Posted by med_empowered on July 26, 2007, at 20:57:01
In reply to Re: can we talk Typical Antipsychotics?, posted by bipolarspectrum1 on July 26, 2007, at 20:19:54
here's the thing: since the "atypicals" have come on the scene, some docs have acted as if all the old drugs ("typicals") are essentially the same, with the only differences being potency. Not true.
Perphenazine (Trilafon), for instance, has moderate potency, so it was a good choice for the CATIE study. Haldol as comparator has made atypicals look very good in trials b/c hi-dose haldol is almost bound to cause pronounced EPS/akathisia, and it unblinds trials once some patients have hardcore dystonic reactions and lots of others don't.
There are others to consider, too. Loxapine is considered "partly atypical," as is moban. Amoxapine (Asendin) is a TCA antidepressant that is partly metabolized into loxapine. The drug compares well to risperidone as an atypical-ish drug, and can lift mood.
Also, watch the dose. Very low doses of perphenazine, for instance, might be all you need; the higher you go up, the higher the risk of initial and late-onset problems, including TD. With bipolar, one good thing is that the use of neuroleptics can usually be limited to discrete periods.
Have you tried a benzo-type tranquilizer? They can be very helpful for problems across the board, including mixed states and psychosis. Klonopin and Ativan are popular; Valium is sometimes also used.
poster:med_empowered
thread:772161
URL: http://www.dr-bob.org/babble/20070719/msgs/772219.html