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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 28. This is the beginning of the thread.
Posted by San Diegan on March 5, 2006, at 21:12:46
So the only antipsychotics so far that have not caused horrendous akathisia have been seroquel and zyprexa, and even those, I have had to start with extremely low doses. Unfortunately, those 2 cause extreme weight gain and stratospheric cholesterol levels.
I recently tried Moban 5mg, and yup, akathisia..extreme anxiety, almost panic, fear, restlessness with sedation. 15mg Temazepam worked wonders...do benzos usually help with this se? I'm on medicare the don't pay for benzos, but medi-cal still does. Does klonopin work for this too? I would think that would be the best one to be on, if you didn't run across a dr. who is anti-benzo and insists on taking you off....
Posted by med_empowered on March 6, 2006, at 0:15:29
In reply to Moban Akathesia, and general antipsychotic se, posted by San Diegan on March 5, 2006, at 21:12:46
hey...yeah, benzos are pretty good for akathisia. Valium, Klonopin, and Ativan seem to be top picks; in the US, Klonopin is probably the "it" benzo right now, although if you're paying for it yourself, Valium might be cheaper.
Posted by yxibow on March 6, 2006, at 3:44:20
In reply to Moban Akathesia, and general antipsychotic se, posted by San Diegan on March 5, 2006, at 21:12:46
> So the only antipsychotics so far that have not caused horrendous akathisia have been seroquel and zyprexa, and even those, I have had to start with extremely low doses. Unfortunately, those 2 cause extreme weight gain and stratospheric cholesterol levels.
>
> I recently tried Moban 5mg, and yup, akathisia..extreme anxiety, almost panic, fear, restlessness with sedation. 15mg Temazepam worked wonders...do benzos usually help with this se? I'm on medicare the don't pay for benzos, but medi-cal still does. Does klonopin work for this too? I would think that would be the best one to be on, if you didn't run across a dr. who is anti-benzo and insists on taking you off....
I'm not anti-benzo (you dont want to know how much Valium I take -- or did I already post it, I forget)... but while benzodiazepines can serve multifunctions, Restoril is generally best left for sleep, it is short acting and you can run into issues of withdrawal. It also is on the hypnotic end of the spectrum rather than the anxiolytic side although a significant dose probably would cover both to some degree I'm sure. I'm glad it did work for you, but there are other benzodiazepines such as Valium and Klonopin that would be better suited as they have much longer half lives.Anticholinergics such as Akineton 1-2mg/dy (which is generally my favored one) work best for EPS, although there is the issue of dry mouth and blurriness if one exceeds the atropine toxicity threshold.
Non cardioselective beta blockers also work for some people -- they're cheap, and can be effective -- propranolol, and possibly nadolol, pindolol, and a few others.
tidings
Jay
Posted by San Diegan on March 6, 2006, at 10:27:14
In reply to Re: Moban Akathesia, and general antipsychotic se » San Diegan, posted by yxibow on March 6, 2006, at 3:44:20
I'm glad it did work for you, but there are other benzodiazepines such as Valium and Klonopin that would be better suited as they have much longer half lives.
I'm sure you're right, but I didn't have anything else on hand. Plus it worked more quickly than klono, and I was in a big hurry for the feeling to end! :o)
>
> Anticholinergics such as Akineton 1-2mg/dy (which is generally my favored one) work best for EPS, although there is the issue of dry mouth and blurriness if one exceeds the atropine toxicity threshold.
>
> Non cardioselective beta blockers also work for some people -- they're cheap, and can be effective -- propranolol, and possibly nadolol, pindolol, and a few others.
>Those things were completely ineffective for me, as well as having far more undesireable side-effects than benzos...The things you mentioned above DO have some effect on the motor restlessness, but absolutely no effect on the most unpleasant part, the extreme anxiety and subjective restlessness.
Posted by ed_uk on March 6, 2006, at 13:54:40
In reply to Re: Moban Akathesia, and general antipsychotic se, posted by San Diegan on March 6, 2006, at 10:27:14
Hi,
For what condition are you taking the antipsychotic?
Regards
Ed
Posted by San Diegan on March 6, 2006, at 16:53:54
In reply to Re: Moban Akathesia, and general antipsychotic se » San Diegan, posted by ed_uk on March 6, 2006, at 13:54:40
> For what condition are you taking the antipsychotic?Bipolar disorder, usually mixed, with a lot of anxiety.
Posted by yxibow on March 6, 2006, at 20:02:10
In reply to Re: Moban Akathesia, and general antipsychotic se, posted by San Diegan on March 6, 2006, at 16:53:54
>
> > For what condition are you taking the antipsychotic?
>
> Bipolar disorder, usually mixed, with a lot of anxiety.
>
>I assume you've been through the atypicals which would have less akathisia, at least for some ? Since Zyprexa and Seroquel are indicated -- at least Zyprexa from my memory for BP.
Posted by San Diegan on March 6, 2006, at 20:26:31
In reply to Re: Moban Akathesia, and general antipsychotic se » San Diegan, posted by yxibow on March 6, 2006, at 20:02:10
Yes, zyprexa and seroquel both caused weight gain and high cholesterol
Posted by yxibow on March 7, 2006, at 2:41:58
In reply to Re: Moban Akathesia, and general antipsychotic se, posted by San Diegan on March 6, 2006, at 20:26:31
> Yes, zyprexa and seroquel both caused weight gain and high cholesterol
I'm sorry to hear that -- Zyprexa is the worst at it. Seroquel is secondary -- it has raised my cholesterol but not to a completely dangerous range. I'm also excercising more now so that could change things, as well as a weight drop. There also is Abilify (I think Geodon is a bit more active in terms of akathisia but that's just my experience). But at any rate, I'm sure you have arrived at an AP that works for you.
Posted by San Diegan on March 7, 2006, at 10:17:17
In reply to Re: Moban Akathesia, and general antipsychotic se » San Diegan, posted by yxibow on March 7, 2006, at 2:41:58
There also is Abilify (I think Geodon is a bit more active in terms of akathisia but that's just my experience).
They both gave me akathesia, but the abilify was more extreme.
But at any rate, I'm sure you have arrived at an AP that works for you.
The seroquel and zyprexa both worked pretty well, with no akathisia, but again, cholesterol 350 and 35lbs weight gain.
All the other ap's have given me extreme akithisia
Posted by ed_uk on March 7, 2006, at 14:44:46
In reply to Re: Moban Akathesia, and general antipsychotic se, posted by San Diegan on March 6, 2006, at 16:53:54
Hi
It sounds like APs are not the right meds for you. I assume you've tried lithium, Depakote, Tegretol.......?
Ed
Posted by San Diegan on March 7, 2006, at 15:03:48
In reply to Re: Moban Akathesia, and general antipsychotic se » San Diegan, posted by ed_uk on March 7, 2006, at 14:44:46
Yep, I've tried everything. Right now I'm ramping up on lamictal, and taking wellbutrin xl, but nothing for the anxiety/mania. Benzo's work pretty well for me, but it's hell getting on them and then the next doctor is "against" benzos and makes you stop.
Posted by ed_uk on March 7, 2006, at 16:39:08
In reply to Re: Moban Akathesia, and general antipsychotic se, posted by San Diegan on March 7, 2006, at 15:03:48
Have you tried various APs at very low doses?
Ed
Posted by San Diegan on March 7, 2006, at 16:53:00
In reply to Re: Moban Akathesia, and general antipsychotic se » San Diegan, posted by ed_uk on March 7, 2006, at 16:39:08
> Have you tried various APs at very low doses?
>
> EdYes I have. Even VERY low doses of zyprexa and seroquel caused weight gain and high cholesterol.
The others caused extreme akathisia even in low doses.
Posted by San Diegan on March 7, 2006, at 17:04:08
In reply to Re: Moban Akathesia, and general antipsychotic se, posted by San Diegan on March 7, 2006, at 16:53:00
Just talked to my pdoc-- she wants to give me cogentin with the moban. I thought cogentin was for stiffness or motor restlessness? Will it do anything for the extreme anxiety/agitation? I'm really afraid to take the moban again without a benzo.
Posted by ed_uk on March 7, 2006, at 17:28:29
In reply to Re: Moban Akathesia, and general antipsychotic se, posted by San Diegan on March 7, 2006, at 17:04:08
Hi
>I thought cogentin was for stiffness or motor restlessness? Will it do anything for the extreme anxiety/agitation?
Cogentin is an anticholinergic. Artane and Akineton are also anticholinergics. Have anticholinergics ever helped AP-induced agitation when you've tried them before? They do help for some people, but not everyone.
I suppose you could return to Seroquel and use medication to treat the high cholesterol etc.
Regards
Ed
Posted by San Diegan on March 7, 2006, at 17:32:29
In reply to Re: Moban Akathesia, and general antipsychotic se » San Diegan, posted by ed_uk on March 7, 2006, at 17:28:29
no, they've never really helped, plus they had unpleasant se's of their own.
It's not just the cholesterol, it's the weight gain too. Diet and exercise have no effect, and as soon as I stopped them I went back to my normal weight.
Why are pdocs so stubborn about giving you stuff that's bad for you, and doesn't work very well, just because some idiots abuse benzos? It's the only thing that works for me, without unacceptable se
Posted by ed_uk on March 7, 2006, at 17:40:38
In reply to Re: Moban Akathesia, and general antipsychotic se, posted by San Diegan on March 7, 2006, at 17:32:29
Hi
>Why are pdocs so stubborn about giving you stuff that's bad for you, and doesn't work very well, just because some idiots abuse benzos?
Because atypical APs are currently very much 'in fashion' among pdocs. The advertising has been very successful.
Are you definitely bipolar? Have other diagnoses been considered? eg. an anxiety disorder. Just curious.
Please tell me, how do you respond to??????
1. Lithium
2. Depakote
3. Tegretol
4. TrileptalKind regards
Ed
Posted by San Diegan on March 7, 2006, at 17:46:20
In reply to Re: Moban Akathesia, and general antipsychotic se » San Diegan, posted by ed_uk on March 7, 2006, at 17:40:38
> Because atypical APs are currently very much 'in fashion' among pdocs. The advertising has been very successful.
>
> Are you definitely bipolar?I've also had various dx such as PTSD and borderline (some pdocs assumed borderline because of cutting--but that was the only symptom I had)
Have other diagnoses been considered? eg. an anxiety disorder. Just curious.
>
> Please tell me, how do you respond to??????
>
> 1. Lithiumweight gain, nausea
> 2. Depakote
weight gain, nausea, so sleepy unable to function at all.
> 3. Tegretol
strange blood disorder
> 4. Trileptal
Heavy, watery feeling in legs, confusion/fuzzy thinking
Posted by ed_uk on March 8, 2006, at 15:20:00
In reply to Re: Moban Akathesia, and general antipsychotic se, posted by San Diegan on March 7, 2006, at 17:46:20
Hi
>Depakote, lithium.......
In spite of the side effects, did either of these drugs relieve your bipolar symptoms? I was wondering whether a lower dose might be of benefit.
Regards
Ed
Posted by San Diegan on March 8, 2006, at 15:39:50
In reply to Re: Moban Akathesia, and general antipsychotic se » San Diegan, posted by ed_uk on March 8, 2006, at 15:20:00
> Hi
>
> >Depakote, lithium.......
>
> In spite of the side effects, did either of these drugs relieve your bipolar symptoms? I was wondering whether a lower dose might be of benefit.Hard to tell. I was so sleepy and sick on depakote I don't know what was going on. I don't think so.
I didn't stay on lithium long enough to tell.
Posted by ed_uk on March 8, 2006, at 16:44:31
In reply to Re: Moban Akathesia, and general antipsychotic se, posted by San Diegan on March 8, 2006, at 15:39:50
Hi
Would you consider giving Depakote a second chance? Some people benefit from very low doses with minimal side effects. Conventional (high!) doses are only really suitable for the treatment of acute severe mania.
Ed
Posted by San Diegan on March 8, 2006, at 17:16:59
In reply to Re: Moban Akathesia, and general antipsychotic se, posted by ed_uk on March 8, 2006, at 16:44:31
> Would you consider giving Depakote a second chance? Some people benefit from very low doses with minimal side effects. Conventional (high!) doses are only really suitable for the treatment of acute severe mania.
>
I'd consider it. Is the weight-gain dose dependent? It doesn't seem to be with the anti-psychotics. Even at VERY low doses they caused me weight-gain. Does depakote have any anti-anxiety properties?
Posted by ed_uk on March 9, 2006, at 12:42:45
In reply to Re: Moban Akathesia, and general antipsychotic se, posted by San Diegan on March 8, 2006, at 17:16:59
Hi
>Is the weight-gain dose dependent?
I have heard various p-babblers say that they didn't gain weight on a low dose.
>Does depakote have any anti-anxiety properties?
It has a good reputation for relieving anxiety and agitation in bipolar disorder.
Regards
Ed
Posted by San Diegan on March 9, 2006, at 12:53:28
In reply to Re: Moban Akathesia, and general antipsychotic se » San Diegan, posted by ed_uk on March 9, 2006, at 12:42:45
Ok, thanks! I'll ask my doctor about it. Thanks very much for your help.
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