Psycho-Babble Medication Thread 64133

Shown: posts 1 to 25 of 34. This is the beginning of the thread.

 

Zombie on Neuroleptics- I'm just not here

Posted by Paul W on May 24, 2001, at 12:55:53

Hello anybody whose taken the time to click this one open.

I've been suffering from chronic depression and the associated joy of anxiety for eight months now. This has not been my first war with these states.

In that time I've gone from Paxil to Lofepramine (TCA) to Effexor XR All mono therapies,all at least 6 week trials with pure hell resulting....
...and now fluanxol (flupenthixol?).
Now,after 4 weeks, my doc has raised me up to 3mg a day of this ancient drug. I'm be worried out of my skin taking this (with the associated risks of tardive dyskenesia-please do not laugh at my spelling and the ironic use of phrase!) if it wasn't for the fact that I've been removed from the planet by it. Or so it feels.

Ok, I can still function, but it takes much effort, but I am not as 'depressed' in a sense (the tears have subsided).

Trouble is I feel so blunted and removed from everything and can barely hold a conversation.

My brain feels the size of a pea, I do not retain simple information, i enjoy nothing, am losing contact with friends and am on the verge of quitting my job and possibly worse, if I cannot rid myself of this feeling and find myself again.

Does anybody have any thoughts to share with me? They would be much appreciated.

I have had excellent results with paxil (20/30mg) before but that failed this time round (merely exacerbating the anxiety and possibly depression)

In summary, I cannot believe what is happening to me and feel quite desperate.

 

Re: Zombie on Neuroleptics- I'm just not here » Paul W

Posted by Sulpicia on May 24, 2001, at 17:05:38

In reply to Zombie on Neuroleptics- I'm just not here, posted by Paul W on May 24, 2001, at 12:55:53

> I'm so sorry that you find yourself in this state.
I can't say I've heard of the med you're taking currently
but it sounds like it may be a bad bargain -- lots of loss
with very little gain, unless it's keeping suicide at bay.

I too deal with chronic depression tho went it recurred for
the 3rd time, I simply stayed on the AD med.
Is there a possibility of adjunctive therapy -- using 2 AD meds in
combo?
The only other insight I can pass on is that the standard dosages of
meds are simply some number of mgs that most people responded to -- it
says nothing about you and your body. For instance, my pdoc doesn't give
up on paxil until 60 mgs -- tho this strategy would be disastrous if you're
having horrible side effects..
Sorry I can't be more helpful but there are people here who have lots of
suggestions for other meds.
Take care :) S.

 

Re: Zombie on Neuroleptics- I'm just not here » Paul W

Posted by judy1 on May 25, 2001, at 10:52:17

In reply to Zombie on Neuroleptics- I'm just not here, posted by Paul W on May 24, 2001, at 12:55:53

Oh Jesus (sorry to offend out there) but this upsets me terribly. To put a patient in an AP that is NOT experiencing psychotic symptoms amounts to malpractice to me. Of course you are feeling like a zombie, that's what APs do- it's like a chemical lobotomy. Been there too. The atypicals aren't as bad and apparently some people have had success here augmenting their AD's with zyprexa, etc. You need to get off this stuff- go get a second opinion (sometimes you have to taper, but not always) Please, before you have permanent brain damage- I've seen it first hand and it's not pretty. Write back and let me know how it goes, I care- judy

 

Re: Zombie on Neuroleptics- I'm just not here » Sulpicia

Posted by Paul W on May 25, 2001, at 11:10:12

In reply to Re: Zombie on Neuroleptics- I'm just not here » Paul W, posted by Sulpicia on May 24, 2001, at 17:05:38

> > I'm so sorry that you find yourself in this state.
> I can't say I've heard of the med you're taking currently
> but it sounds like it may be a bad bargain -- lots of loss
> with very little gain, unless it's keeping suicide at bay.
>
> I too deal with chronic depression tho went it recurred for
> the 3rd time, I simply stayed on the AD med.
> Is there a possibility of adjunctive therapy -- using 2 AD meds in
> combo?
> The only other insight I can pass on is that the standard dosages of
> meds are simply some number of mgs that most people responded to -- it
> says nothing about you and your body. For instance, my pdoc doesn't give
> up on paxil until 60 mgs -- tho this strategy would be disastrous if you're
> having horrible side effects..
> Sorry I can't be more helpful but there are people here who have lots of
> suggestions for other meds.
> Take care :) S.

Sulpicia, thanks for your kind reply.

It's 'funny' but I feel that this med has kept suicidal thoughts at bay, but I simply cannot go on feeling nothing.

I don't know which is worse, depression anxiety or emotional numbness. I guess it's the one that's dominating at the time. Trouble is the grass is never greener in this game is it?

I've taken a huge gamble anyhow and ditched the neuroleptic and gone stright back to paxil, which has worked for me like a dream twice before (even at a lowly 20mg), but not this time round. It's probably a foolish thing to do, without consulting my doc, but it was that or row my own boat and I'm sure I cannot do this.

I live in the UK where Docs do not seem too hot on augmenting, sticking rigidly to monotherapy.
Round here that's the case anyway.

As for other meds, there's a tonne I've yet to try, but it's knowing where to go next and it's the waiting game i can't stand.
I'll just be keeping an eye on this board I guess

Thanks again

 

Re: Zombie on Neuroleptics- I'm just not here » judy1

Posted by Cam W. on May 25, 2001, at 11:29:39

In reply to Re: Zombie on Neuroleptics- I'm just not here » Paul W, posted by judy1 on May 25, 2001, at 10:52:17

Judy - Antipsychotics can decrease the amount of rumination in suicidal thoughts. They are NOT a chemical lobotomy. They do NOT cause permanent brain damage. Typical antipsychotics are NOT supposed to "turn one into a zombie"; this is an indication of either start-up side effects or an indication that the dose is too high. Please do not scare people with misinformation unless you can back up your claims with facts. There IS a risk (4%/yr) of contracting tardive dyskinesia, but the risk is small at such a low dose. - Cam

> Oh Jesus (sorry to offend out there) but this upsets me terribly. To put a patient in an AP that is NOT experiencing psychotic symptoms amounts to malpractice to me. Of course you are feeling like a zombie, that's what APs do- it's like a chemical lobotomy. Been there too. The atypicals aren't as bad and apparently some people have had success here augmenting their AD's with zyprexa, etc. You need to get off this stuff- go get a second opinion (sometimes you have to taper, but not always) Please, before you have permanent brain damage- I've seen it first hand and it's not pretty. Write back and let me know how it goes, I care- judy

 

Tardive Dyskinesia » Cam W.

Posted by judy1 on May 25, 2001, at 16:15:13

In reply to Re: Zombie on Neuroleptics- I'm just not here » judy1, posted by Cam W. on May 25, 2001, at 11:29:39

Since I'm typing this with my right hand since my left has continuous tremors from forced neuroleptic treatment- the rates of TD are 5-7% per year in healthy young adults (I believe that is 1 in 20). The rate is cumulative so that 25-35% of patients will develop the disorder in 5 years of treatment (not uncommon in schizophrenia or bipolar disorder). I believe that is 1 in 4 people. Among the elderly the rate of TD is 20% or more/year (Frenkel et al (1992- Pg 11). Most of these statistics are found in standard textbooks. I am glad you and others on this board have been helped by neuroleptics, I am presenting statistics that are widely published and that have permanently affected me. - judy
P.S. Perhaps my term 'chemical lobotomy' was inaccurate- that is a subjective feeling. When I am hospitalized with people on long term neuroleptic treatment and I see their tongues protruding, or spasms that don't allow them to walk, it is difficult for me not to react strongly.

 

Re: Zombie on Neuroleptics- I'm just not here » Cam W.

Posted by Paul W on May 25, 2001, at 16:37:31

In reply to Re: Zombie on Neuroleptics- I'm just not here » judy1, posted by Cam W. on May 25, 2001, at 11:29:39

> Judy - Antipsychotics can decrease the amount of rumination in suicidal thoughts. They are NOT a chemical lobotomy. They do NOT cause permanent brain damage. Typical antipsychotics are NOT supposed to "turn one into a zombie"; this is an indication of either start-up side effects or an indication that the dose is too high. Please do not scare people with misinformation unless you can back up your claims with facts. There IS a risk (4%/yr) of contracting tardive dyskinesia, but the risk is small at such a low dose. - Cam
>
> > Oh Jesus (sorry to offend out there) but this upsets me terribly. To put a patient in an AP that is NOT experiencing psychotic symptoms amounts to malpractice to me. Of course you are feeling like a zombie, that's what APs do- it's like a chemical lobotomy. Been there too. The atypicals aren't as bad and apparently some people have had success here augmenting their AD's with zyprexa, etc. You need to get off this stuff- go get a second opinion (sometimes you have to taper, but not always) Please, before you have permanent brain damage- I've seen it first hand and it's not pretty. Write back and let me know how it goes, I care- judy

Judy and Cam
Thanks for your responding, albeit from different ends of the spectrum.

Cam, irrespective of your views on Judy's post, the numbness began to hit a couple of weeks into taking only 2mg of fluanxol daily.

This blunted feeling was literally depressing me in every way. I simply had no feelings for anything.
With an emegency telephone call to my long suffering doc, I explained my feelings and asked whether I could try paxil again (as this has been successful before). He answered in the negative and suggested I up the dose to 3mg. I've tried this for 3 days and just feel worse to the point of total disassociation.

As you may gather , I'm speaking in the past tense as possibly the reverse placebo effect has occurred, as I have not taken any (fluanxol) today and already feel more connected.

As my second post explains, I have decided to take paxil again.As a depressive social phobic I just feel it's more suited to me.
However, after four weeks on fluanxol, I'm not sure whether this abrupt cessation and start up of a totally different drug is wise and would appreciate your views. It's a move born out of desperation and my last throw of the dice if you will.
Would augmenting the two be an option. I would rather not, but am willing to try anything to escape this hell.

Is it safe to give Paxil another blast? After eight months maybe my depression has weakened slightly. Maybe the fluanxol has done its job. I'm just a little (very) apprehensive of the negative paxil experience at the beginning of this phase.

I didn't even know what a neuroleptic was until I read this board, so please excuse my ignorance. However, I gather that it's use in tackling depression and anxiety should be short term in any event?

I have some diazepam on board for the start up jitters if required

Am I doing this all wrong? Opinions sought only with much gratitude.

Paul

 

Re: Zombie on Neuroleptics- I'm just not here » judy1

Posted by Paul W on May 25, 2001, at 16:42:00

In reply to Re: Zombie on Neuroleptics- I'm just not here » Paul W, posted by judy1 on May 25, 2001, at 10:52:17

> Oh Jesus (sorry to offend out there) but this upsets me terribly. To put a patient in an AP that is NOT experiencing psychotic symptoms amounts to malpractice to me. Of course you are feeling like a zombie, that's what APs do- it's like a chemical lobotomy. Been there too. The atypicals aren't as bad and apparently some people have had success here augmenting their AD's with zyprexa, etc. You need to get off this stuff- go get a second opinion (sometimes you have to taper, but not always) Please, before you have permanent brain damage- I've seen it first hand and it's not pretty. Write back and let me know how it goes, I care- judy

Judy
I'd already decided to ditch the med, but am fighting in the dark like a headless chicken. I have no real strategy here and cannot see my doc until next friday.

I've decided to give paxil another whirl and have detailed this in my response to Cam's post below.

What was your experience? You survived?

Thanks for caring

Paul

 

Re: Tardive Dyskinesia » judy1

Posted by Paul W on May 25, 2001, at 16:46:25

In reply to Tardive Dyskinesia » Cam W., posted by judy1 on May 25, 2001, at 16:15:13

> Since I'm typing this with my right hand since my left has continuous tremors from forced neuroleptic treatment- the rates of TD are 5-7% per year in healthy young adults (I believe that is 1 in 20). The rate is cumulative so that 25-35% of patients will develop the disorder in 5 years of treatment (not uncommon in schizophrenia or bipolar disorder). I believe that is 1 in 4 people. Among the elderly the rate of TD is 20% or more/year (Frenkel et al (1992- Pg 11). Most of these statistics are found in standard textbooks. I am glad you and others on this board have been helped by neuroleptics, I am presenting statistics that are widely published and that have permanently affected me. - judy
> P.S. Perhaps my term 'chemical lobotomy' was inaccurate- that is a subjective feeling. When I am hospitalized with people on long term neuroleptic treatment and I see their tongues protruding, or spasms that don't allow them to walk, it is difficult for me not to react strongly.

Judy

I'm so sorry
Please ignore my last post about you surviving. We crossed in the post somewhat.

Your account highlights one reason why I do not want to take the med anymore. My doc simply smirked when I mentioned TD etc.

Take care

Paul

 

Re: Zombie on Neuroleptics- Judy and » Paul W

Posted by Cam W. on May 25, 2001, at 17:58:48

In reply to Re: Zombie on Neuroleptics- I'm just not here » Cam W., posted by Paul W on May 25, 2001, at 16:37:31

•Judy - I want to apologize for my harsh post. I over-reacted to what you had said. Many people have taken conventional antipsychotics with developing EPS, let alone TD. These drugs still do have a place in psychiatry, if there use is limited to short-term use, unless absolutely necessary.

I am sorry to hear about your TD. Has your doc suggested trying Clozaril™ (clozapine) or Zyprexa™ (olanzapine) to try to stop the movements. I have personally seen a near miracle with someone taking Clozaril for their TD. This person could not keep a hat on their head because of the movements (worst case of TD I had ever seen) and had dropped from over 200lb to less than 120lb. I was with this person on the day s/he was started on Clozaril and s/he was assigned to my store. For the first 6 months on Clozaril, little change was evident, but from month 8 onwards a progressive lessening of the TD began. At about a year after starting Clozaril, this person was riding a bike and you couldn't tell (unless you knew) that this person had TD. It was really quite remarkable. This case was actually presented at the local Schizophrenia Conference last year.

Again, sorry for the rude post, but I didn't want to scare Paul out of taking a med that was going to potentially help him in the long run.

An apologetic Cam


•Paul - The Fluanxol™ (flupenthixol) would have probably been used short term, but you'd have to ask your doc if this was to be so. I would think that your doc would have a reason for using the Fluanxol over something like Risperdal™ (risperidone) or Zyprexa™ (olanzapine). I have seen the blunting that you mention with Fluanxol, but it was remedied by a lowering of dose.

As for the Paxil™ (paroxetine), it is probably a good choice for comorbid anxiety and depression and may be worth another shot. Unfortunately, one of the start-up side effects of Paxil is increased anxiety. The Valium™ (diazepam) will help with this and the start-up side effects should only last a couple of weeks.

I would phone your doc to tell him/her that you have stopped the Fluanxol, though. It is always good to have everyone on the same page of a treatment plan.

Good luck and keep us posted - Cam

 

Atypical neuroleptics and TD??Cam/Judy?

Posted by CraigF on May 25, 2001, at 18:47:55

In reply to Re: Zombie on Neuroleptics- Judy and » Paul W, posted by Cam W. on May 25, 2001, at 17:58:48

Should a person taking low doses of atypical APs (Amisulpride, Zyprexa) for depressive symptoms medium to long term be concerned about TD/EPS?

 

Re: Tardive Dyskinesia » Paul W

Posted by judy1 on May 25, 2001, at 20:22:43

In reply to Re: Tardive Dyskinesia » judy1, posted by Paul W on May 25, 2001, at 16:46:25

You have no reason to apologize- i'm glad you made a decision that you felt was best for you. I have no experience with treatment resistant depression, but many do on this board- especially Scott (SLS) and he may have suggestions for you for combos of AD's- I think MAOI's are vastly underutilized. If your pdoc didn't take your concerns seriously, then I really think it's time to get another opinion. I wish you the best, and I'm glad the 'zombie' feeling has passed- judy

 

Re: Zombie on Neuroleptics- Judy and » Cam W.

Posted by judy1 on May 25, 2001, at 20:28:20

In reply to Re: Zombie on Neuroleptics- Judy and » Paul W, posted by Cam W. on May 25, 2001, at 17:58:48

Thank you for the apology. As you can see this is a very triggering issue for me. I do take risperdal when psychotic, usually for 1 week or less (basically until symptoms have passed). Women with bipolar disorder are more susceptible to TD then men, and my pdoc is well aware of the risks involved- hence he only uses it for psychosis and short term. Since I am pregnant I am keeping meds to a minimum, but thank you for the info on your client- judy

 

Re: Atypical neuroleptics and TD??Cam/Judy? » CraigF

Posted by judy1 on May 25, 2001, at 20:37:24

In reply to Atypical neuroleptics and TD??Cam/Judy?, posted by CraigF on May 25, 2001, at 18:47:55

I'm concerned- simply because it takes years to gather the necessary statistics. They have been shown to cause TD and NMS, albeit to a lower percent than traditional neuroleptics. I guess my stance (and my pdoc's) is to use risperdal only when I am psychotic and only short-term. You should probably discuss your concerns with your dr. Best of luck- judy

 

Re: Zombie on Neuroleptics- I'm just not here

Posted by SLS on May 25, 2001, at 21:10:06

In reply to Zombie on Neuroleptics- I'm just not here, posted by Paul W on May 24, 2001, at 12:55:53

> Oh Jesus (sorry to offend out there) but this upsets me terribly. To put a patient in an AP that is NOT experiencing psychotic symptoms amounts to malpractice to me. Of course you are feeling like a zombie, that's what APs do- it's like a chemical lobotomy. Been there too. The atypicals aren't as bad and apparently some people have had success here augmenting their AD's with zyprexa, etc. You need to get off this stuff- go get a second opinion (sometimes you have to taper, but not always) Please, before you have permanent brain damage- I've seen it first hand and it's not pretty. Write back and let me know how it goes, I care- judy


Dear Judy,

I am a bit surprised by your feelings in this matter. I truly don't know you well enough, but it doesn't sound like you to take such a position. I think we can both agree that it is counterproductive to pigeon-hole drugs and confine their usage to the first label that man has placed on them. Were these labels to be applied rigidly, no one with bipolar disorder who is not also suffering from epilepsy would ever see Depakote or Lamictal; two drugs that have undoubtedly saved some of their lives. An antipsychotic is simply a compound observed to ameliorate the psychotic symptoms of schizophrenia and bipolar mania. It is not a drug with an assigned mission exclusive of all others. Some drugs that exert antipsychotic properties (neuroleptics particularly) have also demonstrated efficacy in depression, nausea and emesis, and hiccups. Hiccups are no laughing matter. For some, it makes for good medical judgment to use Thorazine (chlorpromazine), one of the "ancient" typical neuroleptic antipsychotics to treat them.

I am definitely not stating that Paul should remain on his medication. His doctor might want to discontinue it were Paul to report to him his experiences. I also do not fail to recognize the magnitude of the side effects that are possible with these drugs. I began taking Zyprexa a few days ago with the hope that it would help as a bridge during the washout period following MAOI discontinuation. I have been taking it for three days, and I have experienced a perceptible improvement in clarity of thought rather than an obfuscation of it. Some people suffering from depression report Risperdal to be activating rather than sedating. Geodon seems to produce insomnia rather than somnolence. These are hardly similar to the popular notion of what results from a lobotomy.

In my case, it seems that Zypexa and Risperdal can produce a noticeable antidepressant effect when combined with other medications. Other people have experienced a robust antidepressant response to another antipsychotic, amisulpride, as monotherapy. Of course, all three carry with them the risk of serious side effects, including some that can be irreversible; each drug displaying different frequencies of their occurrences. However, I think there comes a time in an individual's pursuit of relief from pain the necessity to weigh the risk versus benefit of any available drug. I have read posts here on Psycho-Babble for which the withholding of an antipsychotic to treat depression could be viewed as grounds for malpractice.

I am curious about the choice of Fluanxol (flupenthixol). Usually, one of the newer atypical antipsychotics is chosen to augment antidepressants. However, my own doctor has mentioned Moban (molindone), a more typical neuroleptic, to fill that role, so I am reluctant to second-guess the doctor here. With regard to the type of cognitive disturbance that is being described by Paul of flupenthixol, its unmitigated persistence beyond two weeks after a medication change probably indicates that it will not resolve.

Oh yeah...

Hi Paul! I didn't mean to be writing about you behind your monitor. :-) I hope things begin to head in a more positive direction for you soon. I think I know exactly what you are describing. I began to experience the same things at relatively low dosages of both Zyprexa and Risperdal. I am hoping that this was the result of an interaction with Parnate, an MAOI that I have just discontinued. Everything seemed distant, or perhaps better said, I felt distant from everything around me. I could not learn or remember new things. I could not remember easily old things. I could not even "feel" what I already knew. My knowledge did not feel accessible to me (not that there is a whole lot of it to feel). If you have not told your doctor about your cognitive side effects, you should probably do so right away. Good luck.

Oh yeah...

I love you, Judy.


- Scott

 

Re: Tardive Dyskinesia » judy1

Posted by SLS on May 25, 2001, at 21:19:00

In reply to Tardive Dyskinesia » Cam W., posted by judy1 on May 25, 2001, at 16:15:13

> Since I'm typing this with my right hand since my left has continuous tremors from forced neuroleptic treatment-


I have no words to express my grief. I wish I could close my eyes and make it go away for you.

Thanks for citing statistics.


- Scott

 

Re: Zombie on Neuroleptics- I'm just not here » SLS

Posted by judy1 on May 25, 2001, at 21:35:47

In reply to Re: Zombie on Neuroleptics- I'm just not here, posted by SLS on May 25, 2001, at 21:10:06

Scott,
I have developed tardive dyskinesia in my hand (see TD post to Cam) and this is a triggering subject for me. I'm also 2 weeks away from amniocentesis and terrified (I was on a bunch of drugs when I got pregnant) so I think I'm going to bow out from this site for a while. I have no ill feelings to anyone, just incapable of being positive here. Love to you too- judy

 

Re: Atypical neuroleptics and TD??Cam/Judy?

Posted by SLS on May 25, 2001, at 21:36:22

In reply to Re: Atypical neuroleptics and TD??Cam/Judy? » CraigF, posted by judy1 on May 25, 2001, at 20:37:24

> I'm concerned- simply because it takes years to gather the necessary statistics. They have been shown to cause TD and NMS, albeit to a lower percent than traditional neuroleptics. I guess my stance (and my pdoc's) is to use risperdal only when I am psychotic and only short-term. You should probably discuss your concerns with your dr. Best of luck- judy


Judy.

First of all, I admire your aggressive and well-apportioned management of your disorder(s), most especially during your pregnancy. Wow. What a joyous thing to have happen.

It is somehow ironic that your recurrent psychoses can be treated episodically, and thus intermittantly with an antipsychotic, while it seems that a recurrent or chronic depression need be treated continuously with same.

I don't think I ever bother to tell you how much I admire, respect, and enjoy you, and I sure ain't gonna' start now.

:-)

Take care.


- Scott

 

Re: Tardive Dyskinesia = Cam, Sunnely, anyone?

Posted by SLS on May 25, 2001, at 22:34:43

In reply to Tardive Dyskinesia » Cam W., posted by judy1 on May 25, 2001, at 16:15:13

> the rates of TD are 5-7% per year in healthy young adults (I believe that is 1 in 20). The rate is cumulative so that 25-35% of patients will develop the disorder in 5 years of treatment (not uncommon in schizophrenia or bipolar disorder). I believe that is 1 in 4 people. Among the elderly the rate of TD is 20% or more/year (Frenkel et al (1992- Pg 11). Most of these statistics are found in standard textbooks. I am glad you and others on this board have been helped by neuroleptics, I am presenting statistics that are widely published and that have permanently affected me.

These statistics are really scary. I may have to consider taking a Zyprexa-type drug indefinitely, so for me they are very relevant.

What statistics or characterizations of risk do you believe represent the incidences of tardive-dyskinesia with various antipsychotics and dosages?

Thanks.

I read something that suggested that the rate of TD is actually higher in people being treated for bipolar disorder than for schizophrenia.


- Scott

 

Re: Zombie on Neuroleptics- I'm just not here » judy1

Posted by SLS on May 25, 2001, at 22:42:43

In reply to Re: Zombie on Neuroleptics- I'm just not here » SLS, posted by judy1 on May 25, 2001, at 21:35:47

> Scott,
> I have developed tardive dyskinesia in my hand (see TD post to Cam) and this is a triggering subject for me. I'm also 2 weeks away from amniocentesis and terrified (I was on a bunch of drugs when I got pregnant) so I think I'm going to bow out from this site for a while. I have no ill feelings to anyone, just incapable of being positive here. Love to you too- judy


Be well...

Prayers to be offered for you, baby, et al.

Come back soon. You will be missed.

Love,
Scott

 

Re: Tardive Dyskinesia = Cam, Sunnely, anyone? » SLS

Posted by Sunnely on May 26, 2001, at 0:07:11

In reply to Re: Tardive Dyskinesia = Cam, Sunnely, anyone?, posted by SLS on May 25, 2001, at 22:34:43

Hi Scott,

Just responding to your post and not to any of the previous ones.

In a prospective study done by (John) Kane et. al., 1988, involving over 850 patients, assessed for TD every 3 months, the following were their findings:

1) Mean age of the patients - 29 years

2) 43% of patients were females

3) 12 months - median length of exposure to neuroleptics

4) The incidence rate (number of new cases occurring in a population during a specified time period and does not count for all currently affected patients):

a) 5% after 1 year

b) 10% after 2 years

c) 15% after 3 years

d) 19% after 4 years

e) 23% after 5 years

f) 26% after 6 years

The incidence rate increases as the duration of neuroleptic treatment increases, and there is a linear progression for the first several years.

Incidentally, John Kane, MD (from NY) is one of the psychopharmacology gurus. He led the multicenter (US) clozapine clinical trials in 1988 that led to its subsequent FDA approval.

You're right. Believe it or not, the rate of TD developing in bipolar disorder patients is higher than in schizophrenia patients.

Incidentally, the following are the risk factors for TD:

1) Age - is the most consistent risk factor. Five percent of young patients develop TD after 1 year compared to 30% in the elderly. Also, TD is more severe and persistent in older patients. The rates of remission if the neuroleptics is discontinued after TD develops is as follows: over 60 years old = 36% while younger than 60 = 83%. Caution: Not all involuntary mouth movements in the elderly is TD. Five percent of the elderly develop spontaneous oral dyskinesia in the absence of neuroleptic treatment.

2) Sex - women appear to have higher rate of developing TD than men. However, evidence suggests that this is limited to the geriatric age range. It appears that there is an increased risk for older women than younger women. The exact reason is unclear but suggested that hormonal factors may play a role (e.g., estrogen may act as protective mechanism to TD).

3) Organic brain syndromes - it appears that patients with dementia (e.g. Alzheimer's and others), mental retardation, and history of brain injury are at higher risk for TD.

4) Affective or mood disorders (e.g., depressive disorders and bipolar disorders), compared to schizophrenia, may be particularly susceptible to both an earlier onset and severity of TD. However, recovery may be more rapid than in nonmood disodered patients.

5) Type of neuroleptics - virtually all conventional neuroleptics have been reported to cause TD. The risk of TD appears to be much less with the newer (atypical) neuroleptics. Among the atypical neuroleptics, TD seems to be most likely to occur with the use of risperidone (Risperdal).

6) Dosage and duration of neuroleptic use - the higher the dose, the longer the period of treatment, the greater the risk of TD. The "intermittent (or targeted)" neuroleptic form of therapy is more likely to cause TD than the "continuous low-dose" neuroleptic form of treatment.

7) Concomitant use of anticholinergic drugs (e.g., benztropine, trihexyphenidyl, etc.) higher risk for TD.

8) Early signs of extrapyramidal symptoms (EPS) such as acute dystonia, akathisia, parkinsonism, are more likely to develop TD with continued neuroleptic treatment.

9) Smoking - appears to be associated with increase rate of TD. It was sugggested that nicotine stimulates dopamine release from the nigrostriatal neurons. On the other hand, there appears to be an inverse relationship between smoking and the rate of Parkinson's disease.

10) Alcoholism - schizophrenic patients with history of alcohol abuse appear to have a significantly higher TD scores than nonabuser schizophrenics.

11) Diabetics - on neuroleptics have higher rate of developing TD than nondiabetics on neuroleptics.

12) Ethnicity - in one study (4 continents), the lowest rate of TD was reported in Asia.

13) Unknown individual factors - possibly a genetically determined vulnerability to TD plays an essential part.

14) TD can also develop in patients taking nonneuroleptic drugs such as metoclopramide (Reglan), for stomach distress. Reglan is actually a dopamine receptor blocker belonging to the class of substituted benzamides, which also include neuroleptics such as sulpiride, amisulpiride, remoxipride, raclopride, emonapride.

+++++++++++++++++++++++++++

> > the rates of TD are 5-7% per year in healthy young adults (I believe that is 1 in 20). The rate is cumulative so that 25-35% of patients will develop the disorder in 5 years of treatment (not uncommon in schizophrenia or bipolar disorder). I believe that is 1 in 4 people. Among the elderly the rate of TD is 20% or more/year (Frenkel et al (1992- Pg 11). Most of these statistics are found in standard textbooks. I am glad you and others on this board have been helped by neuroleptics, I am presenting statistics that are widely published and that have permanently affected me.
>
>
>
> These statistics are really scary. I may have to consider taking a Zyprexa-type drug indefinitely, so for me they are very relevant.
>
> What statistics or characterizations of risk do you believe represent the incidences of tardive-dyskinesia with various antipsychotics and dosages?
>
> Thanks.
>
> I read something that suggested that the rate of TD is actually higher in people being treated for bipolar disorder than for schizophrenia.
>
>
> - Scott

 

Re: Tardive Dyskinesia = Cam, Sunnely, anyone?

Posted by stjames on May 26, 2001, at 2:47:12

In reply to Re: Tardive Dyskinesia = Cam, Sunnely, anyone? » SLS, posted by Sunnely on May 26, 2001, at 0:07:11

> Hi Scott,
>
> Just responding to your post and not to any of the previous ones.
>
> In a prospective study done by (John) Kane et. al., 1988, involving over 850 patients, assessed for TD every 3 months, the following were their findings:

James here....

What AP's were the sample group on ? Or would this include the newest AP's ?

James

 

Re: Tardive Dyskinesia Sulpiride.

Posted by JahL on May 26, 2001, at 7:35:53

In reply to Re: Tardive Dyskinesia = Cam, Sunnely, anyone?, posted by SLS on May 25, 2001, at 22:34:43

> > > the rates of TD are 5-7% per year in healthy young adults (I believe that is 1 in 20). The rate is cumulative so that 25-35% of patients will develop the disorder in 5 years of treatment

> > These statistics are really scary. I may have to consider taking a Zyprexa-type drug indefinitely, so for me they are very relevant.

I've been on Sulpiride 150mg/day for over a year now. My pdoc *guaranteed* there was no likelihood of TD. I don't think the literature bears his claims out. I'm likely to be on it for some time. Anyone know how it compares to conventional APs? Thanks v much.

> > I read something that suggested that the rate of TD is actually higher in people being treated for bipolar disorder than for schizophrenia.

I've seen this a no. of times & I've just been dx'd BP. :-0

J.

 

Re: Tardive Dyskinesia = Cam, Sunnely, anyone? » stjames

Posted by Sunnely on May 26, 2001, at 12:55:31

In reply to Re: Tardive Dyskinesia = Cam, Sunnely, anyone?, posted by stjames on May 26, 2001, at 2:47:12

None were on atypical antipsychotics. At least here in the US, atypical antipsychotics were not available in the market until 1990 (Clozaril was approved).

+++++++++++++++++++++++++++++

> > Hi Scott,
> >
> > Just responding to your post and not to any of the previous ones.
> >
> > In a prospective study done by (John) Kane et. al., 1988, involving over 850 patients, assessed for TD every 3 months, the following were their findings:
>
> James here....
>
> What AP's were the sample group on ? Or would this include the newest AP's ?
>
> James

 

Re: Tardive Dyskinesia = Cam, Sunnely, anyone?

Posted by stjames on May 26, 2001, at 18:55:40

In reply to Re: Tardive Dyskinesia = Cam, Sunnely, anyone? » stjames, posted by Sunnely on May 26, 2001, at 12:55:31

> None were on atypical antipsychotics. At least here in the US, atypical antipsychotics were not available in the market until 1990 (Clozaril was approved).

James here....

Then it is not new news nor is it highly predictive of the course of treatment for newer, post 1990 AP. 1 out of 4 taking older meds longterm will get TD or something like it....DUH !

I have seen chronic TD up close, it is not pretty.
But the benifits did out weight this side effect in chronic scitzohrenia. For me, I would not take a newer AP, for a non-psychotic condition, unless I had really tried everything else. We need more than 10 years sampling to say what the instance of TD is in the newer ones.

James


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