Psycho-Babble Medication Thread 544502

Shown: posts 1 to 25 of 26. This is the beginning of the thread.

 

Cymbalta / ADs and repetitive hand motions

Posted by Galen on August 20, 2005, at 19:38:32

My ex-husband (father of my child) has been on antidepressants for more than a decade. He had great success with Serzone, but it pooped out after a while. He then started taking another AD (like Serzone, but I can't remember the name). About two years ago, he started making unconscious hand motions -- flexing his hands rhythmically, tapping his hands, and most often repetitively rubbing his thumb across his fingers. It seemed a little idiosyncratic, but he clearly enjoyed doing it.

Four months ago he had a concussion, which caused a lot of problems: anxiety, depression, a change in personality for a while. His shrink put him on Cymbalta. Since then his hands are in near-constant motion. It is not involuntary -- he can stop the motions if he wants to. However, the motions seem to be initiated unconsciously: when he drives, reads, watches TV, or sits down for a minute the thumb-finger rubbing and tapping and hand flexing start right up. I've known the man for 20 years and have never particularly noticed him speaking with his hands, but now, his speech is also accompanied by a lot of (sort of unusual) hand motion.

Any idea what this is? I've browsed the Web and come across terms like stereotypies, tics, akathisia, athetosis -- can't say I really understand these terms, but none of them exactly fit the bill (except probably stereotypies). The motions seem odd to me and I keep hoping my exes' shrink will notice, but the shrink hasn't known him long and it's likely my ex controls his hands more in a focused interview. The ex does not view his hand motions as a problem, but I'm not sure he realizes how much he does it.

And maybe it isn't a problem, though it seems to me Cymbalta has made this habit(?) much worse. What I'm really wondering is whether this is a symptom of some kind of neurologic condition.

Has anyone else experienced this? Any thoughts on what it might be?

 

Re: Cymbalta / ADs and repetitive hand motions

Posted by linkadge on August 20, 2005, at 21:43:29

In reply to Cymbalta / ADs and repetitive hand motions, posted by Galen on August 20, 2005, at 19:38:32

I had some similar problems initiated by ADs. For me it was a need to scrape my thumb against my index finger.

Strange.

Linkadge

 

Re: Cymbalta / ADs and repetitive hand motions » Galen

Posted by theo on August 20, 2005, at 23:06:41

In reply to Cymbalta / ADs and repetitive hand motions, posted by Galen on August 20, 2005, at 19:38:32

I had this with SSRI's like Paxil and Prozac. Whenever I would start Paxil, I would rub my index and thumbnail to where I would have grooves in these nails. Also a little jaw and teeth clinching.

With Prozac, I would catch myself rubbing my middle finger against my thumb so much I would notice myself creating a blister.

WEIRD!

 

Re: Cymbalta / ADs and repetitive hand motions

Posted by yxibow on August 20, 2005, at 23:52:56

In reply to Re: Cymbalta / ADs and repetitive hand motions » Galen, posted by theo on August 20, 2005, at 23:06:41

Its possible its subclinical Tardive Dyskinesia because the patient is not aware of the symptoms. Or it could be some tic generated by the medicines. It does sound like a stereotypy that would match one of the above but not at a level that would be considered clinically elevated (not that it doesnt concern you).

just my 2c

 

Did it stop when you went off the A/D?

Posted by Galen on August 20, 2005, at 23:56:45

In reply to Re: Cymbalta / ADs and repetitive hand motions » Galen, posted by theo on August 20, 2005, at 23:06:41

Thanks for yr responses, Theo and Linkadge.

Did it stop when you went off the AD? When you talked to your shrink did he/she have a name for it? Did they consider it a problem?

It's interesting that you both seem to have disliked your hand motions, whereas my ex seems to enjoy it. Maybe it's nothing -- it's just become so obviously idiosyncratic that it makes me wonder if something else is going on (like a kind of tardive dyskinesia or something).

It's also occurred to me that it's anxiety. But he's experienced anxiety his whole life -- and the hand thing is fairly new.

 

Re: Did it stop when you went off the A/D?

Posted by linkadge on August 21, 2005, at 0:51:54

In reply to Did it stop when you went off the A/D?, posted by Galen on August 20, 2005, at 23:56:45

For the most part this effect has gone away.

SSRI's can lower dopaminergic neurotransmission which is involved in smooth muscle control.

Linkadge

 

Re: Did it stop when you went off the A/D?

Posted by med_empowered on August 21, 2005, at 21:21:28

In reply to Re: Did it stop when you went off the A/D?, posted by linkadge on August 21, 2005, at 0:51:54

I luckily only got weird hand movements on a Tofranil+Cymbalta combo but...there have been some reports of tardive dyskinesia resulting from Effexor (I think the cases were super-high dosage,but I'm not sure). There are also some reports of TD of varying severity from things ranging from tricyclic antidepressants to amphetamines to vistaril. TD is the only explanation I can think of....although, some people tend to gesticulate a lot and move their hands a good bit in general when they're hypomanic. Maybe its a little *too much* drug induced mood elevation.

 

Re: Did it stop when you went off the A/D?

Posted by Galen on August 21, 2005, at 23:13:21

In reply to Re: Did it stop when you went off the A/D?, posted by med_empowered on August 21, 2005, at 21:21:28

I'm reading about TD. All articles say TD motions are involuntary and some say involuntary and uncontrollable. He can definitely control (i.e. stop) the rubbing and tapping and flexing. As to involuntary -- well, it's not like a facial tic. It doesn't interrupt his other activities; it's just the minute he's not doing anything else, he keeps himself occupied with hand motions.

So unless I'm misunderstanding involuntary, I don't think it's TD. The main thing that fits the description is sterotypies. My sources say they are associated with many disorders, but autism is the only one I know of.

Can A/Ds make people autistic-ish?

 

Re: Did it stop when you went off the A/D? » med_empowered

Posted by ed_uk on August 22, 2005, at 16:42:59

In reply to Re: Did it stop when you went off the A/D?, posted by med_empowered on August 21, 2005, at 21:21:28

Hi Med! :-)

AFAIK, there's a risk of TD with all SSRIs.

Kind regards

~Ed

 

Re: Did it stop when you went off the A/D?

Posted by yxibow on August 22, 2005, at 16:58:55

In reply to Re: Did it stop when you went off the A/D?, posted by Galen on August 21, 2005, at 23:13:21

> I'm reading about TD. All articles say TD motions are involuntary and some say involuntary and uncontrollable.

According to the Wirshings, et al (who are experts on TD if there is such a title), TD motions are things that are involuntary, that the patient is not generally aware of doing without being pointed out.

I've also seen articles that say that when the patient has been pointed out, they can attempt to control the motion (however unpredictible it is). The other characteristic that I'm not sure of but I think also occurs is some form of interruptability by outside interference (vocal) and transference to a different stereotypy.

>He can definitely control (i.e. stop) the rubbing and tapping and flexing. As to involuntary -- well, it's not like a facial tic. It doesn't interrupt his other activities; it's just the minute he's not doing anything else, he keeps himself occupied with hand motions.

Tics come in many varieties of ways, only a doctor could really tell that, but it doesnt quite sound like one, I agree.

>
> So unless I'm misunderstanding involuntary, I don't think it's TD. The main thing that fits the description is sterotypies. My sources say they are associated with many disorders, but autism is the only one I know of.
>
> Can A/Ds make people autistic-ish?

I doubt that.

In my opinion, and I don't recall what sort of care he is under, he should be evaluated with an AIMS examination (its a simple 12 part test of observation and interactive questions) by a competent psychiatrist who understands TD

http://www.uspharmacist.com/oldformat.asp?url=newlook/files/feat/may00tar.htm

lists such a description of the exam.

From there, you may gather more information about how to continue on.

cheers

 

Re: Did it stop when you went off the A/D?

Posted by yxibow on August 22, 2005, at 17:04:18

In reply to Re: Did it stop when you went off the A/D? » med_empowered, posted by ed_uk on August 22, 2005, at 16:42:59

> Hi Med! :-)
>
> AFAIK, there's a risk of TD with all SSRIs.
>
> Kind regards
>
> ~Ed

There is is a risk, you are right, but its miniscule within a typical dose range and usually shows multifold years more than typical antipsychotics. Zoloft is probably the worst implicator as it does swipe by the dopamine receptors more than any of the others as far as I know, and I've heard a few reports of it.

 

Re: Did it stop when you went off the A/D? » yxibow

Posted by ed_uk on August 22, 2005, at 17:27:02

In reply to Re: Did it stop when you went off the A/D?, posted by yxibow on August 22, 2005, at 17:04:18

Hi,

>There is is a risk, you are right, but its miniscule........

I agree that the risk is small. The reason I posted was because it was mentioned that there might be a risk of TD with Effexor. I don't think Effexor is any more problematic than the SSRIs RE tardive dyskinesia.

Kind regards

~Ed

 

Re: Did it stop when you went off the A/D? » yxibow

Posted by ed_uk on August 23, 2005, at 15:39:07

In reply to Re: Did it stop when you went off the A/D?, posted by yxibow on August 22, 2005, at 17:04:18

Hi yxibow,

What dose of Seroquel are you on now? I hope it's still helping.

Tidings!

~ed

 

Re: Did it stop... Seroquel

Posted by yxibow on August 23, 2005, at 15:44:39

In reply to Re: Did it stop when you went off the A/D? » yxibow, posted by ed_uk on August 23, 2005, at 15:39:07

> Hi yxibow,
>
> What dose of Seroquel are you on now? I hope it's still helping.
>
> Tidings!
>
> ~ed

900 mg at bedtime. I have been as high as 1200 and as low as 400. Its a drug that has a very wide range of dosing much beyond its standard PDR label.

cheers

 

Re: Did it stop... Seroquel » yxibow

Posted by ed_uk on August 23, 2005, at 17:05:47

In reply to Re: Did it stop... Seroquel, posted by yxibow on August 23, 2005, at 15:44:39

Hi!

Was 1200 similar to 900mg?

~Ed

 

Re: Did it stop... Seroquel

Posted by yxibow on August 24, 2005, at 0:43:38

In reply to Re: Did it stop... Seroquel » yxibow, posted by ed_uk on August 23, 2005, at 17:05:47

> Hi!
>
> Was 1200 similar to 900mg?
>
> ~Ed

1200 was more somnolescent I think, hard to say, I'm an insomniac. But after a period it produced more facial muscle trembling EPS than a lower dose as I recall. I still get it, it is not observed as TD by my doctor.

Its still annoying, sort of trembling lip and tightened muscle chords around the lower mouth region, especially after a cold milkshake or anything that really uses the oral-facial region. Not constant.

 

Re: Did it stop... Seroquel » yxibow

Posted by ed_uk on August 24, 2005, at 14:18:44

In reply to Re: Did it stop... Seroquel, posted by yxibow on August 24, 2005, at 0:43:38

Hi Y!

Have you tried an anticholinergic? A very low dose might help.

~Ed

 

Re: Did it stop... Seroquel

Posted by yxibow on August 24, 2005, at 14:37:38

In reply to Re: Did it stop... Seroquel » yxibow, posted by ed_uk on August 24, 2005, at 14:18:44

> Hi Y!
>
> Have you tried an anticholinergic? A very low dose might help.
>
> ~Ed

I've used Akineton (much better stuff) and occasionally Artane (mmph) and Cogentin (like drugged out, man) every once in a while... they may have some limited value but a higher dose is really necessary, which brings out an atropine like sense.

Since my main complaint is that my visual pathways at D2 and however else, contrast and brightness are being affected by some sort of somatiform condition, the atropine atmosphere only adds to that unfortunately :/

Even propranolol does, because it undoes the serotonin load which upgrades the dopamine. I still use the above said medicines on occasion but I guess I tough it out most of the time. As we speak I am having it.

Its possible the polypharmacy causes this to happen as well, I just started Robaxin for a 9 year old back and scalp muscle condition caused by too rapid of withdrawal of Tranxene (has never ended but its passed by the wayside and I put up with it too).

My doctor suggested a genomic profile the other day to see how my body metabolizes the drugs in my system per P450 et al. Its expensive but I might do it perhaps.

 

Re: Did it stop... Seroquel » yxibow

Posted by ed_uk on August 24, 2005, at 14:55:21

In reply to Re: Did it stop... Seroquel, posted by yxibow on August 24, 2005, at 14:37:38

Hi Y,

>Artane (mmph)

LOL, what does mmph mean?

Is 900mg S the optimum dose for you?

~Ed

 

Re: Did it stop... Seroquel

Posted by yxibow on August 24, 2005, at 15:48:50

In reply to Re: Did it stop... Seroquel » yxibow, posted by ed_uk on August 24, 2005, at 14:55:21

> Hi Y,
>
> >Artane (mmph)
>
> LOL, what does mmph mean?
>
> Is 900mg S the optimum dose for you?
>
> ~Ed

I was rating how the standard anticholinergics help or dont help me... I dont think Artane is as strong but its been a while since I've used it.

900 has been what I've been on for some time now... its more optimal than the 400 I was on for a stint several years ago. I would say though that from what my doctor generalizes, 400 is where a clinical dosage of Seroquel generally starts for people, and it goes up from there (way up sometimes). What is optimal for me is hard to say since this is such a complex problem that I seem so far to be the only one on the planet that has it which is all the more frustrating. Even the switch that I requested from Klonopin to Valium has actually made a little bit of a difference, although that taper hasnt finished yet.

Well -- somatiform disorders definately exist and people have pseudoseizures all the time but these are generally more limited episodes, not something that has lasted for 4 years although thankfully has improved a lot.

 

Re: Did it stop... Seroquel » yxibow

Posted by ed_uk on August 24, 2005, at 16:10:02

In reply to Re: Did it stop... Seroquel, posted by yxibow on August 24, 2005, at 15:48:50

Hi yxi!

>900 has been what I've been on for some time now... its more optimal than the 400 I was on for a stint several years ago.

Perhaps you could reduce the dose a little..... and still benefit - without suffering EPS?

My somatoform symptoms seem to be related to OCD, and respond best to high doses of SSRIs eg. Celexa 80mg.

Kind regards

~ed

 

Re: Seroquel, Somatiform, et al » ed_uk

Posted by yxibow on August 25, 2005, at 1:29:37

In reply to Re: Did it stop... Seroquel » yxibow, posted by ed_uk on August 24, 2005, at 16:10:02

> Hi yxi!
>
> >900 has been what I've been on for some time now... its more optimal than the 400 I was on for a stint several years ago.
>
> Perhaps you could reduce the dose a little..... and still benefit - without suffering EPS?

Its hard to say, I think I suffered some EPS between 400 and 900 regardless.. Its a compromise.. I have an affective disorder and people with affective disorders tend to have higher EPS risks than those with a different brain makeup who are afflicted by schizophreniform disorders.

I think Zyprexa would have helped me more but I suffered what I think is permanent or partially permanent mild pseudoparkinsonism that didnt go away when I stopped. Of course that could still be attributed to taking Seroquel.. its better these days anyhow although I still suffer a slightly annoying 1/2 Hz subtremor in my hands which gets a bit tiring. Its like mild arthritis or something, I dunno, if I put my hands back when I go to sleep I can feel it more. Perhaps the tremor is partially masked by the Klonopin/Valium (taperover).

Risperdal made my right 2nd finger twitch very mildly permanently (4 years going). I personally think Risperdal is atrocious stuff, its just a semi-derivative form of Haldol.

Geodon, and to my great disappointment Abilify gave me nasty akathisia to the point I was clutching pillows or carpet.


> My somatoform symptoms seem to be related to OCD, and respond best to high doses of SSRIs eg. Celexa 80mg.

Yes, I first was on Luvox for OCD, up to a substantial dose. It was used for the idea that the somatiform was related to OCD in a sort of "spectrum disorder" and also for a circular obsessive state about my main disorder, thinking 16 hours a day, etcetra, etc. That actually worked, at least for the circular part. Eventually when Duloxetine (Cymbalta) came around my doctor switched me to that to address both transmitters. Does a SSNRI work any better or worse than a SSRI, I dunno... its certainly better than Effexor. That stuff is like a caffeine IV. I tend to avoid caffeine for the most part these days, just revs my metabolism and makes things worse.


So that's the above in a run-on nutshell :)

cheers


>
> Kind regards
>
> ~ed

 

Re: Seroquel, Somatiform, et al » yxibow

Posted by ed_uk on August 25, 2005, at 15:42:47

In reply to Re: Seroquel, Somatiform, et al » ed_uk, posted by yxibow on August 25, 2005, at 1:29:37

Hi Y,

>Yes, I first was on Luvox for OCD, up to a substantial dose. It was used for the idea that the somatiform was related to OCD in a sort of "spectrum disorder" and also for a circular obsessive state about my main disorder, thinking 16 hours a day, etcetra, etc. That actually worked.....

Why did you stop taking it?

~Ed

 

Re: Seroquel, Somatiform, et al

Posted by yxibow on August 25, 2005, at 23:53:35

In reply to Re: Seroquel, Somatiform, et al » yxibow, posted by ed_uk on August 25, 2005, at 15:42:47

> Hi Y,
>
> >Yes, I first was on Luvox for OCD, up to a substantial dose. It was used for the idea that the somatiform was related to OCD in a sort of "spectrum disorder" and also for a circular obsessive state about my main disorder, thinking 16 hours a day, etcetra, etc. That actually worked.....
>
> Why did you stop taking it?
>
> ~Ed


It was initially chosen because it was the most somnolescent of the SSRIs (with the SSRIs, I treat depression, not anxiety, they dont really do both for me, its one type of drug or the other). It had benefits but my doctor felt, and the newest SSNRI came onto the market as well, that duloxetine (Cymbalta) would be more helpful because as an SSNRI it would both still provide some SSRI-like activity and possibly make me more awake with the norephrinine reuptake.

 

Re: Seroquel, Somatiform, et al » yxibow

Posted by ed_uk on August 26, 2005, at 13:48:11

In reply to Re: Seroquel, Somatiform, et al, posted by yxibow on August 25, 2005, at 23:53:35

How do you find the other SSRIs? So far, I prefer citalopram.

~Ed


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