Posted by med_empowered on October 27, 2005, at 14:57:32
In reply to Re: Potent neuroleptics » silmarilone, posted by ed_uk on October 26, 2005, at 14:08:48
hi! OK, so the situation with old-school antipsychotics is kinda complicated right now. Since the atypicals have their problems--they do cause TD, and they often cause weight gain and/or diabetes--there's been renewed interest in trying lower doses of the standard drugs, since consensus seems to be that they were given in excessive amounts in the past (interestingly, there also seems to be a tendency to prescribe atypicals ABOVE studied doses). TD tends to occur more often where there are "mood issues"--schizoaffective, schizophrenia with significant mood components, bipolar, and psychotic mood disorders--so its definitely something to be concerned about. TD **might** be related to "oxidative stress"; apparently, antipsychotics tend to promote free radical formation and damage to the brain (maybe atypicals do this a bit less?)...its this theory that's formed the basis of using vitamin E to treat tardive dyskinesia, with mixed (and not too exciting) results. My concern is that you're taking this for bipolar disorder--although bipolar often has a psychotic component, it is first and foremost a mood disorder, so your risk of TD is higher than that of people with schizophrenia. The rate for TD with the old drugs is given as 20% after 5 years; long term, the estimates range from 30% to over 50%..my own guess is that the higher estimates are probably closer, since they take into account ALL forms of TD (some of the lower numbers were calculated by artificially removing the most mild and most severe cases, and also removing the number of cases of TD that were expected to go into remission...a good number of TD cases will stop or get better, but the process can take years). TD is also linked by some people to an overall decline on cognitive function, and there's some indication that, at least with the old drugs, long-term neuroleptic use can cause a reduction in cognitive skills. Keep in mind that when Thorazine was first being used on the mentally ill, it was openly referred to as a "chemical lobotomy"; the il-effects on cognition and personality can be pretty profound. For the akathisia..you should first try dose reduction. While reducing the dose, your doc can also add something--propranolol, Cogentin, a benzo-- to help as well. The best numbers I've heard for TD with the new drugs relate to zyprexa...the incidence is I believe estimated to be .5-1%/year. Abilify doesn't have good data on it for TD yet, but it looks pretty promising...there doesn't appear to be very much up-regulation of the D2 receptors (probably b/c of the agonist/antagonist action) and it also appears to be great at treating existing cases of TD w/o worsening the syndrome (this is similar to clozapine, which has a very low rate of TD). I dont want to push you to change something thats working for you but...with Abilify, the akathisia seems to go away after the start-up; co-prescribing with a benzo or propranolol can help significantly (20mgs propranolol, 3-4X daily helped a lot for me). The added benefits are clearer cognition (b/c of the lack of sedation, probably), weight-neutrality, and some antidepressant action. Abilify can also be used with old drugs--I read a case study where a woman with marked TD was given Abilify, 30mgs, plus Thorazine, 300mgs..the TD went away pretty much completely, and the added Thorazine didn't cause a worsening of the TD or much of a change at all from "normal" on the involuntary movements scale. I imagine you could do a cross-taper, so you could eventually end up just on abilify after a bit of time on perphenazine+abilify. But..if you opt to stay on perphenazine, I guess I'd recommend that you keep the dose at an **absolute** minimum, especially since you have bipolar..the goal should be no EPS, no akathisia w/o having to use add-on medication. In addition, supplementing antioxidants might be useful--when I was on neuroleptics, I always took a multi-vitamin, plus extra vitamin e/c (combo pill), selenium, and alpha lipoic acid. Adding a benzo may also help minimize the antipsychotic dose (some studies show xanax, ativan, and klonopin as being the benzos of choice for this sort of thing). Good luck!
poster:med_empowered
thread:571572
URL: http://www.dr-bob.org/babble/20051024/msgs/572432.html