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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by xbunny on March 10, 2006, at 5:20:37
I have my biannual psychiatrists appt coming up and I think its time I tweaked my meds. My rationale, I have been on my current regiem for about a year and my progress whilst remarkable has levelled out and has still failed to hit the anxiety I get when I go out. Its frustrating, I am not psychotic, my mood is good, I am motivated, However I still cannot walk around a supermarket without getting anxious and ratty nor sit through a film at the cinema and other things that I would like to do. I originally added pericycazine to my regiem to help this and I think its the correct time to accept its not really helping. My current medication is flupenthixol 6mg, pericycazine 20mg and mirtazapine 30mg. I am looking for suggestions for new things to try, some ideas I had;
a) add an SSRI, SSRI's make me psychotic but now I have my antipsychotic sorted perhaps an SSRI will help my anxiety.
b) replace pericyazine or both antipsychotics with another typical. Ideally I would like a medium sedating antipsychotic which doesnt cause akathasia, EPS I think I can handle with procyclidine if the drug is worthwhile. Which drug to try? ones I havent which seem interesting are haldol or perphenazine.
c) replace flupenthixol with zuclopenthixol - on the surface at least it appears that zuclopenthixol is the sedating version of flupenthixol. If that were so it sounds quite promising. Just how sedating is it I wonder though!?
d) replace one or both antipsychotics with an atypical I havent tried. Aripiprazole, quetiapine, zotepine and clozapine are the ones I havent tried. I have found the atypicals I have tried (olanzapine, risperdal, amisulpride) made me feel profoundly weird compared the typicals but perhaps its time give another one a go. From what I can tell the atypicals arent that great for anxiety anyways.Thats all I got so far, thanks for reading and for any ideas you might have.
Best Regards Bunny
Posted by ed_uk on March 10, 2006, at 15:50:38
In reply to antipsychotic for anxiety (again sorry), posted by xbunny on March 10, 2006, at 5:20:37
Hi
One option would be to taper off the pericyazine and replace it with a low dose of quetiapine. Quetiapine does sometimes help anxiey.
Another option would be to add diazepam to your regimen.
Regards
Ef
Posted by med_empowered on March 10, 2006, at 16:53:49
In reply to Re: antipsychotic for anxiety (again sorry) » xbunny, posted by ed_uk on March 10, 2006, at 15:50:38
hi! I understand that benzos aren't frequently RX'd in the UK but I think that may be the best course of action. In addition to helping with anxiety, there's some evidence that benzos can help with schizophrenia, either as add-ons to stable antipsychotic treatment or as as-needed agents when the person is at risk of a relapse (google "diazepam for schizophrenia" or something similar and you'll find some recent studies that confirm this.) So...I'd personally say try a benzo--klonopin, ativan, diazepam, etc.
Another option would be BuSpar, but I don't know how that would work..it plays with serotonin and dopamine, which are both also affected by neuroleptics and antidepressants; it seems that throwing buspar in the mix might not be the best course of action.
Some people say zyprexa or seroquel help with anxiety, so tapering off one or both of your current meds and going onto one or both of those might be worth a shot...since you're on 2 antipsychotics already, its probably a good idea to switch stuff out at this point, instead of adding on..there isn't much evidence for multiple antipsychotics being beneficial, and the side effects can get kind of extreme.
Can you do CBT therapy? I don't know how it works in the UK but here there's a growing interest in doing CBT and other forms of therapy with people with schizophrenia or other psychotic disorders (in the past, it was kind of assumed that meds and vocational rehab were all that could really be done for such disorders). Since you're stable and functioning, it seems like you'd be a good candidate.
Good luck!
Posted by Phillipa on March 10, 2006, at 18:31:57
In reply to hey, posted by med_empowered on March 10, 2006, at 16:53:49
Have you heard of ACT? Another form of theraphy which does deal with schizophrenia. Google it it's hard to explain. Fondly, Phillipa
Posted by tizza on March 11, 2006, at 4:43:11
In reply to antipsychotic for anxiety (again sorry), posted by xbunny on March 10, 2006, at 5:20:37
Hey there xbunny, I found seroquel which I'm sure you know is an atypical AP to be extremly sedating and work really well for anxiety, if you're having trouble sleeping this will knock you out cold, well it did for me anyway and quite a few other p-babblers in here that I have posted about it in the past. It was too strong for me and left me in a stupor the next day but I have heard that it works wonders for some people. Paul
Posted by San Diegan on March 12, 2006, at 3:26:34
In reply to Re: antipsychotic for anxiety (again sorry) » xbunny, posted by tizza on March 11, 2006, at 4:43:11
I still fail to understand why docs think it's ok to give people dangerous drugs like antipsychotics (very high rates of irreversible TD, etc. etc.) When cheaper, more effective meds are available for anxiety. They should all be sued for malpractice!
Maybe it's the propaganda from the drug-warriors and their phony concern for addiction...
Posted by med_empowered on March 12, 2006, at 11:12:35
In reply to Re: antipsychotic for anxiety (again sorry), posted by San Diegan on March 12, 2006, at 3:26:34
yup. I think the whole "war on drugs," fight addiction thing has made docs more willing to damage their own patients to avoid giving out "addictive" RXs. I mean, of course antipsychotics aren't addictive; they're so hellishly unpleasant that many people won't even take them willingly--I hardly think that's a selling point.
Posted by tizza on March 12, 2006, at 19:28:34
In reply to APs for anxiety, posted by med_empowered on March 12, 2006, at 11:12:35
> yup. I think the whole "war on drugs," fight addiction thing has made docs more willing to damage their own patients to avoid giving out "addictive" RXs. I mean, of course antipsychotics aren't addictive; they're so hellishly unpleasant that many people won't even take them willingly--I hardly think that's a selling point.
Despite what I said above about seroquel, I should have never been prescribed it or zyprexa for that matter, for anxiety, GAD, SP and depression. They just damaged my spirit and totally numbed any hope I had left. Benzo's have worked wonders for me. Paul
Posted by Caedmon on March 13, 2006, at 0:07:23
In reply to antipsychotic for anxiety (again sorry), posted by xbunny on March 10, 2006, at 5:20:37
You might try quetiapine. As far as atypicals go I understand that it tends to have decent anxiolytic properties. I'm afraid I'm not very familiar with the typicals, sorry.
Clozapine is great, but requires a lot of skill and can be tricky.
Posted by xbunny on March 13, 2006, at 4:52:35
In reply to Re: antipsychotic for anxiety (again sorry), posted by San Diegan on March 12, 2006, at 3:26:34
> I still fail to understand why docs think it's ok to give people dangerous drugs like antipsychotics (very high rates of irreversible TD, etc. etc.) When cheaper, more effective meds are available for anxiety.
I agree with you though I fail to see why cheaper should be an issue for a patient. My personal case is slightly different though, I must take antipsychotics for my schizophrenia however I would like the one(s) I take to also tackle anxiety. My subject line "antipsychotic for anxiety" is misleading in that respect.
Best regards Bunny
Posted by San Diegan on March 13, 2006, at 10:36:30
In reply to Re: antipsychotic for anxiety (again sorry) » San Diegan, posted by xbunny on March 13, 2006, at 4:52:35
OH! That makes sense. I misunderstood. I'm not saying antipsychotics shouldn't be used for psychotic symptoms, just that they shouldn't be used off-label. Cheaper is definitely an issue for patients for two reasons. One would be if they pay out-of-pocket, and Two would be that unnecessary use of expensive drugs makes insurance more expensive for everyone...
> I agree with you though I fail to see why cheaper should be an issue for a patient. My personal case is slightly different though, I must take antipsychotics for my schizophrenia however I would like the one(s) I take to also tackle anxiety. My subject line "antipsychotic for anxiety" is misleading in that respect.
Posted by ed_uk on March 13, 2006, at 13:25:24
In reply to Re: antipsychotic for anxiety (again sorry) » San Diegan, posted by xbunny on March 13, 2006, at 4:52:35
Hi Bunny
IMO, combining APs can be useful in some cases if the two APs have substantially different properties.
Flupenthixol and quetiapine are quite different. A low(ish) dose of quetiapine might be useful in combination with flupenthixol. If you do decide to try quetiapine, is might be best to taper off the pericyazine first.
A long-acting benzo might also be a useful add-on. Diazepam, clonazepam or chlordiazepoxide would be logical choices.
Kind regards
Eddy
Posted by xbunny on March 13, 2006, at 15:04:07
In reply to Re: antipsychotic for anxiety (again sorry) » xbunny, posted by ed_uk on March 13, 2006, at 13:25:24
Hi Ed!
Thanks for your suggestions they both seem great. My only concern with quetiapine is that its apparently majorly sedating. I find heavy sedating meds do work well against my anxiety (ie dothiepin was great for anxiety) but usually after a few weeks of them I am totally sick of feeling tired all the time. Also its an atypical and the atypicals I have tried havent agreed with me, still they are all different right?
The benzo idea is great one though I am concerned about the addiction/dependancy aspects of it and also the likelyhood of it being prescribed at all.
No suggestions of typicals for me? Perphenazine is also prescribed for anxiety, is it much different to stelazine? Levomeprazine seems like another one in the sedating phenothiazine group, is it more similar to chlorpromazine or thioridazine?
So many questions, sorry if I am bugging you!
To be honest I am quite stressed about the whole thing, I havent seen a psychiatrist for many months and am quite anxious that he do something for me before writing me off for another 6 months.
Buns
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