Psycho-Babble Medication Thread 408750

Shown: posts 1 to 6 of 6. This is the beginning of the thread.

 

doc screwed me over? redirected my DA?

Posted by lostforwards on October 29, 2004, at 11:39:43

"I used to like math" said the doc... I don't. I didn't. I liked thinking.

But I used to, under stress, spin things. When I was put on a low dose AP in the night for sleep, and the rest in the morning it got even harder to stop acting weird under stress. I couldn't look people in the face. Developed sterotypies. The doctor would just up the dose.

Note: I was hyperdopaminergic naturally in either phases of my bipolar. They didn't tell me everything though.

Now 4 weeks later. I feel emotionally flat. My arms don't swing at all. I have little to no drive. I find it difficult to think. My mind goes completely blank. My will feels as if it's been crushed. My sex drive is dead. I care about hardly anything except, by a hair, this problem. All things related to the frontal lobes.... has he screwed me over for life. Could he do something like that?

What was he doing to me? what's happened to me?
This isn't just typical withdrawal. I know that as a fact.

 

Re: doc screwed me over? redirected my DA?

Posted by linkadge on October 29, 2004, at 12:40:07

In reply to doc screwed me over? redirected my DA?, posted by lostforwards on October 29, 2004, at 11:39:43

Withdrawl from any psychiatric drug can mess with your mind.

It seems that you have both positive and negative symptoms of your disorder. Mood disturbances and psychotic disturbances.

It will take time for you to withdrawl from an antipsychotic.

I wouldn't go as far as to say that your state is permanent.

If you think you are hyperdopaminergic, but you don't want the effects of the antipsychotics. Then perhaps take a combination of lithium and divalprox. BOth are robustly neuroprotective, both have antipsychotic qualities too. Find a doctor that will give you a trial of a mood stabalizer.


Linkadge

 

Re: doc screwed me over? redirected my DA?

Posted by linkadge on October 29, 2004, at 12:43:47

In reply to doc screwed me over? redirected my DA?, posted by lostforwards on October 29, 2004, at 11:39:43

Also: Just because a doctor may have made poor treatment choices does not mean he is out to get you in any way. I found it very difficult to take a mood stabalizer when I was feeling high. It felt like everyone was trying to bring you down. This is not their intention.

You can't stay high forever. Mood stabalizers are intented to reduce the highs - so that that lows aren't as profound. Seems like you are experiencing a depressive phase.


Linkadge

 

Re: doc screwed me over? redirected my DA?

Posted by ed_uk on October 29, 2004, at 13:34:57

In reply to doc screwed me over? redirected my DA?, posted by lostforwards on October 29, 2004, at 11:39:43

Hello,
I've posted the following study and case report because I felt that it was relevant to you and perhaps a few other people on psychobabble as well. It has been adapted (by me) from a study presented in The Journal of Neurology, Neurosurgery and Psychiatry. I can supply you with the full report if you would like.
Your lack of arm swing suggests that you are experiencing some residual parkinsonism despite the fact that you are no longer taking Risperdal. Contrary to popular belief, Parkinsonism doesn't always resolve rapidly when an antipsychotic(neuroleptic) such as risperidone(Risperdal) has been stopped. The case report below describes the case of a woman who treated with an antipsychotic. Even after the neuroleptic was discontinued, Parkinsonism and numbed emotions persisted for a long time. Nevertheless, the patient did eventually get back to normal though :)

EXTRAPYRAMIDAL SIDE EFFECTS OF ANTIPSYCHOTICS/NEUROLEPTICS
Neuroleptic medications are among the most commonly used drugs for treating patients with serious mental illness. These agents, which for the most part act by blocking the D2 subtype of dopamine receptor, are associated with acute or subacute neurological side effects, which generally resolve when the medication is discontinued. These so-called "extrapyramidal" side effects, which include dystonia, parkinsonism, and akathisia, are thought to arise as a direct consequence of the dopamine receptor blockade in the striatum.

Neuroleptic drugs are also, however, associated with delayed onset, or tardive, syndromes, which typically begin after the patient has been taking the medication for some time, and which can persist for months, or even years, after the drug is discontinued. The existence of these tardive syndromes indicates that neuroleptic drugs are capable of producing long lasting changes in brain function. The nature of these long term changes, and the pathophysiology of the tardive syndromes, continue to be poorly understood.

Among the tardive syndromes which have been described are tardive dyskinesia, tardive dystonia, and tardive akathisia. There has been little attention to the potential of neuroleptic drugs to produce tardive parkinsonism.

CASE REPORT
A 37 year old married woman with no personal or family history of psychiatric or neurological illness consulted her family physician with complaints of anxiety, insomnia, sadness, inertia, and restlessness. Despite there being no evidence of psychosis, she was treated (inappropriately) for five months with intramuscular injections of the neuroleptic fluphenazine decanoate (10-35 mg every two to four days), supplemented by oral fluphenazine (5-55 mg/day). On this regimen she became very slowed down, with a shuffling gait, mask-like face, cogwheel rigidity, and difficulty in writing. (All signs of Parkinsonism). Because of her continuing parkinsonism the neuroleptic drugs were stopped, whereupon she developed pelvic rocking and gyrating (a rare form of tardive dyskinesia). Six months later the patient was admitted to hospital. **Examination at that time showed a flat affect(numbed emotions), expressionless voice, and staring expression.** There was cogwheel rigidity at the elbows and wrists, slowness and freezing during performance of alternate motion rate tasks, and micrographia. (ie. her parkinsonism had persisted). She maintained a stooped posture and had a slow shuffling gait with flexion at the elbows and no arm swing. The patient described an inner compulsion to move (akathisia) but displayed no spontaneous gesturing or movement, aside from constant pelvic rocking. Extensive laboratory investigations, including MRI, EEG, and evoked potentials, were all negative.

Over the ensuing five months the patient had trials of lorazepam(Ativan), propranolol(Inderal), and benztropine(Cogentin), with minimal response. Treatment with levodopa/carbidopa(Sinemet) and a course of electroconvulsive therapy(ECT) given for her depression produced noticeable improvement in her parkinsonism, although she continued to have severe akathisia and pelvic dyskinesia. Eighteen months after her last dose of neuroleptic drugs there was still evidence of mild parkinsonism, mild akathisia, and minimal pelvic dyskinesia. ***At a two and a half year follow up she had no evidence of parkinsonism, dyskinesia, or akathisia.***

Study Title: Persistent loss of tyrosine hydroxylase immunoreactivity in the substantia nigra after neuroleptic withdrawal.

(Tyrosine hydroxylase is an enzyme which has an important role in dopamine synthesis in the body).

Summary of animal study performed.
The case described above prompted a study of the effect of an eight week course of haloperidol (an antipsychotic) followed by two week withdrawal, on dopaminergic neurons of the substantia nigra in rats. Animals treated with haloperidol showed a highly significant 32%-46% loss of tyrosine hydroxylase immunoreactive neurons in the substantia nigra, and 20% contraction of the tyrosine hydroxylase stained dendritic arbour. Neuroleptic drug induced downregulation of nigral dopaminergic neurons may help to explain the persistent parkinsonism found in many patients after withdrawal of medication.

Discussion of the results of the animal study.

These results indicate that neuroleptic medications can produce a persistent down regulation of tyrosine hydroxylase in dopaminergic neurons in the substantia nigra. Animals exposed to haloperidol for eight weeks and then withdrawn from the medication had a 32%-44% reduction in the number of tyrosine hydroxylase immunoreactive nigral cell bodies, and a 20% decrease in nigral cross sectional area, two weeks after the drug had been discontinued.

***The ability of neuroleptic drugs to induce persisting suppression of tyrosine hydroxylase in nigrostriatal neurons suggests that these agents may be capable of producing tardive parkinsonism.*** Melamed et al reported on two 35 year old patients with schizophrenia who, after many years of neuroleptic treatment, developed progressive parkinsonism that continued to worsen after discontinuation of the neuroleptic medication. Hardie and Lees found that 14 of 16 patients with neuroleptic drug induced parkinsonism (median age 61) had incomplete resolution of the parkinsonism after prolonged withdrawal from neuroleptic drugs. In another series, five of 48 elderly patients with drug induced parkinsonism had persistent parkinsonian features seven weeks after stopping the drug, and another five initially improved but later went on to develop idiopathic parkinsonism. The patient whom we studied, despite being young and despite having no previous neurological symptoms, had parkinsonism for at least 18 months after completing a five month course of high dose neuroleptic treatment.

Ed

 

Re: doc screwed me over? redirected my DA?

Posted by ed_uk on October 29, 2004, at 13:56:23

In reply to Re: doc screwed me over? redirected my DA?, posted by ed_uk on October 29, 2004, at 13:34:57

Hello again..
I just wanted to add that although I believe your lack of arm swing is related to your use of Risperdal, I can't be sure whether your depressive symptoms and apathy are related to the Risperdal or not. Perhaps you are experiencing a depressive phase of your bipolar disorder. I really don't think your doctor had any intension of causing any long term changes by prescribing the Risperdal. I think you've just been unlucky in that you've experienced some side effects. Many of your symptoms could well improve over the next few weeks. Although the parkinsonism can sometimes persist for a long time I must stress that this is not at all common. Also, the dose of Nozinan you were on was very low. It would have had very little effect on dopamine neurotransmission at that dose, it would probably have been acting more as a sedationg antihistamine than anything else. I seriously doubt that any of the problems you are experiencing at the moment are related to the Nozinan. High doses of Nozinan can interact with Risperdal but if I remember correctly you were only taking a miniscule 10mg at night.
Try to keep your hopes up...
Ed

 

Re: doc screwed me over? redirected my DA?

Posted by Sebastian on October 30, 2004, at 10:22:11

In reply to Re: doc screwed me over? redirected my DA?, posted by linkadge on October 29, 2004, at 12:43:47

It may work to just take the medicine when it will be of benifit, and not take it when it is bringing you down.


This is the end of the thread.


Show another thread

URL of post in thread:


Psycho-Babble Medication | Extras | FAQ


[dr. bob] Dr. Bob is Robert Hsiung, MD, bob@dr-bob.org

Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.