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Dr. Bob is Robert Hsiung, MD,
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Posted by ed_uk on February 3, 2005, at 7:44:56
In reply to Re: SEROQUEL, posted by yxibow on February 2, 2005, at 17:20:53
Hi Y!
Thanks for the link :-)
I'd generally still suggest taking it twice daily when used for psychosis- it's short half-life suggests that taking it once daily might lead to large fluctuations in the plasma concentration over 24h. Taking the whole dose at night might be optimal for some people though, esp. if it was effective in minimizing day-time drowsiness and/or improving compliance, YMMV!
Here is an interesting study- it's a small study though so I think it would be best to treat its conclusion with caution......
Can J Psychiatry. 2003 Apr;48(3):187-94.
A random-assignment, double-blind, clinical trial of once- vs twice-daily administration of quetiapine fumarate in patients with schizophrenia or schizoaffective disorder: a pilot study.
Chengappa KN, Parepally H, Brar JS, Mullen J, Shilling A, Goldstein JM.
Mayview State Hospital, 1601 Mayview Road, Bridgeville, PA 15017-1599, USA.
OBJECTIVE: To evaluate the efficacy and safety of administering quetiapine once vs twice daily. METHOD: Utilizing a double-blind design, 21 hospitalized adult men or women with DSM-IV schizophrenia or schizoaffective disorder, who had received unchanged doses (for 2 weeks) of either 400 or 600 mg daily of quetiapine administered in 2 doses, were randomly assigned to once- or twice-daily administration for 4 weeks and then crossed over to the opposite dosing regimen for an additional 4 weeks. Standard psychopathology and safety measures were used in the study. RESULTS: Nearly 70% (15/21) of the subjects met the a priori efficacy responder criteria with no statistical differences in response between those assigned to once- or twice-daily quetiapine administration. Statistical analyses confirmed that most subjects maintained efficacy during the switch to once- or twice-daily administration with quetiapine. A minority (15%) did experience worsening of symptoms or orthostatic hypotension during the crossover. Quetiapine was generally well tolerated at either twice- or once-daily administration. CONCLUSIONS: These pilot data suggest that it is clinically feasible to switch most quetiapine-treated subjects receiving a therapeutic twice-daily dosing schedule to a once-daily regimen. A minority may experience worsening of symptoms or orthostatic hypotension during the switch. This strategy of administering quetiapine entirely at bedtime may promote improved adherence to treatment.
Ed.
Posted by ed_uk on February 3, 2005, at 7:48:16
In reply to Re: I hate Thorazine!! » ed_uk, posted by olysi79 on February 2, 2005, at 20:00:26
Hi Chris :-) (I haven't got your name wrong, have I?!)
How effective did you find Benadryl compared to Ativan? What dose of Ativan did you use?
Have you ever tried Wellbutrin?
Ed.
Posted by ed_uk on February 3, 2005, at 7:59:16
In reply to TO ED_UK, posted by Jeroen on February 2, 2005, at 17:31:42
Hi Jeroen :-) Bonjour Jeroen :-) Goedemiddag Jeroen :-)
> i feel very depressed for 5 months now
Are you still taking amantadine? Is it still helping your depression?
>i tryed 5 medicines with no result
All the medicines that you've tried are antipsychotics, perhaps a different type of drug would be better. I think you should ask your new doctor for suggestions. Perhaps an antidepressant such as Sipralexa would be more helpful.
>SEROQUEL: POSSIBLE CREATES PSYCHOSIS WITH ME FELT HEAVY SEDATED AND CANNOT FUNCTION IN LIFE, I WAS ZOMBIE!!
Most people would feel awful if they suddenly took 400mg Seroquel! If you increase the dose gradually it should be much more pleasant. Please will you ask your new doctor to prescribe the 25mg tablets, I honestly believe that he would be fine about it if only you asked.
Ed.
Posted by olysi79 on February 3, 2005, at 9:29:12
In reply to Re: I hate Thorazine!! » olysi79, posted by ed_uk on February 3, 2005, at 7:48:16
Hi Ed- indeed you got my name right :) I found 100 mgs of over the counter Benedryl to be very helpful. Ativan was good, even at a low dose (roughly .25???). I have taken Wellbutrin before, a good medicine but watch out for anxiety and insomnia from it, but taken with an SSRI, it may be a great combo.
> Hi Chris :-) (I haven't got your name wrong, have I?!)
>
> How effective did you find Benadryl compared to Ativan? What dose of Ativan did you use?
>
> Have you ever tried Wellbutrin?
>
> Ed.
Posted by ed_uk on February 3, 2005, at 9:48:56
In reply to Re: I hate Thorazine!! » ed_uk, posted by olysi79 on February 3, 2005, at 9:29:12
Hi Chris!
> I have taken Wellbutrin before, a good medicine but watch out for anxiety and insomnia from it, but taken with an SSRI, it may be a great combo.
Yes, I would quite like to try bupropion. In the UK it's only used for smoking cessation though. Also, the government has warned doctors not to combine it with SSRIs. I mentioned it to my pdoc but he hadn't heard of it. Btw, what country do you live in?
Ed.
Posted by olysi79 on February 3, 2005, at 10:19:13
In reply to Re: Wellbutrin » olysi79, posted by ed_uk on February 3, 2005, at 9:48:56
oops I tried to post something back to you but goofed. I live in the U.S. and docs here prescribe it with SSRI's regularly. It's too bad they don't do that in the UK. I'd like to get on 100-150MGS/day to help with some of the dopamine problems I've been experiencing. Also I'm a light/moderate smoker and if it can help me quit, and all abotu it! I'm going to ask around the board for input on it. It may also help with these periodic bouts of depression and anxiety I go through. They're wierd, they last 2 to 3 days then head out the door. I call in unipolar cycling because I'm not having any hypomanias right now, just that. are trhere and APs you've taken that don't cause akathisia for you? I wish there was one out there that had a solidlong lasting anti-anxiety effect.
Chris> Hi Chris!
>
> > I have taken Wellbutrin before, a good medicine but watch out for anxiety and insomnia from it, but taken with an SSRI, it may be a great combo.
>
> Yes, I would quite like to try bupropion. In the UK it's only used for smoking cessation though. Also, the government has warned doctors not to combine it with SSRIs. I mentioned it to my pdoc but he hadn't heard of it. Btw, what country do you live in?
>
> Ed.
Posted by ed_uk on February 4, 2005, at 6:20:02
In reply to Re: Wellbutrin » ed_uk, posted by olysi79 on February 3, 2005, at 10:19:13
Hi Chris!
> I'd like to get on 100-150MGS/day to help with some of the dopamine problems I've been experiencing.
You might need 300mg to help you quit smoking though!
>It may also help with these periodic bouts of depression and anxiety I go through.
Some people find Wellbutrin causes/worsens anxiety. Did it have any effect on your anxiety?
>are there any APs you've taken that don't cause akathisia for you?
I've only tried chlorpromazine. Low doses didn't cause akathisia at all but at high doses it was very severe.
Not many people get akathisia from thioridazine (Mellaril) but it's rarely used anymore due to the risk of cardiac arrhythmias. It was the most popular AP in the UK for many years!
>I wish there was one out there that had a solidlong lasting anti-anxiety effect.
Chlorpromazine didn't reduce my anxiety at all :-(
Best Regards,
Ed.
Posted by olysi79 on February 4, 2005, at 14:35:28
In reply to Re: Wellbutrin » olysi79, posted by ed_uk on February 4, 2005, at 6:20:02
Hey Ed,
I'm a moderate smoker so 100-150 may do the trick. As far as anxiety is concerned, Wellbutrin has caused me to be a bit jittery before, but then agian I took it alone without an SSRI for over 2 years. With an SSRI to augment may be even better. I'm hoping Wellbutrin will help when I get those problems where I have a lack of pleasure in anything,that alone causes despair. As far as the APS are concerned, I worship Zyprexa for its sedating properties, and as an emergency med. IF things are starting to get really whacked, I pop a 2.5 with extra trileptal and I'm out. Seems like a "game over-reset the program" button essentially and I'm very grateful for it, but if I take it too long, akathisia sets in. I naturally am a fidgety foot tapper, which is indicative of dopamine irregularities, hence a good old cigarrette or wellbutrin is a welcome addition :)> Hi Chris!
>
> > I'd like to get on 100-150MGS/day to help with some of the dopamine problems I've been experiencing.
>
> You might need 300mg to help you quit smoking though!
>
> >It may also help with these periodic bouts of depression and anxiety I go through.
>
> Some people find Wellbutrin causes/worsens anxiety. Did it have any effect on your anxiety?
>
> >are there any APs you've taken that don't cause akathisia for you?
>
> I've only tried chlorpromazine. Low doses didn't cause akathisia at all but at high doses it was very severe.
>
> Not many people get akathisia from thioridazine (Mellaril) but it's rarely used anymore due to the risk of cardiac arrhythmias. It was the most popular AP in the UK for many years!
>
> >I wish there was one out there that had a solidlong lasting anti-anxiety effect.
>
> Chlorpromazine didn't reduce my anxiety at all :-(
>
> Best Regards,
> Ed.
Posted by ed_uk on February 5, 2005, at 10:11:08
In reply to Re: Wellbutrin » ed_uk, posted by olysi79 on February 4, 2005, at 14:35:28
Hi Chris!
>I'm a moderate smoker so 100-150 may do the trick.
I hope so :-) Are you motivated to quit?
How long can you (personally) take Zyprexa 2.5mg/day for without getting akathisia?
Ed.
Posted by Jeroen on February 5, 2005, at 10:30:39
In reply to Re: Wellbutrin » olysi79, posted by ed_uk on February 5, 2005, at 10:11:08
i just emailed suicide prevention
i just cannot take it anymore
Posted by ed_uk on February 5, 2005, at 13:50:31
In reply to to ed uk, posted by Jeroen on February 5, 2005, at 10:30:39
Hello Jeroen,
I think you need to be hospital. If you feel suicidal, immediately go to the emergency department at your local hospital. Once you are in hospital you can start clozapine. It should reduce your blinking and make you feel less suicidal. DO NOT hurt yourself, I would miss you very much if you were gone. Your family would also miss you. You are a good friend.
Best Wishes,
Ed.
Posted by Jeroen on February 5, 2005, at 15:59:33
In reply to Re: to ed uk » Jeroen, posted by ed_uk on February 5, 2005, at 13:50:31
hi thanks, plan on doing this...
seroquel low dose for few weeks then evaluate the eye problem... if that fails i will try use a new drug under development its, ASENAPINE
do you think this is wise?
i just send an email to a doctor he said yes i am egible for this study its 1/4 chance is Zyprexa and 3/4 chance its ASENAPINEplease your comments,
i did GEODON in study their aswell but the eye problem occured TD
what should i be aware of when i take that new drug, please help thanks
Posted by ed_uk on February 5, 2005, at 20:38:29
In reply to some hope maybe?, posted by Jeroen on February 5, 2005, at 15:59:33
Hi Jeroen,
>some hope maybe?
Yes, there is hope for you Jeroen :-)
>seroquel low dose for few weeks then evaluate the eye problem
I think you should gradually increase the dose of Seroquel until you're on an effective dose. I wouldn't take asenapine until you're sure that Seroquel isn't helping. If you increase the Seroquel gradually, it may take several weeks to reach an effective dose. Don't rusk into trying asenapine until you have given Seroquel a chance to work.
>what should i be aware of when i take that new drug
When a drug is as new as asenapine, very little is known about its side effects. Because Seroquel and Leponex have been around for many years, a lot is known about their side effects. Leponex has been proven to be a very effective drug. Asenapine is very new, it might be very effective but it might turn out to be useless! Also, it may cause side effects that are not yet known. I don't think you should take asenapine until you've tried Seroquel and Leponex. If Seroquel and Leponex don't help, you could try asenapine.
Ed.
Posted by olysi79 on February 6, 2005, at 1:26:33
In reply to Re: Wellbutrin » olysi79, posted by ed_uk on February 5, 2005, at 10:11:08
Hey Ed :)
The motivation is there to quit to a certain extent, yet at the same time I'm having a hard time. I tried to reduce myself to a lighter kind of cigarette and within a day I was feeling the effects and back I went to my other cigs.
I can only handle Zyprexa for a couple of days before it (akathisia) starts to set in. One PDOC told me that patients used to get it so bad that they would throw themselves off of buildings in mental hospitals. How pleasant. You feel wierd, like you want to run around the world or something, very restless. I must have sensitive dopamine receptors, even Buspar does it to me, which is really wierd. Buspar itself has some mild dopamine receptor blockage. One PDOC wanted me to try Geodon, which is both a receptor antagonist and agonist. I politely declined :)> Hi Chris!
>
> >I'm a moderate smoker so 100-150 may do the trick.
>
> I hope so :-) Are you motivated to quit?
>
> How long can you (personally) take Zyprexa 2.5mg/day for without getting akathisia?
>
> Ed.
>
>
Posted by olysi79 on February 6, 2005, at 1:52:06
In reply to Re: QUESTION » Jeroen, posted by ed_uk on February 2, 2005, at 7:07:25
Hey Ed,
Another question for you. Have you ever had agitated depressions/mixed states? That was the most recent depression I went through and also tends to be the flavor I get periodically for 3-4 days every month or so. I have intense anxiety, agitation, despair and become afraid of everything, almsot like a wierd paranoia. Yuck, hate those. They usually dissapate within a few days, thank god.
Posted by ed_uk on February 6, 2005, at 8:25:29
In reply to For Ed_uk » ed_uk, posted by olysi79 on February 6, 2005, at 1:52:06
Hi Chris!
>One PDOC told me that patients used to get it so bad that they would throw themselves off of buildings in mental hospitals. How pleasant.
Yes, I have heard that some people have killed themselves because of akathisia.
I found this interesting. It describes the effect that the antipsychotic droperidol had on a healthy psychologist. In the study, where droperodol was given to several healthy psychologists, one of them had to admitted to a psychiatric ward for suicidal ideation!!
(From the New Scientist)
Leading clinical psychologist describes feelings of "helplessness" and "uncontrolled weeping" after taking neuroleptic (antipsychotic)
February 1, 2004
A leading clinical psychologist has described his experience of taking a neuroleptic medication as part of a clinical trial.
Richard Bentall, professor of clinical psychology at the University of Manchester, told the New Scientist magazine how he experienced the symptoms of akathisia, and became agitated and depressed.
Bentall, one of clinical psychology's most outspoken critics of psychiatry's medical model, took 5mgs of the neuroleptic droperidol . He was one of the subjects in a study organised by David Healy, professor of psychological medicine at the North Wales Hospital in Bangor.
Dr Bentall, a leading proponent of cognitive behavioural therapy in the treatment of psychosis, explained to the magazine: "I felt lethargic and sedated...I felt a sense of depression and hopelessness but also an inner sense of restlessness and agitation. It was a combined wanting to do something and not being able to.
"I had to do these neuropsychological tests, and it was embarrassing, but I burst into tears halfway through. I started weeping uncontrollably, so much so that I was given an anticholinergic drug as an antidote and David took me out to get some fresh air.
"I suddenly felt I had to tell him about all the things I had ever felt guilty about. Then I went back and fell asleep for three hours. I woke up with a woozy hangover, like there was a glass wall between me and the world and that lasted for about a week after a single dose."
Have a look at this.....
http://bmj.bmjjournals.com/cgi/content/full/324/7352/1506If ever I go into hospital I'll make sure that a warning is written on my drug chart. I would never agree to take take haloperidol, metoclopramide or prochlorperazine- drugs which are widely used as anti-nauseants in English medical wards. I'd be happy to take domperidone, cyclizine or ondansetron though.
What scares me the most is that I might be given an antipsychotic when I'm old and I can't refuse eg. if I had dementia. If I became agitated they'd just keep increasing the dose until I was in hell!! It terrifies me to think how common this must be.
>Have you ever had agitated depressions/mixed states? That was the most recent depression I went through and also tends to be the flavor I get periodically for 3-4 days every month or so. I have intense anxiety, agitation, despair and become afraid of everything, almsot like a wierd paranoia.
No, I've never had that. I had a lot of very severe anxiety when I was younger though. Perahaps you should take Ativan preventatively when you take Zyprexa for more that a day. What do you think?
Ed.
Posted by ed_uk on February 6, 2005, at 9:06:45
In reply to Re: For Chris » olysi79, posted by ed_uk on February 6, 2005, at 8:25:29
Hello!
What have you decided to do?
Ed.
Posted by Jeroen on February 6, 2005, at 9:20:57
In reply to Re: For Chris » olysi79, posted by ed_uk on February 6, 2005, at 8:25:29
seroquel for few weeks, and increase it
Posted by Jeroen on February 6, 2005, at 18:38:53
In reply to ED UK, posted by Jeroen on February 6, 2005, at 9:20:57
hi, could this be acute dystonia i had from geodon?
ocular crisis? eye rolling back in the head
if yes its been 5 months can it still be this or not?
i not only blink but my eye want to look up also and seems to be rolling into my head
i called suicide help yesterday, i cant take it anymore, there are people out there with bigger problems
it just wont stop my misery!
Posted by Jeroen on February 6, 2005, at 18:40:18
In reply to TO ED UK, posted by Jeroen on February 6, 2005, at 18:38:53
sorry i ment oculogyric crisis, a crisis occurring in epidemic encephalitis, postencephalitic parkinsonism, or secondary to use of antipsychotic agents; the eyeballs become fixed in one position, typically upwardly rotated, for minutes or hours.
Posted by ed_uk on February 7, 2005, at 5:53:29
In reply to TO ED UK, posted by Jeroen on February 6, 2005, at 18:38:53
Hi Jeroen,
No, it is not an acute dystonia. An acute dystonia would have dissapeared soon after stopping the Geodon. Also, an acute dystonia would have improved with Akineton.
>my eye want to look up also and seems to be rolling into my head
That's a type of tardive dystonia. Tardive dystonia is a variant of tardive dyskinesia.
>i called suicide help yesterday, i cant take it anymore, there are people out there with bigger problems
I'm so sorry that you're going through so much pain. I really hope the Seroquel helps. If it doesn't, there are other options- don't forget that! There are several treatments for tardive dyskinesia/tardive dystonia that we haven't even discussed yet. Stay hopeful :-)
Ed.
Posted by ed_uk on February 7, 2005, at 5:54:21
In reply to For Ed_uk » ed_uk, posted by olysi79 on February 6, 2005, at 1:52:06
Did you see my post to you above? Hope you are well :-)
Ed.
Posted by Jeroen on February 7, 2005, at 19:33:22
In reply to Re: Hi Chris » olysi79, posted by ed_uk on February 7, 2005, at 5:54:21
ill start this week with seroquel 25 mg at night, i hope to see improvement within few weeks on it with the eye problem,
my doctor doesnt know about it .. i feel i cant trust him sorry..
the seroquel gives me nightmares.. will this side effect go away?
Posted by Jeroen on February 7, 2005, at 19:43:22
In reply to Re: Hi Chris, posted by Jeroen on February 7, 2005, at 19:33:22
ASENAPINE is a 5HT2A & D2 antagonist
RISPERDAL is a 5HT2A & D2 antagonist
I FELT VERY BAD WITH RISPERDAL, was like a zombie, felt drugged
doctor sais ASENAPINE is high sedation...i dont think i will feel good on this dog po0p
what do you think? but it might fix the eye problem who knows, its given for neurological disorders
Posted by olysi79 on February 7, 2005, at 23:53:51
In reply to Re: For Chris » olysi79, posted by ed_uk on February 6, 2005, at 8:25:29
Hey Ed :)
I was reading through that info with the PDOC flipping out after having the AP. Very interesting for some of those PDOCS to get a taste of their own medicine :) I have Ativan and Klonopin handy and that seems to help witht hat restless feeling. Another nifty little trick is Benedryl of all things, it works good to a certain extent and helps.> Hi Chris!
>
> >One PDOC told me that patients used to get it so bad that they would throw themselves off of buildings in mental hospitals. How pleasant.
>
> Yes, I have heard that some people have killed themselves because of akathisia.
>
> I found this interesting. It describes the effect that the antipsychotic droperidol had on a healthy psychologist. In the study, where droperodol was given to several healthy psychologists, one of them had to admitted to a psychiatric ward for suicidal ideation!!
>
> (From the New Scientist)
>
> Leading clinical psychologist describes feelings of "helplessness" and "uncontrolled weeping" after taking neuroleptic (antipsychotic)
>
> February 1, 2004
>
> A leading clinical psychologist has described his experience of taking a neuroleptic medication as part of a clinical trial.
>
> Richard Bentall, professor of clinical psychology at the University of Manchester, told the New Scientist magazine how he experienced the symptoms of akathisia, and became agitated and depressed.
>
> Bentall, one of clinical psychology's most outspoken critics of psychiatry's medical model, took 5mgs of the neuroleptic droperidol . He was one of the subjects in a study organised by David Healy, professor of psychological medicine at the North Wales Hospital in Bangor.
>
> Dr Bentall, a leading proponent of cognitive behavioural therapy in the treatment of psychosis, explained to the magazine: "I felt lethargic and sedated...I felt a sense of depression and hopelessness but also an inner sense of restlessness and agitation. It was a combined wanting to do something and not being able to.
>
> "I had to do these neuropsychological tests, and it was embarrassing, but I burst into tears halfway through. I started weeping uncontrollably, so much so that I was given an anticholinergic drug as an antidote and David took me out to get some fresh air.
>
> "I suddenly felt I had to tell him about all the things I had ever felt guilty about. Then I went back and fell asleep for three hours. I woke up with a woozy hangover, like there was a glass wall between me and the world and that lasted for about a week after a single dose."
>
>
> Have a look at this.....
> http://bmj.bmjjournals.com/cgi/content/full/324/7352/1506
>
> If ever I go into hospital I'll make sure that a warning is written on my drug chart. I would never agree to take take haloperidol, metoclopramide or prochlorperazine- drugs which are widely used as anti-nauseants in English medical wards. I'd be happy to take domperidone, cyclizine or ondansetron though.
>
> What scares me the most is that I might be given an antipsychotic when I'm old and I can't refuse eg. if I had dementia. If I became agitated they'd just keep increasing the dose until I was in hell!! It terrifies me to think how common this must be.
>
> >Have you ever had agitated depressions/mixed states? That was the most recent depression I went through and also tends to be the flavor I get periodically for 3-4 days every month or so. I have intense anxiety, agitation, despair and become afraid of everything, almsot like a wierd paranoia.
>
> No, I've never had that. I had a lot of very severe anxiety when I was younger though. Perahaps you should take Ativan preventatively when you take Zyprexa for more that a day. What do you think?
>
> Ed.
>
>
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