Posted by Honore on January 16, 2007, at 11:09:50
In reply to Re: ABILIFY + EPS--alanjacobs » Honore, posted by yxibow on January 16, 2007, at 1:42:46
I was doing some reading on the EPS-TD relationship last night. Seems not to be absolute, although people with TD often have had EPS-- and people with EPS develop TD more than twice as frequently as people w/o it, in the first year after a study. (Those studies did not show a difference in the rate of developing TD between typical and atypical APs.)
But researchers seem unclear about the relationship. Definitely not clear that everyone who has TD had EPS-- or that everyone with EPS develops TD.
I also noticed that Cogentin is used to treat EPS, but won't help TD. But also some indication that Cogentin, itself, could make TD worse.
And that sometimes, a very early expression of EPS can be transitory with use of atypicals. This would seem to be very unclear, however, given that lack of definitive understanding of either syndrome, or the cause of relationships between them.
On the other hand, while there are many claims that atypicals greatly reduce the frequency of TD, this hasn't yet been fully substantiated. For one thing, there's a greater than usual number of false negatives for the presence of movement disorders in the type of testing that's used in studies. And some careful studies seem to suggest a higher rate than was previously hoped. Yet, it does seem to be less.
I guess there's certain precedent for using Cogentin for EPS-- but I really couldn't find any study or article that considered whether there was masking. But definitely, it's important to monitor the situation pretty carefully.
Maybe if the symptom doesn't recur, it was transitory. On the other hand, with the old APs, about 65% of patients develop TD (over a fifteen year period, after which seemingly, the risk is greatly reduced). How much less this would be true of atypicals, and whether an early manifestation of EPS is a strong indication just isn't clear.
It's certainly a decision individuals have to make for themselves. Only they can evaluate the benefits and risks that they are prepared to take.
Honore
poster:Honore
thread:721839
URL: http://www.dr-bob.org/babble/20070113/msgs/722856.html