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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by bigscreen on December 17, 2005, at 21:46:11
i take 10mg of abilify. i feel inside like my legs are restless and some anxiety. i have an urge to do something. i take klonopin .5 twice a day. and i just started celexa 10mg. is there anything i can take for the akathesia. its been going close to a week
Posted by Phillipa on December 17, 2005, at 22:27:40
In reply to is this akathisia from abilify, posted by bigscreen on December 17, 2005, at 21:46:11
You will definitely get responses to your thread. Isn't benadryl something that helps. Not sure though. Fondly, Phillipa
Posted by lynn971 on December 18, 2005, at 0:10:02
In reply to Re: is this akathisia from abilify » bigscreen, posted by Phillipa on December 17, 2005, at 22:27:40
When I experienced akathasia it felt as though I wanted to jump out of my skin. I read an article that said it is often mistaken for anxiety. All I know is that it was the most horrible feeling in the world.
Posted by ed_uk on December 18, 2005, at 5:13:06
In reply to is this akathisia from abilify, posted by bigscreen on December 17, 2005, at 21:46:11
Hi Bigscreen
Akathisia refers to a uniquely distressing type of physical restlessness induced by (often excessive) doses of antipsychotics and other dopamine antagonist drugs. Other drugs have also been implicated in causing akathisia-like symptoms.
>is there anything i can take for the akathesia
Yes - but it might not be necessary. You could reduce your Abilify dose in steps of 2.5mg every few days until the restlessness disappears. *If necessary*, you might be able to increase the dose back up to 10mg in a few weeks time.
Celexa can occasionally cause restlessness too, especialy when you first start taking it. You could decrease the dose to 5mg for a few days until you're feeling better. You could then return to 10mg.... and increase gradually if necessary.
If your doctor agrees, a *temporary* increase in your Klonopin dose might be helpful during the next few days. You can return to 0.5mg twice a day when the restlessness is no longer a problem.
Drugs used to treat akathisia include.......
1. Propranolol (Inderal)
2. Diphenhydramine (Benadryl) - 50mg can be taken in the evening for insomnia and akathisia. Small doses can be taken during the day if necessary.
3. Anticholinergic antiparkinsonian drugs eg. benztropine, procyclidine, trihexyphenidyl, orphenadrine, biperiden etc.
Such drugs are often necessary in two situations....
1. As a short term treatment for severe akathisia - while the dose of the offending drug is being tapered.
2. As a long term treatment for akathisia in severely ill patients who require high doses of APs to treat their illness.
In general, if akathisia occurs, it's best to reduce the dose of the offending drug or switch to a different drug. Long term treatment with anti-akathisia drugs should only be contemplated if no other option is available. This is most likely to be the case in people with schizophrenia or other psychotic disorders characterised by paranoid delusions and hallucinations.
For what condition are you taking Abilify?
Kind regards
Ed
Posted by med_empowered on December 18, 2005, at 5:55:42
In reply to Re: is this akathisia from abilify » bigscreen, posted by ed_uk on December 18, 2005, at 5:13:06
yup...sounds like akathisia. "Anxiety" to me felt different...akathisia is a sort of inner-Hell. Personally, I'd try to up the Klonopin (very effective) while lowering the Abilify; the Klonopin can be pushed back down later. Benadryl helps too, for some people. Propranolol helps,but its usually best for dealing with tremors and what not...its effects on the emotional element of akathisia are pretty minimal, at best.
Posted by bigscreen on December 18, 2005, at 10:18:27
In reply to Re: is this akathisia from abilify, posted by med_empowered on December 18, 2005, at 5:55:42
i am taking ability to control hearing voices and hallucinations
Posted by ed_uk on December 18, 2005, at 12:58:38
In reply to Re: is this akathisia from abilifyed uk, posted by bigscreen on December 18, 2005, at 10:18:27
Hi
LOL that was brief ;-)
>i am taking ability to control hearing voices and hallucinations
Do you have a diagnosis?
Will you take my advice?
Regards
Ed
Posted by bigscreen on December 18, 2005, at 23:19:45
In reply to Re: is this akathisia from abilifyed uk » bigscreen, posted by ed_uk on December 18, 2005, at 12:58:38
psychotic depression but i really think ocd
Posted by yxibow on December 19, 2005, at 21:54:57
In reply to Re: is this akathisia from abilify ed uk, posted by bigscreen on December 18, 2005, at 23:19:45
> psychotic depression but i really think ocd
True psychotic depression could probably be managed with a less activating atypical like Seroquel; I know someone with that diagnosis and medication regime. However I won't second guess your doctor. I've had akathisia from Abilify, it wasn't as bad as Geodon where I was writhing on the floor. As for medications other than klonopin to regulate it, I would vote for biperiden (Akineton) as a good anticholinergic. Your pharmacy may have to special order it, its not stocked frequently like Cogentin. It however has much less nasty atropine effects, in my opinion.
Posted by med_empowered on December 20, 2005, at 9:51:43
In reply to Re: is this akathisia from abilify ed uk, posted by yxibow on December 19, 2005, at 21:54:57
Some people with psychotic depression get relief with RU-486 (I dont know the trade name, sorry). Its the "abortion drug"--apparently, it also lowers cortisol levels, which are quite elevated in psychotic depression. I dont know if the formulation of the drug specifically for psychotic depression is available yet, but RU-486 has been on the market for a good while; I imagine an RX for just the pills would be helpful (the usual routine involves in-office shots of booster hormones to terminate the pregnancy).
Other than that...sometimes akathisia goes away. Its pure hell, but some people can wait it out for a couple weeks to a month. Sometimes adding BuSpar helps, although BuSpar can also induce an akathisia-type syndrome in some users (also, avoid high doses). Reducing the Abilify dose would be a nice way to give yourself a break...like ed said, you can always up it at a later date, once your body has adjusted.
I dont know if this would be the best thing for you specifically, but some patients get better on antipsychotic polypharmacy. The doc will blend two antipsychotics (usually at low doses) to get more improvement with fewer side effects. I would think that cutting the Abilify and adding in a little bit of Seroquel would help. Since seroquel (and zyprexa) are so sedating, they have a bit of built-in anticholinergic action, which helps reduce akathisia and EPS. Plus, seroquel has a built-in antihistamine action (kind of like Benadryl plus an antipsychotic in one), so I would think that it might prove helpful.
Have you tried Symbyax? It has zyprexa, which can cause sedation and weight gain BUT...it is convenient, and it does help a lot of people. Its becoming pretty standard treatment for bipolar and some forms of depression. Since zyprexa is on the sedating side, you might end up with less akathisia or no akathisia at all with the combo pill.
Some studies have found that going without an antipsychotic will still treat the problem--once the depression gets better, the psychosis may also stop. This may or may not be the case for you. Tricyclic antidepressants (Elavil, Tofranil) are standard treatments for this kind of depression; perhaps trying one of these, maybe with a newer antidepressant (but without an antipsychotic) will be sufficient.
If you think the problem is more OCD, you could try Luvox. Or Anafranil. Anafranil is also a very, very powerful antidepressant, so it could clear up underlying depressive symptoms.
Sorry this was so long. I wish you the best of luck, and please keep us all posted.
Posted by ed_uk on December 20, 2005, at 15:54:45
In reply to Re: is this akathisia from abilify ed uk, posted by yxibow on December 19, 2005, at 21:54:57
Hi J
In your experience, how do the effects of biperiden and benztropine differ?
Ed
Posted by yxibow on December 20, 2005, at 18:35:44
In reply to Re: is this akathisia from abilify ed uk » yxibow, posted by ed_uk on December 20, 2005, at 15:54:45
> Hi J
>
> In your experience, how do the effects of biperiden and benztropine differ?
>
> EdIt may be a dosing issue, but Cogentin is far more atropine-like for me, which is not a direction I want to go since I have enough problem with things being too bright (dilated pupils are common with strong anticholergics). Plus its more lethargic-causing.
There is an upper range for me for Akineton as well, but it isn't quite as dilating and atropine-like, and it is more activating (apparently some people abuse it because of that although I cant imagine why). But more than about 2-4mg a day and the dilation effects and all the rest are also there.
Posted by ed_uk on December 21, 2005, at 14:22:14
In reply to Re: is this akathisia from abilify ed uk, posted by yxibow on December 20, 2005, at 18:35:44
Hi J
>It may be a dosing issue, but Cogentin is far more atropine-like for me
Akineton is believed to be a selective M1 antagonist whereas Cogentin is not.
>Plus its more lethargic-causing.
Cogentin seems to cause more lethargy than any of the other anticholinergics. Akineton causes drowsiness relatively frequenly too. Procyclidine and trihexyphenidyl tend to be more stimulating.
Regards
Ed
Posted by Sebastian on December 23, 2005, at 17:01:50
In reply to is this akathisia from abilify, posted by bigscreen on December 17, 2005, at 21:46:11
I tried abilify and had the same problems. Zyprexa works much better for me. I too had psychotic drpression.
Posted by bigscreen on December 24, 2005, at 1:25:22
In reply to Re: is this akathisia from abilify, posted by Sebastian on December 23, 2005, at 17:01:50
do you think if i change the klonopin to ativan and take .25mg of risperdal, 10mg of celexa would that be a good med combo or does the dosages need to be higher. you said you had psychotic depression. well i took two meds that did not mix and i started having thoughts of hurting my youngest son only he lives with my mother. but when i get depressed or under stress i start having those thoughts. is that what your psychotic depression was or similar to please inform me. my body is sensitive to meds. ive tried seroquel but it made me gain weight and abilify make me akathesia.
Posted by yxibow on December 24, 2005, at 4:58:35
In reply to Re: is this akathisia from abilifysabastian, posted by bigscreen on December 24, 2005, at 1:25:22
> do you think if i change the klonopin to ativan and take .25mg of risperdal, 10mg of celexa would that be a good med combo or does the dosages need to be higher.
10mg is a fairly low dose of celexa, but SSRI response varies highly, and do take some weeks to show full effect
>you said you had psychotic depression. well i took two meds that did not mix and i started having thoughts of hurting my youngest son only he lives with my mother.
If the medication combination caused some psychosis, it doesn't necessarily follow that there is a psychosis then, however you continue..
>but when i get depressed or under stress i start having those thoughts. is that what your psychotic depression was or similar to please inform me.
I don't hold an MD so it wouldn't be wise for me to diagnose, but it does sound more like some form of psychotic depression or possibly some form of the schizophrenia spectrum.
>my body is sensitive to meds. ive tried seroquel but it made me gain weight and abilify make me akathesia.
A lot of people are sensitive to neuroleptics, especially if what you have is more on the affective side of disorders.
If Abilify is any indication of akathisia, Risperdal would be at least twice as likely to do the same. But anything that is therapeutic is worth trying. It is the most powerful of the atypical antipsychotics in terms of side effect profiles; others will argue that Clozaril is the most powerful of atypical antipsychotics in general. However, I wouldn't go that route until all things are exhausted. .25mg of Risperdal is a fairly low dose of Risperdal; it does dramatically change its potency as it is increased, as Risperdal is actually fairly chemically closely related to Haldol.
I recognize that Seroquel can definately cause lipid changes and some weight gain but it is not as powerful in that direction as Zyprexa. If Risperdal causes undesirable akathisia, and predictably Geodon would too, then one would have to weigh the cost benefit of things. Revisiting Seroquel and managing a diet might be the thing.
But there's always anticholinergics to take the edge off of akathisia if you can tolerate the combination -- I would recommend Akineton or Artane -- Cogentin is a bit more on the sedating side. Then again, the Ativan might reduce the EPS a bit too.
If its true psychotic depression there is an old medication called Amoxapine which acts sort of like a antipsychotic with antidepressant features. It does carry the same risks as neuroleptics and is probably not prescribed very often.
tidings
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