Posted by Larry Hoover on November 18, 2002, at 8:56:00
In reply to Central Anticholinergic Syndrome (CAS), posted by rod on November 18, 2002, at 7:53:23
> First I have to say, that I am not a medical professional. Things I say here are based on my personal opinion and things I have read on the internet.
>
> Central Anticholinergic Syndrome (CAS)
>
> This may explain why I get bad response to alcohol, paradox reaction on benzos, impaired thinking on non-anticholinergic (like Effexor, Prozac, Celexa, ...).
>
> My main complaints are: impaired thinking and memory, physical agitation (foot tapping), and nervoursness, "sometimes an agresive or angry look at my face without feeling that way".Is this the pattern after taking medication, or why you are taking medication?
> I ever thought, I only have CAS if I have things like urinary retention, blurred vision, dry mouth etc. But it can have many symptoms and is ofen overlooked.
It should go away if you stop taking the offending medication. Does it?
> Im sorry, but I did only find a really good article about this in german.
> http://www.tu-dresden.de/medkai/969714.pdf
>
> It says, any psych. medication can cause this (anticholinergic and non-anticholinergic), because cholinergic neurons are closly linked to the other transmitter systems like Serotonin, Dopamine, etc. Any imbalance in this system (think about the SSRIs, although people say it balances serotonin levels, I dont think this is true, because they can cause serotonin syndrome, dopamine depletion ..) can cause disturbance of linked systems.
>
> I made a self test, and found out lecitin is really helping and blows worst symptoms away for a few hours. But I can not explain why at the same time the classic anticholinergic symptons appear like dry mouth, sweating, blurred vision, while others like nervousness, agressive look, insomnia goes away.The classic symptoms form a pattern that come and go together. The simple fact that this does not occur in you argues against CAS. There are a great many other syndromes which need to be ruled out (called the differential diagnosis) before you are left with a diagnosis of CAS.
> And I ever wondered why I dont have these symptoms because I take Amitryptiline (strong anticholinergic TCA) and sometimes Diphenhydramin (old anti-histaminic drug, very anticholinergic) for sleep and never had a dry mouth.
If the diphenhydramine didn't make the symptoms of CAS worse, then that can't be the problem. Diphenhydramine is a classic and well-known triggering drug for CAS. Paradoxical reactions are more likely to involve individual differences in the ratio of activity of different liver enzymes than anything else. This is a genetic trait, which presents challenges in finding appropriate medication for individuals with this trait.
> They even made my mouth _wet_. Only if I take lecitin (precorsor of acetylcholin) I get the classic symptoms, while others disappear.
Lecithin does other things than just supply a precursor to acetylcholine. The phosphatidyl-choline, phosphatidyl-inositol and phosphatidyl-ethanolamine it contains are both signalling compounds and constituents of cell membranes.
> As long as no one really knows whats going on I can only try and see. I am looking forward to meet my doc again and convince her to prescribe me an acetylcholinesterase Inhibitor (the mechanism that breaks down acetylcholin, like mao), because diagnosis can only be done by trying this and see if it helps. (one article says this)Please don't be too surprised if your doctor refuses you such a drug. Overdose can easily bring on death.
> I even read, SSRI withdrawal can trigger CAS.
>
>
> so long
>
> rodRod, it is really wonderful that you are trying to understand how your body reacts to medication. Everybody is different, and without the effort you're showing, you may stumble blindly from drug to drug without gaining any new knowledge about yourself.
In order to determine if you have CAS, the most important thing is to withdraw all medication, while monitoring the patient. Then the patient is challenged with specific medication, under close supervision.
The very fact that some of the classic symptoms are not present would cause most doctors to look for another reason for your difficulties (my opinion).
Good luck,
Larry
poster:Larry Hoover
thread:128095
URL: http://www.dr-bob.org/babble/20021116/msgs/128102.html