Posted by yxibow on February 3, 2007, at 12:36:57
In reply to Re: Atypicals for anxiety?))yxibow, posted by mindevolution on February 3, 2007, at 4:13:50
> i really think you are the one succumbing to generalisations without any evidence that they hold true. I can cite many studies that show that akathisia from antipsychotics can induce suidicality, can you show me one that shows that the risk of suicide in schizophrenic patients never treated with antipsychotics is higher than AP treated patients?
I'm not interested in this argument about akathisia any more. Its a phenomenon of every neuroleptic, it is a manageable EPS, and if it becomes an issue, a less potent neuroleptic should be tried. There are so many other types of EPS, that while this one may seem nasty, its predictable. That's all we can really say about a class of drugs that is an unfortunate necessity.
> > I can also back up a study in the BJP that did an extensive study of TD in Zyprexa vs Haldol and came up with an average rate of 2.66% and a yearly average of 0.52% http://bjp.rcpsych.org/cgi/content/abstract/174/1/23
>
> good point, however, did you notice that that was a summary and the test did not focus on D2 receptor occupancy? realistically to accurately compare the eps potential of two antipsychotics the doses of each have to produce the same level of dopamine blockade. this and most tests do not make such a comparison rendering the vast majority of head to head comparisons irrelevant.I know about D2 occupancy rate, the difference is that haloperidol occupies it at nearly 100% and doesn't let go, and while Seroquel and Zyprexa may also occupy it at a fairly substantial rate, they do let go, many times more in an interval than Haldol does.
http://www.akathisiasupport.org/akathisia5/nwh-akathisia-usen3.pdf
Sorry -- maybe a nice support for people with akathisia, but I don't argue with websites that look amateurish, don't subscribe to HON or have other health credos to back up. Its why I don't get into Ashton discussions.
> > Well I can think of a number of benzodiazepines that could work and possibly some other AEDs, that's true. I never said antipsychotics are a first line defense, except in some complex bipolar cases when there is a clear line that mania is occurring, and sure, even then lithium and other choices are available but don't always work.
>
> APs are as serious and damaging as it gets, are you sure if you were the doctor you wouldn't try something less toxic like clonidine, propranolol, or even methodone?I fail to see where methadone is going to help a bipolar suicidal patient but we can ignore this red herring. Clonidine and propranolol are nice adjunctives to help EPS, they don't do a whole lot by themselves except in certain situations like clonidine for child hyperactivity. Propranolol masks the anxiety but does not take it away like benzodiazepines. Its good for essential tremor and drug induced tremor.
> > Well every substance out there that has a CAS number is given an MSDS rating actually. We know the LD50
>
> i didn't know that existed. LD50 of Polonium 210: estimated at 10 (inhaled) to 50 (ingested) nanograms in humans makes this one of the most toxic substances known. One gram in theory could poison 100 million people of which 50 million would die!Yes, did you not read the news of the Russian who was poisoned in London ? It takes a lot of nuclear reactor activity to create Polonium and dispersal is quite another story, but it is still an unsolved case.
> are there LD50s for psychopharmaceuticals?A fair number, yes, especially for more modern medications, but I'm not going to post them for obvious reasons.
> ok, but can't the government say "you want this drug approved, give us 20million, and we will conduct independent testing for you". there is no loss to the company, they would have still had to pay for the research, except now the trial is government controlled and much more independent.
But government controlled or company controlled its not a third party. To really have one you would need something like commonwealth countries have, a crown corporation.
> > I mean I could rant that the US could spend more money on education and health care than on military forays, but we would get into an Iraq argument and everyone has a different opinion (I support the troops, but I think there has been great mismanagement to say an understatement, of things.)
>
> let's leave that argument for another thread.Agreed, I don't interject much politics in the non politics board.
poster:yxibow
thread:728141
URL: http://www.dr-bob.org/babble/20070201/msgs/729330.html