Posted by med_empowered on November 4, 2005, at 0:30:56
In reply to Re: Haldol experiences? » yesac, posted by pseudoname on November 3, 2005, at 17:16:16
Haldol by itself is pretty dulling drug--its rough stuff. Haldol and Lithium combined **sometimes** results in permanent brain damage--there's this weird thing that happens with haldol and some other old-school neuroleptics when they're added to lithium; it seems to induce a sort of brain damage (I think similar to encephalitis, but I'm not sure) that can sometimes be permanent. In addition, the neuro-toxicity of APs is boosted by Lithium...there are some studies that show that bipolar people on long-term APs tend to have cognitive impairment that isn't seen in control groups OR in bipolars not on antipsychotics; one theory is that the APs alone do this (very, very possible)...another is that the once common practice of combining lithium with antipsychotics bumps up the brain damag/cognitive impairment, either causing impairment OR worsening the impairment. Plus, Haldol is rough stuff--it tends to dull people, cause akathisia, it causes tardive dyskinesia A LOT...its just not a good drug all around.
I understand your need for cheap drugs. But...Haldol is rough stuff. In addition to the previously mentioned side effects, it tends to cause dopamine hypersensitivity...basically, you could end up **needing** to take Haldol b/c it sensitives dopamine receptors...also, the withdrawal from Haldol (should you choose to withdraw) could lead to a "withdrawal psychosis" (probably caused by dopamine super-sensitivity) and other problems (withdrawal-emergent akathisia, tremors, etc.). And, if you do go back onto antypical antipsychotics...the dopamine sensitization caused by Haldol could change your brain so that higher doses of the atypical are required, which means that you'd get fewer of the good effects of the atypicals and more of the side effects. So...I guess my position would be to TRY to do without antipsychotics (bipolars are particularly prone to tardive dyskinesia and EPS), try another old antipsychotic (my votes would be for Trilafon, Molindone, and Loxapine--in that order), or ditch the lithium and just focus on using the antipsychotic as your primary mood-stabilizer. Trilafon (perphenazine) was recently studied in the CATIE study for schizophrenia; it did almost as well as Zyprexa, for considerably less cash (it is very, very cheap). Its sedating, but not as sedating as Thorazine (its an "intermediate potency" AP, whereas Haldol is "high potency" and Thorazine is "low potency"; EPS and akathisia are more common in high-potency, sedation in low-potency).
If you do opt to try Haldol, you should probably have some Cogentin or similar anti-EPS med on hand. You should probably also have propranolol and/or Benadryl on hand for possible akathisia; benzos help as well (and may help reduce agitation in **some** people...Klonopin is good for schizoaffective/bipolar).
poster:med_empowered
thread:574968
URL: http://www.dr-bob.org/babble/20051031/msgs/575243.html