Posted by the kindling effect on February 9, 2006, at 14:03:56
In reply to Re: ATTN: fenix. » the kindling effect, posted by ed_uk on February 8, 2006, at 13:25:03
> Hi Dave
>
> I hope you don't mind me asking you the same questions I asked Fenix.......
>
> Tell us about your akathisia.Indescribable.
It's probably easier if you ask someone more pointed questions like, where do you feel it, when, what makes it worse.What makes it better. Does walking/pacing help. You can really narrow it down quickly.And tehn even question based on the answers.
It can be difficult to concentrate with TA. I used to use the analogy of imagine you have to go to the bathroom really,really badly but there are 500 in front of you in line (que(sp?) for you) and your legs are clamped and you're squirming and a friend is trying to show you the details on a tacky new sweater they got....
that's not truly accurate though, that's probably a better description of anxiety. Anxiety doesn't make you want to jump out a window necessarily. And akathisia there's rarely an urge to urinate no matter how bad the 'anxiety'is. the squirming is accurate,as are at times mewling and crying, torso twists and stepping on the spot like a little kid.
I found the movement neuorlogists could quickly pinpoint if it was akathisia(Tardive or otherwise) they were dealing with or not with the correct questions. Some trademarks you can't get away from; and as you know several things can mimic akathisia.
TA; wha t a way to solve the first world's obesity epidemic.No matter how much you eat you keep losing weight! And if you exercise it only brings on excruciating akathisia in the following hours or next day.A lot of people with TA I would assume had previous psychiatric problems. This justs clouds the issues. Apparently there is a strong mental componement to TA as well. (was you Ed who felt a kind of bad ,insecure anxiety on Risperdal or a similar AP? That's part of it for me. Like you're a frightened,timid child? again it's difficult to explain but it's not your regular insecurity.
You really should differentiate between acute, chronic and Tardive akathisia. If recall correctly you yourself Ed have suffered a bout of acute akathisia. Tardive is the same but different. Basically, I'm sure you can understand that you likely couldn't survive a long-term attack of acute akathisia.
How long have you had it? Probably underlying since '99 or 2000. Tardive likely since....for 2 years maybe? Bad the last year. I have med/mood calendars since 2001. It's embarassing to be able to se the progression of it now. One neurologist sort of tracked his way along and just said "wow". Although they are always surprised at the low doses. In my opinion that's likely where the kindling effect/ revervse stimulant tolerance from past C/alcohol/ssri combo come in.
Which medication was responsible?Numerous. 5 years on sertraline. Had some akathisia(had no idea what it was), bruxism and broken back molar from jaw clencing.Pre- 2000 I couldn't have told you what the hell serotonin was. I felt good on the med and had a life so I ignored these things. Sporadic C use while bingeing alcohol on sertraline pre-2000. Dec.2000 first panic attack(what the hell was that!?!?) on-set of anxiety, akathisia from zoloft(still don't know what it is) put on high dose benzo (cloxazolam(sp.)-Brasilian) akathsia calms.Return to Canada, Can no longer tolerate sertraline,nor any other SSRI.Start lorazepam(until today)Tolerate low-dose EFXR up to 75mg. Eventually lowered to 18.75mg.due to side effects(dysphoria, akathisia(still didn't understand it) (special pharmacy in Toronto makes exact doses). Many other trials while on Efxr and before. Mood stabilizers horrible (mostly agitation). Hit on olanzapine with EFXR, doc insists on .625mg. to begin. Success. I insist on raising olanzapine (nope,drowsy, bad agitation, outburts)(Quick trial of Risperidone .25mg. after three days can't sleep due to aka., takes three days to wear off after stopping.Do well on Zyp./EFXR for nearly a year along with intermittent 100mg Wellbutrin (2x week?) but akathisia shows up again about 3 mos. in, throw more lorazepam on it. Switch to Seroquel 25mg, lower Efxr to 14mg. due to speedy chest, stiffness. Do well more or less (Daily flucuaions and mild dysphoria on/off entire 2001-present) second broken molar from jaw-clenching, more akathisia, begins showing up in daytime,along with mental akathisia(my term, I didn't realize it acually existed!)Add/Try several beta blockers, loraz creeps up a little more
Doc moves to B.C mess with meds(raise Seroquel to 50mg several times-can't sit still,tics,jaw clenching, sleep much worse after few days, lower dose again........f.f....hospitalized, psychiatrists diagnose everything nameable then chage their minds (they love that Bi-Polar as do some people on this board for a catch-all). Nix most dx's after getting me off meds and raising lorazepam. Just depression ,anxiety and something else they can't figure out. After over year of dizzying array and specialists 4 seperate movement neurologists dx TA plus, plus plus.(was stupidly still trying to get back on ADs etc. with a psychiatrist)When did you stop the offending medication?
see above.
Close to a year psychotropic free.Did you suffer from acute extra-pyramidal side effects when you were still taking the offending medication?
See above. Still have mild left side neck dystonia, lower back dystonia.
Problems are always more severe/ show up more on left side; weakness,facial twitches, my famous ankle dip, stiffness.What medication(s) are you on at the moment?
lorazepam 5 mgs. (told to go as high as ten), several attempts wit propranolol.hich meds have you tried for the akathisia so far?
For some reason clonazepam causes muscle tightness/stiffness, and insomnia in the past.Lorazepam is one of the few GABA meds I don't seem to have problems with. Gabapentin caused horrible insomnia and anxiety.Haven't tried Tetrabenazine or opiates.Was prescribed Nabilone by a doc but I filled the script and didn't take it and he changed his mind. It was a long shot.Pot never used to do anything but make me flat and sad.
-haven't tried Clozapine, surpringsly only one psych/neurologist suggested it.
-perhaps pergolide?(due to partial DA agonism/antgonism?)Clonidine worked physically somewhat(didn't stop daily fluctuation);my body lay flat for the first time in ages. pulled off it (it was a fairly low dose) because it made my sensitivity to background sounds and light much worse, and my hyper-vision worse, bit of an E-bay buying binge,very speedy mentally, freezing,BP up again(i know i know it's a BP med;also told I know have an 'autonomus system dysregulation',whatever) anxiety,chest pain(a constant mostly for 5 years which I learned to deal with. and anxiety is often a good thing-pay attention to how you look, mind actually worries/thinks about other things rather than wrapped up in this horrible inner turmoil/restless/impatient/vibrating/squirming feeling. don't know, I usually ignore side efxs for most part.
Apparently pulse-dosing your psychotropics (especially APs) can hasten/put you more a risk of contracting TD syndromes.
Apparently DA agonists can worsen TA in long run. Was on pramipexole a few times (totally killed the akathisia back in the Zyprexa days but couldn't handle the med).
Apparently beta-blockers are often of little use in TA. TA is not well understood but éxtremly difficult to treat(tired of reading/hearing this)
Apparently different cases may respond differrently to different treatments.Hands are freezing, gotta stop.OK Dr. Ed I'm up off the couch now, our time is up.
excuse the incoherrent mess. Makes H.S.T. look slow and poetic.DAVE
poster:the kindling effect
thread:604046
URL: http://www.dr-bob.org/babble/20060205/msgs/607973.html