![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 4 to 28 of 45. Go back in thread:
Posted by med_empowered on November 23, 2005, at 1:23:38
In reply to Re: Experiences on Risperdal... Im afraid of TD » Tepiaca, posted by alexandra_k on November 23, 2005, at 0:52:18
hi! I personally don't think you should take antipsychotics. The TD risk from newer antipsychotics is lower than with the old ones...now, instead of being a common side effect, its relatively infrequent (but still a risk). The question I think is whether or not its appropriate to expose people to the risks of antipsychotics for something like anxiety...I don't think it is. I think you should tell your doc your fears, and push to move away from using antipsychotics in your treatment.
Posted by Shelley on November 23, 2005, at 11:58:01
In reply to Experiences on Risperdal... Im afraid of TD, posted by Tepiaca on November 22, 2005, at 21:04:17
Tepiaca,
Please don't give up hope. I am sure you will find something to alleviate your anxiety.
Have you tried antidepressants like celexa and zoloft or mood stabilizers?
If you feel your doctor does not understand your concern about taking APs, would you consider trying to see someone else?
Take care,
Shelley.
Posted by Tepiaca on November 23, 2005, at 13:36:51
In reply to Re: Experiences on Risperdal... Im afraid of TD » Tepiaca, posted by alexandra_k on November 23, 2005, at 0:52:18
> Hey there.
>
> Are you sure that your muscle twitches were caused by taking AP's as opposed to some other reason?
Well they started when I took pherpenazine 3 years ago. I took only an small dose, 2 o 3 mg I dont remember exactly
>
>
> That being said... I have known people to get muscle twitches on the newer style AP's and a low dosage of cogentin seems to sort that out for them.
>Alexandre I wonder ifyou know someone that has developed TD with the new Ap?
> Can you talk to your doc about your fear?
>I have been telling to my doctor since I was 15 that I am afraid of people. He says I have an shizoaffective disorder. I have tell him that
I also think that Social Phobia is something that
fits perfect on me. He told me that it may be possible.
I exactly dont know what I have. I only know that my brain is not working well.
Posted by Tepiaca on November 23, 2005, at 13:44:58
In reply to Re: Experiences on Risperdal... Im afraid of TD, posted by med_empowered on November 23, 2005, at 1:23:38
> hi! I personally don't think you should take antipsychotics. The TD risk from newer antipsychotics is lower than with the old ones...now, instead of being a common side effect, its relatively infrequent (but still a risk). The question I think is whether or not its appropriate to expose people to the risks of antipsychotics for something like anxiety...I don't think it is. I think you should tell your doc your fears, and push to move away from using antipsychotics in your treatment.
hi med,
I think my doctors prescribes me AP because the firts med in my life that helped me was Zyprexa.
Before zyprexa I tried all kind of meds in the market and nothing worked on me.
Then I change to seroquel and I felt better. 1 year on zyprea and 2 years on Seroquel. After that time, meds that hadnŽt help me , started to help me a little ( like Zoloft ). Then it came Nardil , the best one but still I didnŽt feel the way I want
Posted by Tepiaca on November 23, 2005, at 13:50:24
In reply to Re: Experiences on Risperdal... Im afraid of TD » Tepiaca, posted by Shelley on November 23, 2005, at 11:58:01
Hi shelley
> Please don't give up hope. I am sure you will find something to alleviate your anxiety.
>Iam tired shelley :(
> Have you tried antidepressants like celexa and zoloft or mood stabilizers?
>Yes I have tried them but didnŽt help me.
> If you feel your doctor does not understand your concern about taking APs, would you consider trying to see someone else?
>Yes, I have seen many doctors. The one that is prescribing me risperdal is the first one I attended in my life. He also gave me the Nardil. Maybe this doctor is the best of all.
I think Im going off med again
Posted by Tepiaca on November 23, 2005, at 13:53:44
In reply to Re: Experiences on Risperdal... Im afraid of TD » Tepiaca, posted by Phillipa on November 22, 2005, at 23:36:20
> Tep, because you are a wonderful caring person. Fondly, Phillipa
Hi phillipa thank you for your support. Phillipa how much time hacve you been on meds?
-Best whishes
Tep
Posted by alexandra_k on November 23, 2005, at 15:31:56
In reply to Re: Experiences on Risperdal... Im afraid of TD » alexandra_k, posted by Tepiaca on November 23, 2005, at 13:36:51
> Well they started when I took pherpenazine 3 years ago. I took only an small dose, 2 o 3 mg I dont remember exactly
Okay. That sounds like a really low dose to be triggering TD.
> > That being said... I have known people to get muscle twitches on the newer style AP's and a low dosage of cogentin seems to sort that out for them.
> Alexandre I wonder ifyou know someone that has developed TD with the new Ap?Nope. I don't know a single person. The people I know with TD have been taking heavy dosages of the older style AP's (like chlorpromazine) over... 20 years or something like that.
The people I know who have muscle twitches don't have TD. They take a little bit of cogentin and that stops that for them. They get muscle twitches and jaw clamping. But the cogentin sorts that out for them.
Christopher Frith in "The Cognitive Neuro-Psychology of Schizophrenia" considers that TD symptoms... Might not be caused by AP's. He thinks... That TD symptoms... Might be the result of schizophrenia being a degenerative brain thing, and he considers that it might be the case that without the AP's... People would have the same symptoms anyway. He says that people were recorded as having TD type symptoms... Well before the development of AP's. I don't know whether he is correct or not, but it is something to think about.
I would say... Not that I really know... But I would say that a small dosage of a newer style AP... Would put you at a very low risk of developing TD. So if you find benefit to taking the medication I would stick with it. But that being said, if you don't find a benefit to taking it... Then no risk is better than low risk.
> > Can you talk to your doc about your fear?> I have been telling to my doctor since I was 15 that I am afraid of people.
Okay. Personally... Personally... I think one would be better off taking a low dose of an AP for anxiety than one would be in taking a more typical 'anti-anxiety' medication like a benzodiazapine. Because... Of the very real risk of psychological / physical dependence.
The best treatment for social anxiety (that I am aware of) is therapy. To talk through some of your fears and getting you to work on exposing yourself very gradually in very small steps to situations that you are frightened of. Have you had any therapy for that?
> I exactly dont know what I have. I only know that my brain is not working well.
I don't think it matters what they choose to call it... Point is you have symptoms that make it hard for you to live your life.
I hope you find some relief for those.
Posted by Phillipa on November 23, 2005, at 18:17:36
In reply to Re: Experiences on Risperdal... Im afraid of TD » Phillipa, posted by Tepiaca on November 23, 2005, at 13:53:44
Tep, I've been on medications since my early 20's when I had my first panic attack. Valium worked for lot of years. Ever since my throid became hypothyroid I've been on some sort of antidepressant. But they either have intolerable side effects or don't do anything for me. Fondly, Phillipa
Posted by Tepiaca on November 23, 2005, at 21:52:12
In reply to Re: Experiences on Risperdal... Im afraid of TD » Tepiaca, posted by alexandra_k on November 23, 2005, at 15:31:56
>
> Nope. I don't know a single person. The people I know with TD have been taking heavy dosages of the older style AP's (like chlorpromazine) over... 20 years or something like that.
>
20 years? then IŽll have it when IŽll be 45the people you are women? I read women have more probabilities to develop this sindrome.
> The people I know who have muscle twitches don't have TD. They take a little bit of cogentin and that stops that for them. They get muscle twitches and jaw clamping. But the cogentin sorts that out for them.
>sorry... what is cogentin? . So I can have jaw clamping and that does not mean I have TD
> Christopher Frith in "The Cognitive Neuro-Psychology of Schizophrenia" considers that TD symptoms... Might not be caused by AP's. He thinks... That TD symptoms... Might be the result of schizophrenia being a degenerative brain thing, and he considers that it might be the case that without the AP's... People would have the same symptoms anyway. He says that people were recorded as having TD type symptoms... Well before the development of AP's. I don't know whether he is correct or not, but it is something to think about.
>Very interesting.
so just schizophrenics could have TD? that what hes is trying to tell us?>
> > > Can you talk to your doc about your fear?
>
> > I have been telling to my doctor since I was 15 that I am afraid of people.
>
> Okay. Personally... Personally... I think one would be better off taking a low dose of an AP for anxiety than one would be in taking a more typical 'anti-anxiety' medication like a benzodiazapine. Because... Of the very real risk of psychological / physical dependence.
>what is the problem with becoming dependent with a benzo? . I only would have to take it all my life rigth? but nothing wrong would happen,or I am wrong
> The best treatment for social anxiety (that I am aware of) is therapy. To talk through some of your fears and getting you to work on exposing yourself very gradually in very small steps to situations that you are frightened of. Have you had any therapy for that?
>I was in therapy for two years when everything started. But nothing helped me as much as meds
> I hope you find some relief for those.
>
>Thank you very much
Posted by Tepiaca on November 23, 2005, at 21:57:22
In reply to Re: Experiences on Risperdal... Im afraid of TD » Tepiaca, posted by Phillipa on November 23, 2005, at 18:17:36
So phillipa , after all your life on meds, do you think is worth to live like this?
Posted by Phillipa on November 23, 2005, at 23:22:03
In reply to Re: Experiences on Risperdal... Im afraid of TD » Phillipa, posted by Tepiaca on November 23, 2005, at 21:57:22
Tep, there is always hope. I am planning on sticking around. Love Phillipa
Posted by Declan on November 24, 2005, at 13:52:21
In reply to Re: Experiences on Risperdal... Im afraid of TD » Tepiaca, posted by Phillipa on November 23, 2005, at 23:22:03
Hey Tepi, lots of times life's just not worth living so we need faith and hope, or trust in somethingorother. Life can be really awful but there are so many lovely things we should be trying to preserve, as I know you are. And that's why we're all here together.
Declan
Posted by alexandra_k on November 24, 2005, at 21:23:29
In reply to Re: Experiences on Risperdal... Im afraid of TD » alexandra_k, posted by Tepiaca on November 23, 2005, at 21:52:12
> 20 years? then IŽll have it when IŽll be 45
Thats not what I said. I said that they developed it after about 20 years OF TAKING A VERY HIGH DOSAGE OF AN OLDER STYLE AP.
Best I can figure you have been taking a relatively low dose.
Best I can figure you have been taking a newer style AP, not an older style AP.
So to the best of my knowledge...
I would be suprised if you did develop TD in another 10 years or even in another 20 years.
But I should also say that I haven't studied TD and don't know very much about it...
> the people you are women? I read women have more probabilities to develop this sindrome.
I know a few ladies, but mostly men. People I met who lived in supported accomodation. Part of the de-institutionalisation effort. I don't know about whether women are more likely to develop it than men or not.
> > The people I know who have muscle twitches don't have TD. They take a little bit of cogentin and that stops that for them. They get muscle twitches and jaw clamping. But the cogentin sorts that out for them.
> sorry... what is cogentin?Not too sure. Some medication that counters side-effects. I had an injection of dypixol once and my jaw started to lock up and my tongue started to swell. Took a small dose of cogentin once or maybe twice a day and it went away. No problem. Have seen cogentin do the same thing with twitching, jaw locking, shaking etc.
> So I can have jaw clamping and that does not mean I have TD
You can have jaw clamping for all kinds of reasons.
To the best of my knowledge... TD is medication resistant (by definition I suppose). That means... That cogentin wouldn't help alleviate those symptoms. There isn't anything we can do about TD. Thats why its not good to develop it. But people get TD symptoms which ARE treatable (by cogentin for example) and when people stop taking those meds or switch to another med or whatever then the symptoms go away. Not so with TD.
I really don't think... That you would be likely to have TD.
And I really don't think... That on a low dose of a new AP you would be very likely to get it.
> so just schizophrenics could have TD? that what hes is trying to tell us?No. He is just trying to tell us that the prevalance rates of TD is something that you hear about sometimes... But how many of the people who develop TD symptoms would have developed those same symptoms without AP's??? Because if this is the case for half the prevalance of TD then that would mean that TD is only half as common as we thought. And we thought... The chance of getting it on a low dosage of a new AP wasn't very high in the first place...
> what is the problem with becoming dependent with a benzo? . I only would have to take it all my life rigth? but nothing wrong would happen,or I am wrongThe problem with dependence is a little something else that happens along with dependance: tolerance. Tolerance means your system gets used to the dosage of the drug and adjusts to that drug. So you find yourself needing more of the drug to have the same effect. And sometimes... More and more and more... And sometimes... You end up craving the drug and going through horrible withdrawals (which means terrible anxiety far worse than you probably experience now) if you don't get the drug.
Not everybody finds this...
But a fair few do...
Personally...
I would think the risk of developing TD would be lower than the risk of developing dependence / tolerance / addiction.
> I was in therapy for two years when everything started. But nothing helped me as much as medsOkay.
Well...
Good luck with finding the right one then :-)
Posted by Chairman_MAO on November 25, 2005, at 13:02:06
In reply to Re: Experiences on Risperdal... Im afraid of TD » Tepiaca, posted by alexandra_k on November 23, 2005, at 15:31:56
The notion that TD is somehow a result of schizophrenia is madness in my opinion; in the 1950s or early 60s (I forget which) some investigators announced they'd found the biological basis of schizoprenia. There was a lot to do about this announcement. There was a "spot" found on a specific area of the brain post-mortem in schizophrenics that was not there in controls. Excitement faded when it was found that this abberation--the "spot"--" was caused by the administration of chlorpromazine and had nothing to do with schizophrenia.
How can this person say such things in light of what I have just described? I would like to see references to these cases of TD in people who've never taken an antipsychotic. I am open to new ideas, but am very--and understandably--extremely skeptical here, considering that we do not understand the biological basis for any mental illness. Sure, there are tons of potentially meaningful correlates (that is, Tom Cruise is not Tom Szasz!), but we have no concept of what an actual "biological model" of mental illness would even look like.
Posted by med_empowered on November 25, 2005, at 17:36:04
In reply to Re: Experiences on Risperdal... Im afraid of TD » alexandra_k, posted by Chairman_MAO on November 25, 2005, at 13:02:06
I'm really skeptical about this, too. There were apparently mentions of it here and there in the past, but there are problems with that..first of all, TD-like movements are common after a bout of encephalitis lethargica (which, interestingly enough, causes a brain pathology quite similar to the effects of full-dose conventional antipsychotics). Also, lots of people with advanced syphillis and nutritional problems were diagnosed with "schizophrenia" In addition, the people I read pushing this theory the most tend to be the most adamantly pro-neuroletpics...people like E. Fuller Torrey, who advocates allowing more involuntary drugging and outpatient commitment laws. These people have a vested interest in making neuroleptics seem more benign--after all, what psychiatrist wants to go on record saying in public "I 100% support forcing people to take neurotoxic compounds that can cause intellectual impairment, weight gain, akathisia, emotional blunting, EPS, and tardive dyskinesia." The more palatable they make medication seem, the easier it is for them to sell their "shoot 'em up with haldol" argument. The worst part about Torrey at least is when he argues that the ill-effects of the old school neuroleptics are, in fact, being confused with schizophrenia itself. Come on. I've taken the *new* neuroleptics, and I felt like a zombie. I'd really appreciate it if Torrey and other like-minded "mental health professionals" would avoid p*ssing on my leg and telling me its raining. I'd also like if they'd stop abusing and misusing data and statistics to back up their pre-formed conceptions and beliefs. Such behavior is dogmatic, not scientific.
Posted by alexandra_k on November 25, 2005, at 19:20:45
In reply to TD in untreated schizophrenics, posted by med_empowered on November 25, 2005, at 17:36:04
i will check the book (i have it - so i'll find the bit and quote it later today or tomorrow).
I'm not sure about whether to believe him or not, but I'm fairly sure he will have referenced that thought so we can have a little look at his sources.
A bit about Frith...
He is a psychologist, not a psychiatrist.
The book is (as I was saying...)
"The Cognitive Neuro-Psychology of Schizophrenia"
What that means... He does consider the abnormalities in structure / neurotransmission that have been found upon autopsy.
He does consider how much the abnormality may be due to medication vs the degenerative nature of the illness.
He does acknowledge that the brain abnormalities are a matter of 'tendancies' across population samples rather than being a litmus test for whether individuals have been appropriately diagnosed or not.
He does acknowledge that the brain abnormalities tend to be a matter of 'degree' rather than a huge difference in kind.
He is most interested to develop cognitive models of positive and negative symptoms.
Cognitive models of what cognitive-neurological factors might be responsible for delusions of alien control, thought withdrawal, passivity phenomena, negative symptoms, speech / communication problems etc.He doesn't have a drug line to push either way...
(In fact you would expect him to be sceptical being a psychologist rather than a psychiatrist)I'll chase those up...
Thanks for the interest...
:-)
Posted by alexandra_k on November 25, 2005, at 20:57:00
In reply to Re: thanks for the thoughts., posted by alexandra_k on November 25, 2005, at 19:20:45
Okay. So some of my thoughts were a little off (in the above post).
Here is what Frith has to say:
'My purpose in this chapter is to outline the evidence for believing that schizophrenia results from a brain disorder. A recent and detailed account of some of this evidence may be found in Kerwin (1992)...
Nevertheless, it was believed that brain abnormalities would soon be found. This has proved to be more difficult than expected. Neuropathologists searched diligently and abnormalities were frequently reported, but they were never replicated. Indeed, schizophrenia eventually came to be known as "the graveyard of neuropathology" (Plum, 1972). I have known neuropathologists to remark facetiously that it is easy to recognise the brains from schizophrenic patients because they are the ones which look normal... (p.15)
It is not suprising, in such a climate, many people came to believe that there was no brain abnormality associated with schizophrenia...
There were two major reasons for the dramatic switch of opinion in recent years towards the belief that schizophrenia is essentially a disease of the brain. The first was the chance discovery of antipsychotic drugs and the subsequent demonstration of their association with the neurotransmitter, dopamine. The second was the development of quantitative rather than qualitative studies of brain structure... (p. 16)
There are two distinct types of effects of treatment with antipsychotics on the movement system. Many patients treated with these drugs show signs similar to those observed in patients with Parkinson's disease: tremor, stiffness, and an abnormal gait. These "Parkinsonian" side-effects appear soon after drug treatment commences and disappear when treatment is discontinued. They are a direct consequence of the effects of the drugs on the dopamine system (Marsden, Tarsy, & Baldessarini, 1975). We know that Parkinson's disease is a consequence of the loss of dopamine-containing nerve terminals in the striatum (Ehringer & Hornykiewicz, 1960). A similar, but temporary, lack of dopamine is produced by antipsychotic drugs. The Parkinsonian side-effects of these drugs are very common and many schizophrenic patients are given additional drugs (usually anticholinergics such as procylindine) in the belief that these drugs will combat these side effects.
In addition to these Parkinsonian side-effects there is another kind of movement disorder associated with anti-psychotic drug treatment known as "tardive dyskinesia" (Jeste & Wyall, 1982). The most striking signs of the syndrome are strange involountary movements of the mouth, tongue, and jaw (orofacial dyskinesia, buccal dyskinesia). These signs are widely believed to be the irreversible consequence of long-term treatment with antipsychotics. They are believed to continue and, perhaps, even to get worse when treatment with antipsychotics is discontinued. There is evidence, however, that these movement disorders were observed in chronic schizophrenic patients before antipsychotic treatment was available, and they can also be observed in patients today who have never been treated with antipsychotics (Owens, Johnstone, & Frith, 1982) (p.20).
Regarding structural changes (brain abnormalities). He does not talk about it being 'degenerative' in fact he argues that it is not, so sorry for misrepresenting him there. He says
'In the 1970's there was a technological breakthrough, which is continuing to revolutionise the study of the brain in man. Computerised axial tomography (CAT) permitted a detailed image of the brain to be obtained from a living subject. In particular it was possible to measure the size of the ventricles (the fluid-filled spaces in the middle of the brain).
Simple measurement of the cross-sectional area of the lateral ventricles revealed them to be significantly enlarged in schizophrenic patients (Johnstone et al., 1956). Furthermore, for the first time in neuropathological studies of schizophrenia, this result has been replicated repeatedly (Gattaz, Kohlmeyer, & Gasser, 1991). Of course, the difference is quantitative, not qualitative. It is not the case that all schizophrenic patients have abnormally large ventricles. Rather it is the case that the mean ventricle size of a group of schizophrenic patients is larger than that of a control group matched for age, sex, and socioeconomic status. At the most, perhaps 25% of chronic schizophrenics have abnormally large ventricles. Inevitably this quantitative difference was missed by the classical neuropathologists, who were seeking qualitative differences. From their point of view the discovery of enlarged ventricles in schizophrenia is not very satisfactory. The enlargement is certainly not unique to schizophrenia, it is also observed in a more exaggerated form in all kinds of organic dementia. Furthermore, the enlargement is not found in all schizophrenics. What, then, does it tell us about schizophrenia?
We might first consider whether enlarged ventricles are associated with a particular kind of schizophrenia in terms of signs and symptoms. (p.20)
We would expect them to be associated with a more "organic" picture. To some extent this is true. Enlarged ventricles are associated with involvountary movement disorders (Owens et al., 1985), a lack of response to drug treatment (Weinberger et al., 1980), and negative signs, rather than positive symptoms (Andreasen et al., 1982)...
There is evidence that the enlargement is more marked in the part of the ventricular system that lies within the temporal lobe (the temporal horn) particularly on the left side of the brain (Crow et al., 1989). Consistent with these observations, some studies have found that the hippocampus and the adjacent area of cortex, the parahippo-campal gyrus, are reduced in size in schizophrenia (Bogerts et al., 1985; Brown et al., 1986). Both of these structures are part of the temporal lobe. Here again the differences are quantitative rather than qualitative. The differences may well represent a general reduction in the size of temporal lobe structures of all patients relative to the distribution in the normal population. The overlap between patients and normal subjects is such, however, that the size of the brain structures cannot qualify as "markers" for schizophrenia. (p.23)
... Repeated scans or scans of schizophrenic patients who have been ill for different lengths of time have not provided any evidence that the ventricles become progressively larger (Gattaz et al., 1991). There are a few instances where patients happened to have received scans well before the onset of schizophrenia. These cases have been found to have had large ventricles even at that early time, well before the onset of symptoms (O'Callaghan et al., 1998; Weinberger, 1998). These results suggest that schizophrenia is not a neurodegenerative disease and that brain abnormalities, including enlarged ventricles, precede the onset of the illness' (p.24).
Hmm.Nature / Nurture...
Some people have more of a biological componant than others...
And by the sounds of it...
Those are the people who are more likely to develop TD regardless of whether they take AP's or not...Still...
Maybe thats not quite right?
The full reference is:
Owens, D.G.C., Johnstone, E.C., & Frith, C.D (1982) Spontaneous involountary disorders of movement. *Archives of General Psychiatry, 39* 452-461.
Posted by alexandra_k on November 25, 2005, at 22:11:46
In reply to Experiences on Risperdal... Im afraid of TD, posted by Tepiaca on November 22, 2005, at 21:04:17
> I still have muscles twitches.I wonder if they might have something to do with your anxiety?
Or if they might be caused by some other reason.
I don't know.
Could you check with a GP about some of the causes of muscle twitches?
How often do you have them?
I'm just thinking...
That if you are very worried about them then that might make them worse too...I don't know.
Posted by ed_uk on November 26, 2005, at 14:02:10
In reply to TD in untreated schizophrenics, posted by med_empowered on November 25, 2005, at 17:36:04
>I'd really appreciate it if Torrey and other like-minded "mental health professionals" would avoid p*ssing on my leg and telling me its raining.
LOL, that really made me laugh :D
Ed
Posted by Tepiaca on November 26, 2005, at 15:20:11
In reply to Re: Experiences on Risperdal... Im afraid of TD » Tepiaca, posted by alexandra_k on November 25, 2005, at 22:11:46
> I wonder if they might have something to do with your anxiety?
Maybe , but they started when I begin taking APs
>>
> How often do you have them?
>Sometimes they just last 1 or 2 minutes but other times like in these days they last 2 or 3 hours.
In this moment my rigth eye is twitching , I also have some very little moves in my tongue. They dont bother me, but I am worried that these are the first signs of TD.> I'm just thinking...
> That if you are very worried about them then that might make them worse too...
>
> I don't know.Yes maybe If y try to stop thinking in them ,I would be better
Thank you alexandra
Posted by zeugma on November 26, 2005, at 15:39:49
In reply to Re: Experiences on Risperdal... Im afraid of TD » alexandra_k, posted by Tepiaca on November 26, 2005, at 15:20:11
I have read that TD is actually more prevalent in people with affective disorders who take AP's.
Clozapine is the only AP definitely not associated with TD risk.
While movement disorders of all kinds occur without AP use, including syndromes that resemble TD, this merely means that your chances of getting TD are greatly heightened by AP use (excluding clozapine and possibly a few others, most likely Seroquel and Abilify).
The reason AP's are in vogue so much these days is because a lot of them are still on patent. And by the time their true long term safety profiles are known, they will be off patent, which is convenient for the makers of such drugs.
-z
Posted by ed_uk on November 26, 2005, at 16:07:18
In reply to Re: Experiences on Risperdal... Im afraid of TD, posted by zeugma on November 26, 2005, at 15:39:49
Hi Tepi
>The reason AP's are in vogue so much these days is because a lot of them are still on patent. And by the time their true long term safety profiles are known, they will be off patent, which is convenient for the makers of such drugs.
So true, especially in the US. Things are a bit different here, doctors are strongly encouraged to prescribe the cheapest generic drugs unless there is no alternative, it's all about avoiding wastage of National Health Service resources. Lexapro, for example, is much less popular in the UK than generic fluoxetine (Prozac), which is cheaper by a factor of TEN - and generally similarly effective. The side effects are also broadly comparable.
Kind regards
Ed
Posted by ed_uk on November 26, 2005, at 16:08:11
In reply to Re: Experiences on Risperdal... Im afraid of TD » zeugma, posted by ed_uk on November 26, 2005, at 16:07:18
Posted by ed_uk on November 26, 2005, at 16:32:28
In reply to Re: Experiences on Risperdal... Im afraid of TD, posted by zeugma on November 26, 2005, at 15:39:49
Prescribing escitalopram (Cipralex, Lexapro) instead of fluoxetine (as a first line treatment for depressive illness) would be a massive waste of UK taxpayers money! In the UK, fluoxetine 20mg costs the NHS about Ł1.50 ($2.57) for a box of 30 caps (one month supply), escitalopram 10mg costs about Ł15.00 ($25.74) for a box of 28 tabs (one month supply).
Ed
Posted by zeugma on November 26, 2005, at 17:40:08
In reply to Re: Experiences on Risperdal... Im afraid of TD » zeugma, posted by ed_uk on November 26, 2005, at 16:07:18
Lexapro, for example, is much less popular in the UK than generic fluoxetine (Prozac), which is cheaper by a factor of TEN - and generally similarly effective. The side effects are also broadly comparable.>>
Hi Ed
In the U.S., the way it would work for the typical patient with symptoms of depression is that they would be given Lexapro samples for free. Then if the decision was made that the pills were needed a prescription would be written for Lexapro. Insidious, isn't it?By the way, most studies that show that SSRI's have fewer side effects than TCA's use studies that compare them against imipramine or amitriptyline. If the studies were made against the secondary amine TCA's, the results would be about equal. Lofepramine invalidates the argument that even a well-tolerated TCA is cardiotoxic, but for that reason will never be an option here. Instead we can pay through the nose for Strattera which IMO is not in the same league as any of the major TCA's as an AD, but has as its great selling point the fact that it is not 'cardiotoxic.' It may not be, but it's certainly on patent, and doctors' offices are crammed with samples.
-z
-z
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Dr. Bob is Robert Hsiung, MD,
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