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Dr. Bob is Robert Hsiung, MD,
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Posted by Phillipa on December 29, 2005, at 19:11:13
In reply to Re: Don't be Scared of Antipsychotics!!!!!!, posted by linkadge on December 29, 2005, at 19:06:49
Hi Link did you Mom ever find another Ap? Fondly, Phillipa
Posted by linkadge on December 29, 2005, at 21:22:38
In reply to Re: Don't be Scared of Antipsychotics!!!!!! » linkadge, posted by Phillipa on December 29, 2005, at 19:11:13
Oh sure, she found another AP alright. But she will never find one that works identically to the Mellaril.
For the past 20 years her brain has molded around the Mellaril. Coming off of it was scarry stuff, let me tell you !:) I saw sides of her that I could have well done without seeing.
Emotionally, she is doing a little better, but
she has a whole host of strange things that happen to her now, movement and otherwise.Thats why I would recomend seeking the oppinion of somebody who has been on and off them. Cause if you've never had to discontinue, you only see one side of the coin.
Linkadge
Posted by med_empowered on December 29, 2005, at 22:02:18
In reply to Re: Don't be Scared of Antipsychotics!!!!!!, posted by linkadge on December 29, 2005, at 21:22:38
hi! I'm glad this guy doesn't have (noticeable) tardive dyskinesia. But..why was he on chlorpromazine at age 5? That strikes me as a sort of medical child abuse.
From what I understand, the first cases of TD popped up around 1957. Apparently they paid more attention to this problem in Europe than in the US (US doctors also seemed to use higher doses of neuroleptics than European ones).
Anyway, with the Patient's Rights and Psychiatric Survivor's movements of the 60s and 70s (and the anti-psychiatric literature of this period), there was more attention paid to the problems these drugs were causing..also, it became possible for patients to sue their shrinks, which they did. Often. In 1980, the American Psychiatric Association finally got around to compiling some data on TD. According to their (conservative) estimates, about 3% of patients will develop TD per year. Factor in certain at-risk groups (people on lithium, older people, children, people with affective disorders, etc.) and the number comes up to 20% at the end of 5 years of treatment. From what I understand, the APA data was "processed" in such a way that the numbers don't reflect the actual incidence--if you look at more minor cases of TD, the number for 5years could be more like 30%, and the numbers for "long-term" treatment could be over 50%.
Newer antipsychotics seem to be better. It seems like the data is strongest on Zyprexa, which apparently causes TD at a rate of about .5-1%/year. That's much better than Haldol, but think about it: the way atypicals are being sprayed on everyone, for everything (sleep, anxiety, OCD, depression, Bipolar, Boredline Personality Disorder, etc.) we could still be looking at a whole lot of new cases of TD, since the number of patients being treated with neuroleptics is being greatly increased.
Also, patients with mood disorders tend to develop TD more often than those with "classic" schizophrenia, so I find it disconcerting that so many mood-disordered patients are being put on atypicals instead of other, less potentially harmful medications. Think about it this way: there are about 2 million schizophrenics in the US. The vast majority of these people are medicated, or will take medication for a good while before discontinuing treatment. Even if only 1/8 of them--250,000--complete a year of treatment with an atypical antipsychotic, there will still be about 1,250 new cases of TD **per year** of exposure to the drug. And that's if you use low-end numbers (to take into account the patients who stop taking meds) for patients and the low-end rate for development of TD.
Its important to realize that, the first time around, TD was kind of denied. Doctors said it was infrequent for movement disorders to be permanent, the meds were safe, blah blah blah. Also, APs have other risks, like the often-fatal Neuroleptic Malignancy Syndrome. I read one estimate that puts the number of fatalities due to this "rare" syndrome at about 100,000 worldwide since Thorazine was introduced. Think about it: 100,000 people dead. Benzos, on the other hand, have hardly killed anyone. They may be "addictive," but they dont cause fatal reactions and overdoses are rarely fatal. So, compare and contrast: docs hesitate to RX benzos, the "bad" drugs, b/c they might be "addictive"...but they'll hand out super-expensive drugs that can cause TD and NMS.
Personally, I think neuroleptics should be considered controlled substances. They may not be "addictive" in the conventional sense, but the risks inherent in neuroleptic treatment call for more stringent monitoring of dosing and prescribing habits of doctors.
Posted by ed_uk on December 30, 2005, at 14:25:50
In reply to Don't be Scared of Antipsychotics!!!!!!, posted by ace on December 29, 2005, at 10:03:07
Antipsychotics are powerful drugs. Side effects are frequent and sometimes severe. I don't recommend fear, but I do recommend respect.
Ed
Posted by linkadge on December 30, 2005, at 19:46:47
In reply to I'm scared of Antipsychotics., posted by med_empowered on December 29, 2005, at 22:02:18
My big question is why. Why are these drugs being used for sleep disorders? Why are they being used for anxiety? I remember Trazedone augmentation was really popular about 10 years back, but we've abandoned it for atypical augmentation.
Atypicals made my anxiety worse, because I started to panic when I realized how my cognition was being affected.
I asked about Trazodone augmentation of celexa, but my doc put me on risperdal instead.It's all about the *latest* drug
Linkadge
Posted by Phillipa on December 30, 2005, at 19:52:26
In reply to Re: I'm scared of Antipsychotics. » med_empowered, posted by linkadge on December 30, 2005, at 19:46:47
Link I agree. During the summer during a bad time I could not sleep on valium called the gp and he said either resperidol or seroquel. I no longer saw him. Fondly, Phillipa
Posted by linkadge on December 30, 2005, at 20:06:03
In reply to Re: I'm scared of Antipsychotics. » linkadge, posted by Phillipa on December 30, 2005, at 19:52:26
When I went to the hospital, 2 years back I asked them what their plan was. They said I had terrable OCD tendancies, and that the only solution was to bump my zoloft upto 250-300mg (from 25mg) in the course of 1-2 weeks, and add zyprexa 5-10mg.
Normally I am fairly complient in the hospital, but I resisted this chanGE like grim death. They were angry but they gave up.
I left the hospital on 10mg of celexa.
They said to me, you know you're never really going to get better if you resist treatment.
Perhaps, but I sat there for two weeks at watched them boost my fellow inpatients up to 300mg of zoloft, and all considered, I stand behind my decisions.
Linkadge
Posted by tepiaca on December 30, 2005, at 23:35:36
In reply to Re: I'm scared of Antipsychotics. » med_empowered, posted by linkadge on December 30, 2005, at 19:46:47
are you off meds now Link ?
Posted by yxibow on December 31, 2005, at 1:06:14
In reply to I'm scared of Antipsychotics., posted by med_empowered on December 29, 2005, at 22:02:18
> hi! I'm glad this guy doesn't have (noticeable) tardive dyskinesia. But..why was he on chlorpromazine at age 5? That strikes me as a sort of medical child abuse.
Perhaps... we didn't know then.
>
> From what I understand, the first cases of TD popped up around 1957. Apparently they paid more attention to this problem in Europe than in the US (US doctors also seemed to use higher doses of neuroleptics than European ones).Yes, cases started to appear.
From what I understand, the APA data was "processed" in such a way that the numbers don't reflect the actual incidence--if you look at more minor cases of TD, the number for 5years could be more like 30%, and the numbers for "long-term" treatment could be over 50%.This perhaps is for a lifetime use of Haloperidol in those most susceptible to tardive dyskinesia, something we unfortunately still don't completely understand and even with novel antipsychotics the jury is still out.
>
> Newer antipsychotics seem to be better. It seems like the data is strongest on Zyprexa, which apparently causes TD at a rate of about .5-1%/year.Yes, that is about correct... you will not be able to read the abstract unless your university subscribes to it, but the British Journal of Psychiatry had a study of olanzapine vs haloperidol (The British Journal of Psychiatry 174: 23-30 (1999)) and concluded that "the one-year risk was 0.52% with olanzapine (n = 513) and 7.45% with haloperidol (n = 114)".
That's much better than Haldol, but think about it: the way atypicals are being sprayed on everyone, for everything (sleep, anxiety, OCD, depression, Bipolar, Boredline Personality Disorder, etc.) we could still be looking at a whole lot of new cases of TD, since the number of patients being treated with neuroleptics is being greatly increased.
This is possible -- on the other hand if my aunt was on an atypical for BP-II during her downswings, maybe she would still be alive. Its a tradeoff -- I agree, they shouldn't be used by people who are not familiar with all their effects. They should only be prescribed by psychopharmacologists.
Think about it this way: there are about 2 million schizophrenics in the US. The vast majority of these people are medicated, or will take medication for a good while before discontinuing treatment. Even if only 1/8 of them--250,000--complete a year of treatment with an atypical antipsychotic, there will still be about 1,250 new cases of TD **per year** of exposure to the drug. And that's if you use low-end numbers (to take into account the patients who stop taking meds) for patients and the low-end rate for development of TD.But think about the number of people not with negative symptoms and introversiveness, but with positive symptoms and paranoid agitation. Is it really worth the risk on society to have a paranoid schizophrenic with a gun (how so easy to get in this country) walk into a crowded building and rant and start shooting? Or worse, the recent tragedy of a mentally ill patient on a return flight from Central America being "taken down" by Federal Marshals because he was off his medication?
>
> Its important to realize that, the first time around, TD was kind of denied. Doctors said it was infrequent for movement disorders to be permanent, the meds were safe, blah blah blah.From the experts on movement disorders who have studied this for decades, such as the Wirshings, movement disorders fall into three categories basically: 30% remit completely over time, 30% dont get worse, and the remaining third do unfortunately worsen.
Also, APs have other risks, like the often-fatal Neuroleptic Malignancy Syndrome. I read one estimate that puts the number of fatalities due to this "rare" syndrome at about 100,000 worldwide since Thorazine was introduced. Think about it: 100,000 people dead.
I'm not sure which journal that came from, but even if 100,000 people were killed, which is an awful tragedy, take a look at what that would be compared to the entire world population: 1.54 thousandth of a percent. Plus, there are a lot of signs leading up to NMS that, I agree, patients put into the right hands of the right doctors would be able to reverse this condition.
Benzos, on the other hand, have hardly killed anyone. They may be "addictive," but they dont cause fatal reactions and overdoses are rarely fatal.
I would agree with that one statement to a degree.. benzodiazepines are probably the safest psychiatric medication that has been invented. The LD50 vary; some are safer than others but it can be estimated that the fatal dosage is far greater than any prescribed amount. Respiratory depression is the major problem. Flumazenil can be administered.
So, compare and contrast: docs hesitate to RX benzos, the "bad" drugs, b/c they might be "addictive"...
Well, I prefer to call them habituating rather than addictive. And some people, just like those genetically predisposed to alcoholism, may exceed than line of habituating into abuse and addictiveness, finding underground sources and faked prescriptions.
but they'll hand out super-expensive drugs that can cause TD and NMS.
Every drug has a side effect. If aspirin were released by Bayer this year it probably wouldnt pass the FDA.
>
> Personally, I think neuroleptics should be considered controlled substances. They may not be "addictive" in the conventional sense, but the risks inherent in neuroleptic treatment call for more stringent monitoring of dosing and prescribing habits of doctors.I think that is the "all doctors are idiots" concept. As said before, I fully believe that neuroleptics should be prescribed by those who are fully knowledged in their usage, psychopharmacologists. There is recent controversy that novel antipsychotics such as Zyprexa and Seroquel perform no better than old drugs like chlorpromazine and the like and have nasty diabetes potential if not monitored -- but there's one thing missing from that argument, and that is the quality of life beyond the "sanity", the EPS and TD nature. If one were to extrapolate the BJP study of Zyprexa, one could estimate that Seroquel might even be 1/4% per year or even less. The jury is still out.
I think every day what if, as I take Seroquel -- but even though I have some unusual EPS, mostly mild -- I have to weigh it against the factor of the rare disorder (non-psychotic) for which it is partially benefitting. Sure, I experience blunting of affect. I wish I was the person I was in college. But we look future forward, I can't change time or why what happened to me did. I can only say that after 4 years, my somatiform disorder is far less prevalent in my mind than it was before when I had to wear sunglasses in clubs from the sheer distraction of strobe lights.
I don't know how long I will have to take the Seroquel, or the other medications I take. But I have to move forward with my life eventually. If for some that means they prefer pure psychodynamic talk therapy to medicine or a combination of the both, then be so for them. But just remember the high rate of suicide in schizophrenic, schizoaffective, and bipolar patients and the emotional burden that places on their family.
2005 holds so far no antipsychotic that will not 100% not produce TD, save for Clozaril which is nearly but not 100% (there have been a few doubtful cases) and has all sorts of unpleasant side effects that can render a patient socially reclusive. There are exciting drugs in the pipeline, though they probably wont be released until 2007 or beyond. May the future hold a brighter day for the whole schizophreniform spectrum, which consumes more than $2 billion alone in just the United States.
Posted by Dinah on December 31, 2005, at 11:09:11
In reply to Re: I'm scared of Antipsychotics. » med_empowered, posted by yxibow on December 31, 2005, at 1:06:14
At least for some of us.
I take them for severe anxiety in stressful situations. They give a deep down feeling of calm that Klonopin just can't compare with. They have an antidepressant effect for me that SSRI's can't match, and without excess drowsiness. Perhaps because depression and anxiety are so linked for me.
As angry as I was at my psychiatrist giving me Thorazine as an adolescent while telling me it was Valium, who knows what my life would have been like without it? I was rapidly careening towards agoraphobia caused by an OCD preoccupation with vomit. And I literally begged my pdoc for something equivilant to Thorazine when similar stressors entered my life recently. If I hadn't been able to manage the anxiety, I would have had to leave home, at minimum.
I know the risks, but if I'm feeling bad enough I just want the relief.
Posted by linkadge on December 31, 2005, at 12:05:22
In reply to Re: I'm scared of Antipsychotics. » linkadge, posted by tepiaca on December 30, 2005, at 23:35:36
Yeah, I've been off meds for almost a year now.
Linkadge
Posted by linkadge on December 31, 2005, at 12:20:44
In reply to Re: I'm scared of Antipsychotics. » med_empowered, posted by yxibow on December 31, 2005, at 1:06:14
I just don't think it makes sence for us to compare a drug that has been around for a few years to a drug that has been around for decades, and say that the newer one is safer.
I don't think we will have a full understanding of the true risk of TD with the atypicals till many years down the road.
The atypicals also may do a much better job at masking movement related neurological problems due to the fact that the serotonin blockade will independantly provides symptomatic releif from TD. That doesn't mean that they are not likewise creating a underlying condition.
When you get a study released these days to compare TD in older vs. newer drugs, there will be an extreme bias towards showing less TD in the newer, since in other respects (ie. efficacy), the newer drugs may not be all that much better.
It bothered me that they turned "A Beautiful Mind" into a commercial for atypical antipsychotics, since Nash probably only used drugs for a 2-3 years. I think he said that he never used antipsychotics after 1973.
There are people who feel more comfortable taking their atpyical antipsychotics based on how the movie lauded them. Thats wrong.
Linkadge
Posted by ed_uk on December 31, 2005, at 12:52:26
In reply to But they work so *well*, posted by Dinah on December 31, 2005, at 11:09:11
Hi Dinah
Atypical APs certainly work well for some people, both those who are psychotic and those who aren't.
>And I literally begged my pdoc for something equivilant to Thorazine when similar stressors entered my life recently.
If you lived in England you would probably have got more Thorazine, although it (chlorpromazine) is called Largactil here. Low doses are still used as a short term treatment for severe anxiety.
>I know the risks, but if I'm feeling bad enough I just want the relief.
You take a very low dose of Risperdal only when required, yes? I don't think the risks of such as strategy are great. In fact, I think they are probably very small.
Regards
Ed
Posted by Sonny Liston on December 31, 2005, at 14:56:27
In reply to Re: I'm scared of Antipsychotics., posted by linkadge on December 31, 2005, at 12:05:22
> Yeah, I've been off meds for almost a year now.
>
>
> Linkadge
That's fantastic. How are you holding up? I know throughout the year you had some rough spots.
Posted by Dinah on December 31, 2005, at 15:30:32
In reply to Re: But they work so *well* » Dinah, posted by ed_uk on December 31, 2005, at 12:52:26
> You take a very low dose of Risperdal only when required, yes? I don't think the risks of such as strategy are great. In fact, I think they are probably very small.I'm back to a low dose. I'm working down to occasionally as needed. :)
I think the risk is probably very small too, and well worth it for the benefits.
Posted by linkadge on December 31, 2005, at 17:00:00
In reply to Re: I'm scared of Antipsychotics., posted by Sonny Liston on December 31, 2005, at 14:56:27
>That's fantastic. How are you holding up? I know >throughout the year you had some rough spots.
Well, don't we all. I am not saying that the AD's were incapable of doing anything.
I just feel as a whole, I am getting my brain back.
Linkadge
Posted by linkadge on December 31, 2005, at 17:25:50
In reply to Re: I'm scared of Antipsychotics., posted by linkadge on December 31, 2005, at 17:00:00
I feel like the drugs just morphed my problems into something else, making my life equally as difficult to get through.
Linkadge
Posted by yxibow on December 31, 2005, at 23:37:40
In reply to But they work so *well*, posted by Dinah on December 31, 2005, at 11:09:11
> As angry as I was at my psychiatrist giving me Thorazine as an adolescent while telling me it was Valium, who knows what my life would have been like without it? I was rapidly careening towards agoraphobia caused by an OCD preoccupation with vomit.-- that's a curious situation because strong antipsychotics also tend to block vomiting (e.g. Compazine)
Posted by Dinah on January 1, 2006, at 6:10:44
In reply to Re: But they work so *well* » Dinah, posted by yxibow on December 31, 2005, at 23:37:40
My OCD obsession was with other people vomiting. :) But it still worked pretty well. (Although it was actually prescribed for night terrors, according to my pediatric chart.)
Posted by cecilia on January 3, 2006, at 1:12:30
In reply to Don't be Scared of Antipsychotics!!!!!!, posted by ace on December 29, 2005, at 10:03:07
> Speaking to a bloke tonight.
>
> This guy has been on Largactal from age 5 to age 43...NO SIDE EFFECTS AT ALL!!!!!!
>
> And that is an old antipsychotic which is ment to be more dangerous.....
>
> So swallow that AP with a smile on your dial!
>
> Peace, Merry Xmas, and Happy New Years from your resident Nardil Champ!!!
>
>
> Ace!!!!Just because one person took AP's for 38 years without side effects isn't exactly scientific proof that they're safe for the other 99.999999999999 % of the population! Cecilia
Posted by cecilia on January 4, 2006, at 1:37:45
In reply to But they work so *well*, posted by Dinah on December 31, 2005, at 11:09:11
But I am scared of them. They do seem to work well for some people. But I don't understand why doctors seem to be prescribing them so freely these days. Seroquel prescribed for insomnia, for example, seems crazy to me. It's like using a machine gun to kill a fly. I'm not sure if it's because the drug reps are pushing them so hard or just that most doctors are so benzo-phobic. Cecilia
Posted by Phillipa on January 4, 2006, at 18:29:37
In reply to Re: AP's, posted by cecilia on January 4, 2006, at 1:37:45
I think it's both. Fondly Phillipa
Posted by Camille Dumont on January 5, 2006, at 11:10:08
In reply to Re: AP's, posted by cecilia on January 4, 2006, at 1:37:45
It's almost automatic now if the ADs don't work well enough. They gave me Seroquel at 100mg to help with insomnia and "augment" the ADs. I stopped because it was making me a zombie ... and get this ... GP then hands me a script of all things Zyprexa at 5mg (to start) and tells me that this will "help me sleep". In his defense it did make me sleep ... like 20h a day and then I started twiching all over, could barely speak, was unable to write or read or type and ended up with seizures that wouldn't stop.
Suffice to say this was my last experience with APs. I don't care what they say I have, I will never willingly take an AP for as long as I live.
> But I am scared of them. They do seem to work well for some people. But I don't understand why doctors seem to be prescribing them so freely these days. Seroquel prescribed for insomnia, for example, seems crazy to me. It's like using a machine gun to kill a fly. I'm not sure if it's because the drug reps are pushing them so hard or just that most doctors are so benzo-phobic. Cecilia
Posted by linkadge on January 5, 2006, at 18:20:05
In reply to Re: AP's, posted by Camille Dumont on January 5, 2006, at 11:10:08
In terms of side effect profile, I would be more willing to take a sedating TCA for the uses that APs are prescribed.
I have taken all three of the newer AP's, and all three were bad experiences.
I found seroquel the most tollerable, but even that seemed to mess up my best attempts for recovery.
Linkadge
Posted by Dinah on January 7, 2006, at 10:19:25
In reply to Re: AP's, posted by linkadge on January 5, 2006, at 18:20:05
Maybe researchers should look more closely at drug reactions to help in classifying illnesses better.
Because we all know that depression isn't a single illness and anxiety isn't a single illness. And they don't have a single cause or treatment.
It would be interesting to compare the neurochemical makeup or PET scans or something of those who respond well to one class of drugs or another.
SSRI's had both good and bad effects for me. Anything with NE was toxic. And AP's have always been like aspirin to me, able to cure more than one thing. Somehow they work on depression as well as anxiety in me.
Wouldn't it be good to try to figure out why some people respond so d*mn well to AP's (or Prozac or Wellbutrin or Effexor) while other people respond so poorly? So if you took the people who responded best and worst to these classes of drugs and studied what was different about them, mightn't it lessen the hit and miss prescription of drugs?
I'll volunteer. :)
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