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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by rene5150 on September 5, 2011, at 16:58:53
anyone there taking Trilifon and having weight gain? I havent had any so far.
Posted by Christ_empowered on September 5, 2011, at 18:06:39
In reply to weight gain, posted by rene5150 on September 5, 2011, at 16:58:53
I read that perphenazine isn't as bad with weight gain as the atypicals. Most antipsychotics, though, are associated with at least minor weight gain. The only exceptions I can think of are Geodon (though I think it still happens to some patients) and Moban, which isn't on the market in the US anymore.
I would think that switching from Seroquel to perphenazine might result in some weight loss. Has it?
Posted by jono_in_adelaide on September 5, 2011, at 19:02:02
In reply to Re: weight gain, posted by Christ_empowered on September 5, 2011, at 18:06:39
The drugs that cause weight gain are usualy those with potent antihistaminic effects..... chlorpromazine, thioridazine, olanzapine, quetiapine, and amitriptyline and mirtazepine in the antidepressant group.
Generaly, the more initial drowsiness a drug causes, the more weightgain it is likely to cause.
Perphenazine, Haloperidol, trifluroperazine cause little sedation and little weight gain.
Posted by rene5150 on September 5, 2011, at 19:08:27
In reply to Re: weight gain, posted by Christ_empowered on September 5, 2011, at 18:06:39
Accualy, i have lost weight. Thing it was the depression. havent really cut back food, dont eat much anywaw
Posted by emmanuel98 on September 5, 2011, at 20:19:21
In reply to Re: weight gain, posted by rene5150 on September 5, 2011, at 19:08:27
I took perphenazine for a while and didn't gain any weight and I did gain lots of weight on all the atypicals except geodon. I also took haldol briefly and didn't gain weight on that.
Posted by Phillipa on September 5, 2011, at 20:46:32
In reply to Re: weight gain, posted by emmanuel98 on September 5, 2011, at 20:19:21
Interesting as if the atypicals are new why bother creating them if weight is a factor? Phillipa
Posted by B2chica on September 5, 2011, at 21:11:39
In reply to weight gain, posted by rene5150 on September 5, 2011, at 16:58:53
on very low dose perphenazine, but no weight gain...able to loose weight.
gained weight on zyprexa but only once go to 10mg.
none on geodon
none on abilify
none on risperdal
about 10 on seroquel
Posted by jono_in_adelaide on September 5, 2011, at 22:18:01
In reply to Re: weight gain, posted by Phillipa on September 5, 2011, at 20:46:32
Phillipa, I think the atypicals were seen as an advance, even though they cause weight gain etc, because they are more effective against the negative symptoms of schitzophrenia than the older drugs, and cause fewer EPS type side effects
Posted by Phillipa on September 5, 2011, at 23:44:00
In reply to Re: weight gain, posted by jono_in_adelaide on September 5, 2011, at 22:18:01
Jono trade one for the other I guess thanks. Phillipa
Posted by Zyprexa on September 6, 2011, at 6:53:10
In reply to Re: weight gain » jono_in_adelaide, posted by Phillipa on September 5, 2011, at 23:44:00
I don't get weight gain on 36mg perphenazine. I do find it to be sedating. Which I like.
Posted by Christ_empowered on September 6, 2011, at 11:54:46
In reply to Re: weight gain, posted by jono_in_adelaide on September 5, 2011, at 22:18:01
OK, from what I read, when the atypicals first came out they noticed less EPS and less TD, at least in animal studies. Now, it turns out that part of the problem was that docs tended to use excessively high doses of high potency, harsh drugs (especially Haldol for some reason), particularly in the US (in Europe, they apparently haven't been as heavy-handed with antipsychotics). It wasn't uncommon for people to be given 10-20 milligrams of Haldol, for instance; modern brain imaging studies have shown that you can get sufficient D2 blockade out of 2-5 milligrams daily.
With a lot of the atypicals, if you ramp the dose up enough, they start acting more like the old drugs--EPS, TD, dysphoria, cognitive dulling, that sort of thing. With the older drugs, if you keep the dose low enough, you can get improvement in positive symptoms w/o EPS or cognitive problems or drug-induced dysphoria/depression. Of course, nobody's backing the old drugs anymore, so docs (especially in the US) tend to Rx the newer ones right off the bat and switch people to the newer ones if they're on the older ones.
To be fair, Zyprexa did have a slight edge over both perphenazine and the other atypicals in the CATIE study. It also tended to cause lots of weight gain and metabolic problems.
The only truly novel antipsychotic on the market in the US right now is Abilify, which functions as a partial agonist at D2 receptors (and elsewhere, I think). This doesn't seem to translate into anything particularly amazing, at least not for me; all I've noticed with Abilify is symptom control w/o EPS or significant cognitive dulling. People still report feeling slowed down/zombie-fied at higher doses, it can still cause NMS, EPS, and TD in some people, and it has its own problems (akathisia, lack of sedation, etc.).
A lot of the switch to atypicals was done because of marketing, honestly.
Posted by sigismund on September 6, 2011, at 14:33:31
In reply to atypicals vs conventional neuroleptics, posted by Christ_empowered on September 6, 2011, at 11:54:46
The thinking in the 70s was that side effects (EPS) became less pronounced at higher dosages.
I don't know if this was true. Perhaps not?
Posted by jono_in_adelaide on September 6, 2011, at 17:28:49
In reply to Re: atypicals vs conventional neuroleptics » Christ_empowered, posted by sigismund on September 6, 2011, at 14:33:31
Yes Christ, a lot of it certainly has to do with the power of advertising
Posted by emmanuel98 on September 6, 2011, at 20:57:47
In reply to atypicals vs conventional neuroleptics, posted by Christ_empowered on September 6, 2011, at 11:54:46
My p-doc told me that geodon (according to something he read) has a 5% market share for APs and perphenezine has a 4% market share. So somebody is still prescribing the old drugs.
Posted by emmanuel98 on September 6, 2011, at 21:02:02
In reply to Re: atypicals vs conventional neuroleptics, posted by jono_in_adelaide on September 6, 2011, at 17:28:49
Everyone I talked to at McLean and my own p-doc said higher dosages of the old APs are associated with more EPS problems. McLean put me on 36mg of perphenezine and my p-doc, when I got out, cut it down immediately to 12 mg. I had akathesia from the 36 mg and he was worried about other EPS effects. I now take haldol PRN to control suicidal urges (like every two or three weeks) and he doesn't want me to take more than 10mg, even infrequently because of the potential for EPS problems.
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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