![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by alanjacobs on January 12, 2007, at 20:39:45
Hello,
I started Abilify 2.5mgs about a month ago. After two weeks of taking the meds I started getting the EPS side effect, like tardive dyskenesia (spelling?.) It really made me nervous so I took myself off the Abilify and poke with my Psychiatrist after the weekend. He had me come in, we talked, agreed to stay just on the Prozac( which I started at the same time as Abilify) He also prescribed me Cogentin, which after two days of taking it completely rid me of the EPS syndrom.
Here is the problem. I felt better on the Abilify then I have in 5-6 years. Any of the drugs in the same family as Abilify could cause the same side effects which I seem to be suseptable too.
This week I met with my Pdoc again we decided to try the ABilify again but with an ongoing dose of the cogentine.
What do you think? Seem like a reasonable plan, what do you think?
Posted by yxibow on January 13, 2007, at 1:50:01
In reply to ABILIFY + EPS, posted by alanjacobs on January 12, 2007, at 20:39:45
> Hello,
>
> I started Abilify 2.5mgs about a month ago. After two weeks of taking the meds I started getting the EPS side effect, like tardive dyskenesia (spelling?.) It really made me nervous so I took myself off the Abilify and poke with my Psychiatrist after the weekend. He had me come in, we talked, agreed to stay just on the Prozac( which I started at the same time as Abilify) He also prescribed me Cogentin, which after two days of taking it completely rid me of the EPS syndrom.
>
> Here is the problem. I felt better on the Abilify then I have in 5-6 years. Any of the drugs in the same family as Abilify could cause the same side effects which I seem to be suseptable too.
>
> This week I met with my Pdoc again we decided to try the ABilify again but with an ongoing dose of the cogentine.
>
> What do you think? Seem like a reasonable plan, what do you think?
First of all, lets get our terms correct -- I think he should have given you informed consent about the medication. Abilify is a neuroleptic that can cause EPS which is another term for side effects on neuroleptics. EPS and TD are generally on a sliding scale, and TD, meaning Tardive, is something almost always developed late in treatment.
What you felt was akathisia, a form of EPS. Akathisia is intense restlessness which may feel to someone like anxiety but it is not, it is a movement disorder caused by neuroleptics.
The general scale of strength (and EPS) of atypicals -- we now have a new one, Invega, which is basically a patent extender of Risperdal, would probably roughly be {Risperdal,Invega}->{Geodon,Abilify}->Zyprexa->Seroquel->{Clozaril, except for pseudoparkinsonism}.
Strong EPS can be a sign of possible future TD but in general atypicals on average with limited studies are about 2% annually, with a wide variation. Also if one is aware first of a movement issue, it is generally EPS and not TD, as a rule, but doctors nevertheless should give AIMS exams every 6 months.
And yes, Cogentin will help with EPS, it is one of the strongest of the anticholinergics, with Artane and Akineton being a bit less. Too much of them of course can cause an atropine syndrome which is not a pleasant thing and involves chills or heat and can lead to psychosis itself. So keep to your dosage.
Now getting the medical stuff out of the way, what is the diagnosis that warrants an atypical and an SSRI, but can get by with an SSRI alone for a period of time while your doctor made a decision to restart ? That is the key here. I'm assuming it is for some sort of bipolar or psychotic depression or schizophreniform disorder to warrant a mid-strength atypical neuroleptic. Otherwise I don't see the plan of continuing a medication that has given you akathisia when there are other classes of medications out there that are effective. But obviously your doctor thinks there is something warranted so I think we would need to hear something more about how you feel and what is going on to give any opinion on your treatment plan.-- Jay
Posted by alanjacobs on January 13, 2007, at 5:19:26
In reply to Re: ABILIFY + EPS » alanjacobs, posted by yxibow on January 13, 2007, at 1:50:01
The effects I experienced were the slight protrusion of my tongue and some uncontrollable frowning and facial movements. Mostly the frowning though.
So when you say the "General Scale of Strength of A typical" you are showing that Abilify is in the middle of the pack but below Zyprexa and Seroquel?
I understand the low percentage of actually getting TD, still worries me though.
My PDoc told me that 20 years ago similar medicines would have been prescribed with congentin at the same time.
TD really scares the crap out of me because I don’t think I could live with it, maybe just how I am feeling now.
Some Background on me
Was diagnosed bipolar 4 years ago. Had some real lousy treatment at U of Penn, which included 3 P Docs leaving me during a 10 month period of time. I got so upset with them I stopped going and took myself off my meds which had helped very little.
Through U of Penn I was on lamictall and celexa first, then some seroquel in small dosage (25mg) for sleep. I still felt like crap and the seroquel gave me the worst hangover in the morning. So I went off the seroquel and the celexa and moved to Effexxor, still nothing at all. At this point I stopped not because the drugs but because Of the Docs kept changing on me and I felt the general care there was sub par. That was maybe 16 months ago.
During the time with no therapy and no meds I of course got worst and worse.
In November I decided to find someone on my own. Found a therapist over the net and went for a visit. I like her a lot and think she really listens understands and is helping me. The P Doc I began to see was someone she had recommended to me. I like him a lot. The first visit I met with him and his nurse-practioner for a total of 2 hours. I told them my history and the medicines I had been on that had not worked.
His first thoughts were Prozac and Abilify. I took this regiment for two weeks and I started feeling really good. Probably the best I have felt in 5-6 years. Then the problems start. I was frowning one Friday night a little, was not sure what it was from. Took my abilify and went hunting the next day. While hunting I noticed it was getting worse and worse and that my tongue felt swollen and was pushing to exit my mouth a bit. This really bothered me to say the least. When I got home I looked up side effects of Abilify and the one it closely resembled was Tardive. But I had also red tardive usually appears much later after long periods of taking these type of drugs. I called the doctor who I luckily had an appointment with a few days later. I told him I stopped taking the abilify. He was fine with that. When I went for my visit and explained what was going on he said Ill give you some cogentin and that should reduce the symptoms right away and we will just stay on the Prozac and see how you do. Well the cogentin worked great 2-3 days later I was back to normal except for my mood which had gone down the tube once again. SO I met with him Tuesday of this week. He said since we had such good mood results with Abilify we should try it again this time also with ongoing cogentin.
Jay you seem very knowledgeable, Whets your background if I may. Your reply was probably the most informative I have ever received on here.
Please ask me more if I did not answer you fully.
Ps. He also gave me some lunesta to try Seems to work pretty well so far.
Thanks
Posted by theo on January 13, 2007, at 14:11:08
In reply to Re: ABILIFY + EPS, posted by alanjacobs on January 13, 2007, at 5:19:26
Did you take your Abilify at bedtime or in the morning?
Posted by yxibow on January 13, 2007, at 15:12:04
In reply to Re: ABILIFY + EPS, posted by alanjacobs on January 13, 2007, at 5:19:26
>
>
> The effects I experienced were the slight protrusion of my tongue and some uncontrollable frowning and facial movements. Mostly the frowning though.This early on suggest EPS but I understand your concern.
>
> So when you say the "General Scale of Strength of A typical" you are showing that Abilify is in the middle of the pack but below Zyprexa and Seroquel?Roughly... for most people. Of course, as they say, your miles may vary. I was showing in order of descending strength, I should have made that clear, Zyprexa and Seroquel while they have cholesterol side effects are less "potent".
>
> I understand the low percentage of actually getting TD, still worries me though.Worries me too as well but treatment can't continue with constant worry so maybe a less potent one is of more value -- but if you are doing well on it, maybe that outweighs it. That is for better or worse "informed consent."
> My PDoc told me that 20 years ago similar medicines would have been prescribed with congentin at the same time.
This is true, and they still are, although there is Artane and Akineton and if your in other countries a few more. They all came from about the same era. They're anti-parkinsonian as well and still used.
> TD really scares the crap out of me because I don’t think I could live with it, maybe just how I am feeling now.I know -- as I say, it still does for me -- its a tradeoff. If it really does, there are other treatments for BP... I am assuming BP I, but I can't be sure. Lithium, Depakote come to mind and Depakote has some of the least side effects in general.
> Some Background on me
>
> Was diagnosed bipolar 4 years ago. Had some real lousy treatment at U of Penn, which included 3 P Docs leaving me during a 10 month period of time. I got so upset with them I stopped going and took myself off my meds which had helped very little.:( That doesn't create a good atmosphere for psychiatry.
> Through U of Penn I was on lamictall and celexa first, then some seroquel in small dosage (25mg) for sleep. I still felt like crap and the seroquel gave me the worst hangover in the morning. So I went off the seroquel and the celexa and moved to Effexxor, still nothing at all. At this point I stopped not because the drugs but because Of the Docs kept changing on me and I felt the general care there was sub par. That was maybe 16 months ago.
I don't know enough about SRIs on Bipolar... Seroquel is fairly strong in the antihistamine department, I know, I take it. It takes a while to get used to it but you still are lethargic.
You were probably I assume most feeling the side effects of Seroquel and not Lamictal.
> During the time with no therapy and no meds I of course got worst and worse.
>
> In November I decided to find someone on my own. Found a therapist over the net and went for a visit. I like her a lot and think she really listens understands and is helping me. The P Doc I began to see was someone she had recommended to me. I like him a lot. The first visit I met with him and his nurse-practioner for a total of 2 hours. I told them my history and the medicines I had been on that had not worked.It sounds at least like you have a good set of doctors you trust and believe in. That is the most important. There is no point in wasting time and money on therapy when it doesn't come to value. I had a good psychologist in college but the psychiatrist who ran that part of the student health center like it was her fiefdom was a royal b**
> His first thoughts were Prozac and Abilify. I took this regiment for two weeks and I started feeling really good. Probably the best I have felt in 5-6 years. Then the problems start. I was frowning one Friday night a little, was not sure what it was from.
Probably initial strong EPS is my guess. Oral fasciculations.
Took my abilify and went hunting the next day. While hunting I noticed it was getting worse and worse and that my tongue felt swollen and was pushing to exit my mouth a bit. This really bothered me to say the least.Yes, I have had slight tongue movements here and there but not protrusions. Nonetheless you are on a slightly stronger medication so it doesn't surprise me earlier on that it could be stronger.
When I got home I looked up side effects of Abilify and the one it closely resembled was Tardive. But I had also red tardive usually appears much later after long periods of taking these type of drugs. I called the doctor who I luckily had an appointment with a few days later. I told him I stopped taking the abilify. He was fine with that. When I went for my visit and explained what was going on he said Ill give you some cogentin and that should reduce the symptoms right away and we will just stay on the Prozac and see how you do. Well the cogentin worked great 2-3 days later I was back to normal except for my mood which had gone down the tube once again.
This is the first indication that it is not TD. TD almost probably 100% for reasons we still don't fully understand does not respond well at all -- in fact badly opposite, to anticholinergics. If it was TD, your symptoms would have been magnified by the Cogentin, not reduced.
SO I met with him Tuesday of this week. He said since we had such good mood results with Abilify we should try it again this time also with ongoing cogentin.
>
> Jay you seem very knowledgeable, Whets your background if I may. Your reply was probably the most informative I have ever received on here.
My background is 19 years of mental health issues, mostly in the OCD/depression region. My mother's sister did... well anyhow is no longer here, due to BP-II. My mother herself has foibles of sorts, a cluster of phobias about elevators, etc. but has never treated herself. She could never go back to the Grand Canyon again, sadly -- the beauty of standing at the rim and looking far across, but I understand, she would suffer from vertigo. I guess I have the elevator/claustrophobia thing a little bit too.
I did also work for a psychiatrist group once administratively and computer support.
But mostly it is years of my own experience with mental/psychobiological illness and medications and what I've responded too -- which I can sometimes identify with people and sometimes not. So I don't foray into responses when I can't really offer the best suggestions, but I know how I've responded to medications. And its also important to remember that its only how you've responded and others can be completely different.
But you are probably right that you will respond similarly to other neuroleptics, just less strongly so if they are less potent (usually.) You can always try Geodon, its a tossup between the two. Zyprexa especially and Seroquel to an extent you should blood monitor lipid (cholesterol) and weight and diabetes potential levels because that is their achilles heel to otherwise more gentle atypical antipsychotics.
> Please ask me more if I did not answer you fully.I think you've explained some of the history about the bipolar in fair degree, I see the reason for trying a neuroleptic after a history of other medications. Nonetheless you might ask about lithium and Depakote if you haven't tried them.
> Ps. He also gave me some lunesta to try Seems to work pretty well so far.
That sounds good... Lunesta is a bit less strong than Ambien but if you are a responder than that is good. Some people will have sort of a metallic taste when going to bed (some swear it still remains after) but since you don't seem to be having that, don't worry about it. Over time, it is possible to become habituated to it, it is conceivable, so you may have to back off of your dose and start again, although it is supposed to be less so with Lunesta. Also, you may discover that your insomnia will go away alone without Lunesta as treatment continues and you become more used to your other medications.
>
> Thanks
>No worries -- keep us posted on how Abilify treats you, and your doctor as well and your concerns about getting possibly a baseline AIMS exam so he can compare it in the future with a 6 month one if you decide to stick it out that far. A lot of doctors don't give AIMS exams because they don't know the protocol or don't see the need but it is good practice to keep tabs on any movement disorders. It is just a simple less than 5 minute subjective test of muscles and reflexes and the like to monitor a patient's response to a neuroleptic agent.
Hope that answers some of your questions and continue to post here as much as you like -- I'm sure people with first hand experience of BP I or II can answer more detail on the actual disorder itself.-- Jay
Posted by Sebastian on January 13, 2007, at 16:06:09
In reply to ABILIFY + EPS, posted by alanjacobs on January 12, 2007, at 20:39:45
for me Abilify does not help with paranoia. i still need zyprexa. Abilify is a great AD and energiser.
Posted by Sebastian on January 13, 2007, at 16:08:12
In reply to Re: ABILIFY + EPS » alanjacobs, posted by yxibow on January 13, 2007, at 1:50:01
Posted by alanjacobs on January 13, 2007, at 17:02:29
In reply to Re: ABILIFY + EPS » alanjacobs, posted by yxibow on January 13, 2007, at 15:12:04
Jay,
Thanks again. We will see how the abilify works with the cogentin this time. I hope it goes better. The Lunesta gives me the metallic taste in my mouth and it can last all day.
Someone else asked me about the Abilify, I take it at night before bed. Why do you ask
Thanks again everyone for responding
Posted by cgd092 on January 14, 2007, at 0:09:27
In reply to Re: ABILIFY + EPS » alanjacobs, posted by yxibow on January 13, 2007, at 1:50:01
You wrote, "What you felt was akathisia, a form of EPS. Akathisia is intense restlessness which may feel to someone like anxiety but it is not, it is a movement disorder caused by neuroleptics."
If it's true that the original poster felt akathisia and didn't have actual "tardive d.", then I a comment: I tried Abilify once and it gave me very bad akathisia. Just terrible. I was afraid to try another atypical antipsychotic, Seroquel, but Seroquel didn't give me any akathisia.
Posted by alanjacobs on January 14, 2007, at 7:23:27
In reply to Re: ABILIFY + EPS, posted by cgd092 on January 14, 2007, at 0:09:27
I was worried about going back on Abilify as well but the cogentin worked so well that I am puting trust in my PDoc that the symptoms wont re occur. If they do then I am off Abilify once and for all
Posted by Honore on January 14, 2007, at 11:33:20
In reply to Re: ABILIFY + EPS, posted by alanjacobs on January 14, 2007, at 7:23:27
Hi, Alanjacobs.
I'm not an expert, by any means, but personally I'm concerned about the experiment your pdoc is running.
I completely understand your (and his) desire to stay with the abilify-- and maybe the risk is worth it.
My concern would be that if you suppress the symptoms, they might not manifest themselves even as the condition actually persisted. Then it might become harder to treat, when and if it did reemerge.
My suggestion is that you get a second opinion, in this. There must be pdocs who specialize in TD and someone like that, who has an expertise in that particular area, would be able to say if it's safe (or worth the risk) to continue. S/he might also be able to give you much better guidance on what to look for, and how to monitor the possible underlying condition.
I would strongly recommend that, under the circumstances, given the difficulty of treating TD, if you're considering continuing abilify.
Honore
Posted by med_empowered on January 14, 2007, at 16:40:12
In reply to Re: ABILIFY + EPS--alanjacobs, posted by Honore on January 14, 2007, at 11:33:20
The Cogentin is only going to *mask* the initial EPS. Over time, you may still develop tardive dyskinesia, which the abilify itself will partially mask. This means that if you do develop TD (and the odds are worse for someone with bipolar vs. schizophrenia, and early EPS is a *bad* sign), you will not notice it at first, and when/if the drug is withdrawn or your dosage gets lower, your abnormal movements could actually get **worse**, not better.
I'm not trying to scare you, but these drugs are not to be played with, and your doctor is playing with them--without informing you of the risks, or offering any alternatives.
In some people, TD goes away or the symptoms get better. For some people, the symptoms remain and they can be crippling; sever TD/tardive dystonia (a related problem) can disable people, forcing them to use wheel chairs.
Good luck.
Posted by yxibow on January 14, 2007, at 19:19:28
In reply to Re: ABILIFY + EPS, posted by cgd092 on January 14, 2007, at 0:09:27
> You wrote, "What you felt was akathisia, a form of EPS. Akathisia is intense restlessness which may feel to someone like anxiety but it is not, it is a movement disorder caused by neuroleptics."
>
>
> If it's true that the original poster felt akathisia and didn't have actual "tardive d.", then I a comment: I tried Abilify once and it gave me very bad akathisia. Just terrible. I was afraid to try another atypical antipsychotic, Seroquel, but Seroquel didn't give me any akathisia.
This would make sense -- I thought Abilify would have less effects given the pushme-pullyou partial D2, but it turns out to be about on the level of Geodon. Seroquel is much weaker in the EPS department, especially akathisia. I'm pretty sensitive to akathisia and a lot of people with affective (mood, bipolar, etc, not deep psychosis/schizophrenia) disorders are as well.
Posted by yxibow on January 15, 2007, at 0:24:24
In reply to do you need a neuroleptic?, posted by med_empowered on January 14, 2007, at 16:40:12
> The Cogentin is only going to *mask* the initial EPS. Over time, you may still develop tardive dyskinesia, which the abilify itself will partially mask. This means that if you do develop TD (and the odds are worse for someone with bipolar vs. schizophrenia, and early EPS is a *bad* sign), you will not notice it at first, and when/if the drug is withdrawn or your dosage gets lower, your abnormal movements could actually get **worse**, not better.
>
> I'm not trying to scare you, but these drugs are not to be played with, and your doctor is playing with them--without informing you of the risks, or offering any alternatives.
>
> In some people, TD goes away or the symptoms get better. For some people, the symptoms remain and they can be crippling; sever TD/tardive dystonia (a related problem) can disable people, forcing them to use wheel chairs.
>
> Good luck.
They will mask the effects and you are right to note that early strong effects can produce TD but it is not a forgone conclusion. We don't know how atypicals will create a lesser or worse TD than old line neuroleptics but there have been several studies of those on atypicals and aggregate data suggest about 2% per year (which can be extrapolated to weaker agents and probably less formation). It isn't quite cumulative although that has been the general thought. Sometimes switching from one to another remits TD, this still holds with atypicals.
TD roughly remits in 1/3 of the cases, goes no further in another 1/3, and may become worse in the following 1/3.
Prudent use of the MED (minimum effective dose) of any neuroleptic or for that matter any psychotropic is always advised and is advised by Wirshing and Wirshing, who are experts on movement disorders such as TD.
Still for the short term management of Bipolar disorder, atypicals are indicated if the severity of the condition is warranted. It would be cruel to give any antipsychotic and not offer management of EPS, whether it is an anticholinergic or a benzodiazepine.
I agree, that, if their doctor-patient relationship decides that it is too strong of a medication there are other treatments out there as I suggested including still lithium, Depakote, and a variety of things. I don't believe the doctor is "playing" with medications, that sort of characterizes the doctor patient relationship as a sandbox -- one doesn't know the extent of how severe the BP is. Still, phrased differently, yes, there are other alternatives, mostly AEDs that can be used as primary medications with perhaps a smaller dose of a less strong neuroleptic as an adjuctive.-- tidings
Posted by yxibow on January 15, 2007, at 0:37:32
In reply to Re: ABILIFY + EPS--alanjacobs, posted by Honore on January 14, 2007, at 11:33:20
> Hi, Alanjacobs.
>
> I'm not an expert, by any means, but personally I'm concerned about the experiment your pdoc is running.
>
> I completely understand your (and his) desire to stay with the abilify-- and maybe the risk is worth it.
>
> My concern would be that if you suppress the symptoms, they might not manifest themselves even as the condition actually persisted. Then it might become harder to treat, when and if it did reemerge.
>
> My suggestion is that you get a second opinion, in this. There must be pdocs who specialize in TD and someone like that, who has an expertise in that particular area, would be able to say if it's safe (or worth the risk) to continue. S/he might also be able to give you much better guidance on what to look for, and how to monitor the possible underlying condition.
>
> I would strongly recommend that, under the circumstances, given the difficulty of treating TD, if you're considering continuing abilify.
>
> HonoreThe general guidance of using any neuroleptic is using the MED (minimum effective dose.) Abilify is dosed up to 30mg and beyond, we are talking about a 2.5mg dose if I am correct here. This is a rather small dose, and while the akathisia is noticeable, it is an EPS that is probably noticeable at any dose of Abilify. Regardless of the effectiveness of Zyprexa, pseudoparkinsonism was a noticeable effect at any level of zyprexa for me including a split of the smallest available dose.
Neuroleptic use, myself included, is and should be an informed consent. As long as the doctor has given a general description of what really EPS is and what really TD is, and is prepared to give AIMS exams, then the tradeoff is between feeling better for whatever period of time, or going down the path of what BP can manifest and I needn't describe. Akathisia is probably among the most noticeable effects of any neuroleptic, new or old. I had horrible akathisia from the phenothiazine Compazine in the ER. They didn't give me oral Benadryl or anything similar to take home and it wore off and I could barely tell the taxi driver how to get back home let alone cogitate any coherent thought. But phenothiazines are many times stronger than atypicals. Still, Abilify and to some extent Geodon had me crawling on the carpet. But at least I was lucid. There will always be tradeoffs.
At any rate, I hope your treatment goes well and do discuss your concerns about what I have mentioned above in your own words and take things as they go.
One side comment, you may experience some bright or blurry vision with Cogentin, being the most atropine like anticholinergic. This is to be expected and may or may not dissapear as things progress. It is presumably dosal related.
-- tidings
Posted by Honore on January 15, 2007, at 20:04:38
In reply to Re: ABILIFY + EPS--alanjacobs » Honore, posted by yxibow on January 15, 2007, at 0:37:32
Akathesia wasn't the EPS that alanjacobs said he experienced.
In this case, that's a definite factor in my reaction.
Honore
Posted by yxibow on January 16, 2007, at 1:42:46
In reply to Re: ABILIFY + EPS--alanjacobs » yxibow, posted by Honore on January 15, 2007, at 20:04:38
> Akathesia wasn't the EPS that alanjacobs said he experienced.
>
> In this case, that's a definite factor in my reaction.
>
> HonoreMy bad, I thought he described a double EPS. But akathisia is one of the most common. What he described was an EPS orofacial form of ID, or initial dyskinesia, I believe.
Posted by Honore on January 16, 2007, at 11:09:50
In reply to Re: ABILIFY + EPS--alanjacobs » Honore, posted by yxibow on January 16, 2007, at 1:42:46
I was doing some reading on the EPS-TD relationship last night. Seems not to be absolute, although people with TD often have had EPS-- and people with EPS develop TD more than twice as frequently as people w/o it, in the first year after a study. (Those studies did not show a difference in the rate of developing TD between typical and atypical APs.)
But researchers seem unclear about the relationship. Definitely not clear that everyone who has TD had EPS-- or that everyone with EPS develops TD.
I also noticed that Cogentin is used to treat EPS, but won't help TD. But also some indication that Cogentin, itself, could make TD worse.
And that sometimes, a very early expression of EPS can be transitory with use of atypicals. This would seem to be very unclear, however, given that lack of definitive understanding of either syndrome, or the cause of relationships between them.
On the other hand, while there are many claims that atypicals greatly reduce the frequency of TD, this hasn't yet been fully substantiated. For one thing, there's a greater than usual number of false negatives for the presence of movement disorders in the type of testing that's used in studies. And some careful studies seem to suggest a higher rate than was previously hoped. Yet, it does seem to be less.
I guess there's certain precedent for using Cogentin for EPS-- but I really couldn't find any study or article that considered whether there was masking. But definitely, it's important to monitor the situation pretty carefully.
Maybe if the symptom doesn't recur, it was transitory. On the other hand, with the old APs, about 65% of patients develop TD (over a fifteen year period, after which seemingly, the risk is greatly reduced). How much less this would be true of atypicals, and whether an early manifestation of EPS is a strong indication just isn't clear.
It's certainly a decision individuals have to make for themselves. Only they can evaluate the benefits and risks that they are prepared to take.
Honore
Posted by yxibow on January 16, 2007, at 19:15:33
In reply to Re: ABILIFY + EPS--alanjacobs, posted by Honore on January 16, 2007, at 11:09:50
> I was doing some reading on the EPS-TD relationship last night. Seems not to be absolute, although people with TD often have had EPS-- and people with EPS develop TD more than twice as frequently as people w/o it, in the first year after a study. (Those studies did not show a difference in the rate of developing TD between typical and atypical APs.)
This is a Venn diagram of sorts> But researchers seem unclear about the relationship. Definitely not clear that everyone who has TD had EPS-- or that everyone with EPS develops TD.
Also true, A and B Venn diagrams.
> I also noticed that Cogentin is used to treat EPS, but won't help TD. But also some indication that Cogentin, itself, could make TD worse.
This is true, unfortunately. Anticholinergics for reasons unclear will not help TD, and is one clear indication that something is not TD or not any manifestation that we could call TD.
> And that sometimes, a very early expression of EPS can be transitory with use of atypicals. This would seem to be very unclear, however, given that lack of definitive understanding of either syndrome, or the cause of relationships between them.
And can be transitory with typicals as well. Also can change with dose adjustments, I know personally.
> On the other hand, while there are many claims that atypicals greatly reduce the frequency of TD, this hasn't yet been fully substantiated. For one thing, there's a greater than usual number of false negatives for the presence of movement disorders in the type of testing that's used in studies. And some careful studies seem to suggest a higher rate than was previously hoped. Yet, it does seem to be less.
There are false negatives, and false negatives generated by doctors not trained in the nuances of TD versus ID or EPS. Careful monitoring of patients should always be done, and AIMS exams should always be done for long term use, its vital.The BJP (British Journal of Psychiatry) noted I believe a 1/2% per year on Zyprexa in one lengthy study a while ago.
Another accessible study showed in adults but not older adults 0.8% aggregate:
http://ajp.psychiatryonline.org/cgi/content/full/161/3/414
> I guess there's certain precedent for using Cogentin for EPS-- but I really couldn't find any study or article that considered whether there was masking. But definitely, it's important to monitor the situation pretty carefully.Some old articles make reference to masking, but this is unclear -- a lot of things about TD are still not completely clear. I agree, and there have been more than 50 years of monitoring of old line agents.
> Maybe if the symptom doesn't recur, it was transitory. On the other hand, with the old APs, about 65% of patients develop TD (over a fifteen year period, after which seemingly, the risk is greatly reduced). How much less this would be true of atypicals, and whether an early manifestation of EPS is a strong indication just isn't clear.Its hard to say whether its 65% -- possibly with high dose phenothiazines for years, but we don't really know. It is definately higher with old line drugs, that has been demonstrated.
> It's certainly a decision individuals have to make for themselves. Only they can evaluate the benefits and risks that they are prepared to take.
It's an individual decision, not one I take lightly with Seroquel. But I have the trust in both my psychopharmacologist and several personal meetings with leading experts in TD. Its something I think about because I present odd EPS formations but they would not occur in the way they do or the fashion that agents can attack it were they TD.
Its called informed consent -- that is, if your doctor informs you, you consent to it, unless you are in such a psychotic state that you have no lucidity and are in danger to others or yourself and have to be held in a 72 hour hold by the state or local authorities.
> Honore
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.