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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by linkadge on September 8, 2005, at 10:11:34
The only AD's that have worked have been the ones that have caused strong akathesia. Is akathesia necessary for a theraputic responce ?
Is it indicitive of some sort of positive neurochemical change, or is it a compltetely unneccesary side effect ?
Linkadge
Posted by Chairman_MAO on September 8, 2005, at 23:46:00
In reply to Is akathesia necessary ??, posted by linkadge on September 8, 2005, at 10:11:34
It is a wholly unnecessary side effect. There is no correlation between akathesia and therapeutic reponse to any drug; or at least I'd bet money on that. Who knows if I'm right.
As a matter of fact, akathesia is by definition an abberation; it is an imbalance between acetylcholine and dopamine, caused by DA blockade (antipsychotics) or SE stomping DA (SSRIs). There may be other mechanisms.
Posted by linkadge on September 9, 2005, at 7:07:18
In reply to Re: Is akathesia necessary ?? » linkadge, posted by Chairman_MAO on September 8, 2005, at 23:46:00
Of all the AD's I've tried, the only ones that I would consider mood brightening, were the ones that caused the most akathesia. THe ones that caused akathesia were the only ones that I would say changed my behavior. I guess I just subcontiously linked the two events.
Perhaps
Posted by yxibow on September 9, 2005, at 15:28:20
In reply to Is akathesia necessary ??, posted by linkadge on September 8, 2005, at 10:11:34
> The only AD's that have worked have been the ones that have caused strong akathesia. Is akathesia necessary for a theraputic responce ?
>
> Is it indicitive of some sort of positive neurochemical change, or is it a compltetely unneccesary side effect ?
>
> LinkadgeIts an indication dopamine-blocking agents, mostly at D2, making their way toward the basal ganglia, the part of the involuntary primitive motor system of the human body.
As for antidepressants, its rare but can happen especially with long term Zoloft usage. But primarily it occurs with antipsychotics.
The old, 1950s, pre-atypical model of antipsychotics was to dial the patient up until you started seeing side effects like akathisia and pseudoparkinsonism and other unpleasant EPS, and then you'd say, yup, we have enough Haldol for that patient now, we've hit their D2 receptors.
Times have changed and there is more of a shift to atypicals (at least in parts of the world where they can be afforded at the moment), and this model is definately not followed. It doesn't mean akathisia and other EPS still cant happen, and they do, in my own experience. But its now more of a benefit vs. humane experience that charges most care under antipsychotics.
Sure, there are still the schizophrenic patients who have to be on heavy doses of older non atypicals or even ghastly combinations of several, but the model of dial 'em up is not the exclusive way of thinking.
Posted by ed_uk on September 9, 2005, at 15:52:19
In reply to Is akathesia necessary ??, posted by linkadge on September 8, 2005, at 10:11:34
Dear Link,
Akathisia is never a good thing.
~Ed
Posted by linkadge on September 9, 2005, at 20:10:44
In reply to Re: Is akathesia necessary ?? » linkadge, posted by ed_uk on September 9, 2005, at 15:52:19
I get bad akathesia with SSRI's. I don't know how to explain it.
Normally I feel a somewhat warm & fuzzy feeling towards my own body. You know, how you're happy to jump into your jammies and watch a move. Even when I am depressed, I don't hate my body.
When I take an SSRI, it is this terrable feeling like I don't exist anymore. All of a sudden my jaw clenches, and my neck becomes stiff, then this terrable feeling sets in like I hate my body, and I just want out of it.
I don't think I can take another dose of a drug that makes me feel so much worse on the first dose.
Thats why I liked marajuanna (only tried it twice) because it killed my anxiety, insomnia, and lack of appetite, and I felt free in my own body.
Linkadge
Posted by needesp on September 9, 2005, at 20:44:42
In reply to Re: Is akathesia necessary ??, posted by linkadge on September 9, 2005, at 20:10:44
> I get bad akathesia with SSRI's. I don't know how to explain it.
>
> Normally I feel a somewhat warm & fuzzy feeling towards my own body. You know, how you're happy to jump into your jammies and watch a move. Even when I am depressed, I don't hate my body.
>
> When I take an SSRI, it is this terrable feeling like I don't exist anymore. All of a sudden my jaw clenches, and my neck becomes stiff, then this terrable feeling sets in like I hate my body, and I just want out of it.
>
> I don't think I can take another dose of a drug that makes me feel so much worse on the first dose.
>
> Thats why I liked marajuanna (only tried it twice) because it killed my anxiety, insomnia, and lack of appetite, and I felt free in my own body.
>
>
>
> LinkadgeOh linkage....you sound like my son (he's 21 years old)....your knowledge/IQ seem remarkable were you studying at uni? If only there were pdocs out there that knew what the drugs really did and how it feels (like you!!!!)
My son is going to stick with the regimne he is on for 6 mths (no changes unless something sh$$ty happens). NO MORE INCREASES THOUGH!!!
We together think that it may be just time on a particular drug (i.e. a drug or combo that is doing at least something!!)....God I wish I felt confident saying this! but it may be the answer (the side effects initially and then the feelings (?side effects)later all seem so intense....)but maybe the key is letting your brain (chemical wise) grow accustomed to the onslaught of medications......wish i could help...
Posted by yxibow on September 9, 2005, at 21:15:43
In reply to Re: Is akathesia necessary ??, posted by linkadge on September 9, 2005, at 20:10:44
> I get bad akathesia with SSRI's. I don't know how to explain it.
This may be redundant but have you run the entire gamut of SSRIs, Prozac, Zoloft, Paxil, Luvox, Celexa, Lexapro, and even the pseudo-SSRI Anafranil?
If so, do each give the same effect, because the selectivity of each has generally changed to be more targeted. Zoloft was the worst offender of hitting the dopamine receptors; Prozac isn't terribly specific either in some ways.
Just curious.
Posted by ed_uk on September 10, 2005, at 2:27:44
In reply to Re: Is akathesia necessary ??, posted by linkadge on September 9, 2005, at 20:10:44
Hi Link,
>When I take an SSRI, it is this terrable feeling like I don't exist anymore. All of a sudden my jaw clenches, and my neck becomes stiff, then this terrable feeling sets in like I hate my body, and I just want out of it.
........but do you feel physically very restless? .......so you can't stay still, even for a short time. With akathisia, you *never* feel comfortable in your own body, everything feels awful because you're just so restless. You can't get any pleasure out of little things like getting into a freshly made bed because you're driven to keep moving. Even when you move you don't feel better, but you still have to keep moving.
The jaw clenching and neck stiffness sound like typical SSRI side effect.
Does Cogentin relieve these symptoms?
~Ed
Posted by yxibow on September 10, 2005, at 16:30:51
In reply to Re: Is akathesia necessary ?? » linkadge, posted by ed_uk on September 10, 2005, at 2:27:44
> The jaw clenching and neck stiffness sound like typical SSRI side effect.
>
> Does Cogentin relieve these symptoms?
>
> ~EdI'll add benadryl/diphenhydramine OTC if he doesnt have access to Cogentin.
Posted by linkadge on September 11, 2005, at 9:54:06
In reply to Re: Is akathesia necessary ?? » linkadge, posted by yxibow on September 9, 2005, at 21:15:43
Yeah, now I have tried them all. Paxil seemed to cause the most problems.
Zoloft may have been the best in terms of suicidiality.
Clomipramine was ok, but it made me feel like a seizure was immanent.
Linkadge
Posted by linkadge on September 11, 2005, at 9:57:03
In reply to Re: Is akathesia necessary ?? » linkadge, posted by ed_uk on September 10, 2005, at 2:27:44
Yeah it is more than the just the jaw clenching. It is a feeling like I need to get out of my own body. Like I need to kill myself to just be free.
It is like panic, restless legs, and suicidiality all wrapped into one dose. I do a lot of running. When I up the dose I have to run harder or take a benzo to cut the feelings.
Linkadge
Posted by linkadge on September 11, 2005, at 9:58:34
In reply to Re: Is akathesia necessary ?? » ed_uk, posted by yxibow on September 10, 2005, at 16:30:51
I've tried cogentin, and it helps but the combo is a muttled little experience.
Linkadge
Posted by yxibow on September 12, 2005, at 14:39:56
In reply to Re: Is akathesia necessary ??, posted by linkadge on September 11, 2005, at 9:58:34
> I've tried cogentin, and it helps but the combo is a muttled little experience.
>
> Linkadge
>Cogentin is one of the more sleep/foggy making anticholinergics. Akineton (biperiden) works fairly well for akathisia and is neutral to activating. Artane (trihexiphenidyl) also works somewhat.
Posted by FredPotter on September 12, 2005, at 16:54:15
In reply to Re: Is akathesia necessary ??, posted by linkadge on September 11, 2005, at 9:58:34
what's the difference between akathesia and agitated depression?
Posted by Chairman_MAO on September 16, 2005, at 10:29:41
In reply to Is akathesia necessary ??, posted by linkadge on September 8, 2005, at 10:11:34
Great treatment for akathesia. Also confers energy & helps with SSRI sexual side effects.
NMDA antagonist property may help AD effect.
Posted by KaraS on September 17, 2005, at 21:58:06
In reply to Re: try amantadine » linkadge, posted by Chairman_MAO on September 16, 2005, at 10:29:41
> Great treatment for akathesia. Also confers energy & helps with SSRI sexual side effects.
>
> NMDA antagonist property may help AD effect.
Hi Chairman,What kind of dosage of amantadine would you use for this purpose?
k
Posted by KaraS on September 19, 2005, at 6:36:47
In reply to Re: try amantadine » linkadge, posted by Chairman_MAO on September 16, 2005, at 10:29:41
Does amantadine work like Mirapex in terms of providing energy initially but later producing lethargy and fatigue?
Posted by Chairman_MAO on September 21, 2005, at 13:37:06
In reply to Re: try amantadine - also » Chairman_MAO, posted by KaraS on September 19, 2005, at 6:36:47
No. amantadine is a dopamine releaser; it is also not a direct DA agonist. It has a mild psychostimulant effect in some people probably resulting from NMDA antagonism.
Long-term cabergoline had no sedative effect in me.
Posted by KaraS on September 24, 2005, at 5:04:47
In reply to Re: try amantadine - also » KaraS, posted by Chairman_MAO on September 21, 2005, at 13:37:06
> No. amantadine is a dopamine releaser; it is also not a direct DA agonist. It has a mild psychostimulant effect in some people probably resulting from NMDA antagonism.
>
> Long-term cabergoline had no sedative effect in me.
Thanks. That's good to know. Between cabergoline and amantadine which do you think would be better for motivation? Can either of them be taken with a stimulant (Dexedrine)? (I'm assuming there wouldn't be any problem combining either of them with atenolol.)btw, you're living in an area that's close to where I grew up - in Utica.
k
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