Psycho-Babble Medication Thread 528069

Shown: posts 1 to 15 of 15. This is the beginning of the thread.

 

AP Akathisia ... does it go away?? Amant. helpful?

Posted by cache-monkey on July 15, 2005, at 13:42:05

Hey all,

I've been running through the various atypical APs. Mostly for anxiety/depression and to avoid the hypomania that happened the last time I went on an AD without a moodstabilizer. I seem to be having the same problem with the three APs that I've tried (Seroquel, Zyprexa, and now Geodon). Namely, akathisia: restlessness/jitteriness, increased agitation, bouncy legs.

I understand that this is a somewhat common side effect of the APs. What I'm wondering is: will it resolve on its own at some point? Or should I expect it to more or less be present until I reduce my dose or stop the med completely?

Also, my pdoc prescribed amantadine as a possible way of reducing it (and to help with quitting smoking). Has anyone tried this/found it to be helpful with akathisia?

Thanks!
cache-monkey

 

Re: AP Akathisia ... does it go away?? Amant. help

Posted by med_empowered on July 16, 2005, at 3:23:57

In reply to AP Akathisia ... does it go away?? Amant. helpful?, posted by cache-monkey on July 15, 2005, at 13:42:05

amant. is kind of popular for akathisia...the old-school, tried-and-true (and CHEAP) remedies are: dipenhydramine (Benadryl in the US; 25-50mgs as needed), propranolol, and benzodiazpenes (ativan and klonopin seem to be pretty popular). Cogentin is used for some EPS as well. Speaking from personal experience, akathisia doesn't really "go away" with add on meds. I mean, I personally felt better, but I still had moments of total and complete inner-torment. Once, on Seroquel, I couldnt stop moving about and I started crying my eyes out. It was awful, simply awful.

 

Re: AP Akathisia ... does it go away?? Amant. help med_empowered

Posted by ed_uk on July 16, 2005, at 8:37:37

In reply to Re: AP Akathisia ... does it go away?? Amant. help, posted by med_empowered on July 16, 2005, at 3:23:57

Hi Med,

>total and complete inner-torment.....

That was an excellent description. Did you ever try procyclidine for the akathisia?

Kind regards

~Ed

 

Re: AP Akathisia ... does it go away?? Amant. help

Posted by Declan on July 16, 2005, at 16:20:11

In reply to Re: AP Akathisia ... does it go away?? Amant. help, posted by med_empowered on July 16, 2005, at 3:23:57

So Seroquel can do that? It is an awful feeling.
Declan

 

Re: AP Akathisia ... does it go away?? Amant. help

Posted by cache-monkey on July 16, 2005, at 17:49:27

In reply to Re: AP Akathisia ... does it go away?? Amant. help, posted by Declan on July 16, 2005, at 16:20:11

> So Seroquel can do that? It is an awful feeling.
> Declan

Yeah, I got it on a really low dose (50 mg). I think I have very sensitive (or few) D-2 receptors or something...

~cache-monkey

 

Re: AP Akathisia ... does it go away?? Amant. help med_empowered

Posted by cache-monkey on July 16, 2005, at 17:51:32

In reply to Re: AP Akathisia ... does it go away?? Amant. help, posted by med_empowered on July 16, 2005, at 3:23:57

<< Speaking from personal experience, akathisia doesn't really "go away" with add on meds. I mean, I personally felt better, but I still had moments of total and complete inner-torment. Once, on Seroquel, I couldnt stop moving about and I started crying my eyes out. It was awful, simply awful.>>

Sounds like a horrible experience. I'm sorry you had to go through that. One thing: when I wondered about akathisia "going away", what I meant was: assuming I do nothing and stay on the same dose, will it get better? Or am I probably stuck with it for the whole time I'm on the med?

Thanks,
cache-monkey

 

Re: AP Akathisia ... does it go away?? Amant. helpful? cache-monkey

Posted by ed_uk on July 17, 2005, at 6:44:41

In reply to AP Akathisia ... does it go away?? Amant. helpful?, posted by cache-monkey on July 15, 2005, at 13:42:05

Hi Cache,

I think it might be best to discontinue the AP. In the mean time, you could try procyclidine for the akathisia.

~Ed

 

Re: AP Akathisia ... does it go away?? Amant. helpful? ed_uk

Posted by cache-monkey on July 17, 2005, at 14:49:08

In reply to Re: AP Akathisia ... does it go away?? Amant. helpful? cache-monkey, posted by ed_uk on July 17, 2005, at 6:44:41

Hey Ed,

That's the way I'm leaning right now. It's nice to have somone confirm that decision. I'm going to first cut down the Geodon from (20 mg x 2) to (10 mg x 2) and see if things improve. If I still feel the akathisia business, I'll d/c entirely.

I think I'm pretty susceptible to akathisia from the D-2 blockade. I've had similar reactions to BuSpar and all three of the AAPs I've tried. Also, given that I'd like to quit smoking at some point, D-2 antagonism seems counterproductive.

~cache-monkey

> Hi Cache,
>
> I think it might be best to discontinue the AP. In the mean time, you could try procyclidine for the akathisia.
>
> ~Ed

 

Re: AP Akathisia ... does it go away?? Amant. helpful? cache-monkey

Posted by ed_uk on July 17, 2005, at 15:40:45

In reply to Re: AP Akathisia ... does it go away?? Amant. helpful? ed_uk, posted by cache-monkey on July 17, 2005, at 14:49:08

Hi cm!

>I'm going to first cut down the Geodon from (20 mg x 2) to (10 mg x 2) and see if things improve.

I think that's a good idea :-) Perhaps a low dose will provide some 5-HT2 antagonism without affecting D2 receptors very much.

It sounds like D2 antagonism just isn't what you need. It's certainly not what I need! I even get akathisia from Phenergan, an antihistamine with weak D2 antagonism. It makes me feel absolutely dreadful!

Kind regards

~Ed

 

D-2 blockade, Akathisia, Amantadine, Smoking ed_uk

Posted by cache-monkey on July 19, 2005, at 1:04:55

In reply to Re: AP Akathisia ... does it go away?? Amant. helpful? cache-monkey, posted by ed_uk on July 17, 2005, at 15:40:45

<< It sounds like D2 antagonism just isn't what you need. It's certainly not what I need! I even get akathisia from Phenergan, an antihistamine with weak D2 antagonism. It makes me feel absolutely dreadful! >>

It's good to know that I'm not alone here. Out of curiosity, how, exactly, does it feel for you when your D-2 receptors get blocked?

For me it's this very energetic, kinetic kind of anxiety. I find it really hard to keep my mind still, and I feel very negative about everything (almost a sense of impending doom, or maybe hopelessness).

Amantadine actually made me feel worse. Even more energized, but negatively and wholly unable to focus. I'm now on my second day of the lower dose of Geodon and might be feeling a little better. Too early to tell, though.

Actually, given that one of my main treatment goals is to quit smoking, Geodon might be a bad thing. I read this study comparing Haldol-Bromocriptine-placebo. The upshot was that Haldol (D-2 blocker) increased smoking behaviour, while Bromo (D-2 agonist) reduced it.

One thing I'm worried about, though: does agonising the a receptor lead to down-regulation? I.e. if I take bromocriptine to quit smoking would I have problems after withdrawing the drug because I have still fewer D-2 receptors?

If you have a moment, I'd appreciate your thoughts.

Best,
cache-monkey

 

Re: D-2 blockade, Akathisia, Amantadine, Smoking cache-monkey

Posted by ed_uk on July 19, 2005, at 17:38:53

In reply to D-2 blockade, Akathisia, Amantadine, Smoking ed_uk, posted by cache-monkey on July 19, 2005, at 1:04:55

Hi,

>Out of curiosity, how, exactly, does it feel for you when your D-2 receptors get blocked?

Absolutely dreadful. I had to go to the ER after I took Thorazine. I needed 60mg Valium to calm my agitation and akathisia. I was writhing. I wished I was dead. I felt overwhelming panic and extreme motor restlessness. I couldn't be still for more than a second. I felt awful from head to toe, like my muscles were going to explode. I couldn't think normally either, I felt quite confused.

>Amantadine actually made me feel worse.

Have you tried an anticholinergic? I'm not recommending it I'm just curious. I think it would be better to d/c the AP if it isn't helpful at a lower dose.

>One thing I'm worried about, though: does agonising the a receptor lead to down-regulation?

It can do. I'm not sure whether this applies to the D2 receptor though.

Kind regards

~Ed

 

Re: D-2 blockade, Akathisia, Amantadine, Smoking ed_uk

Posted by cache-monkey on July 20, 2005, at 13:20:39

In reply to Re: D-2 blockade, Akathisia, Amantadine, Smoking cache-monkey, posted by ed_uk on July 19, 2005, at 17:38:53

Thanks, Ed!

 

Re: AP Akathisia ... does it go away?? Amant. help cache-monkey

Posted by Chairman_MAO on July 20, 2005, at 20:47:45

In reply to AP Akathisia ... does it go away?? Amant. helpful?, posted by cache-monkey on July 15, 2005, at 13:42:05

Amantadine will work, but it makes a lot of people feel "loopy". My DA agonist of choice is cabergoline (once daily dosing and superb side effect profile); any D2 agonist should work for akathesia, though.

It's good that your doctor brought up amantadine, though, as the other commonly prescribed [anticholinergic] drugs for akathesia (trihexyphenidyl and benztropine) induce a mild dementia in many people.

 

Re: AP Akathisia ... does it go away?? Amant. help cache-monkey

Posted by Chairman_MAO on July 21, 2005, at 15:53:47

In reply to AP Akathisia ... does it go away?? Amant. helpful?, posted by cache-monkey on July 15, 2005, at 13:42:05

Amantadine will work, but it makes a lot of people feel "loopy". My DA agonist of choice is cabergoline (once daily dosing and superb side effect profile); any D2 agonist should work for akathesia, though.

It's good that your doctor brought up amantadine, though, as the other commonly prescribed [anticholinergic] drugs for akathesia (trihexyphenidyl and benztropine) induce a mild dementia in many people.

 

Re: AP Akathisia ... does it go away?? Amant. help

Posted by cache-monkey on July 23, 2005, at 16:36:45

In reply to Re: AP Akathisia ... does it go away?? Amant. help cache-monkey, posted by Chairman_MAO on July 21, 2005, at 15:53:47

Sounds like your pdoc is willing to go further off-label than mine... I tried to get mine to RX bromocriptine, since it has fairly strong D2 agonism. There are also a few small studies that show it's potential benefit with quitting smoking. But, my doc insisted on AMT. It made me feel even crazier. Rushing, unfocussed thoughts. On top of agitated bounciness. Not fun.

Now I'm down to lithium and Klonopin. And I think that even the Li is agitating me some... This whole process of finding the right meds sucks. You know it's bad when you wish you just had basic plain-vanilla depression.

~cache-monkey

> Amantadine will work, but it makes a lot of people feel "loopy". My DA agonist of choice is cabergoline (once daily dosing and superb side effect profile); any D2 agonist should work for akathesia, though.
>
> It's good that your doctor brought up amantadine, though, as the other commonly prescribed [anticholinergic] drugs for akathesia (trihexyphenidyl and benztropine) induce a mild dementia in many people.


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