Psycho-Babble Medication Thread 13392

Shown: posts 1 to 22 of 22. This is the beginning of the thread.

 

My Mum...

Posted by Deborah R on October 18, 1999, at 20:56:09

Hi everyone - I am still searching for info re: side effects of olanzapine/zyprexa...I would be really interested to hear of peoples experiences on this drug. My Mother developed Neuroleptic Malignant Syndrome about three weeks after switching from Risperidone to Olanzapine. Mum was in hospital for 4 weeks - and was actually off all drugs for about a week. It was a magic time for me - I walked in one day to see Mum and I had never seen her like that in my whole memory of the horrible, horrible times. Mum was interested in what I had been doing, smiling, her face was so animated and her smiles went all the way to her eyes. Mum is now back on Olanzapine and the mask is there yet again.

Perhaps selfishly I want my Mum back - the one I saw for that one little week. I have stopped work for a while and would like Mum to go off all drugs to see how she goes. I am very worried about taking this on in case something goes wrong, but I feel time is running out for Mum and her body is shutting down. Mum's next appointment is the 27th and I am aiming to discuss this with her Doc. I have kind of circled around the idea with Mum and of course it has to be her decision, not mine.

Sorry about the long post guys - I sincerely wish everyone the best of everything! Wish me luck.

Deb.

 

Re: My Mum...

Posted by Bob on October 19, 1999, at 0:04:13

In reply to My Mum..., posted by Deborah R on October 18, 1999, at 20:56:09

> Sorry about the long post guys

You call that long? =^P

You can check out a monograph on Zyprexa at www.mentalhealth.com ... just follow the medication link. 'Course, it's all in doctorSpeak so you may need someone like JohnL, Saint James or Elizabeth to translate for you.

Thanks for keeping us posted on your Mum! I'll keep you both in my prayers -- you both deserve to have her back.

Be strong
Bob

 

Hey Bob...

Posted by Deb R. on October 19, 1999, at 10:24:17

In reply to Re: My Mum..., posted by Bob on October 19, 1999, at 0:04:13

> You can check out a monograph on Zyprexa at www.mentalhealth.com

Thanks yet again Bob - I have done a lot of research into this drug over the past months and there is not much mention of NMS being a documented side-effect. I would love to hear from anyone who has taken Olanz/Zyprexa and their experiences. I dont know why I am doing all this searching really, I know what needs to happen, Mum needs to give her body a break from all the drugs she is on. For so many years I have 'parented' Mum and I now wonder if I have the guts to do maybe the one thing that may save her life. The guilt is getting to me as I dont know if I have the strength to take it all on. The commitment is huge and will be on-going. I just dont know what to do.

Bob, how are things with you - have you sorted out that work stuff? Hope it is all going ok.
Best wishes,

Deb.

 

Re: My Mum

Posted by dove on October 19, 1999, at 13:03:35

In reply to Hey Bob..., posted by Deb R. on October 19, 1999, at 10:24:17

I have no personal experiences to share, but from the little I have read online, the Neuroleptic Malignant Syndrome is definitely listed as a rare side-effect with Olanzapine/Zyprexa. I send my best wishes to you and your mother and will keep you both in my thoughts and prayers. Keep us posted, we're listening. Below, I pasted a few things I came across that might be of interest to you, hopefully they're not redundant. Take care.

Medscape has quite a bit of info and abstracts concerning Neuroleptic Malignant Syndrome and the other meds you mentioned:
http://www.medscape.com/Home/Topics/pharmacotherapy/pharmacotherapy.html

Another site discussing treatment and anti-psychotic rechallenging:
http://www.vh.org/Providers/Conferences/CPS/09.html

Neuroleptic Malignant Syndrome: In premarketing clinical trials there were no reported cases of NMS in patients receiving olanzapine. However, NMS is a potentially fatal symptom complex, that has been reported in association with antipsychotic drugs. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmia). Additional signs may include elevated creatine phosphokinase, myoglobinuria (rhabdomyolysis), and acute renal failure.

The management of NMS should include immediate discontinuation of all antipsychotic drugs including olanzapine, intensive monitoring of symptoms and treatment of any associated medical problems. There is no general agreement about specific pharmacological treatment for NMS. If a patient requires antipsychotic drug treatment after recovery from NMS, the reintroduction of therapy should be very carefully considered, since recurrence of NMS has been reported.

Neuroleptic malignant syndrome has been associated with all dopamine blocking drugs (Caroff and Mann 1993). Clozapine, an antipsychotic that does not exhibit significant antagonism of D2 dopamine receptors, has been thought to be less likely to cause NMS. However, at least fourteen cases of NMS have been attributed to clozapine (Reddig et al 1992; Sachdev et al 1995; Thornberg and Ereshefsky 1993). Likewise, three cases of NMS have also been attributed to risperidone, another "atypical" antipsychotic (Webster and Wijeratne 1994; Raitasuo et al 1994) Metoclopramide, prochlorperazine, promethazine, and droperidol are all dopamine antagonists frequently used as antiemetics and for other reasons. NMS has been attributed to all four of these drugs (Caroff and Mann 1993). It is recommended that dopamine blocking antiemetics should only be used long-term in patients with a clear indication.

The abrupt withdrawal of dopaminergic drugs has also produced an NMS-like condition in patients with Huntington's disease and Parkinson's disease (Ebadi et al 1990). Implicated drugs include levodopa, bromocriptine, and amantadine. Not surprisingly, dopaminergic drugs have been studied to treat NMS (Caroff and Mann 1993; Dickey 1991; Ebadi et al 1990; Heiman-Patterson 1993).

~dove


 

Question for the audience ...

Posted by Bob on October 19, 1999, at 16:44:44

In reply to Hey Bob..., posted by Deb R. on October 19, 1999, at 10:24:17

(Hi Deb! I'll leave the work stuff for a new thread later tonight...)

Anybody out there know any work on overmedication and its effects? It seems to me that there was a conversation about this, oh, quite a while ago. My take on it is the old "body as a machine/fix one thing at a time" approach, instead of a more holistic, systemic view. One med causes other problems, so you get a second med ... which causes still other problems, leading to a third med, ad nauseum, ad absurdum, ad infinitum. It's happened to me -- three different psychotropics, and two other meds to deal with side effects. Considering how many meds our elderly get put on these days, could this be what's happening to Deb's mum?

As for the searching, we all need to know that we're doing the right thing in making these sorts of decisions. Maybe, though, you're looking in the wrong place. The "answers" science and medicine may be offering might aim to give her quantity of life, but what about the quality? Are you her only child? Who else is around who can support you and take on part of this burden for you? You shouldn't have to be all alone in facing this situation. We're here for you, but you need someone there with you.

be strong
bob

 

Re: Question for the audience ...

Posted by Noa on October 19, 1999, at 20:12:14

In reply to Question for the audience ..., posted by Bob on October 19, 1999, at 16:44:44

Yes, Bob. That is why good care for the elderly includes review of treatment by a multidisciplinary panel that includes at least an MD, nurse, pharmacist, etc.

 

(((((Bob, dove & noah)))))

Posted by Deb R. on October 21, 1999, at 7:07:56

In reply to Question for the audience ..., posted by Bob on October 19, 1999, at 16:44:44

>Considering how many meds our elderly get put on >these days, could this be what's happening to >Deb's mum?

Bob, from the research I have done I have found that the elderly should be on much lower doses of anti-psychotics than younger folk - I guess it would be to do with metabolism changes as we age or something. Also, post menopausal women again should be on lower doses allegedly. I can honestly say this has never seemed to be a consideration re: the meds Mum has been on over the years. It is a bloody nightmare to put it bluntly.
Dove, many thanks for your input, I have printed it all off and am going to spend tomorrow hunting around the web-sites you mentioned. I just want to at least learn enough so I can discuss issues with some knowledge with Mums Doc.
Thanks for your input too Noah - yes all that should be happening, but alas it just seems to be like Bob wrote in his post, one drug after another is prescribed in a never-ending spiral which will just spin around and punch you in the head in the end.
Bob - you asked about what support I would have in my quest to get my Mum back - well I have fantastic support from my husband and children. I am constantly amazed by our kids understanding of their Nanna - when I was there age all I wanted to do was run away and find a normal family like everyone else seemed to have! I also have two sisters and a brother, but we are a very fractured family unfortunately. Too many terrible things happened to us as kids I guess, I could do the longest post in the universe if I ever got started on that sadness.
Anyway, blessings on all your heads my mates from babble-land. You are lovely people, I wish I could help some of you sometime - I dont know a lot about meds and things, but I have very big ears - all the better to listen with!!!

Love to all,
Deb.

 

Re: (((((Bob, dove & noah)))))

Posted by Bob on October 21, 1999, at 14:25:11

In reply to (((((Bob, dove & noah))))), posted by Deb R. on October 21, 1999, at 7:07:56

Hi Deb,

I think a lot of us can identify with that tortured, twisted family life as kids (though it is reassuring to hear from others that their childhoods were good ... I'd hate to think parenting was an impossible task doomed from the get go).

> ... I wish I could help some of you sometime - I dont know a lot about meds and things, but I have very big ears - all the better to listen with!!!

Your trust is gift enough.

Sounds like your kids have great parents from what you've said ... =^)
Bob

 

Re: Question for the audience ...

Posted by allison on October 21, 1999, at 17:40:20

In reply to Re: Question for the audience ..., posted by Noa on October 19, 1999, at 20:12:14

> Yes, Bob. That is why good care for the elderly includes review of treatment by a multidisciplinary panel that includes at least an MD, nurse, pharmacist, etc.

Right. Excellent point. Sometimes easier said than done.

My mom had impaired liver function due to years of drinking in an effort to deal with years of depression.

She never did stop drinking, which of course made everything worse. But I also learned toward the end of her life that even mineral deficiencies could send her to the hospital in an instant. I remember a couple of years ago friends found her trying to answer the telephone with a kleenex box. My cousin thought she was drunk and read her the riot act, but it turned out that she hadn't been drinking. She had a magnesium/potassium deficiency. I lived 2.5 hours away, and when I got to the hospital found her almost unable to speak. It was one of the saddest moments of my life seeing her so debilitated.

It's so easy for doctors just to prescribe drugs and never really follow up. My mom always had a reason not to relate to any of the rehab programs she ended up in. A couple of years ago, she finally found a psychologist she could talk to (my empty wish is that she had met him 10 years ago). He got her MD to prescribe an AD. First Zoloft, then Paxil. She was also on tamoxifen for breast cancer, and a diuretic to help the fluids get out, and I can't remember what else. I am convinced the AD script was an overdose for her (normal for another, but toxic to someone whose liver is unable to get rid of the chemicals in a timely way). She had hand tremors and complained to me that she had begun to feel unsteady on her feet and actually fell a couple of times (she didn't normally fall when she was drunk). Just into ADs myself, I had some experience in at least knowing that not every AD works with every person and one has to try them on like shoes to find the right fit. I strongly suggested to her that she see her doc about lowering the dose or getting another kind. However, before she could she fell while walking and hit her head on a sidewalk curb. About two days later she was dead, either from a subdural hematoma, a blood clot, internal hemhorraging, whatever -- her doc and I decided that it really didn't matter so we didn't have an autopsy and he listed complications from alcoholism as the cause of death, which was essentially true. Certainly her days were numbered, but her death was not imminent or expected. But I do think if her AD and other meds had been regulated more closely keeping the alcoholism in mind, she might have lived past 62.

From everything I've gleaned from various media (nothing indepth), it seems that not only is medicine woefully unaware of the effects of drugs and treatments on women (because until recently most trials were done only on men), but general knowledge on the effects on the elderly is sorely lacking -- not a comfort as the median age of the entire US population is going up. I hope that by the time I'm her age (if I make it that long), they'll have more and better answers.

 

Re: Question for the audience ...

Posted by Noa on October 21, 1999, at 17:55:04

In reply to Re: Question for the audience ..., posted by allison on October 21, 1999, at 17:40:20

I think we can expect to see some improvement in the care of older people, if only because of the growing numbers of older people and the fact that the next generations to reach that age are more empowered. So called boomer effect. I think it is useful to find a doctor whose specialty is gerontology. ALso, there are social workers and nurses who specialize in gerontology, particular in psychiatric gerontology, and some of them only do case management, ie, coordination of care, services, family support, etc. With all the different doctors and meds, it is important to have someone keeping track and researching how all those meds work together, and being the link among the different prescribers.
Allison, I am so sorry to hear about your mom. How incredibly sad. I guess we need to add a nutritionist to our expert panel. I was also reminded of how a couple of years ago, my dad had a sudden increase in blood pressure that caused him to become cognitively impaired and have amnesia. We are lucky he didn't walk or drive away from home (he actually drove to home in this state, but the worst part of it happened while he was at home). He was alone for a few hours and says he doesn't remember any of it. When my mom got home, she found him to be talking incoherently and seeming completely disoriented and confused. She panicked and got him to the hospital. It turns out his blood pressure had shot up because of some sort of medication mix up--a new prescription or something. If it had gone on for much longer, he wouldn't have made it. I know that potassium/magnesium supplements are part of his cocktail, I guess that is what reminded me of this story.
Deb, is there a nurse or social worker you could bring in who specializes in gerontology? Or maybe even a physician?

 

Re: woeful lack of awareness

Posted by Bob on October 21, 1999, at 23:39:25

In reply to Re: Question for the audience ..., posted by allison on October 21, 1999, at 17:40:20

> ... it seems that not only is medicine woefully unaware of the effects of drugs and treatments on women (because until recently most trials were done only on men), but general knowledge on the effects on the elderly is sorely lacking ...

and here I am, a non-smoking non-drinking middle class caucasian male between the ages of 18 and 55, and they can't pin down why meds work so strangely and ineffectively for me ... makes me feel sorry for all y'all out there with different demographics.

If we could just take all the lawyers and all the stock-optioned CEOs, CFOs, and C-whatever-Os and stick them under the polar ice cap for a while, maybe the development time as well as the number of compounds being investigated would improve. Pardon my soapbox, but it makes me ill to think off all the folks out there getting rich because people get sick.

grrrr
Bob

 

Zyprexa Replacement

Posted by ChrisK on October 22, 1999, at 6:26:24

In reply to Re: woeful lack of awareness, posted by Bob on October 21, 1999, at 23:39:25

I have been taking Zyprexa for almost a year now and it's working well in eliminating my suicidal tendencies. Yesterday I had an appointment with my pdoc and he mentioned that Pfizer is coming out with a new drug in the Zyprexa family this coming February. It's supposed to have fewer side effects especially with regard to appetite increases and feeling tired or sluggish. At the time he didn't have the name of it available but mentioned that we might want to try it sometime.

 

Re: Question for the audience ...Noa

Posted by Deb R on October 22, 1999, at 7:09:34

In reply to Re: Question for the audience ..., posted by Noa on October 21, 1999, at 17:55:04


> Deb, is there a nurse or social worker you could bring in who specializes in gerontology? Or maybe even a physician?

Hi Noa - sorry I spelt your name wrong on my last post! Thanks I will see what is around, but I think my first step will be to see a social worker at an organisation here called ARAFMI - Association for the Relatives and Friends of the Mentally Ill. This is a support service which I had forgotton about until I read your post. My mind is muddled to say the least so thanks for getting me thinking.
Best wishes,
Deb.

 

Re: Woeful lack of Awareness

Posted by dove on October 22, 1999, at 9:49:00

In reply to Re: Question for the audience ...Noa, posted by Deb R on October 22, 1999, at 7:09:34

This problem with harming our elders with meds that are inappropriate or toxic in their dosages is a real problem. My Dad is 55 yrs. and has high blood pressure and was put on a beta-blocker (only one male on his side of the family has ever lived past 55 and that's his older brother) Now my Dad already struggles with extreme mood-swings and depression. He did a quick, massive crash into depression, convinced himself that the world would be better w/o him, so lethargic, sat and stared at walls. My Dad normally can't sit still for 3 minutes and is verbally aggressive. So we are taking all this as a good change because we can actually stand being in his presence.

Then my Mom calls me and says that he's sneaking around the house at night "taking care of loose-ends" and seems to be getting rid of all his possessions. Well, I immediately recognize this because I've done it countless times and I tell her to bring him in to the doc and make a quick search on his meds and send her the info on the serious side-effects.

Goes to the doc, my Mom tries to explain what's going on, the doc explains why this has nothing to do with his meds and has to do with his father's death at the same age ect.. and said he needed to rest more, take more naps during the day. They go home and nothing gets better, he's writing long letters to all the people he knows (he's a minister by the way)and various other omninous activities.

Mom reads all the side-effects, starts asking direct questions and eliciting real answers from Dad, who is in such a fog he doesn't even realize what she's asking or why. She goes to the pharmacy, looks over the dangerous and rare side-effects, states to the pharmicist that he has all these and they tell her to bring him in.

Bring him in, doc says it's not the meds, leave and arrive at the E.R., that doc says yes the meds are the likely cause, do some bloodwork and find him toxic.

Short story long, my Dad finds a different med that still keeps his blood-pressure under control and doesn't cause him to think about suicide 24 hrs a day. His system is now oversensitive to meds and dietary changes either due to aging and/or the bad reaction to all the different meds.

Lessons learned: 55 years old is different than 45, kidneys and livers age just like skin or bones, when no one listens find someone who will, when your loved-one acts strangely investigate. Big personality changes are always cause to worry.
My best to you Deb, I hope you find a solution.

dove

 

Re: Question for the audience ... addendum

Posted by allison on October 22, 1999, at 14:22:21

In reply to Re: Question for the audience ..., posted by allison on October 21, 1999, at 17:40:20

In additon to basic ignorance or lack of information about the elderly, I also think there's a certain prejudice or attitude among some doctors about older people, especially if they have chronic problems, that maybe they don't warrant the same kind of attention that the rest of us more-or-less able-bodied, more "curable" folks allegedly deserve ...
particularly if the patient is partly or fully responsible for the chronic problem. And no doubt frustration plays a part, too. I know my mom's doctor threw his hands up more than once (as did I) over the years. But I cannot let him wholly off the hook.

 

Re: Prejudice

Posted by Noa on October 22, 1999, at 19:09:43

In reply to Re: Question for the audience ... addendum, posted by allison on October 22, 1999, at 14:22:21

Yes. My dad has been told several times that his pains are just something he has to accept as part of getting old. He is a very compliant kind of guy, so he doesn't challenge them. Us kids tell Mom to go with him to the doctors because she does challenge and asks and get second opinions. It turns out he needed surgery and it addressed the problem.
Recently my brother, age 40, went to see his orthopedist for follow up on knee surgery. While he was there he asked about a back ache on one side, which he thought might be related to compensating for his knee weakness. The doctor (age approximately 32), opens my brother's file, and asks, Now, how old are you? When he sees that he is 40, he makes a face and shrugs his shoulders, and says, well, you know.....you are 40. My brother said he had never had feelings aobut his age before but this enraged him (he is not easily enrageable--a super sedate kind of guy).

Deb, good luck with the search for support. Keep us posted.

BTW, on the topic of toxicity...my nephew who has epliepsy diagnosed at age 11 (now 22) became extremely depressed at age 14. It seemed like maybe it was due to starting high school, not having his seizures completely under control (controlled the full blown tonic-clonic seizures, but not the absence ones, and he would lose bladder control with the absence--certainly enough to be depressed about). He started skipping school, they couldn't get him our of bed, he stopped eating, became suicidal. They were about to hospitalize him when a doctor they consulted said maybe it is related to the meds he was taking. They switched meds and the depression went away.

 

Re: Zyprexa Replacement ... an aside ....

Posted by Bob on October 22, 1999, at 21:46:14

In reply to Zyprexa Replacement, posted by ChrisK on October 22, 1999, at 6:26:24

> Yesterday I had an appointment with my pdoc and he mentioned that Pfizer is coming out with a new drug in the Zyprexa family this coming February...

When I first started Zoloft 2.5 years ago, I went to Pfizer's site for some information. They had tons ... about how well their stocks were doing and how you, too, could own a piece of them. Grrr. Went back to check out if they had any info on this new zyprexa-ish drug, and their site has matured quite a bit. It actually has some good information for people who may not want to be overwhelmed with information like the sorts of sites we're used to. Didn't stay long enough to see if they had information on that drug, tho ...

Bob

 

Thanks everyone....

Posted by Deb R. on October 26, 1999, at 9:19:12

In reply to Re: Zyprexa Replacement ... an aside ...., posted by Bob on October 22, 1999, at 21:46:14

Just a quick note to thank Bob, dove, Noa, Allison and Chris K. for your input. Tomorrow is the big day - Mum's next appointment with her Psych. I have had a good look at various sites mentioned in some of your posts and I have printed off lots of information. I just want to go in there tomorrow and be of some use to Mum.
I wanted to thank you all for the time you put into your posts and to let you all know I am very grateful...best wishes always,

Deb.

 

Re: Thanks everyone....

Posted by Bob on October 26, 1999, at 9:30:46

In reply to Thanks everyone...., posted by Deb R. on October 26, 1999, at 9:19:12

Hi Deb!

Don't forget to tell your Mum that she's got all these people half a world away cheering for her.

Bob

 

Re: Thanks everyone....

Posted by dove on October 26, 1999, at 9:46:27

In reply to Re: Thanks everyone...., posted by Bob on October 26, 1999, at 9:30:46

Deb,
You and your Mum are in my prayers. May you both be blessed with answers and some real help. Keep pressing on. You are already 'useful' to your Mum so don't doubt it! Once again, Good luck tomorrow, I will be praying. My thoughts and good wishes go out to you both.

dove

 

Re: Thanks everyone....

Posted by allison on October 26, 1999, at 10:51:08

In reply to Thanks everyone...., posted by Deb R. on October 26, 1999, at 9:19:12

Best of luck to you. I hope things go well.

 

Re: Thanks everyone....

Posted by ChrisK on October 27, 1999, at 6:31:54

In reply to Re: Thanks everyone...., posted by allison on October 26, 1999, at 10:51:08

You are both in my prayers. Good Luck


This is the end of the thread.


Show another thread

URL of post in thread:


Psycho-Babble Medication | Extras | FAQ


[dr. bob] Dr. Bob is Robert Hsiung, MD, bob@dr-bob.org

Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.