Posted by yxibow on October 7, 2006, at 4:40:52
In reply to Atypicals vs old-school meds..., posted by med_empowered on October 6, 2006, at 11:03:06
> really, all I think this study "proves" is what we've already known: the 2nd generation meds are over-hyped. They're still D2 blockers, afterall, so you're still going to get side effects.
>
> Plus, in the US at least, there was a tendency to way, way, waaaay overprescribe the neuroleptics, both in terms of patient selection (Thorazine for "hyperkinetic" children, for instance) and in terms of dosage (20mgs of Haldol was pretty standard for a long time).
Yes, and people were locked up in wards and injected with insulin, but this isn't 1949...
So...when the new drugs came out, of course they looked good up against mind-numbing dosages of old-school drugs. I imagine that 10mgs of zyprexa compared to, say, 200mgs of Thorazine wouldn't look nearly so good. Plus, with the built-in serotonin antagonism, you might be suppressing TD and acute EPS more effectively than with other medsActually with the built in anticholinergic properties probably... I've always been curious about that with Seroquel.
(note that Mellaril had low EPS in part b/c of its effects on serotonin; it still caused TD).
And it still has a dangerous Qtc profile compared to Geodon which was rechallenged.
>
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> I really don't see why we still use neuroleptics. I mean, the whole dopamine theory of schizophrenia is pretty much crap, so why cant docs and drug companies move on?
Where do you get the idea that psychosis because you're seeing things at visual D2 pathways, among other dopamine receptors is crap?Evidence based psychiatry has clearly shown that Clozaril, the gold standard, binds heavily at D4. and even more at D2 despite its nearly zero TD profile than Zyprexa or Seroquel.
(Antipsychotic drugs. In: Pharmacology, 4th edition. Rang HP, Dale MM and Ritter JM. Edinburgh, UK: Harcourt Publishers Ltd, 2001:539–549.)
poster:yxibow
thread:691556
URL: http://www.dr-bob.org/babble/20061003/msgs/692641.html