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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by judy1 on March 31, 2004, at 18:13:35
I've always been given APs for auditory hallucinations (a common symptom of both manic and depressive epiosdes) but have noticed that the effect is not actually getting rid of the voice(s), but more of 'I don't care and I'm tired'. My question is if anyone else is given this class of drugs for similar symptoms, do they actually get rid of the voice, and if not what do you feel. Got into an interesting discussion with my therp today about this, apparently she has another client with a similar response, but while my dx is bipolar 1, her dx is either DD-NOS or DID.
thanks for any input- judy
Posted by SLS on March 31, 2004, at 18:32:29
In reply to A question on APs, posted by judy1 on March 31, 2004, at 18:13:35
> I've always been given APs for auditory hallucinations (a common symptom of both manic and depressive epiosdes)
Hi Judy.
Do you actually "hear" voices as an auditory event or are they more like intrusive thoughts?
- Scott
Posted by jack9999 on March 31, 2004, at 21:21:00
In reply to A question on APs, posted by judy1 on March 31, 2004, at 18:13:35
My wife was put on AP's for a bad manic episode. The horrible thing is, she never heard voices until she was put on AP's! The more voices she heard, the more her AP's were increased, and the worse things got. It has been a horrible 9 months, but we are slowly taking her off the AP's and she seems to be getting better. If you ever come off AP's be aware that a withdrawl reaction will probably happen where the voices will get worse (your brain is dealing with hypersensitve neurons and it takes a while to adjust to the drug not being there). After a month or so, things will calm down (your brain has adjusted) and you may start to feel better. It takes patience.
AP's are HARD on the body - look into B vitamins and Fish Oil to help with your mania. they really work!! Has helped my wife.
Search "orthomolecular psychiatry" on the web.
Good luck and God bless.
Posted by judy1 on April 1, 2004, at 11:30:46
In reply to Re: A question on APs, posted by SLS on March 31, 2004, at 18:32:29
Hi Scott,
Yes, unfortunately I actually hear voices rather than intrusive thoughts. It's more prevalent with severe depressions rather than manic episodes- probably because I'm treated earlier with mania (it's a lot easier to hide depessive symptoms than being 'floridly' manic).
take care, judy
Posted by judy1 on April 1, 2004, at 11:42:35
In reply to Re: A question on APs, posted by jack9999 on March 31, 2004, at 21:21:00
Hi,
I'm sorry your wife had such a disastrous response to APs- which one was she on? I agree as a group they are awful- they are a last ditch med for me. My former shrink (don't have a new one yet) tended to agree they caused more harm than good, but sometimes even in a relatively mild manic episode I get so agitated that benzos can't slow me down and APs (or the major tranquilizers) can stop anyone. I've had all types of side-effects- mostly EPS, but never had an actual induction of voices because of an AP. what did her drs. say? I can see why you are angry at the traditional psychiatric profession, I feel much the same way as you. The positive is that I don't stay on APs very long- maybe 2 or 3 weeks (usually zyprexa), so any withdrawal is fairly mild.
I have done the fish oil program (try a search on the site- a few of us have), unfortunately I didn't have much luck. There is a sub-group of people with bipolar disorder where frankly NOTHING works, I'm part of it and have learned to medicate symptoms rather than stay on a program of medication (after years of trying every conceivable mood stabilzer and combo with other meds).
I hope your wife continues to feel better and I'm glad you are seeking alternative treatments.
take care, judy
Posted by SLS on April 1, 2004, at 19:00:09
In reply to Re: A question on APs » jack9999, posted by judy1 on April 1, 2004, at 11:42:35
Hi Judy.
It has been quite a while since I read into TD and risk factors, so I don't know if this idea is still in circulation. Some of the stuff I read indicated that the risk of developing TD was greater for people who cycled on and off APs than for those who remained on them continually. It was recommended that there should be no drug holidays.
I don't know. Maybe you would be better off staying on an effective atypical? What do you think?
- Scott
Posted by judy1 on April 2, 2004, at 10:31:21
In reply to Re: A question on APs » judy1, posted by SLS on April 1, 2004, at 19:00:09
Hi Scott,
Did the literature you read make you feel confident that the research was done correctly? I know you've read enough scientific articles to question who is behind the funding, the role of placebos, etc.- if you feel that the studies proved that cycling off and on atypicals was detimental then I accept those findings. (I know something similar was found with lithium, but i've also read studies that disproved that).
My side-effects can be quite frightening to me on atypicals- not just weight gain (although that is difficult for someone prone to bulimia); it's the dystonia that scares me, the possibility of permanancy. I've taken cogentin when my shaking is really bad, that helps somewhat. I guess to be honest this group, and I include the older ones like haldol just plain worries me. have you taken any APs long term- and if so which ones? and did you experience any permanant side-effects?
thanks, judy
Posted by SLS on April 2, 2004, at 17:46:34
In reply to Re: A question on APs » SLS, posted by judy1 on April 2, 2004, at 10:31:21
Hi Judy.
> Did the literature you read make you feel confident that the research was done correctly?
No.
> I know you've read enough scientific articles to question who is behind the funding, the role of placebos, etc.- if you feel that the studies proved that cycling off and on atypicals was detrimental then I accept those findings.
At this point, I would still want to scrutinize the evidence or rationale for this contention. I really don't know what to make of it, but I did see it in more than one place. However, I have witnessed the misinterpretation of a single faulty investigation of a drug (modafinil) being embraced and passed along as a putative and established fact, most often in the absence of citation.
> (I know something similar was found with lithium, but i've also read studies that disproved that).
Did that involve its discontinuation and subsequent non-response once it was restarted? I think the term given to this speculative phenomenon was "lithium discontinuation induced lithium refractoriness". Robert Post and his collegues at the NIMH suggested this about 10 years ago. I believe that it is possible, despite more recent assurances to the contrary.
> My side-effects can be quite frightening to me on atypicals- not just weight gain (although that is difficult for someone prone to bulimia); it's the dystonia that scares me, the possibility of permanancy.
I do recall how severe your reactions have been to APs in general, but I thought you had found one that you tolerated well. Yes, I would be scared to death. I have been taking Abilify 10mg for the last year. I have experienced no abnormal movements at all. Because of the seriousness of my condition, I eventually came to feel that the risk versus benefit of using atypical APs continuously was acceptable. I would have no problem taking Zyprexa long term. However, it is very possible that you are a member of a very small minority of people who would develop TD while using these newer drugs. EPS of one type or another has been reported with all of them. Actually, you might be a candidate for using clozapine (Clozaril). It is usually reserved for more stubborn cases because one needs to go for biweekly blood tests to screen for agranulocyctosis. However, it is actually used sometimes to treat TD. The risk of TD with clozapine is considered to be the lowest, although many would argue that quetiapine (Seroquel) has near zero liability.
I would not feel comfortable either encouraging you or discouraging you to use an AP as long-term maintenance therapy. Because the ramifications of making such a decision are so weighty, I just wanted to draw your attention to a potentially critical issue regarding TD and episodic use of APs. I have also seen it suggested by some that the mere appearance of dystonic EPS early in treatment is a prognosticator of the eventual development of TD. Yet, others have cast doubt upon this contention as well. It is hard to know who's right and who's wrong. I hope I haven't upset you. I just want to see you well.
:-)
- Scott
Posted by SLS on April 2, 2004, at 17:52:18
In reply to Re: A question on APs » judy1, posted by SLS on April 2, 2004, at 17:46:34
Judy,
By the way, have you ever tried using clonazepam (Klonopin)? Just a thought.
- Scott
Posted by judy1 on April 3, 2004, at 12:16:53
In reply to Re: A question on APs » judy1, posted by SLS on April 2, 2004, at 17:46:34
I value your opinion so much. I know how much you read (as do I), but there are so many articles published that are in direct contradiction to each other that I've begun to pay more attention to who funds it, etc.
Yes, the lithium study was based on loss of efficacy after going on and off of it (rehashing Post's work) and then studies that proved otherwise. I think lithium is one of those meds that work for a sub-group of people with bipolar disorder (and works well), I am not one of them.
I have considered clozapine, the negative of course is the need for constant testing, something I'm not capable of when in a manic state. The alternative, seroquel, actually doesn't have side-effects for me- it does it's job of sedation but as I mentioned in my initial post- it (along with other APs) does not get rid of auditory hallucinations.
I'm really glad that ablify has helped you- what symptoms does it work for and have you had any side-effects?
thank you, judy
Posted by judy1 on April 3, 2004, at 12:21:51
In reply to Re: A question on APs, posted by SLS on April 2, 2004, at 17:52:18
Yes, klonopin is a med I've taken for 7 years. It pretty much halted any panic attacks (for a comorbid panic disorder), and I honestly feel better on it than off it. I know some consider it a secondary mood stabilizer, but it does not prevent manic episodes for me. I take 2mg tid, a pretty hefty dose. Sometimes I question if it makes me feel depressed (something I don't feel on xanax), but I'm referring to mild depression.
take care, judy
Posted by SLS on April 3, 2004, at 15:53:25
In reply to of course you haven't upset me » SLS, posted by judy1 on April 3, 2004, at 12:16:53
> I'm really glad that ablify has helped you- what symptoms does it work for and have you had any side-effects?
I remember feeling a sort of anxiousness during the first few weeks. I don't know if it was a sort of mild akathisia or not. Abilify is noted for its tendency to produce akathisia, insomnia, and anxiety, at least early in treatment. It seemingly has a low risk of producing abnormal movements, though. The anxiousness that I felt in the beginning completely disappeared.
For me, Abilify helps to take the edge off of agitation and suicidal states. It also has given me a mild boost in mental energy and an increase in sociability. My uneducated guess is that it would be less effective treating hallucinations than Risperdal.
- Scott
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