonism that Geodon provides. Most of the newer atypicals provide 5ht2a antagonism and some of the older ones do as well. At this point I know I need an antipsychotic and the only thing there is left to do is to try them all. Hopefully I can find one just as good as Geodon without the sedation.
Posted by ed_uk on December 12, 2004, at 2:18:11
In reply to Re: To Tom » ed_uk, posted by TomG on December 11, 2004, at 21:07:20
Hello Tom,
I'm not sure where you live but here in England (where we don't have Geodon) we have amisulpride (Solian) which is not usually very sedating.
Regards,
Ed.
Posted by TomG on December 12, 2004, at 10:33:54
In reply to Re: To Tom, posted by ed_uk on December 12, 2004, at 2:18:11
Ed, Yes I am very interested in Amisulpride (Solian). I talked to my doctor about it, but he said he'd never heard of it. That seems right, because I don't think many American doctors dabble in European drugs. However, I may discuss this further with him if all else fails. Amisulpride is a very specific drug in that it only hits D2 and D3 dopamine receptors. I have no idea where I would order it from. Do you? It is nice to have it as an option if the other AP's don't work out.
Posted by Sebastian on December 12, 2004, at 10:34:47
In reply to Re: IM AFFRAID TO TRY CLOZARIL!!!, posted by Jeroen on December 11, 2004, at 15:28:14
You might want to take a AD! You can still take a AP with it in addition.
Posted by ed_uk on December 12, 2004, at 10:52:54
In reply to Re: To Tom » ed_uk, posted by TomG on December 12, 2004, at 10:33:54
Hi Tom,
Unfortunately, I don't know where you could get Solian. I imagine that you'd probably be able to get hold of it if you tried though!
I don't know why Solian isn't available in America. It seems strange because the FDA and the MHRA (UK) seem to agree on most things.
Have you tried any other APs apart form Geodon?
The late-onset drowsiness which you described reminds me of how I get late-onset sedation with SSRIs. After all, Geodon is a weak serotonin reuptake inhibitor so perhaps it might have a similar effect.
Regards,
Ed.
Posted by Jeroen on December 12, 2004, at 11:18:45
In reply to Re: To Tom, posted by ed_uk on December 12, 2004, at 10:52:54
im considering to take an anti depressant but it doesnt cure my problem
its like feeling happy while having Tardive dyskinesia
UNACCEPTABLE!!!!!!!!!
Posted by Jeroen on December 12, 2004, at 11:33:43
In reply to Re: To Tom, posted by ed_uk on December 12, 2004, at 10:52:54
what should i do now???
take zyprexa high dose? like 20 mg, after 3 weeks i felt a change in the blinking... but i gained weight even when taking NIZATIDINEi now have AMANTADINE, weight loss is reported here..
I REALLY DONT KNOW WHAT TO DO....
Posted by TomG on December 12, 2004, at 11:42:49
In reply to Re: To Tom, posted by ed_uk on December 12, 2004, at 10:52:54
Ed, yes the late onset drowsiness is what made me suspicious about the whole thing. For two months on Geodon I couldn't have been better. It was the perfect drug and then the sleepiness set in. The weird thing about it is that I don't sleep all day. I still have mental energy but this veil of sleepiness is over me all day. It is sort of a paradox, because I'm sleepy but awake and I don't really feel like going to sleep. Right now I'm getting some information on Solian together to show to my doctor. I was able to get the full prescribing information on the web. The AP's I've tried are as follows:
Abilify 15mgs- caused akathisia after only a few days so I stopped. I saw no benefit at 15mgs, but I'm now thinking that the akathisia could have covered up any symptom control. I will probably try this next at a lower starting dose.
Zyprexa 15mgs- gained near 25lbs. and slept all the time with no symptom control
Risperdal .75mgs- this is a very low dose and I didn't go any higher. At the time I was also taking Lamictal. I saw no benefit at that low dose of .75mgs and I didn't stay on it for very long
Seroquel- I have only taken this 25mgs at a time to sleep. Of course it had no impact on symptoms at this super low dose. Like I said it was given to me only to sleep.
Thats about it. I'm anxious to see what all the AP's will do because even though they are in the same class they are drastically different drugs from one another. I was misdiagnosed for so long because I was not hearing voices and was having some hypomania from other drugs that were only targeting depression. I know now that I need an antipsychotic and hopefully it will only be a matter of time before I find the right one that leaves me with little to no side effects.
Posted by pretty_paints on December 12, 2004, at 13:02:34
In reply to Re: To Tom » ed_uk, posted by TomG on December 12, 2004, at 11:42:49
Hi Tom_G,
I was interested by your post a little earlier on about your diagnosis.
I too have suffered with psychosis, mainly paranoia and delusions. I've never heard voices either.
I've been ill for a few years, but was only put onto an AP about six months ago. My doc says it is too early to diagnose any more than "a psychotic illness".
If you dont mind me asking, what was the sequence of events that led up to your diagnosis? How long did it take to be diagnosed? And how bad were your delusions/paranoia?
Thanks for any info!! You're the first schizophrenic-without-hearing-voices I've read of.
Cheers :) x
Posted by Sebastian on December 12, 2004, at 14:15:28
In reply to Re: To Tom, posted by Jeroen on December 12, 2004, at 11:33:43
Have you tried any weight loss drugs? Majorly powerfull ones. Maybe something like zantrex 75?
Posted by TomG on December 12, 2004, at 14:57:42
In reply to Sorry if I'm going off topic a bit...., posted by pretty_paints on December 12, 2004, at 13:02:34
pretty paints, Unfortunately my diagnosis has been a long time in the making. I started to know something was wrong about eighteen or nineteen when I started using illegal drugs. I'm 29 now. I was using pot, LSD, cocaine, X, and almost anything else I could get my hands on. But, the bad thing is that I wasn't enjoying the drugs. They made me suspicious of friends, withdrawn, and left me in a highly confused state. I know those drugs will do that to anybody, but now that I can analyze the situation with a clear mind I know that my behavior during that time was much different compared to my friends who were doing the same drugs. My symptoms had been emerging for some time prior to drug use, but the drug use in a sense brought everything closer to the surface so to speak. At 21 after going into an amphetamine psychosis from cocaine use one evening I went into an outpatient rehab program where I was assigned a psychiatrist who thought I needed to be on Prozac. This sent me into about a three month hypomanic episode. At the time I didn't even know what hypomania was much less think that I had a mental illness, because I felt great. To make this long story shorter after I came down from the hypomania I tried in and out for several years to regain what the Prozac had given me. I've had over 8 doctors in that time. Doctors thought that I had social anxiety and doctors thought I might be bipolar, but none of the medicines to treat those disorders helped me one bit. My paranoia and delusions presents itself in thinking there is a cospiracy against me in the town that I live in that people know there is something wrong with me. And sometimes I even thought that my parents may have given me the illness to some extent and that they planned it all. Usually I don't fully believe the delusions. Half of me wants to believe and the other half doesn't so I wasn't completely involved in false beliefs. Also I had a very inflated sense of myself and thought that I was better than everyone else. This is not uncommon with paranoia and more accurately paranoid schizophrenia. So, I don't know if I have full blown schizophrenia. When I ask my doctor if he thinks I do he always replies, "Do you think you have schizophrenia?" I think that there is enough evidence there and I believe he does too. He is a great doctor and although I have taken medicines other than AP's over the two years I've seen him at my request he has stuck by his belief that I need to stick to AP's based on the symptoms I've relayed to him. I finally hit jackpot although its not a full jackpot with Geodon. It has put an end to my suffering for the most part, but I am just so sleepy. More than anything it has left me in control of my thoughts. Before Geodon my thoughts were out of control. They were very disorganized and negative, and I was confused most of the time. I now think that I have schizophrenia based on my response to Geodon and my relation to most of the symptoms of schizophrenia that have been in evolution over about ten years. It is not full blown schizophrenia nevertheless it is still a form of mild schizophrenia. To me it has been more of a thought disorder with depression and anxiety accompanying the paranoia and disorganization. I guess I can be very thankful that I don't hear voices.
Posted by ed_uk on December 12, 2004, at 15:11:30
In reply to Re: To Tom » ed_uk, posted by TomG on December 12, 2004, at 11:42:49
Hi everyone,
One of the reasons that classical neuroleptics are frequently so poorly tolerated by patients is that they are sometimes prescribed such vast doses. 'Overdosing' patients on haloperidol (Haldol) has been particularly common, especially before the atypical antipsychotics were available. The British National Formulary used to state that doses of up to 200mg/day of haloperidol could be used for the treatment of schizophrenia. The maximum dose has now been reduced to 30mg/day but this is still far in excess of the optimum dose for most patients. Consider that some people with schizophrenia only need 0.5mg a day!! Trials comparing atypical APs to Haldol have sometimes used large Haldol doses of up to 20mg/day!! Such trials have usually been concluded by triumphantly announcing the superior tolerability of the new drug. Trials such as these inevitably overexaggerate the advantages of atypicals- mmm I wonder WHY such high doses of Haldol are used? Maybe the pharm companies are afraid that if low doses of Haldol were used the side effect profile of their new and highly expensive drug might not prove to be superior at all!!!
Very low doses of haloperidol seem to be just as effective as high doses for the majority of patients. Only a small minority of people will gain additional benefit from high doses but the side effects of high dose are commonly intolerable. Adverse effects such as akathisia are very much dose-dependent.
2mg/day of haloperidol can be an effective treatment for schizophrenia.......
This double-blinded, randomized controlled study compared the efficacy and tolerability of 2 vs. 8 mg/d of haloperidol over 6 wk in 40 subjects with first-episode psychosis. Both treatments were equally effective in reducing the PANSS Total and subscale scores. The low dose of haloperidol was better tolerated, with fewer extrapyramidal side-effects, less frequent use of anticholinergic medication and smaller elevations in prolactin levels. Using a low dose of haloperidol is at least as effective as, and better tolerated than a high dose of haloperidol in the treatment of first-episode psychosis.
Sometimes, doses of haloperidol <1mg/day are best....Determining the optimal dose of haloperidol in first-episode psychosis.
This study set out to determine whether ultra-low doses of haloperidol could successfully treat patients with first-episode psychosis. Thirty-five patients with a first episode of psychosis were treated with haloperidol in an open label, fixed protocol over a 12-week period with doses restricted to 1 mg per day for the first 4 weeks. Twenty-nine (83%) remained on haloperidol after 12 weeks at a mean dose of 1.78 mg per day, 16 (55%) had stabilized on 1 mg/day or less. The mean percentage reduction in Positive and Negative Symptom Scale score between baseline and 6 and 12 weeks was 30.3% (SD 20.9%) and 41.4% (SD 16.6%), respectively. There were *no* significant differences in mean extrapyramidal symptom ratings between baseline and 12 weeks. Ultra-low doses of haloperidol are effective and well tolerated in first-episode psychosis. Initial doses should be maintained for a sufficient period of time to allow for the medication to take full effect.
To summarise.... many of the alleged advantages of atypicals may in fact be an artifact of the trials which have compared their safety and efficacy to vastly excessive doses of classical neuroleptics.
The tendency of doctors to prescribe mega-doses of haloperidol is mirrored by the haloperidol (Haldol/Serenace) products available on the UK market........
20mg Serence tablets ahhhh!
Single Serenace ampoules of 20mg.
Unfortunately, Haldol is not the only classical AP that people have received excessive doses of.... fluphenazine, trifluoperazine and other potent D2 antagonists have also been used to excess.
My message is.....Although the discovery of the atypical APs has been a great advance, the superior tolerability of the newer drugs has been overstated. Although the atypicals have been a miracle for some people, others might be substantially better off on low doses of older drugs.
Even the dreaded haloperidol has advantages....
Small weight gain compared to most atypicals. Occasionally causes weight loss!
Few autonomic side effects eg. low risk of hypotension.
*Low* doses often produce little sedation.
Risk of extrapyramidal side effects depends on dose, low doses are substantially more tolerable.
Risk of TD is reduced by using low doses.
It is very cheap.
It has been available for a long time and has been studied in a large number of clinical trials.
My own experience with classical APs (Thorazine for anxiety) was that low doses were relatively easy to tolerate. High doses caused such severe side effects that I would not wish such torture on my worst enemy.It scares me to think that some patients who become agitated due to APs may have their dose increased by doctors who are unaware of the fact that APs can induce severe agitation and even panic in some individuals.
To Tom..... some people find low doses of trifluoperaine (Stelazine) activating. As ever, high doses are likely to make you feel (and look) dreadful.
Regards,
Ed.
Posted by TomG on December 12, 2004, at 15:38:44
In reply to Classical Neuroleptics- to Tom (and all pdocs)., posted by ed_uk on December 12, 2004, at 15:11:30
Ed, thank for the post. Yes, low dose Haldol or Orap has been in my plans for quite some time now. They are very potent AP's that can yeild very postive results in low doses and produce very little sedation.
Posted by ed_uk on December 12, 2004, at 15:48:41
In reply to Re: Classical Neuroleptics- to Tom (and all pdocs). » ed_uk, posted by TomG on December 12, 2004, at 15:38:44
Hi Tom,
Since even low doses of haloperidol pose a disturbingly high risk of tardive dyskinesia I certainly think that you should try Solian first though!!
I just get annoyed when I see studies comparing atypicals with massive doses of Haldol... it's unethical :-(
Good luck on the quest for the perfect AP,
keep us all updated.....Ed.
Posted by ed_uk on December 12, 2004, at 16:05:13
In reply to Re: Solian, posted by ed_uk on December 12, 2004, at 15:48:41
I just wanted to say.... it must be very difficult for you to make a decision about your future treatment. Geodon has been effective and well tolerated apart from the sedation (I think). When switching to another drug you are taking the risk that it might not be effective and the side effects might be worse. I really hope you find a effective treatment which is also well tolerated. The risk of TD from Solian seems to be low but it's still quite new (as is Geodon).
Regards,
Ed.
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.