Posted by yxibow on February 2, 2007, at 2:44:51
In reply to Re: Atypicals for anxiety?, posted by mindevolution on February 2, 2007, at 0:55:53
> > My doc reccomended Geodon for my anxiety, and I was wondering if anyone here had much success with this or other APs. My anxiety is typically low level, until something sets me off (usually related to my self esteem / BDD). If I have an anxiety attack, I plunge into a black panicky depression that often lasts for days. (This can be interuppted with Klonopin). I also have times of hypomania. These mood swings are probably not significant enough to be bipolar, but overall, I tend to jump back and forth without much in between.
> >
> > So ... would APs work in my situation? Are they worth the side effect?
> >
> > Matty E
>
> APs are a last resort. At medium to high doses some people suggest they are worse than a frontal lobotomy, due to the vegetative state of mind induced (dose related compares to lobotomy), progressive degeneration of every organ in your body including your brain, a chance of getting diabetes, heart disease, and a condition almost identical to AIDS. also the chance of sudden death increases in line with dose due to elongation of qt interval. + risk of suicide goes up 20 fold and life expectancy falls by 25 years.
>
> APs are typically used on the elderly, the retarded, the criminals, and the mentally ill.
>
> at a low minimally toxic dose these drugs can be a lifeline, it is about informed consent (if you are lucky), and I would only take them by choice as a last resort.
>
> meThis is a vast and unmedically sound description of neuroleptics. It is a description at best of the highest doses of old line neuroleptics.
Geodon has gone through a 4000 patient study and was reapproved by the FDA. It does not posess nearly the QTc elongation that was previously thought. Mellaril still remains on the market with a greater risk and a black box warning. That's 4000 patient-years of study that went for the former (Zeldox) into Geodon.
This doesn't say that there is a 1 in 4000 chance of torsades de pointes and that people with known heart conditions may not be the best candidates for Geodon, but the range of QTc elongation is even longer in Mellaril and was never challenged by the FDA until recently.
The risk of suicide in untreated schizophreniform disorders is magnitudes greater than treated with any neuroleptic. The problem, granted, is patient compliance due to EPS effects which are the bane of neuroleptics and continue to be addressed. Depot injections are one method of patient compliance for the populations that are in danger of harming themselves or others.
The positive side of Geodon is that it doesn't have the weight gain effects of Risperdal, Zyprexa, or Seroquel. The negative side is that it may have more EPS than the latter two.
"> APs are typically used on the elderly, the retarded, the criminals, and the mentally ill."
This is an incredibly insensitive statement for someone (myself) who has a need to take Seroquel. I fall under none of those categories short of "mentally ill" which in your tone is an old fashioned way of describing it and I take offense at that statement.
Furthermore it is an inflammatory charge that the "mentally ill" are a subhuman population. The "mentally ill" are people who, like a lot of us on the board are born with a biochemical imbalance that will change over a lifetime. We are human, we range in our disorders.
There are many, multiple disorders and statements like these only further the health care industry's farming out of insurance to third party carriers who place amazingly low caps on mental (psychobiological) health, partially fixed by the Mental Health Parity Act.
Fortunately some progressive states like California came out with propositions that fund mental health services to those who most despirately needed it.
The only sound statement in the above overgeneralization was "informed consent." All medical practice by law is or should be informed consent and if your doctor is handing out prescriptions without informing of major side effects or if you do not elect to decline counseling at the pharmacy and you are not counseled on your medication you have been done a disservice.The only extent to which it cannot be informed consent is when a doctor must breach his or her confidentiality if they know that there is imminent danger to an elder, a minor, the president, or yourself.
72 hour holds are a standard across the country and while psychiatric hospitals vary in their standard of care, after that 72 hour period, you can walk AMA out of the hospital, untreated.
Now that we have that out of the way -- I would say that atypicals should probably be a second line of defense after at least a few AEDs have been tried. But don't forget, AEDs also have their side effects. They must be started and stopped with care or you could have a seizure even if you aren't epileptic.
I can't speak for the above case because it sounds like some partial bipolar disorder possibly mixed with an OC Spectrum disorder (BDD) and maybe GAD. Mania can be sometimes managed with Trileptal and other AEDs, but brief periods of extreme mania are also capable of being handled with atypicals. The severity and the choice of agents is something that should be a collaboration with your doctor.
Please respect the community without issuing gross generalizations.Thank you.
-- tidings
poster:yxibow
thread:728141
URL: http://www.dr-bob.org/babble/20070201/msgs/728944.html