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Dr. Bob is Robert Hsiung, MD,
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Posted by Chairman_MAO on January 29, 2006, at 15:30:20
In reply to 10mg Abilify.........Akathisia, posted by ace on January 29, 2006, at 9:34:11
Who takes 80mg of Stelazine, inpatient Elephants!?!
Posted by ed_uk on January 29, 2006, at 15:58:15
In reply to 10mg Abilify.........Akathisia, posted by ace on January 29, 2006, at 9:34:11
Hi ACE
10mg Abilify was far too much. Unless you're acutely psychotic or manic you should start at a much lower dose.
>I needed two IV doses of Cogentin (man that stuff is good) to stop it it was so uncomfortable.
You liked Cogentin a lot?
>My next move is 1mg Stelazine
Low doses of trifluoperazine (Stelazine), haloperidol (Haldol, Serenace) and similar neuroleptics can sometimes be helpful for anxiety in the short term but the risk of TD is high in the long term. Akathisia is very common with high potency neuroleptics. Take care. Why not just try a (much) lower dose of Abilify?
>some hospitalised people go up to 80mg.....
That would be very uncommon these days, although such high doses were used in the past.
Ed
Posted by ed_uk on January 29, 2006, at 16:09:56
In reply to 10mg Abilify.........Akathisia, posted by ace on January 29, 2006, at 9:34:11
Manufacturer's recommendations:
Non-psychotic generalised anxiety.......
'Usual dosage is 1 or 2 mg twice daily. Do not administer at doses of more than 6 mg per day or for longer than 12 weeks.'
'When used in the treatment of non-psychotic anxiety, Stelazine should not be administered at doses of more than 6 mg per day or for longer than 12 weeks because the use of Stelazine at higher doses or for longer intervals may cause persistent tardive dyskinesia that may prove irreversible'
I would personally avoid taking single doses of more than 1mg.
Still, are you sure you need a high potency neuroleptic ACE? I thought you were doing well on Nardil, and that your anxiety was under control. Neuroleptics are not an appropriate treatment for mild anxiety.
Take care
Ed
Posted by gibber on January 29, 2006, at 16:36:34
In reply to Re: Akathisia vs. Tardive dyskinesia, posted by fenix on January 29, 2006, at 15:14:42
It seems akathisia is short for tardive akathisia. This is from the University of Kansas Med Center website. This first hit on google:
Tardive akathisia is the third type of tardive syndrome. Akathisia refers to a feeling of restlessness often accompanied by anxiety. In milder cases, the individual may complain of a sensation of inner restlessness and be unable to sit quietly without fidgeting . In more severe cases, the individual may actually be unable to remain seated and must pace or march around the room. Their sense of anxiety increases if they are unable to move about.
tardive dyskenisia is a term reserved for movements mostly of the face.
Posted by ed_uk on January 29, 2006, at 16:40:48
In reply to 10mg Abilify.........Akathisia, posted by ace on January 29, 2006, at 9:34:11
PS. Stelazine can also cause acute dystonia, which can be severe. Please be cautious.
Ed
Posted by fenix on January 29, 2006, at 18:23:00
In reply to Re: Akathisia vs. Tardive dyskinesia, posted by gibber on January 29, 2006, at 16:36:34
Akathisia is not short for tardive akathisia. Tardive akathisia is something different. Tardive is derived from the Latin word meaning late onset.
Tardive akathisia differs from normal akathisia because it 1) lasts for a very long time (if not indefinitely) even when the drugs that caused it are stopped and 2) has a tendency to be extremely difficult to treat; drugs such as propranolol (which is very effective in temporary neuroleptic-induced akathisia, usually does nothing for tardive akathisia), benzodiazepines, opiates, dopamine depleters (such as reserpine), and divers other things have proven unsatisfactory results.
Posted by gardenergirl on January 29, 2006, at 19:54:06
In reply to Re: Akathisia vs. Tardive dyskinesia, posted by fenix on January 29, 2006, at 18:23:00
Sounds like it would make a good case study, since it's so unusual for someone to be diagnosed with that.
gg
Posted by Phillipa on January 29, 2006, at 22:13:06
In reply to Re: Akathisia vs. Tardive dyskinesia » fenix, posted by gardenergirl on January 29, 2006, at 19:54:06
Ace please be careful. Fondly, Phillipa
Posted by ed_uk on January 30, 2006, at 12:08:58
In reply to Re: Akathisia vs. Tardive dyskinesia, posted by fenix on January 29, 2006, at 18:23:00
Hi Fenix
Tell us about your akathisia. How long have you had it? Which medication was responsible? When did you stop the offending medication? Did you suffer from acute extra-pyramidal side effects when you were still taking the offending medication? What medication(s) are you on at the moment? Which meds have you tried for the akathisia so far?
Ed
Posted by yxibow on January 31, 2006, at 1:20:49
In reply to Re: Akathisia vs. Tardive dyskinesia, posted by fenix on January 29, 2006, at 18:23:00
> Akathisia is not short for tardive akathisia. Tardive akathisia is something different. Tardive is derived from the Latin word meaning late onset.
>
> Tardive akathisia differs from normal akathisia because it 1) lasts for a very long time (if not indefinitely) even when the drugs that caused it are stopped and 2) has a tendency to be extremely difficult to treat; drugs such as propranolol (which is very effective in temporary neuroleptic-induced akathisia, usually does nothing for tardive akathisia), benzodiazepines, opiates, dopamine depleters (such as reserpine), and divers other things have proven unsatisfactory results.
You might look into wemove.org and other sites devoted to movement disorders. I can't discuss importation of drugs here, but people have imported Tetrabenazine (Nitoman in Canada) from Canada and England. It is considered a fast track orphan drug by the FDA currently. A company has filed a NDA recently to have it approved in the US for Huntingtons Chorea. It has been used in trials for TD in the same way reserpine has been used. It can cause pseudoparkinsonism, but one has to weight the benefits.Regards
- J
Posted by fenix on February 2, 2006, at 7:25:07
In reply to Re: Akathisia vs. Tardive dyskinesia » fenix, posted by ed_uk on January 30, 2006, at 12:08:58
> Hi Fenix
>
> Tell us about your akathisia. How long have you had it? Which medication was responsible? When did you stop the offending medication? Did you suffer from acute extra-pyramidal side effects when you were still taking the offending medication? What medication(s) are you on at the moment? Which meds have you tried for the akathisia so far?
>
> EdHi Ed, I would respond better but I am so worn and tired really so I will try my best to answer your questions.
1)I have had akathisia for 2 years, and have been diagnosed with Tardive Akathisia, the worst form of it. I have also not been on any psychiatric drugs for 2 years as well, ever since the TA happened, for you see, Tardive Akathisia lasts and lasts even when all causitive drugs have been stopped. Horrific pain.
2)The medication responsible was Geodon, I was also on other neuroleptics for three years or so before I got Tardive Akathisia, so Geodon was just another player in the long term effects these drugs were having on me. (I want to note here now that I was being treated for depression/anxiety, nothing psychotic in nature, and that I was also given Effexor on a number of occasions).
3)I was and still am suffering from extra-pyramidal side-effects. It was worse when I was on the causitive drug. Basically now, I tend to get twitchings mostly in the left leg once in a while and it happens every day.
4)The only medicine I am on now is clonazepam. We first tried propranolol but that didn't work, so we are now trying benzodiazepines (these are helping to an extent, albeit a small one, but still better than nothing).
Any other questions, feel free to ask. Thanks.
Posted by yxibow on February 2, 2006, at 12:13:02
In reply to Re: Akathisia vs. Tardive dyskinesia, posted by fenix on February 2, 2006, at 7:25:07
You might try for a compassionate Prior Authorization from your insurance provider (I'm hoping you have insurance :/) or from Novartis (the current orphan drug manufacturer) for the atypical with the least D2, Clozaril. It costs $9,000 a year (when last checked -- costs are more for the testing than the drug I think) because they have to monitor you weekly for agranulocytosis (low white blood cell count in 2% of patients), but it has a) helped the worst schizophrenia cases and b) sometimes brought people out of Tardive conditions.
Your doctor would have to make a considerable letter/case for it but it might be an option.
If not trying another low on the totem pole atypical such as Seroquel or Zyprexa may and has caused a shift in things before in people.
Tidings
Jay
Posted by ed_uk on February 2, 2006, at 13:53:21
In reply to Re: Akathisia vs. Tardive dyskinesia, posted by fenix on February 2, 2006, at 7:25:07
Hi Fenix
>I would respond better but I am so worn and tired
No problem :)
>Horrific pain
I can imagine. I've suffered severe neuroleptic-induced acute akathisia myself, it was awful. Thankfully it disappeared within 24 hours of stopping the antipsychotic......which I only took for a couple of days. Tardive akathisia must be absolutely dreadful.
>clonazepam....
So you've only tried propranolol and clonazepam?
The treatment of tardive akathisia is very poorly researched. There are many drugs you could try. A process of trial and error is ahead.
Regards
Ed
Posted by fenix on February 2, 2006, at 14:31:38
In reply to Re: Akathisia vs. Tardive dyskinesia » fenix, posted by yxibow on February 2, 2006, at 12:13:02
> You might try for a compassionate Prior Authorization from your insurance provider (I'm hoping you have insurance :/) or from Novartis (the current orphan drug manufacturer) for the atypical with the least D2, Clozaril. It costs $9,000 a year (when last checked -- costs are more for the testing than the drug I think) because they have to monitor you weekly for agranulocytosis (low white blood cell count in 2% of patients), but it has a) helped the worst schizophrenia cases and b) sometimes brought people out of Tardive conditions.
>
> Your doctor would have to make a considerable letter/case for it but it might be an option.
>
> If not trying another low on the totem pole atypical such as Seroquel or Zyprexa may and has caused a shift in things before in people.
>
> Tidings
>
> Jay
No way in hell am I going on SSRIs or neuroleptics again, they caused my pains, and I feel way better now without them. And... I am not schizo, never was, so... thanks for the post anyway.
Posted by fenix on February 2, 2006, at 14:34:15
In reply to Re: Akathisia vs. Tardive dyskinesia » fenix, posted by ed_uk on February 2, 2006, at 13:53:21
Yes... I wish there was more research done on this stuff. I talked to a doctor from Harvard University that did research on adverse drug side-effects from SSRIs, and in fact he wrote a book on it.
However, even he barely knows anything about Tardive Akathsisia.
Posted by yxibow on February 3, 2006, at 0:26:47
In reply to Re: Akathisia vs. Tardive dyskinesia, posted by fenix on February 2, 2006, at 14:31:38
> No way in hell am I going on SSRIs or neuroleptics again, they caused my pains, and I feel way better now without them. And... I am not schizo, never was, so... thanks for the post anyway.It wasn't meant as an insult, I dont know your condition. Clozaril, which has some nasty but non TD side effects, is a treatment for Tardive conditions. That's all I was suggesting.
And yes, after you have exhausted other alternatives, there are numerous case reports where one neuroleptic has altered conditions completely. But I understand your reluctance definately. I can't imagine the pain, because I have experienced some of the worst akathisia on things like Compazine (not for schizophrenia.) It was just a suggestion.
Posted by fenix on February 3, 2006, at 3:52:07
In reply to Re: Akathisia vs. Tardive dyskinesia » fenix, posted by yxibow on February 3, 2006, at 0:26:47
Oh man, I had just typed this long post and then I closed the window by accident.
Basically I am just trying benzodiazepines and other things like resperine at the moment.
I am scared of neuroleptics, they hurt me.
Posted by yxibow on February 3, 2006, at 12:29:55
In reply to Re: Akathisia vs. Tardive dyskinesia, posted by fenix on February 3, 2006, at 3:52:07
> Oh man, I had just typed this long post and then I closed the window by accident.
>
> Basically I am just trying benzodiazepines and other things like resperine at the moment.
>
> I am scared of neuroleptics, they hurt me.I understand. Reserpine is a neuroleptic, by the way, synthesized now from a natural Indian plant. Tetrabenazine, similar, is also a neuroleptic/dopamine depleter.
I know they hurt you alot and I am in no way advising you go down that road, but it is another last resort to these persistent disorders, especially clozaril, which to this date has nearly no provable TD caused directly by itself.
Posted by ed_uk on February 3, 2006, at 13:50:41
In reply to Re: Akathisia vs. Tardive dyskinesia, posted by fenix on February 3, 2006, at 3:52:07
Hi Fenix
So what will you try next after clonazepam?
Some ideas.....
Clonidine
Biperiden
Cyproheptadine
GabapentinEd
Posted by Karla on February 3, 2006, at 23:22:06
In reply to 10mg Abilify.........Akathisia, posted by ace on January 29, 2006, at 9:34:11
I take 30 mg of abilify over last year. What is this Akathisia that you speak of? What are the symptoms? Thanks.
Posted by the kindling effect on February 8, 2006, at 12:49:42
In reply to Re: Akathisia vs. Tardive dyskinesia, posted by fenix on February 3, 2006, at 3:52:07
Hi fenix,
Was diagnosed with TA about a year ago but a lot of difficulty with treatments(big surprise huh). Am in Canada but was told by movement disorer specialists(have seen 4 seperate movement neurologists here but none able to do on-going treatment) to go to US to seek treatment. You mentioned a doc a Harvard? studying/treating Tardive Akathisia. ANy info. you could pass along on docs would be immensly appreciated. You can Babblemail me or post.
Anyone else who knows a tardive specialist in the US please advise. 'Have heard the Wirshing's aren't active anymore?
THis is excruciatingly uncomfortable. Makes the disorders I was treating seem almost benign(although now untreated they obviously complicate things too).
I'd appreciate any help.
DAVE
Oh man, I had just typed this long post and then I closed the window by accident.
>
> Basically I am just trying benzodiazepines and other things like resperine at the moment.
>
> I am scared of neuroleptics, they hurt me.
Posted by the kindling effect on February 8, 2006, at 12:53:07
In reply to Re: Akathisia vs. Tardive dyskinesia, posted by the kindling effect on February 8, 2006, at 12:49:42
,.....basicaly that or something like it was to be the title of above post. Not sure how to respond so person's name appears with those little arrows....
DAVE
Posted by ed_uk on February 8, 2006, at 13:25:03
In reply to ATTN: fenix., posted by the kindling effect on February 8, 2006, at 12:53:07
Hi Dave
I hope you don't mind me asking you the same questions I asked Fenix.......
Tell us about your akathisia. How long have you had it? Which medication was responsible? When did you stop the offending medication? Did you suffer from acute extra-pyramidal side effects when you were still taking the offending medication? What medication(s) are you on at the moment? Which meds have you tried for the akathisia so far?
Ed
Posted by the kindling effect on February 9, 2006, at 11:27:10
In reply to Re: Akathisia vs. Tardive dyskinesia » fenix, posted by yxibow on January 31, 2006, at 1:20:49
> > Akathisia is not short for tardive akathisia. Tardive akathisia is something different. Tardive is derived from the Latin word meaning late onset.
> >
> > Tardive akathisia differs from normal akathisia because it 1) lasts for a very long time (if not indefinitely) even when the drugs that caused it are stopped and 2) has a tendency to be extremely difficult to treat; drugs such as propranolol (which is very effective in temporary neuroleptic-induced akathisia, usually does nothing for tardive akathisia), benzodiazepines, opiates, dopamine depleters (such as reserpine), and divers other things have proven unsatisfactory results.
>
>
> You might look into wemove.org and other sites devoted to movement disorders. I can't discuss importation of drugs here, but people have imported Tetrabenazine (Nitoman in Canada) from Canada and England. It is considered a fast track orphan drug by the FDA currently. A company has filed a NDA recently to have it approved in the US for Huntingtons Chorea. It has been used in trials for TD in the same way reserpine has been used. It can cause pseudoparkinsonism, but one has to weight the benefits.
>
Depression and pseudoparkinsonism are the main two for Tetrabenazine. We have it here in Canada as you mentioned. Apparently it's not a nice drug if you already suffer depression ,anxiety etc. My rough understanding is reserpine is sort of irreversible DA depleter whereas tetrabenazine is reversible (think Moclobimide versus standard MAOIs perhaps). Dysphoria,anxiety,insomnia etc. are other side effects. This is my treatment option I've been given right now but I'm told I need to start in hospital due to possibility of becoming suicidal(more?) and due to side effects. I also believe you must request the drug from government under 'compassionate plea' request (something along those lines. I've been told I have mild chorea or (something that imitates it neurologists have differing opinions) but most say it is the akathisia when I'm under stress and staying still. Along with vatious tics. Huntington's isn't pretty o see. I've already been ruled out for Wilson's and Huntington's.
Nitoman.(always think of Bart Simpson; ie 'neat-o man!' 'not sure how it's supposed to help dysphoria when it can cause it. (rhetorical. No theories or suportive comments please.)
Posted by the kindling effect on February 9, 2006, at 11:59:26
In reply to Re: ATTN: fenix. » the kindling effect, posted by ed_uk on February 8, 2006, at 13:25:03
Hello Ed.
Very bizzare posting here. Have been watching (stalking sounds so unbearably creepy) this board for 5 years now and am very familar with the cases of many long time posters. Have learned a lot from here. Some of it really kept me going. Didn't post before because there were so few people who seemed to have similar symptoms. I kept coming back(this is heading way off on a tangent Ed; i tend to have a lot of verbal spewing now; be forewarned, often completely forget original topic)uummmm lost.
Anyways 40+ psychotropics over last five years. Dxs(which I consider from useless to dangerous if incorrect at times)have become a silly potpourri now. Originally I suppose dysthimia/MDD then anxiety showed up after a period on sertraline. This is going to become a medusa of an explanation.
Basically I've seen 2 or 3 people in 5 years on this board in a similar situation as I (similar causes as well) although my current situation is now further clouded by TA and other neurological dxs(tics(developed mostly on Seroquel/EFXR,) OCD apparently often go together.) Point- Marsha,4WD, is now in the same situation I was attempting to treat the last 5 years. Largest aggravating factor:time of day,same nearly every day. Morning intense,often fear terror drops to despair to dysphoria(anguish as the neuros call it, often unable to move) with energy building again towards evening but usually much better by some hours after darkness. THat's brief, spare you details. Past similarities with these other posters? Several years on SSRI alone(Prozac seems worst, I was on Zoloft) and often some intermittent C(believe you call it Charlie in UK) use with alcohol during that period;hence the kindling effect common in low dose sporadic users.Push it too far one time and don't recover from anxiety. become super-sensitive to SSRIs, including muscle stiffness(esp.Celexa),minor EPSs, anxiety,agitation and many psychotropics, try a plethora of mood stabilizers w/Ad, atypical APs /AD(my biggest help for a couple years) all generally at low dose because of strange(to psychiatrists) side effects....Every possible physical ailment, MRIs,SPECT, psych, neuro-psych testing
I think you asked my some straightforward questions I'm trying to cram 5 years of personal observations down your throat.
...will try again. Exit.
> Hi Dave
>
> I hope you don't mind me asking you the same questions I asked Fenix.......
>
> Tell us about your akathisia. How long have you had it? Which medication was responsible? When did you stop the offending medication? Did you suffer from acute extra-pyramidal side effects when you were still taking the offending medication? What medication(s) are you on at the moment? Which meds have you tried for the akathisia so far?
>
> Ed
>
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