Posted by ed_uk on October 11, 2006, at 12:34:15
In reply to Re: QoL: Old versus atypical antipsychotics » ed_uk, posted by yxibow on October 11, 2006, at 10:27:40
>A 3 point discontinuation rate between Geodon and Seroquel is within the margin of error.
I wasn't comparing Seroquel with Geodon, just noting the very high drop out rate with Seroquel.
>The dose range of perphenazine was chosen to minimize the potential for extrapyramidal symptoms that may have biased previous comparisons of first- and second-generation drugs" This suggests to me that the phenothiazine drug used in the study was used at its MED (minimum effective dose).
Well yes, that's good, excessively high doses would have been inappropriate.
>Have you ever tried a bone chilling dose of Compazine, Ed ? Its staggering.
No, I took a high dose of Thorazine though and it landed me in the hospital with VERY severe akathisia. I once took a low dose of Compazine (5mg orally) and didn't have any side effects. Side effects of neuroleptics are usually dose dependent.
You seem to be missing the point. If typical APs are used, clearly they should not be given at 'bone chilling' doses.
>I'm only glad that there are medications out there that have low EPS levels, regardless of how much I have to use the treadmill.
I'm glad they're available too, but they are not *universally* superior to typicals.
>TD rise markedly up to Risperdal, as well as to old line antipsychotics
I don't actually know of any evidence that the risk of TD is any higher with Risperdal than with any of the other atypicals. Acute EPS seems to be more common with Risperdal but that does not necessarily apply to TD. The evidence I've seen suggests that the risk of TD is similar among all the atypicals, including Seroquel and Risperdal.
>This study also does not focus particularly on affective disorders, where neuroleptics weigh a heavier toll of EPS and TD
I think this is probably a myth. Psychotic patients tend to be more ill and less capable of reporting EPS.
>I'm talking about effects in myself, not what others choose to take, what risks they take in informed consent (old line drugs which have now been out for 50 years show markedly higher TD rates than new medications that have been out for only a decade.)
In the treatment of schizophrenia, I believe that an atypical AP should be used first-line. Among the atypicals, I would not choose Seroquel first.
Ed
poster:ed_uk
thread:691556
URL: http://www.dr-bob.org/babble/20061011/msgs/693834.html