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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 47 to 71 of 85. Go back in thread:
Posted by undopaminergic on January 7, 2021, at 5:23:37
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 7, 2021, at 3:33:26
> I wasnt searching, so I havent found anything except the first drug I took: Nardil
>Right. I understand you regret it in retrospect, but at the time, you couldn't know what would happen further down the line, and it was a reasonable option. Fortunately, your experience is most unusual, and there are fewer people who get to try Nardil than there should be. I mean there are more people who die from not being given Nardil, than there are people who get psychosis from using it.
-undopaminergic
Posted by Lamdage22 on January 7, 2021, at 5:24:29
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by undopaminergic on January 7, 2021, at 5:10:30
> Do you really think none of them would help at all? I think that is only in theory.
No, I think you will take so much damage in the process that the helpful med (once and if you find it) will not make up for!
>
> But you had a reason to try the previous medication, right? If I recall correctly, it even worked for you until it went sour.I could have done extensive bloodwork and orthomolecular instead. It worked at a certain time for a certain symptom (depression). Overall it was devastating though.
> OK. There are numerous potential side effects of most medications. No-one gets all of them. But you know that.
I tried Nortriptyline and I asked my psychiatrist if the other Tricyclics kill sex, too, he said yes. I have researched TCAs that don't, but I decided not to take for other reasons.
Like I said, if it replaces Depression with something equally or more devastating, I am not interested. A med can "work" and still not help because it f*cks you up with other symptoms.
Posted by undopaminergic on January 7, 2021, at 5:26:58
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 7, 2021, at 3:35:44
> What I have found is distress, stigma and humiliation.
But I imagine you were already in distress by the time you tried Nardil? I don't know about the other two without further detail.
-undopaminergic
Posted by Lamdage22 on January 7, 2021, at 5:40:32
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 7, 2021, at 5:24:29
This discussion is ended. Good luck with all that!
Posted by undopaminergic on January 7, 2021, at 5:41:20
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 7, 2021, at 3:43:31
> Back to topic please! I am not asking for new drugs here at all!
Exchanging the offending drug for another one, at least in part, is a valid option in the situation you describe. There are many medications that offer more units of antipsychotic action per unit of weight gain induction.
Note that another option is adding a drug such as amphetamine to help with weight loss, but I didn't mention this, because it seemed inappropriate in your situation.
Another option is simply to reduce the dose of the offending drug, but you say psychosis gets worse if you go too fast.
The final option I can think of is to eat less and exercise more. Probably this is the healthiest approach, and it is certain to work if you have the self-discipline needed to do it successfully.
Other than the above, I don't know what you can do.
-undopaminergic
Posted by undopaminergic on January 7, 2021, at 5:49:34
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 7, 2021, at 5:24:29
OK, so your point is that the cure mustn't be worse than the disease?
Of course I can agree on that. I've personally never had to quit a working treatment due to side effects. I know I am fortunate, but I also don't think the problem is, on average, as common as you seem to be suggesting.
-undopaminergic
Posted by Lamdage22 on January 7, 2021, at 8:04:05
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by undopaminergic on January 7, 2021, at 5:49:34
Im just saying that we need drugs with which people are actually better off than without them. Anf we need to take ALL the effects into account, not just the wanted effects.
Then we need drugs that are safer to try, so that you can try many without suffering any damage, so that by the time you find your drug, you are better off than if you had never tried meds.
If 8 out of 10 meds are a total shitshow, you are going to suffer damage if you try them.
I did say that this applies to me, I didnt say it applies to everyone. Im not the only one though.
Posted by Lamdage22 on January 7, 2021, at 8:06:57
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by undopaminergic on January 7, 2021, at 5:41:20
I can reduce one of the offending drugs, it will just take 1-2 years. Lifestyle, Nutrition and Workouts can be done, too.
Posted by Lamdage22 on January 7, 2021, at 8:11:56
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 7, 2021, at 8:06:57
I think that by the time I get into the 300s the problem will be resolved. Thanks to Metformin also.
Posted by Lamdage22 on January 7, 2021, at 8:41:27
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 7, 2021, at 8:11:56
How likely is Tiaprid to cause high prolactin?
Posted by Christ_empowered on January 7, 2021, at 11:40:18
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by undopaminergic on January 7, 2021, at 5:49:34
just...jumping in here...
i thought -maybe- a D2 partial agonist could be your 1 neuroleptic. I don't know about the newer ones, but Abilify is surprisingly high potency...once you hit the fda-approved max of 30mgs/daily, over 90% of D2 receptors are "occupied" or whatever the experts call it. The only reason people don't twitch and feel horrible like with Haldol or Prolixin is because of the D2 partial agonism, it seems.
that is all. no one is suggesting there is a wonder drug out there, or a pill for every ill. the other potential (possible) upside of a D2 partial agonist is that, at least with Abilify, animal studies show less D2 upregulation, following long term administration. so...assuming that's at all true of human consumption, there -might- possibly be less risk of tardive syndromes, especially tardive psychosis.
i wish you well. my -personal suggestion- would be to try to get down to 1 tranquilizer. in addition to the increase in overall neuroleptic exposure one gets from 2+ at once, some data suggests more risks, overall.
Posted by Lamdage22 on January 7, 2021, at 12:10:45
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Christ_empowered on January 7, 2021, at 11:40:18
I tried Abilify, it was very unpleasant. Yeah the long term goal is just 1 Neuroleptic. My mood is low. Isolation doesnt help!
Posted by undopaminergic on January 7, 2021, at 12:12:03
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 7, 2021, at 8:41:27
> How likely is Tiaprid to cause high prolactin?
Well, as I understand it, tiapride is comparable to amisulpride and sulpiride, which are particularly likely to elevate prolactin among antipsychotics. But I don't think you'd actually notice it, unless you take very high doses.
-undopaminergic
Posted by Lamdage22 on January 7, 2021, at 12:47:53
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by undopaminergic on January 7, 2021, at 12:12:03
Yeah, Risperdal gave me "b*tch t*ts". You see, I have tried quite a few medications. Too many.
Posted by undopaminergic on January 8, 2021, at 5:05:55
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 7, 2021, at 12:47:53
> Yeah, Risperdal gave me "b*tch t*ts". You see, I have tried quite a few medications. Too many.
>Apparently, you are more sensitive to elevated prolactin than I am. It makes sense that this happened with risperidone, because, as I mentioned before, it (and the benzamides/-prides) requires active transport across the blood-brain-barrier, meaning that the peripheral concentrations will be higher than the central. In other words, it produces more elevated prolactin per unit of antipsychotic effect than other neuroleptics.
-undopaminergic
Posted by Lamdage22 on January 8, 2021, at 5:20:59
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by undopaminergic on January 8, 2021, at 5:05:55
Risperdal was essentially a Placebo for me. It calmed me slightly, but no antipsychotic effect. I think I tried more meds than you think!
Posted by undopaminergic on January 8, 2021, at 5:39:21
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 8, 2021, at 5:20:59
> Risperdal was essentially a Placebo for me. It calmed me slightly, but no antipsychotic effect. I think I tried more meds than you think!
>I don't really have any pre-conceived ideas of how many medications you tried. I know you've tried more than I know of. And I expect that you were less afraid of trials before your experience with Nardil.
Interesting that you find Seroquel has antipsychotic effects but Risperdal not. Usually it is the other way around. But I personally feel trimipramine is more antipsychotic than clozapine.
-undopaminergic
Posted by Lamdage22 on January 8, 2021, at 5:41:46
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by undopaminergic on January 8, 2021, at 5:39:21
Yeah, and side effects considered, Trazodone is my best antidepressant. Equal or better than Venlafaxine. Those are the two I benefit from at low dose.
We are all very different although we have similar problems!
Posted by Lamdage22 on January 8, 2021, at 5:46:50
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 8, 2021, at 5:41:46
Psychiatry needs a way of telling who will react well and who will have a bad reaction to each med. That would be a game changer!
Posted by Lamdage22 on January 8, 2021, at 5:54:35
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 8, 2021, at 5:46:50
I am concerned about movement disorders. I will have my psychiatrist take a look! At the tongue, right? What else can be done to check the risk?
Posted by Christ_empowered on January 8, 2021, at 18:03:44
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 8, 2021, at 5:54:35
I think there are a couple of more or less standardized examinations for TD. The AIMS test is the big one, I think. I don't think it has to be a doctor who does it...nurses can, with appropriate training. -if- someone has movements that meet the criteria for TD, etc. there's also an AIMS scale, so then both the treatment provider and the person being treated have any idea of how severe the movement disorder is at the moment, compared to other cases.
problem: neuroleptics both cause TD and suppress the movements. Way back when, common 'treatment' for both TD and what doctors would now recognize as drug-induced akathisia involved increasing the dosage, often to massive amounts. With TD, this -did- suppress movements (not just TD, either), but often led to the development of severe, sometimes crippling TD. and with akathisia...well, that just shut people up, so they stopped pacing and complaining. psychiatry...-sigh-
the fda has approved...2 new drugs for TD, I think. both are (as one would expect) ridiculously expensive in the US. I don't know anything about adverse effects, long term anything, etc. sorry about that.
as neuroleptics are tapered and discontinued, movements can show up that were suppressed. sometimes, it -is- true TD and that will require some sort of treatment (the 'alternative' health people still recommend E, I think also B6, melatonin...honestly, it seems that every antioxidant, ever, could potentially help). Some cases of withdrawal-emergent movement disorders just...go away, or at least get better, over time.
sorry about all this. i had tics and such...I think it was part drug-induced (all "atypicals," btw) and also part severe anxiety...combined, it was just...rough, let's put it that way. now, I'm facial tic free and still stuck on an 'atypical,' so...maybe all the antioxidants, etc. do help?
ok. I hope things get better for you. :-)
Posted by Lamdage22 on January 9, 2021, at 1:19:41
In reply to AIMS test, posted by Christ_empowered on January 8, 2021, at 18:03:44
Thanks, CE,
yeah I heard that Zyprexa is more of an TD offender than Seroquel. Right now my goal is to reduce Seroquel though. Yeah antioxidants may help. I also heard about Manganese helping.
Posted by undopaminergic on January 9, 2021, at 6:23:33
In reply to Re: AIMS test, posted by Lamdage22 on January 9, 2021, at 1:19:41
> Thanks, CE,
>
> yeah I heard that Zyprexa is more of an TD offender than Seroquel.Probably, but it is also a more potent antipsychotic.
> Right now my goal is to reduce Seroquel though. Yeah antioxidants may help. I also heard about Manganese helping.
>Be careful with megadoses of manganese. You don't want manganism; it's worse than Parkinson's!
-undopaminergic
Posted by Lamdage22 on January 9, 2021, at 20:42:31
In reply to Re: AIMS test, posted by undopaminergic on January 9, 2021, at 6:23:33
> > Thanks, CE,
> >
> > yeah I heard that Zyprexa is more of an TD offender than Seroquel.
>
> Probably, but it is also a more potent antipsychotic.So you think if the potency is accounted for, it is not more of an offender?
> > Right now my goal is to reduce Seroquel though. Yeah antioxidants may help. I also heard about Manganese helping.
> >
>
> Be careful with megadoses of manganese. You don't want manganism; it's worse than Parkinson's!How much is safe?
>
Posted by undopaminergic on January 10, 2021, at 0:19:52
In reply to Re: AIMS test, posted by Lamdage22 on January 9, 2021, at 20:42:31
> > > Thanks, CE,
> > >
> > > yeah I heard that Zyprexa is more of an TD offender than Seroquel.
> >
> > Probably, but it is also a more potent antipsychotic.
>
> So you think if the potency is accounted for, it is not more of an offender?Right.
> > > Right now my goal is to reduce Seroquel though. Yeah antioxidants may help. I also heard about Manganese helping.
> > >
> >
> > Be careful with megadoses of manganese. You don't want manganism; it's worse than Parkinson's!
>
> How much is safe?I don't know. It probably depends on the current state, whether that is shortage or excess. Of course, it also depends on how well it is absorbed, which may depend on the form in which it is taken.
-undopaminergic
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