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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by jay on February 18, 2002, at 21:20:41
Going back on a number of posts, I can't believe how many docs are precribing antipsychotics and anticonvulsants for things like sleep, and all forms of anxiety.
I think this has been brought up before, but it seems to be a trend because of the stigma and prejudice against benzos. Maybe if we all started to speak up, we might get some changes.
Posted by Mr. Scott on February 18, 2002, at 23:26:50
In reply to Antipsychotics for sleep/anxiety? Should beBenzos , posted by jay on February 18, 2002, at 21:20:41
Jay,
I agree with you. I have had two psychiatrists discontinue my klonopin in the last 6 years. Neither believed in chronic anxiety (GAD). One badgered me by continually saying "what are you treating?" When I said Anxiety she said you can do that with Zoloft. She insinuated I was treating Bipolar disorder with it and said "she could do better." Personally i would say treating bipolar disorder with Klonopin if and when possible is doing pretty good! She recommended Lamictal. This was years ago and I split because I wasn't ready to try this. Another doc insisted I take 1500mg of Depakote in place of my 1mg of Klonopin. So i tapered off the Klon (not fun, but easier than effexor) and a month later began Depakote which made me impotent and ravenous for food! That didn't last more than a few weeks and I left that doc as well. Mind you I have never been Manic, and never even hypomanic when on klonopin.
People need to leave well enough alone sometimes (patients & doctors). If I was a doc I wouldn't start people off on benzos, but after a couple trials they'd get em if it seemed right instead of dreaming up new categories for the patients to fit into just avoid a perfectly good category of medicines (benzos).
Regards,
Scott
Posted by skills on February 20, 2002, at 10:20:30
In reply to Re: Antipsychotics for sleep/anxiety? Should beBenzos » jay, posted by Mr. Scott on February 18, 2002, at 23:26:50
I do agree that antipycotics are not the best answer to sleeping difficulty. However they have helped me. I have been prescribed many benzo's for sleeping including: zopiclone, halcion, diazepam, nitrazepam, temazepam, librium etc. and none worked. However when i was prescribed 20mg of stellazine and 10 mg of olanzapine finally i managed to sleep but very uncomfortably. So they can be useful but i do agree not used as a first prescrition especially as the extrapyramidal side effects are unpleasent and seem only to be relived by additional administration of the stimulating procyclidine.
Posted by OldSchool on February 20, 2002, at 18:14:28
In reply to Antipsychotics for sleep/anxiety? Should beBenzos , posted by jay on February 18, 2002, at 21:20:41
Using any type of anti-psychotic medication for insomnia and anxiety is a totally incorrect use of these drugs. You are risking all sorts of serious side effects from taking neuroleptics, even in low doses for short periods. I suffered a BAD case of EPS from taking just 50 mg Seroquel for slighly over one month!
Benzos are the correct medications for anxiety and benzos can also be used for insomnia on an as needed basis. Benzos do not have a bad side effect profile and are very very safe, despite the addiction risk.
To put it in plain English, benzos are safe, anti-psychotics are some of the most dangerous drugs you can take.
Old School
Posted by geno on February 20, 2002, at 21:25:17
In reply to Re: Antipsychotics for sleep/anxiety? Should beBenzos , posted by OldSchool on February 20, 2002, at 18:14:28
my opinoin, remeron is the best sleep medication, with built in seratonin releasing ability, norepinephrine regulation, and helps with axiety,and adjitated depression.
augmented with xanax,.5mg only in case of panic attacks, and .5-1mg of klonopin, depending on severety of gad or social phobia and this should icing the cake. after a few week, you may complain of sedation. Up the remeron to 45mg or add low dose of desipramine. They wont cause excess axniety but yet a pieceful bought of energy. or cup of green tea will help. coffee may spark anxiety.
trust me
geno
Posted by Peace on March 8, 2002, at 20:30:56
In reply to Re: Antipsychotics for sleep/anxiety? Should beBenzos , posted by OldSchool on February 20, 2002, at 18:14:28
Hi OldSchool,
I am reading the archives to find out more about Seroquel and I am starting to get a major anxiety attack cause I have been on it for a little over 2 months.
I am curious - did the EPS go away, or do you still have it?
Peace
> Using any type of anti-psychotic medication for insomnia and anxiety is a totally incorrect use of these drugs. You are risking all sorts of serious side effects from taking neuroleptics, even in low doses for short periods. I suffered a BAD case of EPS from taking just 50 mg Seroquel for slighly over one month!
>
> Benzos are the correct medications for anxiety and benzos can also be used for insomnia on an as needed basis. Benzos do not have a bad side effect profile and are very very safe, despite the addiction risk.
>
> To put it in plain English, benzos are safe, anti-psychotics are some of the most dangerous drugs you can take.
>
> Old School
Posted by Essence on March 9, 2002, at 17:36:52
In reply to Re: Antipsychotics for sleep/anxiety? Should beBenzos , posted by Peace on March 8, 2002, at 20:30:56
I am on an antipsycotic called Nozinan. My phsych prescribed it for anxiety and for weird thoughts that I was having. I am concerned now after reading this post. What exactly is EPS that has been experienced with antipsycotics? My psych has now also added Clonazepam for anxiety last week. Maybe I shouldn't be on both???
Posted by Life2.0 on March 10, 2002, at 23:26:18
In reply to Re: Antipsychotics for sleep/anxiety? Should beBenzos , posted by Essence on March 9, 2002, at 17:36:52
To answer your question Essence, EPS stands for extrapyramidal side effects. This class of side effects is conventionally associated with older anti-psychotics (neuroleptics):Haloperidol, Chlorpromazine, Thioridazine, etc., that were used in high doses to treat schizophrenia. A good definition of EPS taken straigh of the Internet is
"...movement disorders thought to be caused by blockade of dopaminergic neurotransmission in the nigrostriatal pathway. They include parkinsonism, akathisia (a subjective feeling of inner restlessness and inability to sit or stand still), dystonia (slow, sustained muscular contractions or spasms), and tardive dyskinesia (abnormal, involuntary, irregular muscle movements, especially around the face and mouth) a rare abnormality which can develop after prolonged exposure to conventional neuroleptics and can become irreversible...."
http://www.futur.com/edu-info/compliance/leaf1/phr_1b.stmThese side effects are scary to read about, but from what I've read here and elsewhere, the so-called novel anti-pyschotics APs like Risperidone and Olanzapine have a much lower risk of EPS because they are very selective on the dopamine receptors they act on, and they also block serotonin neurotransmission. The same article I quoted goes on to state that sulpiride a relatively older but more selective AP, causes far less EPS than the conventional APs.
My current med cocktail includes 300mg of sulpiride. When I first started taking sulpiride it helped tremendously with my insomnia. It stopped the recurrent and obsessive thoughts that were preventing me from sleeping and allowed to to sleep properly for the first time in almost a year. If your insomnia is of this type then an AP may be right for you. I totally disagree with OldSchool's labelling of APs as 'dangerous'. The novel APs have helped quite a few people on PB. I'v been taking 300mg sulpiride along with a benzo (first lorazepam and then clonazepam) for almost a year and I've almost completely eliminated my sleep problems, with no side effects, EPS or otherwise.
L20
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