![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 15 to 39 of 39. Go back in thread:
Posted by Phillipa on January 30, 2007, at 22:19:56
In reply to Re: Atypicals for anxiety?, posted by mattye on January 30, 2007, at 22:07:15
No in my opinion same for me although a different benzo. Love Phillipa
Posted by notfred on January 30, 2007, at 22:28:05
In reply to Re: Atypicals for anxiety?, posted by mattye on January 30, 2007, at 22:07:15
"I've never gotten a high or feel good effect from benzos. It just feels like someone turned down the volume. Thats all. Is that so wrong?"
>Not to me. Who said it was wrong ?
Posted by UGottaHaveHope on January 31, 2007, at 2:30:02
In reply to Re: Atypicals for anxiety? » linkadge, posted by Bob on January 30, 2007, at 16:24:24
Ask your doc for a sample pack, You will know within 30 minutes if it works at all, and a few days if it is going to be good for you. It really hits anxiety hard, but always makes you groggy, but hey all meds have tradeoffs.
Thats hogwash about Klonopin. Its a great drug, and gets a bad rap from ppl who take it for recreational use. Im taking less now than I was 10 years ago (3mg).
Posted by mattye on January 31, 2007, at 11:24:46
In reply to Re: Try Seroquel, posted by UGottaHaveHope on January 31, 2007, at 2:30:02
Yeah 25 mgs of Seroquel at bedtime knocks out my anxiety, but doesn't do much for me during the day. I haven't taken it on a regular basis... just as needed for insomnia. I suppose there is a cumulative effect if I increase dosage and take it daily.
I am concerned about side effects though. I know people who have taken this and it made them really groggy during the day and they gained ALOT of weight... Although I did not gain weight on Remeron and that gives you the munchies like NOTHING else! 25 mgs of Seroquel did not make me as hungry as the Rem.
> Ask your doc for a sample pack, You will know within 30 minutes if it works at all, and a few days if it is going to be good for you. It really hits anxiety hard, but always makes you groggy, but hey all meds have tradeoffs.
>
> Thats hogwash about Klonopin. Its a great drug, and gets a bad rap from ppl who take it for recreational use. Im taking less now than I was 10 years ago (3mg).
Posted by Bob on January 31, 2007, at 13:06:11
In reply to Re: Try Seroquel, posted by UGottaHaveHope on January 31, 2007, at 2:30:02
> Thats hogwash about Klonopin. Its a great drug, and gets a bad rap from ppl who take it for recreational use. Im taking less now than I was 10 years ago (3mg).What's hogwash, specifically?
Posted by UGottaHaveHope on January 31, 2007, at 13:11:03
In reply to Re: Try Seroquel, posted by mattye on January 31, 2007, at 11:24:46
Then consider trying the 100mg tablet.
Not all people gain weight Seroquel, but you might. Who knows? You have to decide what is more important: Feeling less anxious at the risk of a few extra pounds.
Posted by Phillipa on January 31, 2007, at 17:32:51
In reply to Re: Try Seroquel, posted by UGottaHaveHope on January 31, 2007, at 13:11:03
Michael you take klonopin with seroquel? That's a lot of downers in my opinion. Why not pick one or the other? Love Phillipa
Posted by UGottaHaveHope on January 31, 2007, at 18:27:27
In reply to Re: Try Seroquel » UGottaHaveHope, posted by Phillipa on January 31, 2007, at 17:32:51
Well I take Emsam, which is activating. But I might be better on klonopin and Seroquel. It's the anxiety more than depression.
Posted by yxibow on January 31, 2007, at 20:29:18
In reply to Re: Atypicals for anxiety? » Bob, posted by Phillipa on January 30, 2007, at 20:22:19
> Well I for one have taken benzos for over 30years and have varied the ones and the doses a lot without any problems at all. If anxiety in life is down so is my use of benzos. And the or some of the atypicals cause diabetes especially zyprexa. Lawsuit being taken I think And I've seen the vidoe of Jeroen very scarey from geodon. Love Phillipa
You have to realize that the video posted is a rare but unfortunate effect. Also we don't know the complete history of how many typicals or atypicals Jeroen has tried before Geodon, as there is some evidence of cumulative drug dosage, although TD to this date is still not completely understood. Also, while I can completely believe that the video is TD, especially when described as being noticeable by other peers around him, I have yet to hear of any AIMS monitoring of any choices offered to attempt to mitigate the circumstances. At least 1/3 of people lose their TD over time and a significant number never get worse. So it is important to do an AIMS monitoring, baseline and followup any time one makes changes or you'll never actually say, yes, this did something to alleviate it, however little or great. A surprisingly low number of doctors do AIMS tests on patients regularly prescribed neuroleptics. It may seem pointless, but there is a point to it. Its to see that things don't get worse and have a mitigation plan in mind to try different medications like Clozaril and tetrabenazine and sky high doses of BuSpar and other things that have had some positive effects on TD.
Yes, Geodon is a stronger atypical but there are other choices.
The lawsuits in my mind, while may be warranted in some cases, are a typical reaction to the downsides of medication. I'm not speaking for the makers of Zyprexa or Seroquel (which I take), but I think it behooves anyone to have regular physicals and blood tests on any new medications.
Clozaril has been around a lot longer and we know the side effect profile of it, so its not surprising that newer medications have their own issues. To not monitor simple things like kidney, liver, and blood sugar functions during a physical does a disservice to the patient.
At the end of the day, while there are outright damaging things that have been done by medication, such as Thalidomide (which is actually being reintroduced) and the SSRI that preceded Prozac, we are always stuck between wanting the next best thing, yet remembering that the next best thing may have hidden side effects that may not be discovered until later on. Geodon was re-released to the market after extensive QTc assessment, yet Mellaril still remains, albeit a black box, prescribed.
I don't like to be a guinea pig any more than anybody else, but there is always this dichotomy that I hear and that I think too -- gee, what is in Phase III, and then the trials and tribulations of recently approved medications, such as my experience with Lyrica which I unfortunately had to discontinue because it does cause blurry vision in some patients.
Would I choose an atypical as a first line for anxiety -- no, probably not. SSRIs have been out much longer, and benzodiazepines even more and we know the side effects of each (about 15-20 years and 50 years respectively). But some complex disorders may need more than just an SSRI, they may need augmentation with something else.
Still, at the end of the day, its informed consent, and that means knowing the effects, and being informed by your doctor and consenting to treatment, not being passively handed prescriptions. It is and should be a partnership.-- tidings
Posted by Phillipa on January 31, 2007, at 20:44:30
In reply to Re: Try Seroquel » Phillipa, posted by UGottaHaveHope on January 31, 2007, at 18:27:27
Me too which is why I've been watching your response to EMSAM. Will you stick with it do you think? Love Phillipa
Posted by XanyADDam on February 1, 2007, at 3:05:55
In reply to Atypicals for anxiety?, posted by mattye on January 30, 2007, at 14:30:43
> My depression is being well-managed by Lexapro, but I still have significant problems with anxiety. Klonopin helps me a lot, but my doctor says it is not a good long term solution. I, myself, am wary of taking it on a regular basis, because I heard it is a bitch to discontinue.
>
> My doc reccomended Geodon for my anxiety, and I was wondering if anyone here had much success with this or other APs. My anxiety is typically low level, until something sets me off (usually related to my self esteem / BDD). If I have an anxiety attack, I plunge into a black panicky depression that often lasts for days. (This can be interuppted with Klonopin). I also have times of hypomania. These mood swings are probably not significant enough to be bipolar, but overall, I tend to jump back and forth without much in between.
>
> So ... would APs work in my situation? Are they worth the side effect?
>
> Matty ESpeaking from experience, treating anxiety with atypical antipsychotics is no good. The side-effects just aren't worth it, Geodon in particular. Mad akasthisia...it's terrible. If, in your case, your doctor feels that for whatever reason this is the best course of action, suggest Seroquel. It's more or less a sedative, which could theoretically help calm your nerves. Zyprexa is good too, but there's a significant risk of weight gain.
Posted by alienatari on February 1, 2007, at 3:34:11
In reply to Re: Atypicals for anxiety? » Bob, posted by Phillipa on January 30, 2007, at 20:22:19
You know you should try AP's. The risk of diabetes far outways the benefits.
> Well I for one have taken benzos for over 30years and have varied the ones and the doses a lot without any problems at all. If anxiety in life is down so is my use of benzos. And the or some of the atypicals cause diabetes especially zyprexa. Lawsuit being taken I think And I've seen the vidoe of Jeroen very scarey from geodon. Love Phillipa
Posted by mindevolution on February 2, 2007, at 0:55:53
In reply to Atypicals for anxiety?, posted by mattye on January 30, 2007, at 14:30:43
> My doc reccomended Geodon for my anxiety, and I was wondering if anyone here had much success with this or other APs. My anxiety is typically low level, until something sets me off (usually related to my self esteem / BDD). If I have an anxiety attack, I plunge into a black panicky depression that often lasts for days. (This can be interuppted with Klonopin). I also have times of hypomania. These mood swings are probably not significant enough to be bipolar, but overall, I tend to jump back and forth without much in between.
>
> So ... would APs work in my situation? Are they worth the side effect?
>
> Matty EAPs are a last resort. At medium to high doses some people suggest they are worse than a frontal lobotomy, due to the vegetative state of mind induced (dose related compares to lobotomy), progressive degeneration of every organ in your body including your brain, a chance of getting diabetes, heart disease, and a condition almost identical to AIDS. also the chance of sudden death increases in line with dose due to elongation of qt interval. + risk of suicide goes up 20 fold and life expectancy falls by 25 years.
APs are typically used on the elderly, the retarded, the criminals, and the mentally ill.
at a low minimally toxic dose these drugs can be a lifeline, it is about informed consent (if you are lucky), and I would only take them by choice as a last resort.
me
Posted by yxibow on February 2, 2007, at 2:44:51
In reply to Re: Atypicals for anxiety?, posted by mindevolution on February 2, 2007, at 0:55:53
> > My doc reccomended Geodon for my anxiety, and I was wondering if anyone here had much success with this or other APs. My anxiety is typically low level, until something sets me off (usually related to my self esteem / BDD). If I have an anxiety attack, I plunge into a black panicky depression that often lasts for days. (This can be interuppted with Klonopin). I also have times of hypomania. These mood swings are probably not significant enough to be bipolar, but overall, I tend to jump back and forth without much in between.
> >
> > So ... would APs work in my situation? Are they worth the side effect?
> >
> > Matty E
>
> APs are a last resort. At medium to high doses some people suggest they are worse than a frontal lobotomy, due to the vegetative state of mind induced (dose related compares to lobotomy), progressive degeneration of every organ in your body including your brain, a chance of getting diabetes, heart disease, and a condition almost identical to AIDS. also the chance of sudden death increases in line with dose due to elongation of qt interval. + risk of suicide goes up 20 fold and life expectancy falls by 25 years.
>
> APs are typically used on the elderly, the retarded, the criminals, and the mentally ill.
>
> at a low minimally toxic dose these drugs can be a lifeline, it is about informed consent (if you are lucky), and I would only take them by choice as a last resort.
>
> meThis is a vast and unmedically sound description of neuroleptics. It is a description at best of the highest doses of old line neuroleptics.
Geodon has gone through a 4000 patient study and was reapproved by the FDA. It does not posess nearly the QTc elongation that was previously thought. Mellaril still remains on the market with a greater risk and a black box warning. That's 4000 patient-years of study that went for the former (Zeldox) into Geodon.
This doesn't say that there is a 1 in 4000 chance of torsades de pointes and that people with known heart conditions may not be the best candidates for Geodon, but the range of QTc elongation is even longer in Mellaril and was never challenged by the FDA until recently.
The risk of suicide in untreated schizophreniform disorders is magnitudes greater than treated with any neuroleptic. The problem, granted, is patient compliance due to EPS effects which are the bane of neuroleptics and continue to be addressed. Depot injections are one method of patient compliance for the populations that are in danger of harming themselves or others.
The positive side of Geodon is that it doesn't have the weight gain effects of Risperdal, Zyprexa, or Seroquel. The negative side is that it may have more EPS than the latter two.
"> APs are typically used on the elderly, the retarded, the criminals, and the mentally ill."
This is an incredibly insensitive statement for someone (myself) who has a need to take Seroquel. I fall under none of those categories short of "mentally ill" which in your tone is an old fashioned way of describing it and I take offense at that statement.
Furthermore it is an inflammatory charge that the "mentally ill" are a subhuman population. The "mentally ill" are people who, like a lot of us on the board are born with a biochemical imbalance that will change over a lifetime. We are human, we range in our disorders.
There are many, multiple disorders and statements like these only further the health care industry's farming out of insurance to third party carriers who place amazingly low caps on mental (psychobiological) health, partially fixed by the Mental Health Parity Act.
Fortunately some progressive states like California came out with propositions that fund mental health services to those who most despirately needed it.
The only sound statement in the above overgeneralization was "informed consent." All medical practice by law is or should be informed consent and if your doctor is handing out prescriptions without informing of major side effects or if you do not elect to decline counseling at the pharmacy and you are not counseled on your medication you have been done a disservice.The only extent to which it cannot be informed consent is when a doctor must breach his or her confidentiality if they know that there is imminent danger to an elder, a minor, the president, or yourself.
72 hour holds are a standard across the country and while psychiatric hospitals vary in their standard of care, after that 72 hour period, you can walk AMA out of the hospital, untreated.
Now that we have that out of the way -- I would say that atypicals should probably be a second line of defense after at least a few AEDs have been tried. But don't forget, AEDs also have their side effects. They must be started and stopped with care or you could have a seizure even if you aren't epileptic.
I can't speak for the above case because it sounds like some partial bipolar disorder possibly mixed with an OC Spectrum disorder (BDD) and maybe GAD. Mania can be sometimes managed with Trileptal and other AEDs, but brief periods of extreme mania are also capable of being handled with atypicals. The severity and the choice of agents is something that should be a collaboration with your doctor.
Please respect the community without issuing gross generalizations.Thank you.
-- tidings
Posted by mindevolution on February 2, 2007, at 7:18:02
In reply to Re: Atypicals for anxiety? » mindevolution, posted by yxibow on February 2, 2007, at 2:44:51
>It is a description at best of the highest doses of old line neuroleptics.
that's debatable, with many people suggesting that the new antipsychotics are not atypical at all.
indeed why are they called atypical APs? if you block more than 80% of the dopamine in the brain you get eps including dyskinesias, this is impossible to escape therefore there is no such thing as an atypical antipsychotic that opertates by blocking dopamine. a truly atypical drug would achieve its antipsychotic effect by using a non dopamine pathway. it is a marketing ploy to charge 50 times as much for a "new drug" with "less eps" lol!!!!
all the "atypical" drugs block dopamine, can all trigger eps just by upping the dose until dopamine receptor occupancy approaches 80% or greater, none of them can avoid it. Non of the "atypicals" are atypical, they all typically "work" by blocking dopamine. http://www.nature.com/npp/journal/v25/n5/full/1395704a.html
let's see, lets rebrand haloperidol at between 0.1mg and 5mg as the next low eps atypical. our marketing pitch can be "at between 0.1mg and 1mg haloperidol acts as a dopamine agonist, but at higher doses it tends to act more like a typical antipsychotic"if you want to look at your "atypical" of choice ziprasidone, they say the risk of eps is low
"although the risk with risperidone increases in daily doses above 6 mg" this is where dopamine receptor occupancy starts approaching the eps mark. so look for studies > 6mg... in fact I wonder what happens to patients given 20mg????> Geodon has gone through a 4000 patient study and was reapproved by the FDA. It does not posess nearly the QTc elongation that was previously thought. Mellaril still remains on the market with a greater risk and a black box warning. That's 4000 patient-years of study that went for the former (Zeldox) into Geodon.
well these studies say otherwise: http://www.bmj.com/cgi/content/full/325/7375/1253?etoc
http://www.medscape.com/viewarticle/457366_8also who paid for the trial? if the research doesn't support the company they simply do not release the study as they own the data. academics that don't fall into line get axed.
something else for you to read on this point
http://www.slate.com/id/2133061/
> The risk of suicide in untreated schizophreniform disorders is magnitudes greater than treated with any neuroleptic. The problem, granted, is patient compliance due to EPS effects which are the bane of neuroleptics and continue to be addressed. Depot injections are one method of patient compliance for the populations that are in danger of harming themselves or others.show me the studies that prove that antipsychotically naive patients with schizophrenia have higher rates of suicide than patients treated with antipsychotics. this i know you will not be able to produce. most studies that I have read suggest that suicide is induced by the antipsychotics particularly the ones producing greater blocking and damage to the cholinergic system which is the damage induced by most nerve gas eg vx or sarin, pesticides and organophosphates.
> The positive side of Geodon is that it doesn't have the weight gain effects of Risperdal, Zyprexa, or Seroquel. The negative side is that it may have more EPS than the latter two.
now you are deciding what brand to buy, they all do roughly the same thing.
> "> APs are typically used on the elderly, the retarded, the criminals, and the mentally ill."
> This is an incredibly insensitive statement for someone (myself) who has a need to take Seroquel. I fall under none of those categories short of "mentally ill" which in your tone is an old fashioned way of describing it and I take offense at that statement.
I said they are used on, implying that often these groups of people do not get a choice in the consumption of these drugs and the statement is true. criminals get no choice while in prison, "carers" of the elderly and the intellectually retarded also will typically force their patients to take APs, and involuntary patients in hospitals also get no choice in the matter. I am not being discriminatory or uncivil towards another group of people, just pointing out truths that operate in our society.
I stand by my comment that APs are an extremely dangerous and toxic medication, the most toxic psychiatric medication available, and I am sorry that you have to take it, but at least you have a choice in the matter, when the groups I described do not.
>
> Furthermore it is an inflammatory charge that the "mentally ill" are a subhuman population. The "mentally ill" are people who, like a lot of us on the board are born with a biochemical imbalance that will change over a lifetime. We are human, we range in our disorders.I never implied that mentally ill are a subhuman population, in fact I actively campaign for the rights of the mentally ill. see these threads : http://www.dr-bob.org/babble/poli/20061123/msgs/728000.html
http://www.dr-bob.org/babble/poli/20061123/msgs/726938.htmlAlso your comment gives away your position that you actually do think you have been incorrectly grouped with "subhuman" groups in society. you were offended because you regard the mentally ill as superior to the other categories i mentioned. that is you do consider the mentally retarded, criminals and the elderly as subhuman. i on the other hand do not, i see these groups as victimised and persecuted unfairly by our society, and being force fed APs is one way in which they are persecuted.
btw, the biochemical imbalance theory has no scientific backing.
> The only sound statement in the above overgeneralization was "informed consent."well that's your point of view and I am debating it with you.
>All medical practice by law is or should be informed consent and if your doctor is handing out prescriptions without informing of major side effects or if you do not elect to decline counseling at the pharmacy and you are not counseled on your medication you have been done a disservice.
well I agree with you on this point but the mental health legislation does not include the concept of informed consent when considering involuntary detention and treatment. patients are typically treated with APs on arrival even before a diagnosis has been made, biasing the assessment towards a diagnosis of illness. Informed consent is a luxury millions do without when it comes to psychiatric drugs in first world countries.
> Please respect the community without issuing gross generalizations.
after you read my reply and read the threads I mentioned I think you'll realise that I respect this community far more than you give me credit for.
It is important that both sides of the picture are presented in order that a person can truly make an informed choice, I just tend to promote a view that does not support the drug companies, particularly when they produce drugs as toxic as the antipsychotics that can be misused so readily to take advantage. although i should point out that I already said that ADs can also be life saving. you seem to present a view that informed consent is your perspective only, i think of it is a much broader concept than that.
me
Posted by mattye on February 2, 2007, at 13:02:54
In reply to Re: Atypicals for anxiety? » mindevolution, posted by yxibow on February 2, 2007, at 2:44:51
I know this is a long post, but I am figuring out a lot about myself from this board. Reading people's responses has helped me out so much! So please read!
Yxibow, I would say you have me pretty well figured out. I have explained my mood swings and BDD to other doctors, and I haven't gotten a proper diagnosis. My previous therapist had NO idea whasover on how to treat BDD. I explained to him on the first day that my body image obsession was a HUGE factor in my depression and anxiety. I repeated this to him on multiple sessions, and he never addressed it. Also tried to explain to my doctor about my violent mood swings and he just upped my doage of Lexapro, which did help a bit. The thing is my mood swings don't fall into a typical diagnosis for Bipolar. I get hypomania, which I'm really fine with... it is just that I know there will be a crash shortly. Like I feel on top of the world (but not out of control) and then some little thing will set me off and very quickly plunge into a sulky abyss for a few days. It is very disorienting to feel so confident and optimistic one day and then feel like total sh*t the next. I go from feeling like a great person to feeling like an awful, guilty person. It is like having two personalities. My boyfriend calls me Jekyl and Hyde and I feel so bad for him putting up with my unpredictable behavior. Like when I am depressed I get hypersensitive and paranoid and accuse him of deliberately trying to cut me down when he is just teasing me. Then when I feel great I get overconfident and I act like I don't need him and act dismissive towards him.
The great thing about Klonopin is that I can take it as needed and this interrupts this process from happening. If I feel myself starting to fall to peices, I just take a milligram, and because of its long half life, it calms my brain and stops the racing, obsessive thoughts for the rest of the day. I can drink a cup of herbal tea, step back, and start thinking more realistically. Then I can get myself on the right track.
Seroquel, on the other hand, doesn't manage my anxiety all that well. It feels so potent and I get that lobotomized feeling. I feel groggy and foggy throughout the day.
So... my question is... if my symptoms are well managed by an SSRI and a benzo as needed, why would my doctor be so wary of prescribing the benzo? Especially since the side effect profile and the history behind Klonpin shows it to be a much safer drug? Also, how many times do I have to explain that I do not get "high" from klonopin. I just don't! If I take more than nessecary I just get sleepy, and I don't like it. I feel no more urge to abuse Klonopin than I would my Lexapro ... which is NONE!
>
> I can't speak for the above case because it sounds like some partial bipolar disorder possibly mixed with an OC Spectrum disorder (BDD) and maybe GAD. Mania can be sometimes managed with Trileptal and other AEDs, but brief periods of extreme mania are also capable of being handled with atypicals. The severity and the choice of agents is something that should be a collaboration with your doctor.
>
>
> Please respect the community without issuing gross generalizations.
>
> Thank you.
>
> -- tidings
Posted by mindevolution on February 2, 2007, at 15:13:11
In reply to Re: Atypicals for anxiety? » yxibow, posted by mattye on February 2, 2007, at 13:02:54
> So... my question is... if my symptoms are well managed by an SSRI and a benzo as needed, why would my doctor be so wary of prescribing the benzo? Especially since the side effect profile and the history behind Klonpin shows it to be a much safer drug?
now you are asking the right question, and that's what this board should be about :) I would say trash the doc that wants to put you on APs and find one that will give you the much much much safer benzo. (but best of all is no drugs if you can manage)
Posted by yxibow on February 2, 2007, at 20:32:52
In reply to Re: Atypicals for anxiety?))mattye, posted by mindevolution on February 2, 2007, at 15:13:11
> > So... my question is... if my symptoms are well managed by an SSRI and a benzo as needed, why would my doctor be so wary of prescribing the benzo? Especially since the side effect profile and the history behind Klonpin shows it to be a much safer drug?
>
> now you are asking the right question, and that's what this board should be about :) I would say trash the doc that wants to put you on APs and find one that will give you the much much much safer benzo. (but best of all is no drugs if you can manage)
I hear way too many "trash your doctor" statements online here.
This is another generalization, which apparently has gone unnoticed from your previous set of generalizations about neuroleptics in the first place.This doesn't mean that I don't think that one shouldn't start with something less than a neuroleptic for anxiety disorders, but sometimes complex situations may warrant something more. I fully agree that both SSRIs and benzodiazepines have safer side effect profiles for the most part when used as directed.
We don't know the relationship that a consumer has with their provider -- we can make suggestions, we can yell all sorts of opinions about medication, but the sanctity of a doctor-patient relationship is something that the unlicensed individual without a medical degree I don't think should be throwing the baby out with the bathwater.
Not quite yet. Not without really knowing the person at hand and not with a casual find-another-provider so you can go shop for medications. Maybe there's a reason why the doctor is doing what he is doing. And maybe there isnt a good one.
Some people can't manage without any medications. The ideal situation of course would be to manage a situation with various types of therapy alone, but we know that depressive and anxiety disorders work best with a combination of both and here we're talking about someone with concomitant illnesses. It is always best to have the MED (minimum effective dose) of any medication and I think any rational psychiatrist/psychopharmacologist would agree so.
It is my opinion that I feel a general sense of loathing all medications coming from your opinions which is your perogative, but there are people on here who have gone through dozens of trials to find the right mixture for their respective situations and I think that also needs to be respected.-- tidings.
Posted by mindevolution on February 2, 2007, at 23:29:28
In reply to Re: Atypicals for anxiety?))mattye » mindevolution, posted by yxibow on February 2, 2007, at 20:32:52
> I hear way too many "trash your doctor" statements online here.
it is obviously a case by case basis, and I think prescribing APs, being the most toxic psychiatric drug available, as a front line treatment for anxiety is cause for alarm.
> This is another generalization, which apparently has gone unnoticed from your previous set of generalizations about neuroleptics in the first place.
I backed up my generalisations with valid arguments and links to research which is all anyone can do.
On the other hand I questioned you about some of the generalisations you made about the suicide risk for unmedicated people with schizophrenia, and you have not backed up any of your generalisations at all.
> This doesn't mean that I don't think that one shouldn't start with something less than a neuroleptic for anxiety disorders, but sometimes complex situations may warrant something more. I fully agree that both SSRIs and benzodiazepines have safer side effect profiles for the most part when used as directed.
glad to hear it!
> We don't know the relationship that a consumer has with their provider -- we can make suggestions, we can yell all sorts of opinions about medication, but the sanctity of a doctor-patient relationship is something that the unlicensed individual without a medical degree I don't think should be throwing the baby out with the bathwater.
> Not quite yet. Not without really knowing the person at hand and not with a casual find-another-provider so you can go shop for medications. Maybe there's a reason why the doctor is doing what he is doing. And maybe there isnt a good one.
I can see that point, however, from reading posts on this board it becomes very apparent that all too often people trust their doctors, who in return lead them towards highly risky and toxic medications without pointing out such risks to the patientl; meaning the patient is denied informed consent. the moment this happens, the relationship is over in my book. taking their business elsewhere is the only remedy a patient has in such a circumstance.
> Some people can't manage without any medications. The ideal situation of course would be to manage a situation with various types of therapy alone, but we know that depressive and anxiety disorders work best with a combination of both and here we're talking about someone with concomitant illnesses. It is always best to have the MED (minimum effective dose) of any medication and I think any rational psychiatrist/psychopharmacologist would agree so.
well sure, the meds carry the most risk, so the lowest risk alternative is non med treatments, then if these don't work by themselves, a combination of therapy + meds.
however, all too often docs recommend the most risky meds first, like an AP for anxiety, what was he thinking?! a good doctor in my view starts with the lowest risk meds, and then gradually tries progressively more risky alternatives, with the highest risk alternative being the last medication to be suggested, keeping the patient informed all the while. good doctors that operate like this are extremely rare in my experience. for anxiety, I can think of at least 10 different meds that could be tried ahead of an AP with significantly lower risk.
> It is my opinion that I feel a general sense of loathing all medications coming from your opinions which is your perogative, but there are people on here who have gone through dozens of trials to find the right mixture for their respective situations and I think that also needs to be respected.
I am not against medication in any way, however, due to the current drug approval process, even if one reads all the drug company research, I think we do not get the objective data we need to make truly objective informed decisions. How does a patient know when they go to a doctor that APs are extremely toxic and benzos are much safer and are approved for anxiety without coming to a board like this one? Are they supposed to blindly trust their doctor, or should they be given as much information as they need to make their decisions? How do they even know if they have a good doctor?
One idea of mine is to have a central register of drug toxicity, so that every medication is given a toxicity rating for its recommended dose range out of 1000 based on independent government (not drug company) sponsored trials. Patients and doctors can both refer to the register as one way of objectively identifying the relative risks of medication alternatives.
me
Posted by yxibow on February 3, 2007, at 0:17:15
In reply to Re: Atypicals for anxiety?))yxibow, posted by mindevolution on February 2, 2007, at 23:29:28
> I backed up my generalisations with valid arguments and links to research which is all anyone can do.
>
> On the other hand I questioned you about some of the generalisations you made about the suicide risk for unmedicated people with schizophrenia, and you have not backed up any of your generalisations at all.
I can attempt to back that up and argue with journals, but the fact is that for acute suicidality in schizophreniform disorders or for that matter in any disorder, an antipsychotic ranks up there with Lithium in its capability to stop a person from harming themselves in a 72 hour or 14 day hold if it is warranted that the patient cannot yet handle release. The latter is more rare and often consumers are tossed back into the community and their illnesses come right back and something awful happens, or they become part of the walking wounded homeless, untreated, all too visible in a certain city near where I live.
I can also back up a study in the BJP that did an extensive study of TD in Zyprexa vs Haldol and came up with an average rate of 2.66% and a yearly average of 0.52%http://bjp.rcpsych.org/cgi/content/abstract/174/1/23
If we extrapolate further, Seroquel has an even lower potential of TD.
There also was another study recently that compared all atypicals and found that the rate of TD was around 2% give or take, which is a lot better than most of the typicals that preceded them. Yes, there was a study, the CATIE study that said that the effectiveness was not very different, but where's the humanity? Agents like Zyprexa and Seroquel, with all their unfortunate lipid profile issues, have far less EPS than the phenothiazines and others that were compared with.
> > This doesn't mean that I don't think that one shouldn't start with something less than a neuroleptic for anxiety disorders, but sometimes complex situations may warrant something more. I fully agree that both SSRIs and benzodiazepines have safer side effect profiles for the most part when used as directed.
>
> glad to hear it!I never disagreed there...
> > We don't know the relationship that a consumer has with their provider -- we can make suggestions, we can yell all sorts of opinions about medication, but the sanctity of a doctor-patient relationship is something that the unlicensed individual without a medical degree I don't think should be throwing the baby out with the bathwater.
>
> > Not quite yet. Not without really knowing the person at hand and not with a casual find-another-provider so you can go shop for medications. Maybe there's a reason why the doctor is doing what he is doing. And maybe there isnt a good one.
> I can see that point, however, from reading posts on this board it becomes very apparent that all too often people trust their doctors, who in return lead them towards highly risky and toxic medications without pointing out such risks to the patientl; meaning the patient is denied informed consent. the moment this happens, the relationship is over in my book. taking their business elsewhere is the only remedy a patient has in such a circumstance.
I agree with the model of informed consent -- don't get me wrong, I had a psychiatrist in college who I did not like, frankly I think she just hated people who read the PDR and happened also to be male. (I'm not a misogynist, this just seemed to be a sense that I got that as sole controlled substance provider -- nurse practitioners could provide other substances, college mental health was ran as her own fiefdom.) And yes, I was offered olanzapine even though I knew of the possibility, however small, that TD could occur and I was not at that level of anxiety. And I didn't take it.This doctor was also a benzophobe and before I knew well about the dangers of quitting cold turkey, I quit Tranxene only to have scalp muscle spasms. I was given back only half the dose. If I was not poo-pood by the paltry student urgent care clinic (and this is a top tier University in the US with a medical school of shining reputation), I would not have ongoing spasms today.
If I knew then what I know now I would have gone to the off-campus doctor they were all too happy to consolidate to an on campus doctor and an on-campus therapist (who I respected much and got along with unlike the doctor) and gotten my Tranxene back at its level until it could have been properly reduced.
> > Some people can't manage without any medications. The ideal situation of course would be to manage a situation with various types of therapy alone, but we know that depressive and anxiety disorders work best with a combination of both and here we're talking about someone with concomitant illnesses. It is always best to have the MED (minimum effective dose) of any medication and I think any rational psychiatrist/psychopharmacologist would agree so.
>
> well sure, the meds carry the most risk, so the lowest risk alternative is non med treatments, then if these don't work by themselves, a combination of therapy + meds.
I would have to somewhat disagree -- I think that combining first line choices with therapy would work better, but you're entitled to your opinion. If more "harsh" medications are needed, however one wants to describe that, it should also be under informed consent. MDD doesn't respond very well just to therapy alone, it is a consuming disorder, I can tell you.
> however, all too often docs recommend the most risky meds first, like an AP for anxiety, what was he thinking?! a good doctor in my view starts with the lowest risk meds, and then gradually tries progressively more risky alternatives, with the highest risk alternative being the last medication to be suggested, keeping the patient informed all the while. good doctors that operate like this are extremely rare in my experience. for anxiety, I can think of at least 10 different meds that could be tried ahead of an AP with significantly lower risk.
Well I can think of a number of benzodiazepines that could work and possibly some other AEDs, that's true. I never said antipsychotics are a first line defense, except in some complex bipolar cases when there is a clear line that mania is occurring, and sure, even then lithium and other choices are available but don't always work.
> > It is my opinion that I feel a general sense of loathing all medications coming from your opinions which is your perogative, but there are people on here who have gone through dozens of trials to find the right mixture for their respective situations and I think that also needs to be respected.
> I am not against medication in any way, however, due to the current drug approval process, even if one reads all the drug company research, I think we do not get the objective data we need to make truly objective informed decisions. How does a patient know when they go to a doctor that APs are extremely toxic and benzos are much safer and are approved for anxiety without coming to a board like this one? Are they supposed to blindly trust their doctor, or should they be given as much information as they need to make their decisions? How do they even know if they have a good doctor?
I think they should be given as much information as they need to make their decisions. But it goes further as we have a rubber stamp and out the door model of health care in the US. We have large numbers of patients and no universal health care. HMOs have dictated this cycle for years and fortunately we have the Mental Health Parity Act now, but even it doesn't cover the things that should really be part of a treatment program.
> One idea of mine is to have a central register of drug toxicity, so that every medication is given a toxicity rating for its recommended dose range out of 1000 based on independent government (not drug company) sponsored trials. Patients and doctors can both refer to the register as one way of objectively identifying the relative risks of medication alternatives.
However paltry it is, there is an adverse reporting system in the US in the Stage IV (marketing) of a medication and some drugs have been pulled because of numerous reported cases.
Well every substance out there that has a CAS number is given an MSDS rating actually. We know the LD50 in rats and mice and sometimes dogs -- mice may seem miniscule but they serve a valuable purpose as a number of their responses to medication mimic a human response. Would you really want to be a lab mice in the first stage of drug trials for toxicity before it is given to "healthy" humans in Stage I?
The government does sponsor drug trials to the tune of millions of dollars a year, they can be looked up on government web sites at the NIH, etc. But like it or lump it, sans advertising, it takes millions of dollars to produce the "right" compound, and that money can't come from thin air.
I mean I could rant that the US could spend more money on education and health care than on military forays, but we would get into an Iraq argument and everyone has a different opinion (I support the troops, but I think there has been great mismanagement to say an understatement, of things.)
Posted by mindevolution on February 3, 2007, at 4:13:50
In reply to Re: Atypicals for anxiety?))yxibow » mindevolution, posted by yxibow on February 3, 2007, at 0:17:15
> > On the other hand I questioned you about some of the generalisations you made about the suicide risk for unmedicated people with schizophrenia, and you have not backed up any of your generalisations at all.
> I can attempt to back that up and argue with journals, but the fact is that for acute suicidality in schizophreniform disorders or for that matter in any disorder, an antipsychotic ranks up there with Lithium in its capability to stop a person from harming themselves in a 72 hour or 14 day hold if it is warranted that the patient cannot yet handle release. The latter is more rare and often consumers are tossed back into the community and their illnesses come right back and something awful happens, or they become part of the walking wounded homeless, untreated, all too visible in a certain city near where I live.
i really think you are the one succumbing to generalisations without any evidence that they hold true. I can cite many studies that show that akathisia from antipsychotics can induce suidicality, can you show me one that shows that the risk of suicide in schizophrenic patients never treated with antipsychotics is higher than AP treated patients?
> I can also back up a study in the BJP that did an extensive study of TD in Zyprexa vs Haldol and came up with an average rate of 2.66% and a yearly average of 0.52% http://bjp.rcpsych.org/cgi/content/abstract/174/1/23good point, however, did you notice that that was a summary and the test did not focus on D2 receptor occupancy? realistically to accurately compare the eps potential of two antipsychotics the doses of each have to produce the same level of dopamine blockade. this and most tests do not make such a comparison rendering the vast majority of head to head comparisons irrelevant.
so if I want antipsychotic A, although I like the term neuroleptic which I notice you used, to come out ahead of antipsychotic B, all I have to do is make sure the dose of A produces less D2 occupancy than antipsychotic B. this creates endless amounts of research that proves absolutely nothing, which is why I referred you to a study that compared antipsychotics with similar D2 occupancies. Once the doses were truly comparable, there was no noticeable difference between them.
If we extrapolate further, Seroquel has an even lower potential of TD.
In the study I cited they explained that at the doses used in the trial D2 occupancy was less than 80% meaning that eps was not induced. With a large enough dose of seroquel 80% D2 occupancy is achieved and voila eps.I challenge you to produce a report showing d2 occupancy of 80%+ without eps, it can't be done!
every single antipsychotic, atypical or otherwise, can create d2 occupancy of 80% and induce the same eps as each other. just because seroquel is dosed at amounts that create less than 80% d2 occupancy does not make it a safer AP. All APs are dangerous, and equally so with a truly comparable dose. some just have some nice extra bonuses like diabetes or agranulocytosis thrown in for good measure.
> There also was another study recently that compared all atypicals and found that the rate of TD was around 2% give or take, which is a lot better than most of the typicals that preceded them. Yes, there was a study, the CATIE study that said that the effectiveness was not very different, but where's the humanity? Agents like Zyprexa and Seroquel, with all their unfortunate lipid profile issues, have far less EPS than the phenothiazines and others that were compared with.
are you sure they compared doses properly with the same d2 occupancy, I doubt it very much, if you can show me one that does a proper head to head I would be interested in reading it. when we compare this 1mg dose of olanzapine with 10mg of haloperidol, it creates less eps and TD. it isn't really a proper comparison. what would happen if we compaired 20mg olanzapine with 0.5mg haloperidol? unfortunately this is how most AP trials are conducted which in my opinion doesn't prove a thing.
> I agree with the model of informed consent -- don't get me wrong, I had a psychiatrist in college who I did not like, frankly I think she just hated people who read the PDR and happened also to be male. (I'm not a misogynist, this just seemed to be a sense that I got that as sole controlled substance provider -- nurse practitioners could provide other substances, college mental health was ran as her own fiefdom.) And yes, I was offered olanzapine even though I knew of the possibility, however small, that TD could occur and I was not at that level of anxiety. And I didn't take it.btw what about if this happened to you if you decided to use olanzapine for anxiety:
http://www.akathisiasupport.org/akathisia5/nwh-akathisia-usen3.pdf
> This doctor was also a benzophobe and before I knew well about the dangers of quitting cold turkey, I quit Tranxene only to have scalp muscle spasms. I was given back only half the dose. If I was not poo-pood by the paltry student urgent care clinic (and this is a top tier University in the US with a medical school of shining reputation), I would not have ongoing spasms today.If I knew then what I know now I would have gone to the off-campus doctor they were all too happy to consolidate to an on campus doctor and an on-campus therapist (who I respected much and got along with unlike the doctor) and gotten my Tranxene back at its level until it could have been properly reduced.
sorry to hear that.
> I would have to somewhat disagree -- I think that combining first line choices with therapy would work better, but you're entitled to your opinion. If more "harsh" medications are needed, however one wants to describe that, it should also be under informed consent. MDD doesn't respond very well just to therapy alone, it is a consuming disorder, I can tell you.ok well let's agree to disagree on that one.
> Well I can think of a number of benzodiazepines that could work and possibly some other AEDs, that's true. I never said antipsychotics are a first line defense, except in some complex bipolar cases when there is a clear line that mania is occurring, and sure, even then lithium and other choices are available but don't always work.
APs are as serious and damaging as it gets, are you sure if you were the doctor you wouldn't try something less toxic like clonidine, propranolol, or even methodone?
> I think they should be given as much information as they need to make their decisions.
agreed.
>But it goes further as we have a rubber stamp and out the door model of health care in the US.
particularly when applied to mental health care.
> > One idea of mine is to have a central register of drug toxicity, so that every medication is given a toxicity rating for its recommended dose range out of 1000 based on independent government (not drug company) sponsored trials. Patients and doctors can both refer to the register as one way of objectively identifying the relative risks of medication alternatives.
> However paltry it is, there is an adverse reporting system in the US in the Stage IV (marketing) of a medication and some drugs have been pulled because of numerous reported cases.true.
> Well every substance out there that has a CAS number is given an MSDS rating actually. We know the LD50
i didn't know that existed. LD50 of Polonium 210: estimated at 10 (inhaled) to 50 (ingested) nanograms in humans makes this one of the most toxic substances known. One gram in theory could poison 100 million people of which 50 million would die!
are there LD50s for psychopharmaceuticals?
> in rats and mice and sometimes dogs -- mice may seem miniscule but they serve a valuable purpose as a number of their responses to medication mimic a human response. Would you really want to be a lab mice in the first stage of drug trials for toxicity before it is given to "healthy" humans in Stage I?
nope, underlined.
> The government does sponsor drug trials to the tune of millions of dollars a year, they can be looked up on government web sites at the NIH, etc. But like it or lump it, sans advertising, it takes millions of dollars to produce the "right" compound, and that money can't come from thin air.
ok, but can't the government say "you want this drug approved, give us 20million, and we will conduct independent testing for you". there is no loss to the company, they would have still had to pay for the research, except now the trial is government controlled and much more independent.
> I mean I could rant that the US could spend more money on education and health care than on military forays, but we would get into an Iraq argument and everyone has a different opinion (I support the troops, but I think there has been great mismanagement to say an understatement, of things.)
let's leave that argument for another thread.
me
Posted by yxibow on February 3, 2007, at 12:36:57
In reply to Re: Atypicals for anxiety?))yxibow, posted by mindevolution on February 3, 2007, at 4:13:50
> i really think you are the one succumbing to generalisations without any evidence that they hold true. I can cite many studies that show that akathisia from antipsychotics can induce suidicality, can you show me one that shows that the risk of suicide in schizophrenic patients never treated with antipsychotics is higher than AP treated patients?
I'm not interested in this argument about akathisia any more. Its a phenomenon of every neuroleptic, it is a manageable EPS, and if it becomes an issue, a less potent neuroleptic should be tried. There are so many other types of EPS, that while this one may seem nasty, its predictable. That's all we can really say about a class of drugs that is an unfortunate necessity.
> > I can also back up a study in the BJP that did an extensive study of TD in Zyprexa vs Haldol and came up with an average rate of 2.66% and a yearly average of 0.52% http://bjp.rcpsych.org/cgi/content/abstract/174/1/23
>
> good point, however, did you notice that that was a summary and the test did not focus on D2 receptor occupancy? realistically to accurately compare the eps potential of two antipsychotics the doses of each have to produce the same level of dopamine blockade. this and most tests do not make such a comparison rendering the vast majority of head to head comparisons irrelevant.I know about D2 occupancy rate, the difference is that haloperidol occupies it at nearly 100% and doesn't let go, and while Seroquel and Zyprexa may also occupy it at a fairly substantial rate, they do let go, many times more in an interval than Haldol does.
http://www.akathisiasupport.org/akathisia5/nwh-akathisia-usen3.pdf
Sorry -- maybe a nice support for people with akathisia, but I don't argue with websites that look amateurish, don't subscribe to HON or have other health credos to back up. Its why I don't get into Ashton discussions.
> > Well I can think of a number of benzodiazepines that could work and possibly some other AEDs, that's true. I never said antipsychotics are a first line defense, except in some complex bipolar cases when there is a clear line that mania is occurring, and sure, even then lithium and other choices are available but don't always work.
>
> APs are as serious and damaging as it gets, are you sure if you were the doctor you wouldn't try something less toxic like clonidine, propranolol, or even methodone?I fail to see where methadone is going to help a bipolar suicidal patient but we can ignore this red herring. Clonidine and propranolol are nice adjunctives to help EPS, they don't do a whole lot by themselves except in certain situations like clonidine for child hyperactivity. Propranolol masks the anxiety but does not take it away like benzodiazepines. Its good for essential tremor and drug induced tremor.
> > Well every substance out there that has a CAS number is given an MSDS rating actually. We know the LD50
>
> i didn't know that existed. LD50 of Polonium 210: estimated at 10 (inhaled) to 50 (ingested) nanograms in humans makes this one of the most toxic substances known. One gram in theory could poison 100 million people of which 50 million would die!Yes, did you not read the news of the Russian who was poisoned in London ? It takes a lot of nuclear reactor activity to create Polonium and dispersal is quite another story, but it is still an unsolved case.
> are there LD50s for psychopharmaceuticals?A fair number, yes, especially for more modern medications, but I'm not going to post them for obvious reasons.
> ok, but can't the government say "you want this drug approved, give us 20million, and we will conduct independent testing for you". there is no loss to the company, they would have still had to pay for the research, except now the trial is government controlled and much more independent.
But government controlled or company controlled its not a third party. To really have one you would need something like commonwealth countries have, a crown corporation.
> > I mean I could rant that the US could spend more money on education and health care than on military forays, but we would get into an Iraq argument and everyone has a different opinion (I support the troops, but I think there has been great mismanagement to say an understatement, of things.)
>
> let's leave that argument for another thread.Agreed, I don't interject much politics in the non politics board.
Posted by mindevolution on February 3, 2007, at 18:30:45
In reply to Re: Atypicals for anxiety?))yxibow » mindevolution, posted by yxibow on February 3, 2007, at 12:36:57
>> i really think you are the one succumbing to generalisations without any evidence that they hold true. I can cite many studies that show that akathisia from antipsychotics can induce suidicality, can you show me one that shows that the risk of suicide in schizophrenic patients never treated with antipsychotics is higher than AP treated patients?
> I'm not interested in this argument about akathisia any more. Its a phenomenon of every neuroleptic, it is a manageable EPS, and if it becomes an issue, a less potent neuroleptic should be tried. There are so many other types of EPS, that while this one may seem nasty, its predictable. That's all we can really say about a class of drugs that is an unfortunate necessity.
well i disagree, I think there is a growing body of evidence to suggest that akathisia can be shown to induce suicidal and violent behaviour in otherwise calm and peaceful patients. when a drug can potentially turn a calm patient with no history of violence, into a violent one via akathisia which is extreme anxiety, then I think there is cause for alarm, and it represents a significant threat not only to the patient, to any persons who checked the patient in against their will for help, to his doctor who administers the medication, and to the public as well. Historically I believe the patient is blamed for the violence rather than the medication, although the tide is turning, particularly with the same problem occuring with ssri ADs.
>>> I can also back up a study in the BJP that did an extensive study of TD in Zyprexa vs Haldol and came up with an average rate of 2.66% and a yearly average of 0.52% http://bjp.rcpsych.org/cgi/content/abstract/174/1/23
>> good point, however, did you notice that that was a summary and the test did not focus on D2 receptor occupancy? realistically to accurately compare the eps potential of two antipsychotics the doses of each have to produce the same level of dopamine blockade. this and most tests do not make such a comparison rendering the vast majority of head to head comparisons irrelevant.
> I know about D2 occupancy rate, the difference is that haloperidol occupies it at nearly 100% and doesn't let go, and while Seroquel and Zyprexa may also occupy it at a fairly substantial rate, they do let go, many times more in an interval than Haldol does.look here is a chart regarding recommended AP doses:
http://www.npi.ucla.edu/ssg/antipsychotic.htmhaldol occupies 80% d2 at about 3mg from memory yet its max dose is up to 40mg! risperdal occupies 80% d2 at 6mg but max dose is only 8mg. here see the charts here: http://italia.medscape.com/viewarticle/457516_4
and here: http://www.chovil.com/dopamine7.htmlso if we compared max haldol dose to max risperdal dose, risperdal wins as the "safer" AP every time. it is the same across all the "atypicals" vis a vis "typicals" with max doses of the atypicals just enough to induce serious eps if required by the docs, while the max dose of the typicals is way way way over the eps threshold.
just because the new recommended doses of "atypicals" are lower so that eps is not triggered as often doesn't make them safer it is only the illusion of safety. this way they can market new drugs and make 50 times as much money from patents.
in fact from the chart here: http://www.chovil.com/charts.html
one can conclude that for the same level of d2 occupancy, haloperidol will induce the least potential for adverse effects, due to its relatively lower effect on all other receptors. in essence because haloperidol focuses on the d2 receptor, it is the cleanest AP. that is to say that at a properly comparable dose of haloperidol is likely to be as effective with less side effects.
so I would like to see a study that compares 3mg haloperidol to 6mg of risperidone to 18mg of olanzapine to make a fair comparison. although I can guarantee you won't find such a study, instead what you will find is that most studies focus on doses of 10mg and even 20mg of haloperidol used as the typical benchmark for "typical" antipsychotic comparisons!>> http://www.akathisiasupport.org/akathisia5/nwh-akathisia-usen3.pdf
> Sorry -- maybe a nice support for people with akathisia, but I don't argue with websites that look amateurish, don't subscribe to HON or have other health credos to back up. Its why I don't get into Ashton discussions.
it wasn't the website that I was referencing, it was the quite clearly legitimate released medical record of an individual patient that shows that akathisia can literally be torture. would you blame that guy if he committed suicide or assaulted his psychiatrist or anyone else after suffering like that?
>>> Well I can think of a number of benzodiazepines that could work and possibly some other AEDs, that's true. I never said antipsychotics are a first line defense, except in some complex bipolar cases when there is a clear line that mania is occurring, and sure, even then lithium and other choices are available but don't always work.
>> APs are as serious and damaging as it gets, are you sure if you were the doctor you wouldn't try something less toxic like clonidine, propranolol, or even methodone?
> I fail to see where methadone is going to help a bipolar suicidal patient but we can ignore this red herring. Clonidine and propranolol are nice adjunctives to help EPS, they don't do a whole lot by themselves except in certain situations like clonidine for child hyperactivity. Propranolol masks the anxiety but does not take it away like benzodiazepines. Its good for essential tremor and drug induced tremor.methodone produces a sense of well being and is a cns depressant, are you sure you don't see how it may be used in such a patient to induce a pleasant tranquillisation rather than potentially inducing eps, including akathisia, or even nms? clonidine and propranolol and benzos could also be used to reduce anxiety and induce a calm and peaceful state in the patient and have no where near the risks of AP use. yet AP use is the first line med of choice by psychiatrists in psyche wards for everything from anxiety to suicidal ideation or even sleep disorders, and in a suicidal patient eps might just be the thing to make them go through with it.
>>> Well every substance out there that has a CAS number is given an MSDS rating actually. We know the LD50
>> i didn't know that existed. LD50 of Polonium 210: estimated at 10 (inhaled) to 50 (ingested) nanograms in humans makes this one of the most toxic substances known. One gram in theory could poison 100 million people of which 50 million would die!
> Yes, did you not read the news of the Russian who was poisoned in London ? It takes a lot of nuclear reactor activity to create Polonium and dispersal is quite another story, but it is still an unsolved case.I knew it was a radioactive substance but didn't take note of exactly what it was, was it Polonium 210?
>> ok, but can't the government say "you want this drug approved, give us 20million, and we will conduct independent testing for you". there is no loss to the company, they would have still had to pay for the research, except now the trial is government controlled and much more independent.
> But government controlled or company controlled its not a third party. To really have one you would need something like commonwealth countries have, a crown corporation.well with government controlled trials, the direct bias from the drug companies is removed, which would be a major step forward in the drug approval process. I agree with you, in the long run the more indepedent the testing process is the better for consumers and doctors alike and any vehicle to achieve a greater independence should be encouraged.
me
Posted by gardenergirl on February 5, 2007, at 21:22:03
In reply to Re: Atypicals for anxiety?, posted by mindevolution on February 2, 2007, at 7:18:02
> you were offended because you regard the mentally ill as superior to the other categories i mentioned. that is you do consider the mentally retarded, criminals and the elderly as subhuman. i on the other hand do not,Please don't jump to conclusions about another or post anything that could lead others to feel accused or put down. You've been asked to be civil before, so now I am blocking you from posting for a week.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
http://www.dr-bob.org/babble/faq.html#enforceFollow-ups regarding these issues should of course be civil and should be directed to the Admin board. Dr. Bob has oversight over deputy decisions. Thus, you can always appeal this decision to him, and he may choose a different action.
namaste
deputy gg
Posted by torachan on October 5, 2007, at 8:27:54
In reply to Re: Atypicals for anxiety?))yxibow, posted by mindevolution on February 3, 2007, at 18:30:45
You obviously know a great deal about the subject your discussing, but would you please elaborate that there is no scientific backing behind the neurochemical imbalance theory in layman's terms. There have been clear studies done to indicate lower levels of brain activity in the limbic region I believe and the reticular activation system of the brain which includes the brain stem, and these systems of the brain help regulate our general level anxiety (the fight or flight response system) and theory is that when these systems are under activated in certain individuals, there is a tendency for the brain to overcompensate making the person more susceptible to inappropriate over activation of this system.
I believe it's a ridiculous assumption to make to suggest that anxiety disorders are not largely governed and caused by malfunctioning neurobiological and chemical components. Everything about our behavior is largely, if not completely controlled by neurochemical and neurobiological functioning.
This is the end of the thread.
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