![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 20 to 44 of 44. Go back in thread:
Posted by Cam W. on December 28, 2001, at 23:58:52
In reply to EPS Cam, posted by Willow on December 28, 2001, at 22:16:42
>
> > ....or Edmonton Police Service (damn, busted again).
>
> Now what would the Edmonton Police Service want with you?
>
> Wondering WillowWillow - Just hangin' with my homeys on the drug squad. =^P
Posted by Cam W. on December 29, 2001, at 0:11:19
In reply to Re: What is EPS? » Cam W., posted by Willow on December 28, 2001, at 22:15:13
Willow - There are several reasons that your father hasn't been given these drugs. First and foremost, I believe that your dad has tardive dyskinesia (TD), and these meds do little in the way of stopping those movements. The anticholinergics I mentioned are usually used for the extrapyramidal movements and muscle pains associated with EPS.
Secondly, these drugs cause a fair bit of cognitive impairment in the elderly population, especially those prone to Alzheimers, which anticholinergics with significantly worsen. They actually use anticholinesterase inhibitors for Alzheimers patients, which increase acetylcholine concentrations in the body. Blocking acetylcholine receptors would significantly enhance Alzheimers symptoms.
Also, anticholinergics can cause hallucinations in people who are more sensitive to their effects, and they cause lovely side effects like extreme dry mouth, sedation, urinary flow problems, and coordination problems (leading to falls). These side effects are most pronounced in the elderly.
Muscle twitches probably aren't EPS, although some people have reportedly got EPS symptoms from SSRIs and Effexor. It isn't that common. I believe that muscle aches and pains are an early sign. Your doc can do a simple test to determine if you do have EPS (I doubt it, though).
- Cam
> The effexor gives me muscle twitches and sudden jerks. I've been reassured by the doctors that this isn't related to the TD in anyway. Are they correct? Is it safe to say that they aren't related to EPS either?
Posted by Chloe on December 29, 2001, at 9:45:56
In reply to Re: What is EPS? » Cam W., posted by Willow on December 28, 2001, at 22:15:13
> >Do you ever get an irrating tickle running along a nerve in your tongue? I've just always wondered what this is.
Willow,
I have never experienced an irritating tickle. My tongue can get awfully sore and irritated at the tip where is rubs back and forth on my lower teeth. But no nerve problems. That is an interesting one. Does your father experience this?
> > Answers just lead to more questions.Isnt that the truth!
Best,
chloe
Posted by Willow on December 29, 2001, at 15:16:06
In reply to Re: What is EPS? » Willow, posted by Chloe on December 29, 2001, at 9:45:56
Chloe
I asked my dad if he has any problems besides the obvious with the TD because of the tongue movements. He said that just his neck gets sore. The scariest part of it is that he often swallows down the wrong tube and chokes.
Fortunately the zyprexa doesn't give him such a dry mouth and the need to gozzle water isn't as strong. Now this may also be because he substituted his beer for Ativan, he claims the no-name brands don't help the same way.
The question regarding the tickle was for myself. Thankfully it is very infrequent but quite obtrusive as it has wakened me from my sleep which not much can. I've also on separate occassions lost all sense of smell and taste. The taste came back to parts of my tongue in portions, the back first. I don't know if this is related to the tickle.
But from this experience I do believe that these senses affect our mood. Whenever I notice it fading I make a point to eat strong foods and sniff strong odours to try and revive it and to give my mood a kick start.
I do hope your holidays are going well!
BEST WISHES
Willow
Posted by Chloe on December 29, 2001, at 15:55:59
In reply to TD » Chloe, posted by Willow on December 29, 2001, at 15:16:06
Hi Willow,
I am glad your dad is better on Zyprexa and avoiding beer! The inability to swallow stuff is very scary for me. I felt I might have had that when I took Geodon. All foods just seemed so dry, and I had such a hard time forcing down my throat. It was strange, because I did not experience dry mouth with Geodon. So I was too scared to continue with that med.Your tongue phenomenon sounds uncomfortable. Esp. if it's waking you from a sound sleep. Are you taking any antipsychotics? Do you think this is some form of TD that I am unfamilar with? I wonder if it's neurological in some way. In that you are losing sensation, and taste, and then it will return with strong smell. Have you talked to an MD about this? Does it worry you?
I am barely holding it together with the addition of Seroquel. I find it doesn't work as well as the traditional antipsychotics, and I do get exaggerated tongue wiggling/teeth clenching, which is very annoying. But I guess it's better than being "crazy", ie, angry, distorted thinking, paranoid, anxious all the time. But I am still extremely depressed. I just wish there were a cure for what I got. But I really don't have much hope. Esp. when all meds seem to be giving me major side effects. I am *trying* to stay upbeat as possible. I hate to drag people arouond me down with my lousy mood!
Thanks for the holiday good wishes. Same to you.
Chloe
>
> I asked my dad if he has any problems besides the obvious with the TD because of the tongue movements. He said that just his neck gets sore. The scariest part of it is that he often swallows down the wrong tube and chokes.
>
> Fortunately the zyprexa doesn't give him such a dry mouth and the need to gozzle water isn't as strong. Now this may also be because he substituted his beer for Ativan, he claims the no-name brands don't help the same way.
>
> The question regarding the tickle was for myself. Thankfully it is very infrequent but quite obtrusive as it has wakened me from my sleep which not much can. I've also on separate occassions lost all sense of smell and taste. The taste came back to parts of my tongue in portions, the back first. I don't know if this is related to the tickle.
>
> But from this experience I do believe that these senses affect our mood. Whenever I notice it fading I make a point to eat strong foods and sniff strong odours to try and revive it and to give my mood a kick start.
>
> I do hope your holidays are going well!
>
> BEST WISHES
> Willow
Posted by OldSchool on December 30, 2001, at 11:59:48
In reply to What is EPS? (nm), posted by Willow on December 28, 2001, at 16:32:24
I was recently diagnosed with EPS this past fall. Im still battling it actually. It occurred after I took low dose Seroquel for slightly over one a month, just 50 mg!. I was adding the seroquel to an SSRI for "augmentation" for refractory depression...didnt help in fact it made me feel more depressed. After I went off the Seroquel, my muscles got super sore and tight feeling and my tongue got real numb. I felt super weak, but my mood wasnt affected that much. I also had mild weakness on my right side. I also had a lot of small muscle twitches at rest, "twitch, twitch, twitch."
It feels like a very mild, sustained muscle contraction all over my body, with a numb tongue.
I went to my family doctor and he quickly informed me I was suffering from side effects of the Seroquel and he told me to contact my psychiatrist immediately, which I did. I then went and saw my psychiatrist, who informed me after doing some tests that my right side was mildly weak. He told me I had EPS, and that EPS oftentimes affects one side of the body more than the other.
Right now Im just waiting things out to see if things will go back to normal on its own. Its gotten a bit better but the EPS is still there. Only thing Ive tried so far that helps it is OTC Benadryl. Its also started affecting my breathing some I hate to say, like my chest gets tight, all my muscles get tight. Tongue is numb a lot. I cant open my mouth as far as I used to before all this EPS started.
The best way to deal with EPS is to never get it in the first place. When it comes to neuroleptic induced movement disorders, prevention is the best cure. That means avoid taking anti-psychotics unless you are bona fide psychotic or manic. Dont use atypical anti-psychotics for things that oftentimes are a integral part of severe depression like anxiety, insomnia, agitation, irritability and "rumination."
Use anti-psychotics for what they were originally intended for...psychosis. IE; schizophrenia or manic psychosis.
I have kind of come to the conclusion on my own that for people whose primary dx is a mood disorder and if they have psychotic symptoms the best thing might be old fashioned bilateral ECT. Or maybe bifrontal ECT. Instead of anti-psychotics plus antidepressants. Because with ECT there is no danger of movement disorders. Id trade some memory loss for this EPS crap anyday.
In short, if your problem is primarily a severe mood disorder, you might be better off getting shocked than taking anti-psychotics.
Here is a link that describes EPS from the Merck manual website:
http://www.merck.com/pubs/mmanual/section14/chapter179/179d.htm
Old School
Posted by Chloe on December 30, 2001, at 18:05:35
In reply to Re: What is EPS?, posted by OldSchool on December 30, 2001, at 11:59:48
I am just emerging from an agitated phycotic depression that was helped with the last resort Seroquel.
But now I read Old School's story about Seroquel and EPS and I am scared out of my mind. I have jaw clenching and tongue wiggling and my tongue has some pretty bad sores on it. I don't know what from...From all the repetitive rubbing or is it from the increased dry mouth from the Seroquel?
I am barely coping, and today day 5 on 50-100mgs Seroquel, I was able to go out with a friend and not go into a psychotic rage.But now I am so scared to remain on Seroquel. Having my tongue to tense and numb(?) and wiggly and clenching is awful. I can't get in touch with a pdoc till wednesday. What am I supposed to do? I think I will have bigtime rebound craziness if I just go off. I am so suicidal. NOTHING I take really helps that much, and all meds that do help, like lithium or AP's give me such bad side effects. I just want to throw in the towel. The pain is just so unbearable. And now, a med that was marginally workinig looks like it could permanently impair me. God, I guess I don't even care if I get impaired at this piont.
What is am I supposed to do if I need a major tranquilizer like an AP, but I shouldn't take them? Anyone know? God, how do I hang on?
> I was recently diagnosed with EPS this past fall. Im still battling it actually. It occurred after I took low dose Seroquel for slightly over one a month, just 50 mg!. I was adding the seroquel to an SSRI for "augmentation" for refractory depression...didnt help in fact it made me feel more depressed. After I went off the Seroquel, my muscles got super sore and tight feeling and my tongue got real numb. I felt super weak, but my mood wasnt affected that much. I also had mild weakness on my right side. I also had a lot of small muscle twitches at rest, "twitch, twitch, twitch."
>
> It feels like a very mild, sustained muscle contraction all over my body, with a numb tongue.
>
> I went to my family doctor and he quickly informed me I was suffering from side effects of the Seroquel and he told me to contact my psychiatrist immediately, which I did. I then went and saw my psychiatrist, who informed me after doing some tests that my right side was mildly weak. He told me I had EPS, and that EPS oftentimes affects one side of the body more than the other.
>
> Right now Im just waiting things out to see if things will go back to normal on its own. Its gotten a bit better but the EPS is still there. Only thing Ive tried so far that helps it is OTC Benadryl. Its also started affecting my breathing some I hate to say, like my chest gets tight, all my muscles get tight. Tongue is numb a lot. I cant open my mouth as far as I used to before all this EPS started.
>
> The best way to deal with EPS is to never get it in the first place. When it comes to neuroleptic induced movement disorders, prevention is the best cure. That means avoid taking anti-psychotics unless you are bona fide psychotic or manic. Dont use atypical anti-psychotics for things that oftentimes are a integral part of severe depression like anxiety, insomnia, agitation, irritability and "rumination."
>
> Use anti-psychotics for what they were originally intended for...psychosis. IE; schizophrenia or manic psychosis.
>
> I have kind of come to the conclusion on my own that for people whose primary dx is a mood disorder and if they have psychotic symptoms the best thing might be old fashioned bilateral ECT. Or maybe bifrontal ECT. Instead of anti-psychotics plus antidepressants. Because with ECT there is no danger of movement disorders. Id trade some memory loss for this EPS crap anyday.
>
> In short, if your problem is primarily a severe mood disorder, you might be better off getting shocked than taking anti-psychotics.
>
> Here is a link that describes EPS from the Merck manual website:
>
> http://www.merck.com/pubs/mmanual/section14/chapter179/179d.htm
>
> Old School
Posted by gregg on December 31, 2001, at 10:41:32
In reply to Paranoia and Dopamine CamW or anyone ?, posted by janejj on December 26, 2001, at 23:29:50
Jane,
If you read the prescibing info on the manufacturer's web site you will find a paragraph that says Wellbutrin can cause/exacerbate psychosis.
Personally, I only know one person who has used Wellbutrin to treat the depression component of depression with psychotic features. When used alone, the Wellbutrin caused a dramatic worsenning of the psychosis (paranoid delusions). When an anti-psychotic (Risperdal) was added to the 300mg of Wellbutrin, however, the psychosis completely disappeared. While this is only one case, it does suggest that caution may be warranted in using Wellbutrin without an AP if there is a history of psychosis.
gregg
PS Has anyone else seen "A Beautiful Mind"? Great film!
> Hello everyone,
> Hope you had a good holiday !
>
> Ok i'm wondering if Wellbutrin can induce paranoia ? Is it connected to too much Dopamine ?
>
> Thankyou,
>
> jane
Posted by gregg on December 31, 2001, at 10:52:07
In reply to Re: Cam:antipsychotic question » Chloe, posted by Cam W. on December 27, 2001, at 20:44:17
Cam,
I noticed that you say in a couple of your posts that you seldom see Seroquel used as a sole agent. I was wondering why that is. Is Seroquel not as effective as other APs (like Risperdal or Zyprexa) in treating psychosis? It would be a shame if a med with such a benign side-effect profile was a dud in treating the condition it is intended for! I am particularly interested in how effective you have found Seroquel to be in treating the psychosis in depression with psychotic features?
Thanks,
Gregg> Chloe - I haven't heard of using melatonin successfully for EPS or TD. I have seen vitamin E used successfully...once. The Seroquel™ (quetiapine), while it may not stop these movements, will, in all probability, not worsen them (unless, by stopping the Mellaril™ - thioridazine - "unmasks" more severe tardive symptoms). I have never seen Seroquel cause any kind of EPS symptoms (let alone TD), but then again, I seldom see Seroquel used as a sole agent.
>
> The worse case of TD that I had ever seen (the person could not even keep a hat of their head) was basically "cured" using Clozaril™ (clozapine). It did take over 8 months for the effects to kick in, but now this person is riding a bike, and if you did know that this person had TD, you couldn't tell. The transformation was absolutely amazing.
>
> I have heard a similar story with Zyprexa™ (olanzapine), but I have personally only seen the unmasking of Orap™ (pimozide) induced TD with Zyprexa. This could be due to the short time that the person was taking the Zyprexa before stopping it.
>
> - Cam
Posted by Willow on December 31, 2001, at 15:35:27
In reply to Re: EPS, what to do???, posted by Chloe on December 30, 2001, at 18:05:35
> But now I read Old School's story about Seroquel and EPS and I am scared out of my mind. I have jaw clenching and tongue wiggling and my tongue has some pretty bad sores on it. I don't know what from...From all the repetitive rubbing or is it from the increased dry mouth from the Seroquel?
Chloe you mentioned both jaw clenching and sores on your tongue. At night you may have actually injured your tongue with the clenching. Talking to your dentist or doctor and they may be able to give you ideas on how to speed the recovery. I find flossing helps, don't know why but it seems to speed recovery and mouthwash.
>
>I can't get in touch with a pdoc till wednesday. What am I supposed to do? I think I will have bigtime rebound craziness if I just go off. I am so suicidal. NOTHING I take really helps that much, and all meds that do help, like lithium or AP's give me such bad side effects. I just want to throw in the towel. The pain is just so unbearable. And now, a med that was marginally workinig looks like it could permanently impair me. God, I guess I don't even care if I get impaired at this piont.Chloe we are all individuals. Our symptoms may have similarities but how they affect and impair us differ. I believe that our mental health takes precedence, because it affects our identity and ability to think. At the present time I don't let what "MAY" happen affect me, because it may not and there are bigger issues for me to deal with now.
Hang in there! Write down your main concerns and bring them to your doctor's appointment.
Keep in touch ...
Whispering Willow
Posted by jimmygold70 on January 1, 2002, at 2:11:46
In reply to Re: Cam:antipsychotic question, posted by Chloe on December 27, 2001, at 17:18:57
> I HAVE to be on an AP for the at least a few months or much longer. I already have MILD vermicular movements of the tongue from long term use of Melleril several years ago.
That happens - Extrapirmaidal Symptoms
> A well know pharmacologist that was consulted said I should go back on a typical AP and take 10 mgs of Melatonin to conteract tongue movements.
I haven't heard of this
> This was too scary for me, so I opted to go with the more safe AP, seroquel(much less effective, though!).
Try any atypical atipsychotic - Risperdal, Zyprexa, Seroquel or Geodon. There is no reason to presume that a sufficient dose of any of these could be less effective than Melleril for paranoid ideation.
> Do you think the seroquel could turn my mild tongue movements into TD?
No.
> And is there any merit to the use of Melatonin? The RDA for TD prevention in this pdocs mind is 10 mgs. This seems like a very high dose, and possibly depressogic, I would persume.
Very sedating, I presume. Try benztropine (BENZTROP MES, COGENTIN) for that.
> Do you have any thoughts on this???
>
> TIA
> Chloe
Posted by Chloe on January 1, 2002, at 17:44:52
In reply to Re: Cam:antipsychotic question, posted by jimmygold70 on January 1, 2002, at 2:11:46
Thanks for answering my questions. Since my pdoc is out of town I have been using 50 mgs doses of benadryl for the clenching (it doesn't help with the tongue movements at all). Do you think cogentin work better than benadryl for EPS?
I really feel that being on Seroquel is not such a good idea for me. The EPS is significant, and I have terrible tongue sores all around my tongue (ouch!) and on one cheek, an achy, clicking jaw, and trouble swallowing food. The paranoia is less, but the physical symptoms are hell.
There must be something better than this!At least the Mellaril didn't give me EPS, but I am sure in time I would develop more advanced TD.
Is there any other way to manage paranioa and distorted thinking without AP's??? Are there any other major tranquilizers that don't block dopamine???Thanks again
Chloe> > I HAVE to be on an AP for the at least a few months or much longer. I already have MILD vermicular movements of the tongue from long term use of Melleril several years ago.
>
> That happens - Extrapirmaidal Symptoms
>
> > A well know pharmacologist that was consulted said I should go back on a typical AP and take 10 mgs of Melatonin to conteract tongue movements.
>
> I haven't heard of this
>
> > This was too scary for me, so I opted to go with the more safe AP, seroquel(much less effective, though!).
>
> Try any atypical atipsychotic - Risperdal, Zyprexa, Seroquel or Geodon. There is no reason to presume that a sufficient dose of any of these could be less effective than Melleril for paranoid ideation.
>
> > Do you think the seroquel could turn my mild tongue movements into TD?
>
> No.
>
> > And is there any merit to the use of Melatonin? The RDA for TD prevention in this pdocs mind is 10 mgs. This seems like a very high dose, and possibly depressogic, I would persume.
>
> Very sedating, I presume. Try benztropine (BENZTROP MES, COGENTIN) for that.
>
> > Do you have any thoughts on this???
> >
> > TIA
> > Chloe
Posted by Chloe on January 1, 2002, at 17:55:30
In reply to ... what to do??? » Chloe, posted by Willow on December 31, 2001, at 15:35:27
Hi Willow,
You are so right that what happens to one person may not happen to another. It seems that I can get scared out of me witts about these AP meds. Especailly since I had to stop antipsychotics in the late 1990's because of emerging TD. So I guess I am really edgy about trying them in any form again since I have permanent damage already. Though I know this new breed of AP's are safer. But God, do I have some major side effects...I am desperately waiting for a psychpharm consult. I hope the guy will get back to me this week. I really need a better approach to managing my illness, I think...The EPS is all I focus on now, not the paranoia. I wonder if this really is an improvement! I did get some special kanker sore rinse. It has helped a little. Now my sores are white, instead of red! But I think I just make them worse again while I sleep. So I am just trying to keep hope alive that something better is out there for me!
Thanks again Willow. Hope you had a happy new years day.
Chloe
Posted by jimmygold70 on January 1, 2002, at 17:56:40
In reply to Re: Cam:antipsychotic question » jimmygold70, posted by Chloe on January 1, 2002, at 17:44:52
> I really feel that being on Seroquel is not such a good idea for me. The EPS is significant, and I have terrible tongue sores all around my tongue (ouch!) and on one cheek, an achy, clicking jaw, and trouble swallowing food. The paranoia is less, but the physical symptoms are hell.
> There must be something better than this!I know they use risperdal to treat TD ! The best treatment for TD is to increase the dose of the AP you take. Since Risperdal is less likely to cause TD than the typical ones, I would recommend you to try this. There is no well documented uses for sqroquel concerning paranoid ideation. The fact it works for paranoid schizophrenia doesn't imply it is good for paranoid ideation as well.
> At least the Mellaril didn't give me EPS, but I am sure in time I would develop more advanced TD.
> Is there any other way to manage paranioa and distorted thinking without AP's??? Are there any other major tranquilizers that don't block dopamine???No. The definition of a major tranquilizer that it should block D2 receptors. I would stick to an antipsychotic with well proven history of treating paranoid ideation - i.e. Risperdal. Play with the dose of risperdal + Benadryl/cogentin. Zyprexa is also an option. Yes, SSRIs might help too. I would combine high dose Paxil with whatever antipsychotic you take. It might bring more favorable results. Just my intuition.
Jimmy
Posted by OldSchool on January 1, 2002, at 18:05:11
In reply to Re: Cam:antipsychotic question » jimmygold70, posted by Chloe on January 1, 2002, at 17:44:52
> Thanks for answering my questions. Since my pdoc is out of town I have been using 50 mgs doses of benadryl for the clenching (it doesn't help with the tongue movements at all). Do you think cogentin work better than benadryl for EPS?
>
> I really feel that being on Seroquel is not such a good idea for me. The EPS is significant, and I have terrible tongue sores all around my tongue (ouch!) and on one cheek, an achy, clicking jaw, and trouble swallowing food. The paranoia is less, but the physical symptoms are hell.
> There must be something better than this!
>
> At least the Mellaril didn't give me EPS, but I am sure in time I would develop more advanced TD.
> Is there any other way to manage paranioa and distorted thinking without AP's??? Are there any other major tranquilizers that don't block dopamine???
>
> Thanks again
> Chloe
>
Bilateral ECT has powerful dual antidepressant/anti-psychotic properties, without creating the movement disorder problems of anti-psychotic drugs. Side effects? Memory loss.Old School
Posted by Cam W. on January 1, 2002, at 18:16:38
In reply to Re: Cam:antipsychotic question, posted by gregg on December 31, 2001, at 10:52:07
Gregg - I have seen Seroquel™ (quetiapine) added to both atypical and psychotic depressions, with varying degrees of success. Sometimes it added too much excess drowsiness, sometimes did nothing at all, and sometimes brought people "back to the world of the living and functioning." As I have only seen relatively few cases Seroquel used in depression (10 to 20 cases), and the fact that I no longer work closely with the psychiatrists, I am not as privy to a lot of the pdoc decisions as I used to be.
The problem with Seroquel monotherapy is that the drug works like a charm when used alone in a hospital setting. Many (probably most) psychiatrists and hospital clinical pharmacists will, and do, disagree with me on the next point.
"I" feel that when the hospital boys (and girls) are able to stabilize someone with psychosis (usually schizophrenia or schizoaffective disorder) on Seroquel, seeming all thought processes clear up, and functioning dramatically improves. The problems seem to start when the person loses the relative sanctity, safety, and security of the psych ward. The person, more often than not, is place back in the community (ie. thrown back to the wolves), back to the same environment, with the same associated stresses, that help to promote the most recent psychotic break. "I" believe it is this environment, with it's past memories, that overwhelm the activity of the Seroquel, and contribute to another relapse.
Perhaps the reason for this is that Seroquel just doen't have enough D2 receptor blocking ability. Perhaps there is a lower range of consistent block that is required before environmental stressors can again overwhelm the brain, and psychosis rears it's ugly head.
The reason I like seeing Seroquel used with other atypicals is that one can usally get away with lower doses of the others. This is important, especially when reaching doses of 6mg/day of Risperdal™ (risperidone) and 30mg/day (or so) of Zyprexa™ (olanzapine), in which cases the risk of EPS becomes significantly greater.
While I have no scientific evidence of the above (which is probably why the pdocs won't listen to me on this issue - but I got 'em thinkin'), I have read a study showing that using Seroquel and Clozaril™ (clozapine) together, it seems (in this small study) that those who used both drugs in combination, as opposed to using Clozaril alone, gain less weight, while having as good or better control of the psychosis.
I wish the dumbass drug companies (there go a few more job opportunities < sigh >) would drops their egos (and some of their potential profits) to try combinations like this, to see if we can get combinations of drugs (not just antipsychotics) that will maximize efficacy, while minimizing adverse effects.
Cam (stepping down off his soapbox, shaking the clouds from his hair, and going off to check the want ads, again)
Posted by OldSchool on January 1, 2002, at 18:26:30
In reply to Re: Cam:antipsychotic question, posted by jimmygold70 on January 1, 2002, at 17:56:40
>
> I know they use risperdal to treat TD !They do? I never heard that. Doesnt make much sense as Risperdal can cause TD in itself.
> The best treatment for TD is to increase the dose of the AP you take.
LOL This is the "old" way of dealing with TD, primarily if you are classic schizophrenic. Increasing the dosage of the neuroleptic merely masks and covers up the TD symptoms for awhile, only to let the TD symptoms arise again later even worse. Increasing the neuroleptic dosage to mask over TD symptoms is an extremely poor method of dealing with TD (incompetent actually).
The best way to deal with TD is to get off the TD inducing drug entirely. In time, the TD will probably get better if the offending drug is removed. In the case of schizophrenia, obviously taking someone off their neuroleptic permanently is simply not possible. In which case a switch to Clozapine is probably indicated.
Clozapine has the lowest incidence of TD and EPS of all anti-psychotic medications.
>Since Risperdal is less likely to cause TD than the typical ones, I would recommend you to try this. There is no well documented uses for sqroquel concerning paranoid ideation.
HUH? Where do you get your information from? Seroquel is very well intended for paranoid ideation. Paranoid ideation is a classic reason to take a drug like Seroquel.
>The fact it works for paranoid schizophrenia doesn't imply it is good for paranoid ideation as well.
Um...I dont agree with this. Seroquel is used for a wide spectrum of mental disorders and I can guarantee you that paranoid ideation is one of them.
One of the better things about Seroquel is that its one of the handful of neuroleptics which doesnt use the 2D6 enzyme for drug metabolism. Which means Seroquel is less likely to create pharmacokinetic drug/drug interactions compared to other neuroleptics. This in my opinion, is the greatest thing about Seroquel. Seroquel uses 3A4 for metabolism, not 2D6.
>
> > At least the Mellaril didn't give me EPS, but I am sure in time I would develop more advanced TD.
> > Is there any other way to manage paranioa and distorted thinking without AP's??? Are there any other major tranquilizers that don't block dopamine???
>
> No. The definition of a major tranquilizer that it should block D2 receptors. I would stick to an antipsychotic with well proven history of treating paranoid ideation - i.e. Risperdal. Play with the dose of risperdal + Benadryl/cogentin. Zyprexa is also an option. Yes, SSRIs might help too. I would combine high dose Paxil with whatever antipsychotic you take. It might bring more favorable results. Just my intuition.
Seroquel is just as effective an anti-psychotic as is Risperdal. All these atypical anti-psychotics are basically the same drugs, variations on a theme. That variation on a theme is "antagonize 5HT2 receptors while simultaneously antagonizing D2 receptors." All of them basically do the same thing.You can avoid neuroleptics by going back to the basics of psychiatry and having ECT instead.
Bilateral ECT has powerful dual antidepressant/anti-psychotic effects, which can come in handy with mood disordered folks who have psychotic features such as "distorted thinking." ECT does not carry with it the danger of inducing movement disorders like EPS and TD.
Bilateral ECT is the single most effective treatment for mood disorders with psychotic features and all the literature you will read will back that up.
Old School
Posted by gregg on January 1, 2002, at 18:44:08
In reply to Re: Cam:antipsychotic question » gregg, posted by Cam W. on January 1, 2002, at 18:16:38
Cam,
Thanks for your thorough response. I've often wondered why clinical trials can show a med to work great, with subsequent "real world" experience showing that it isn't as good as expected or has some bad side effect. Being the cynical type, I assumed that the researchers, whose research funding often comes from the manufacturer, were simply not receptive to negative findings. Your point about the added stresses of the "real world" might, however, be a better explaination for this.
Thanks
Gregg
> Gregg - I have seen Seroquel™ (quetiapine) added to both atypical and psychotic depressions, with varying degrees of success. Sometimes it added too much excess drowsiness, sometimes did nothing at all, and sometimes brought people "back to the world of the living and functioning." As I have only seen relatively few cases Seroquel used in depression (10 to 20 cases), and the fact that I no longer work closely with the psychiatrists, I am not as privy to a lot of the pdoc decisions as I used to be.
>
> The problem with Seroquel monotherapy is that the drug works like a charm when used alone in a hospital setting. Many (probably most) psychiatrists and hospital clinical pharmacists will, and do, disagree with me on the next point.
>
> "I" feel that when the hospital boys (and girls) are able to stabilize someone with psychosis (usually schizophrenia or schizoaffective disorder) on Seroquel, seeming all thought processes clear up, and functioning dramatically improves. The problems seem to start when the person loses the relative sanctity, safety, and security of the psych ward. The person, more often than not, is place back in the community (ie. thrown back to the wolves), back to the same environment, with the same associated stresses, that help to promote the most recent psychotic break. "I" believe it is this environment, with it's past memories, that overwhelm the activity of the Seroquel, and contribute to another relapse.
>
> Perhaps the reason for this is that Seroquel just doen't have enough D2 receptor blocking ability. Perhaps there is a lower range of consistent block that is required before environmental stressors can again overwhelm the brain, and psychosis rears it's ugly head.
>
> The reason I like seeing Seroquel used with other atypicals is that one can usally get away with lower doses of the others. This is important, especially when reaching doses of 6mg/day of Risperdal™ (risperidone) and 30mg/day (or so) of Zyprexa™ (olanzapine), in which cases the risk of EPS becomes significantly greater.
>
> While I have no scientific evidence of the above (which is probably why the pdocs won't listen to me on this issue - but I got 'em thinkin'), I have read a study showing that using Seroquel and Clozaril™ (clozapine) together, it seems (in this small study) that those who used both drugs in combination, as opposed to using Clozaril alone, gain less weight, while having as good or better control of the psychosis.
>
> I wish the dumbass drug companies (there go a few more job opportunities < sigh >) would drops their egos (and some of their potential profits) to try combinations like this, to see if we can get combinations of drugs (not just antipsychotics) that will maximize efficacy, while minimizing adverse effects.
>
> Cam (stepping down off his soapbox, shaking the clouds from his hair, and going off to check the want ads, again)
Posted by Chloe on January 1, 2002, at 19:20:51
In reply to Re: Cam:antipsychotic question, posted by OldSchool on January 1, 2002, at 18:26:30
> You can avoid neuroleptics by going back to the basics of psychiatry and having ECT instead.
>
> Bilateral ECT has powerful dual antidepressant/anti-psychotic effects, which can come in handy with mood disordered folks who have psychotic features such as "distorted thinking." ECT does not carry with it the danger of inducing movement disorders like EPS and TD.
>
> Bilateral ECT is the single most effective treatment for mood disorders with psychotic features and all the literature you will read will back that up.
>Old School,
You seem to be a real advocate for ECT. Have you ever had any treatments? Do you have any first hand knowlegde of this or seen any patients truly respond to ECT in the LONG TERM?ECT, though it has come a long way since it's inception, is still a "risky" treatment. Many people have had several rounds of ECT and had no benefit and had a major loss of memory and ability to think and process information. I think you offer this treatment as some kind of miracle cure for distorted thinging and mood disorders. When there is no assurance that it's going to help, and just may cause PERMANENT impairment cognitively (versus physically-TD and EPS).
I also must add, that ECT is expensive and may even require hospitalization for the duration...Not to mention the social stigma...And I don't know that this is a long term solution. The instigation of some maintaince medication will inevitably be needed post ECT, hence the side effect problem again.
I have read much about ECT being a good LAST RESORT therapy for people who are stuck in a deep resistant depression, or who are flagrantly psychotic, ie. completely in their own world and out of touch with reality. BUT for the average patient, who may have distorted thinking as part of a bipolar 2, rapid cycling and paraniod tendencies, I am not sure a series of zaps to the brain is worth the gamble.
Do you know of any bipolar patients who have benefited from ECT? I am not aware of it being used for this with any success. Depression, yes, but not for bipolar, cycling, rage and paranoia. Could you point me to studies if you know of any.
Thanks
Chloe
Posted by OldSchool on January 1, 2002, at 20:05:21
In reply to Re:ECT over AP's? » OldSchool, posted by Chloe on January 1, 2002, at 19:20:51
>
> Old School,
> You seem to be a real advocate for ECT. Have you ever had any treatments? Do you have any first hand knowlegde of this or seen any patients truly respond to ECT in the LONG TERM?I have never had ECT myself. However I am seriously considering it and have had it recommended to me multiple times. I oftentimes wish I had just gone and "gotten shocked" back in the beginning of my severe depression. I wonder sometimes had I done this early on in my illness, maybe I would have fully recovered early on and wouldnt be a chronic mental patient today.
ECT's primary side effect is memory loss. My depression, which is very severe (about as severe as it can get actually) has totally destroyed my memory and pretty much all cognition. Ive improved some with heavy medication and exercise, but have never achieved anything remotely close to what could be considered full remission.
Severe depression destroys cognition all by itself, no ECT involved. So I am of the opinion that ECT, while it causes short term memory loss, it also has the highest rates of FULL REMISSION of depression of any treatment known in psychiatry. If you achieve FULL REMISSION of your mood disorder, your cognition is going to fully return, which includes your memory.
I dont have to worry about movement disorders with ECT like I do if I take anti-psychotics. I dont have to worry about screwing up my blood pressure with ECT like if I take MAOIs. With ECT the worst thing about it is the social stigma and the memory loss.
>
> ECT, though it has come a long way since it's inception, is still a "risky" treatment.Oh really? Are you sure about that? Its that "risky?" Thats not what Ive been reading about it. Taking anti-psychotic drugs for a mood disorder for long periods in my opinion is quite "risky." Certainly at least as risky as ECT.
> Many people have had several rounds of ECT and had no benefit and had a major loss of memory and ability to think and process information.
I have heard of very few individuals who had ECT and it didnt blast them out of severe depression. Its efficacy for severe mood disorders is unsurpassed.
> I think you offer this treatment as some kind of miracle cure for distorted thinging and mood disorders.
Well, honestly, ECT is just about a "miracle cure" for mood disorders with psychotic features.
>When there is no assurance that it's going to help, and just may cause PERMANENT impairment cognitively (versus physically-TD and EPS).Movement disorders are quite serious. Certainly more serious than some memory loss, IMO.
>
> I also must add, that ECT is expensive and may even require hospitalization for the duration...Not to mention the social stigma...And I don't know that this is a long term solution. The instigation of some maintaince medication will inevitably be needed post ECT, hence the side effect problem again.Yes, ECT is expensive. However most insurance plans will cover it. ECT has become known as the "rich man's way out of severe depression." Unlike thirty or forty years ago when ECT was frequently done at many state mental institutions and forced on unwilling patients, now its mostly done only at the better quality teaching hospitals in private settings. Again its become known as the depression treatment for the affluent. Many celebrities and rock stars have had ECT, when they came out of recreational drug induced psychotic depressions and manic episodes.
>
> I have read much about ECT being a good LAST RESORT therapy for people who are stuck in a deep resistant depression, or who are flagrantly psychotic, ie. completely in their own world and out of touch with reality. BUT for the average patient, who may have distorted thinking as part of a bipolar 2, rapid cycling and paraniod tendencies, I am not sure a series of zaps to the brain is worth the gamble.Um...in my opinion when you resort to taking seroquel for a mood disorder, you are pretty bad off. Just my personal opinion. Thats pretty serious.
>
> Do you know of any bipolar patients who have benefited from ECT? I am not aware of it being used for this with any success. Depression, yes, but not for bipolar, cycling, rage and paranoia. Could you point me to studies if you know of any.ECT is used for all mood disorders. Unipolar major depression, manic depression, psychotic depression, medication resistant depression, refractory schizophrenia. It even has off label uses for parkinsons and drug induced movement disorders.
ECT has anti-psychotic and anti-parkinsons effects all at the same time...wild huh?
Here are some good links to credible websites that discuss ECT for mood disorders:
http://www.mhsource.com/pt/p010621.html
This article is from the American College of Neuropsychopharmacology and is really good...covers everything about ECT. This article about ECT mentions that 80% of those experiencing full mania achieved full remission after ECT!
http://www.acnp.org/G4/GN401000108/Default.htm
And this article discusses ECT treatment of bipolar mania specifically:
http://www.electroshock.org/archives/BMJ_Editorial_Bipolar_Treatment.htm
Remember one of the things that ECT does is it pushes up the seizure threshhold, thus it creates a strong anticonvulsant action. Anti-convulsants are some of the primary drugs used to treat bipolar disorder. ECT is indeed as effective for bipolar disorder as it is for severe depression.
Old School
>
> Thanks
> Chloe
Posted by akc on January 1, 2002, at 20:41:01
In reply to Re:ECT over AP's? » OldSchool, posted by Chloe on January 1, 2002, at 19:20:51
I guess I always wonder when someone comes along and starts saying that a med or a treatment or whatever is bad or good. The tone of some of these posts have been pretty on the downside of AP's in general (seroquel in particular). And other posts seem to preach ECT as the cure-all. I am certain that for some, AP's have been a nightmare and for some ECT has offered a great cure. But I would guess the opposite is also true. I know one thing, because most of us here are not professional researchers, it sure would help me if people would talk about their experience. For instance, when I was on zyprexa (along with other stuff), I gained 60 pounds. Since I have been on seroquel (along with some other stuff), I have added about 5 more, depending on the week. For me, the zyprexa was great for my distorted thinking, but I couldn't handle the weight gain. For me, the seroquel doesn't do quite as good a job with the thinking, but I'm not gaining the weight. Journal articles are also useful, but it is these personal experiences that help me most. Reading on this board how many people struggle with weight gain while on zyprexa -- well, it made me feel less of a fat slob. When dealing with depression and distorted thinking, that is a useful piece of information for me to have. To have someone come along and share his or her horrible experience with AP's -- while I might not be having the problem now, or am not on that drug now, it is something I can file away. But when a person talks in generalities, while it scares me, I wonder what is really going on. Why the need to convert all? As has been pointed out, what works for one, may not work for another -- I'm just don't think is wise to be throwing the baby out with the bathwater. ECT may save one, but zyprexa or seroquel may save another. And they both have risks. We just have to weigh the risks. And the more personal stories I get, the better I can make that decision.
akc
Posted by OldSchool on January 1, 2002, at 21:19:24
In reply to The Sky is Falling, posted by akc on January 1, 2002, at 20:41:01
> I guess I always wonder when someone comes along and starts saying that a med or a treatment or whatever is bad or good. The tone of some of these posts have been pretty on the downside of AP's in general (seroquel in particular). And other posts seem to preach ECT as the cure-all. I am certain that for some, AP's have been a nightmare and for some ECT has offered a great cure. But I would guess the opposite is also true. I know one thing, because most of us here are not professional researchers, it sure would help me if people would talk about their experience. For instance, when I was on zyprexa (along with other stuff), I gained 60 pounds. Since I have been on seroquel (along with some other stuff), I have added about 5 more, depending on the week. For me, the zyprexa was great for my distorted thinking, but I couldn't handle the weight gain. For me, the seroquel doesn't do quite as good a job with the thinking, but I'm not gaining the weight. Journal articles are also useful, but it is these personal experiences that help me most. Reading on this board how many people struggle with weight gain while on zyprexa -- well, it made me feel less of a fat slob. When dealing with depression and distorted thinking, that is a useful piece of information for me to have. To have someone come along and share his or her horrible experience with AP's -- while I might not be having the problem now, or am not on that drug now, it is something I can file away. But when a person talks in generalities, while it scares me, I wonder what is really going on. Why the need to convert all? As has been pointed out, what works for one, may not work for another -- I'm just don't think is wise to be throwing the baby out with the bathwater. ECT may save one, but zyprexa or seroquel may save another. And they both have risks. We just have to weigh the risks. And the more personal stories I get, the better I can make that decision.
>
> akc
AKC, Im just trying to point out objective facts about some of the treatments for hard to treat mood disorders. Such as atypical anti-psychotic augmentation and old fashioned ECT.The facts for atypical anti-psychotics are:
1) the risk factor for development of movement disorders is NOT zero or nil, as the pharmaceutical companies would like to have us believe. This is particularly true for people who have primarily mood disorders, like depression.
2) movement disorders, once developed can be difficult to get rid of and can greatly complicate treatment. Normally thought of only in relation to schizophrenia, movement disorders also can occur in those with depression who have been treated with atypical anti-psychotics.
its these mood disordered folks who get hit by movement disorders that is especially sad. With schizophrenia/schizoaffective, you kind of expect it eventually. But why should someone with depression end up with a numb tongue or stiff muscles? Thats fucked up and I dont think it ought to be tolerated.
2) atypical anti-psychotics significantly raise blood sugar and can induce diabetes. These drugs also cause obesity.
The facts for ECT are:
1) the main side effect is memory loss. Usually short term memory loss, around the time of the ECT.
2) social stigma is high, because of the way ECT was used in the past before psychiatry reform
3) ECT is psychologically scary, because people are afraid of electricity.
But ECT doesnt raise blood sugar levels, make you fat, cause diabetes or cause movement disorders. In fact ECT gets the dopamine flowing good and makes you loose as a goose. Do you see my point? ECT is devoid of the many drug side effects so many complain about.
Old School
Posted by shellir on January 1, 2002, at 23:10:35
In reply to Re: The Sky is Falling, posted by OldSchool on January 1, 2002, at 21:19:24
Well, I'm with Old School here: personally I would rather take the risks of ECT (unilateral, anyway), than the risks of any AP, atypical or otherwise.
I've been researching ECT for a while, and have not found any long term memory effects reported by unilateral ECT. I also spent some time several weeks ago with a woman receiving unilateral ECT who after five sessions had not experienced any memory loss.
As far as the atypical APs, last doctor has had several patients who have developed TD after being on serequel--and my understanding is that they were not on it for years and years. The atypical ADs begain to come out ten years ago, and I find it appaulling that I am unable to find any stats on TD, for people who have been on these drugs for five years, or even one year.
The good news is that my pdoc said that both her "cases" of TD were resolved within four months. As a photographer, however, TD would mean an absolute hiatus from my business until resolution. So if both ECT and an AP yielded the same results, I would take my chances for ECT, at this point in my life, anyway.
Actually now I am on opiates again to control my depression, and of course this is still another imperfect solution. In my case, however, it seems like the best of the imperfect options, and hopefully, I'll find a different solution before I run out, and have to resort to mulitiple doctors and multiple lies.
Shelli
Posted by Chris A. on January 2, 2002, at 1:36:47
In reply to Re: The Sky is Falling, posted by OldSchool on January 1, 2002, at 21:19:24
Don't knock the potential cognitive losses ECT can impose. For me they have been devasting. A taste of TD also leaves me shunning APs. When I bring these subjects up I have a therapist who says "You're still alive. Perhaps they helped." Frankly I'll never know, but I don't want to revisit either APs or ECT. Risk vs benefit. We will never be able to get away from it. I made choices I regret, but made them with the best information available to me at the time.
ECT and APs can save lives. Intellectuallly that's a no-brainer. Personally ... that's another matter.Chris A.
Posted by shellir on January 2, 2002, at 10:29:59
In reply to Be careful, posted by Chris A. on January 2, 2002, at 1:36:47
> Don't knock the potential cognitive losses ECT can impose. For me they have been devasting. A taste of TD also leaves me shunning APs. When I bring these subjects up I have a therapist who says "You're still alive. Perhaps they helped." Frankly I'll never know, but I don't want to revisit either APs or ECT. Risk vs benefit. We will never be able to get away from it. I made choices I regret, but made them with the best information available to me at the time.
> ECT and APs can save lives. Intellectuallly that's a no-brainer. Personally ... that's another matter.
>
> Chris A.
Hi Chris,Thanks for the feedback: any information I can get on ECT, positive or negative, is very useful to me. I am in a much better position this week to not determine my next step out of desperation.
But I am extremely interested in knowing whether your cognitive impairment was as a consequence of unilateral or bilateral ECT. I know you're not anxious to revisit, but this information might help me make more rational decisions, since so far I have not come upon any information about significant memory impairment and unilateral ECT.
TIA for any feedback you're willing to offer.
Shelli
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