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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 26. This is the beginning of the thread.
Posted by fenix on November 27, 2007, at 10:37:42
This is a list I made with some specific medications that could possibly treat Tardive Akathisia:
Benztropine (Cogentin®)
Clonidine
Cyproheptadine (Periactin®)
Gabapentin (Neurontin®)
Piracetam (Nootropil®, Myocalm®, Dinagen®)
Pregabalin (Lyrica®)
Ritanserin
Selegiline (l-deprenyl)Other medications in general: anticholinergics, antihistamines, benzodiazepines, beta-blockers, opiates.
Posted by Phillipa on November 27, 2007, at 11:53:15
In reply to List Of Possible Treatments For Tardive Akathisia, posted by fenix on November 27, 2007, at 10:37:42
Wow you know your meds sounds like you got them all. Phillipa
Posted by pstrait on November 27, 2007, at 14:44:02
In reply to List Of Possible Treatments For Tardive Akathisia, posted by fenix on November 27, 2007, at 10:37:42
don't forget mirtazapine and mianserin.
Posted by fenix on November 27, 2007, at 15:44:36
In reply to Re: List Of Possible Treatments For Tardive Akathi, posted by pstrait on November 27, 2007, at 14:44:02
> don't forget mirtazapine and mianserin.
I'm trying to stay away from as many ADs and APs as possible in that listing.
Posted by pstrait on November 27, 2007, at 16:02:35
In reply to List Of Possible Treatments For Tardive Akathisia, posted by fenix on November 27, 2007, at 10:37:42
Then why include selegiline or ritanserin? Ritanserin works for the same reason mianserin and mirtazapine work -- they are 5ht2 antagonists.
I'm not sure why you wouldn't want to consider these medicines.
Medlink's article on Tardive Akathisia includes the following:
Management
It is important that psychotic patients be warned about the possible development of akathisia from taking neuroleptics, lest they misinterpret the condition as worsening agitation and stop taking their medication or become suicidal (Drake and Ehrlich 1985). The surest remedy for acute or subacute akathisia is to reduce or eliminate intake of the offending drug. If this is not feasible, consider substituting one of the newer antipsychotics with a lower propensity to causing akathisia. No universally successful treatment exists, but antipsychotic-induced akathisia may respond to a variety of medications. The most consistently effective appear to be beta-blockers (Miller and Fleischhacker 2000). Nonselective serotonin antagonists such as mirtazapine, ritanserin, mianserin, and cyproheptadine may also be beneficial (Fischel et al 2001; Poyurovsky et al 2003). Other agents reported to relieve symptoms of akathisia include anticholinergics, amantadine, clonidine, benzodiazepines (Lima et al 2002), opiates, nicotine patches, and trazodone (Stryjer et al 2003). Acute, severe akathisia may respond to intravenous or intramuscular biperiden (Hirose and Ashby 2000) or intravenous diazepam (Hirose and Ashby 2002).
In tardive akathisia, the catecholamine depletors reserpine and tetrabenazine have been the most effective agents (Burke et al 1989), much as in tardive dyskinesia.
Posted by fenix on November 27, 2007, at 16:22:42
In reply to Re: List Of Possible Treatments For Tardive Akathi, posted by pstrait on November 27, 2007, at 16:02:35
> Then why include selegiline or ritanserin? Ritanserin works for the same reason mianserin and mirtazapine work -- they are 5ht2 antagonists.
>
> I'm not sure why you wouldn't want to consider these medicines.
>
> Medlink's article on Tardive Akathisia includes the following:
>
>
>
> Management
>
> It is important that psychotic patients be warned about the possible development of akathisia from taking neuroleptics, lest they misinterpret the condition as worsening agitation and stop taking their medication or become suicidal (Drake and Ehrlich 1985). The surest remedy for acute or subacute akathisia is to reduce or eliminate intake of the offending drug. If this is not feasible, consider substituting one of the newer antipsychotics with a lower propensity to causing akathisia. No universally successful treatment exists, but antipsychotic-induced akathisia may respond to a variety of medications. The most consistently effective appear to be beta-blockers (Miller and Fleischhacker 2000). Nonselective serotonin antagonists such as mirtazapine, ritanserin, mianserin, and cyproheptadine may also be beneficial (Fischel et al 2001; Poyurovsky et al 2003). Other agents reported to relieve symptoms of akathisia include anticholinergics, amantadine, clonidine, benzodiazepines (Lima et al 2002), opiates, nicotine patches, and trazodone (Stryjer et al 2003). Acute, severe akathisia may respond to intravenous or intramuscular biperiden (Hirose and Ashby 2000) or intravenous diazepam (Hirose and Ashby 2002).
>
> In tardive akathisia, the catecholamine depletors reserpine and tetrabenazine have been the most effective agents (Burke et al 1989), much as in tardive dyskinesia.
>
>Side-effects pretty much, and the fact that ADs and the like give me shivers when I think about them.
Your argument could then be that the side-effects are similar. Well, then my argument would be that I decided not to try and include ADs and APs in the list because a) I was interested in things that could treat TA that are not ADs and APs and b) because even though ADs and APs could treat TA they could worsen it in the long run (especially APs I think). Then your argument could be that so could the other things I mentioned worsen it perhaps in the long run.
So then I will just say that I was interested in treatments that are not ADs or APs. Why is that? I was researching more in the realm of Dyskinisia and Parkinsons, drugs you might give for those or neuropathic pains. Some of the things I mentioned I don't think you would see being given for TA, I was thinking that these drugs might work though.
Posted by saturn on November 27, 2007, at 18:54:55
In reply to List Of Possible Treatments For Tardive Akathisia, posted by fenix on November 27, 2007, at 10:37:42
Vitamin E too.
Posted by pstrait on November 27, 2007, at 19:56:55
In reply to Re: List Of Possible Treatments For Tardive Akathi, posted by fenix on November 27, 2007, at 16:22:42
I didn't know for what reason you were making the list, I just wanted to bring up a couple treatment options that it seemed like you had omitted which seem especially promising. Since your list includes antidepressants, including Ritanserin, I figured it should be mentioned that analogues like mianserin and mirtazapine should be mentioned. I am fascinated by the 5ht2 receptors, esp. 5ht2c.
My understanding is that tardive akathisia is caused by d2 antagonism, so i think you are definately right on to be wary of antipsychotics -- they are more the cause than the cure.
Talipexole, a dopamine autoreceptor agonist, is another one to look into. http://sciencelinks.jp/j-east/article/200203/000020020301A0813733.php
Posted by fenix on November 28, 2007, at 5:08:05
In reply to List Of Possible Treatments For Tardive Akathisia, posted by fenix on November 27, 2007, at 10:37:42
Thanks.
I have tardive akathisia by the way. I haven't been on anything in a few years and I still have it.
What's with TA being aloof with opiates? The worst part of the illness is the physical pain; am I missing something here?
Posted by pstrait on November 28, 2007, at 15:42:33
In reply to Re: List Of Possible Treatments For Tardive Akathi, posted by fenix on November 28, 2007, at 5:08:05
I bet someone would write a buprenorphine script.
Where do you have pain? I thought tardive akathisia mostly presented as restlessness. Have you been shot down specifically by doctors when requesting a painkiller?
Posted by fenix on November 28, 2007, at 16:27:26
In reply to Re: List Of Possible Treatments For Tardive Akathi, posted by pstrait on November 28, 2007, at 15:42:33
> I bet someone would write a buprenorphine script.
>
> Where do you have pain? I thought tardive akathisia mostly presented as restlessness. Have you been shot down specifically by doctors when requesting a painkiller?The pain in tardive akathisia is unique I think. It is physical pain, the restlessness and agitation is painful physically somehow, very painful. I never requested painkillers before for it, I thought it would not be fruitful. Why have I not? Because I get this feeling that first of all, the doctors I have seen so far don't know much about TA and even if they did I feel weird about asking for opiates because akathisia, even in this state I have, is subjective.
I can't give a blood sample for instance showing that I have it.
But, it is very painful physically. Tardive akathisia, from my experience with it, is not just akathisia that lasts after you have stopped taking the offending drugs. It actually feels different than "normal" akathisia that you get when you are on something and you feel restless. The difference is that tardive akathisia not only lasts and lasts, it actually feels much worse. And there seem to be some slight extra-pyramidal symptoms too.
Posted by pstrait on November 28, 2007, at 20:20:21
In reply to Re: List Of Possible Treatments For Tardive Akathi, posted by fenix on November 28, 2007, at 16:27:26
Have you described explicitly how much pain you are in? If so, how have doctors responded?
Posted by linkadge on November 28, 2007, at 23:59:04
In reply to Re: List Of Possible Treatments For Tardive Akathi, posted by pstrait on November 28, 2007, at 20:20:21
If you happen to be in considerable physical pain for which OTC painkillers are insufficiant, then I would describe that to your doctor. I certainly don't think they would ever prescribe a painkiller for pure akathesia, but if you are in physical pain then you would want to describe that to your doctor.
Akathesia typically isn't associated with severe enough pain to warrent painkillers, but everbody's case is different.
Although it may not be your intent, it would seem to come across to a doctor as a drug seeking behavior for which they would be unlikely to comply.
Linkadge
Posted by fenix on November 29, 2007, at 6:26:26
In reply to Re: List Of Possible Treatments For Tardive Akathi, posted by linkadge on November 28, 2007, at 23:59:04
> Although it may not be your intent, it would seem to come across to a doctor as a drug seeking behavior for which they would be unlikely to comply.
>
> Linkadge
>
>Yes, which is why I am hesitant.
Posted by fenix on November 29, 2007, at 7:27:32
In reply to Re: List Of Possible Treatments For Tardive Akathi, posted by pstrait on November 28, 2007, at 20:20:21
> Have you described explicitly how much pain you are in? If so, how have doctors responded?
I did and one doctor came to the conclusion that it was probably akathisia. None ever brought up anything about treating the pain of it.
I eventually started to take diazepam, even though it helps it doesn't help that much, but the side-effects are safer than a lot of other things I could try, so I keep debating with myself whether I should try something else. A psychiatrist doesn't prescribe it to me, my normal doctor does, however, I am aware that my doctor here is not that familiar with any kind of akathisia.
I didn't want to go to a psychiatrist as I have a distrust for them when it comes to their ability to treat this, even though they should know more about it than a general doctor. I have a big list of things I could take, but I have a feeling that there is a possibility that even if I bring them up, the psychiatrist will either a)not be aware of treating the illness with the specific medicine I bring up b)insist on giving me something like an anti-psychotic to treat it.
Posted by fenix on November 29, 2007, at 7:29:22
In reply to Re: List Of Possible Treatments For Tardive Akathi, posted by pstrait on November 28, 2007, at 15:42:33
> I bet someone would write a buprenorphine script.
Why buprenorphine?
Posted by fenix on November 29, 2007, at 7:32:02
In reply to Re: List Of Possible Treatments For Tardive Akathi, posted by pstrait on November 27, 2007, at 19:56:55
> Talipexole, a dopamine autoreceptor agonist, is another one to look into. http://sciencelinks.jp/j-east/article/200203/000020020301A0813733.phpIs talipexole something that is rare in the USA? I don't think I've heard of it before. Does it have a trade name?
Posted by fenix on November 29, 2007, at 7:36:42
In reply to List Of Possible Treatments For Tardive Akathisia, posted by fenix on November 27, 2007, at 10:37:42
Another thing I want to bring up again is the diazepam. It is generic and I have heard that the generic forms of benzodiazepines can be impotent sometimes. I think this might be the case with what I am taking, so I wonder if it would be worth trying to get the brand name instead?
However, diazepam isn't that great for TA, so I could perhaps stop taking it eventually and take something else, but I figured that as long as I am on it I then may as well see if I am actually taking a weak form of it.
Posted by James R on November 29, 2007, at 13:44:13
In reply to List Of Possible Treatments For Tardive Akathisia, posted by fenix on November 27, 2007, at 10:37:42
Hi,Someone recently offered me a *cure* for my tardive dystonia, and it worked.
I had chronic jaw stiffness and tension headaches.The combination of meds I took was:
1) Quercetin (PKC inhibitor) + Bromelain 500 MG/day
2) Benadryl (diphenhydramine) 4x50mg tablets (200 mg total) every 4 hours.
3) Alpha-Lipoic-AcidThe Quercetin blocks the enzyme that breaks
phosphatadylcholine into choline. The Benadryl is useful for its anticholinergic properties. The combo reverses dopamine receptor supersensitivities.
I was on the pills for about 5 days. Its very fatiguing after a few days, but in the end it was
worth it. The dosages,etc,are a rough guideline
to get started with. The doses that worked for me
may not be the perfect one for someone else. I had
one other side effect which dissipated after discontinuing treatment which was a transient pain in my side.Best of luck,
James R
Posted by James R on November 29, 2007, at 15:02:54
In reply to List Of Possible Treatments For Tardive Akathisia, posted by fenix on November 27, 2007, at 10:37:42
This isn't as good in my opinion as using the
quercetin+benadryl cure, but you may want to add
to your treatment list acamprosate.Acamprosate was a drug used for alcoholism, but
indications are it can treat tardive movement
disorders. There is current a company called
Somaxon phamaceutical doing clinical trials in the
use of Acamprosate for TD.:http://www.somaxon.com/pages/product.htm
Regards,
James R
Posted by Phillipa on November 29, 2007, at 17:55:32
In reply to Re: List Of Possible Treatments For Tardive Akathi, posted by fenix on November 29, 2007, at 7:36:42
Generics can be 20% stronger or weaker than the name brand. What country are you in? Phillipa
Posted by fenix on November 29, 2007, at 18:21:03
In reply to Re: List Of Possible Treatments For Tardive Akathi » fenix, posted by Phillipa on November 29, 2007, at 17:55:32
> Generics can be 20% stronger or weaker than the name brand. What country are you in? Phillipa
USA
Posted by Phillipa on November 29, 2007, at 18:55:02
In reply to Re: List Of Possible Treatments For Tardive Akathi, posted by fenix on November 29, 2007, at 18:21:03
Fenix then it applies. Phillipa
Posted by yxibow on November 30, 2007, at 5:17:28
In reply to Re: List Of Possible Treatments For Tardive Akathi » fenix, posted by Phillipa on November 29, 2007, at 18:55:02
There are no "cures" for any Tardive phenomenon, however proper diagnosis by a movement disorder neurologist to determine if it is in fact what the patient thinks is important.
There are "palleatives" which in fact covers half the drugs on the market, that is, something that works to cover up a condition and improves someone's life.
TD: higher recovery rate, lower palleative
TDy: lower recover rate, rather rare, higher palleative
TA: not one I've heard of commonly, but similar palleatives would be thrown at it if it is severe.Dopamine agonists
Antiparkinsonians
APs on this list that did not "cause" it:
Clozaril, Seroquel, Zyprexa
Posted by James R on November 30, 2007, at 13:24:04
In reply to Re: cure for tardive akathisia,dyskinesia,dystonia, posted by James R on November 29, 2007, at 13:44:13
I made an error, the benadry dose is 1/2 what
I stated (25 mg tablets not 50).2) Benadryl (diphenhydramine) 4x25mg tablets (100 mg total) every 4 hours.
>
> Hi,
>
> Someone recently offered me a *cure* for my tardive dystonia, and it worked.
> I had chronic jaw stiffness and tension headaches.
>
> The combination of meds I took was:
> 1) Quercetin (PKC inhibitor) + Bromelain 500 MG/day
> 2) Benadryl (diphenhydramine) 4x50mg tablets (200 mg total) every 4 hours.
> 3) Alpha-Lipoic-Acid
>
> The Quercetin blocks the enzyme that breaks
> phosphatadylcholine into choline. The Benadryl is useful for its anticholinergic properties. The combo reverses dopamine receptor supersensitivities.
>
>
> I was on the pills for about 5 days. Its very fatiguing after a few days, but in the end it was
> worth it. The dosages,etc,are a rough guideline
> to get started with. The doses that worked for me
> may not be the perfect one for someone else. I had
> one other side effect which dissipated after discontinuing treatment which was a transient pain in my side.
>
> Best of luck,
> James R
>
>
>
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