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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by MARTY on March 24, 2006, at 16:39:41
Greetings,First, I already thanks you for the time you will take to read my post. It is long because I had 2 objectives in writing it; to get help from the very knowlegeable and kind people of this forum AND also freeze on the Internet something that could be instructive and helpful.
BTW, I'll give 500 points to anyone who find a solution to my problems :P
Before exposing my atypical and very rare problems/symptoms, here's some facts..
that you can skip if you already know about them.+=--- The facts; Acethylcoline 101, effects of antipsychotics, ExtraPyramidal syndrome, parkinson etc.
1: I've been prescribed Procyclidine, which is and anticholinergic drug usually prescribe to treat symptoms of Parkingson.
2: I'm taking Risperdal, an antipsychotic, to help with my anxiety and depression.
3: Antipsychotics usually works by antagonisim (diminishing) Dopamine neurotransmitter in the brain.
4: Antagonisim Dopamine sometime create an imbalance with another neurotransmitter called Acethylcoline; Too much Acethylcoline, not enough Dopamine to counteract. This condition, when symptoms are strong and disabling, is called ExtraPyramidal syndrome.
5: ExtraPyramidal syndrome, or weaker Dopamine/Acetylcoline imbalance, symptoms usually are similars of the symptoms of Parkingson, which also create an imbalance between Dopamine and Acethylcoline.
6: When strong, symptoms are tremors or trembling; difficulty maintaining balance and gait; rigidity or stiffness of the limbs and trunk; and general slowness of movement (also called bradykinesia),dry mouth, blurred vision, constipation, confusion, drowsiness, poor memory (especially visual), and slowness at learning.
7: Acethylcoline Antagonist, like procyclidine, helps by reestablishing balance between Dopamine and Acethylcoline by diminishing Acethylcoline in the body nerves, muscles and the brain.
+=--- My diagnostic and current Cocktail ...
Diag: Generalize Anxiety, Social Phobia which is supposedly modulate (follows) a not yet confirmed Bipolarity type 2 (maybe Type 2.5 (or Type 4) which is hypomania only caused by some antidepressant, 1 episode)
Cocktail:
MAOI (Nardil 60mg) antidepressant
Lamictal 150mg BID (300mg/day)
Neurontin 100mg when needed (help anxiety and sexual side-effect)
Risperdal .5mg at sleep time
and newly added Procyclidine 2.5mg 3/day...+=--- My problems ...
When I take an antipsychotic (Risperdal, Seroquel, etc), I'm suffering very atypical symptoms:Since I've withdrawn from CLONAZEPAM (benzodiazepine anxiolitc)4 months ago, I got strange sensations in my face, sometimes like waves of tingling, dull pain mixed with electric shock in some part like teeth, gums, palate, jaw, nose. I also got pressure in my eyes and bizarre sensation behind my eyes like if the optical nerves are swollen. Also, this is causing weird and strong Anesthsia of the nose, cheecks, near ears and sometime on top of my skull. Those symptoms are 1 day on 5 painfull, sometime are partially disabling and doesn't help my depression.
This is usually starting after diner and get to his paroxism in the evening.
Those symptoms stop when I withdraw (catastrophic results) from Risperdal (antipsychotic, dopamine antagonist) and comeback when I'm back on an antipsychotic (Risperdal OR Seroquel). I've found some CLONAZEPAM, and against what my Pdoc will, took some to see the effect on my facial symptoms; remember that all this started with a withdrawal of Clonazepam. The clonazepam did atenuate the force of the symptoms.
The procyclidine that I started 4 days ago, for the second time, totally solve the problem. This indictate that I suffer from an imbalance between Acetylcoline and dopamine caused by my antipsychotic Riperdal. But at a cost...
BTW; I only take .5 mg of Risperdal ! (this is a very small dose compare to the majority of people who are taking 3-4 mg)
And when I take procyclidine (very small dose also) I'm feeling bad; difficulty speaking, little anxiety, different sens of reality, walking and moving differently, very weird.
I have a hard time with it. Enough to have the dilem between face problem vs Procyclidine.So here's where you could help me..
* Have you ever heard of a similar story ? Face symptoms ? different part of the body ?
* How can such a small dose of antipsychotic can cause all those problems ?
* Is there something, other then Acethylcoline Antagonist, I could try ? (Challenge: I'm on a MAOI, Nardil 60mg which even interact with meds you don't even take ;) )
* Could procyclidine lower too much my Acethylcoline level causing an inverse inbalance making the procyclidine very unpleasant to take ?
* Could those symptoms caused by an underlying physical condition like dental problems ? a small benign tumor (not dangerous) in the sinus (I have one) ?
* What could be the link between Clonazepam withdrawal face symptoms appearance and cause by Risperdal that I was, with Seroquel, taking a couple of months before the withdrawal ?
* Since it is drug induced, what are the probability that the whole think is something 'physical' like Facial Anaesthesia or Atypical Face Pain syndrome ?
Thank you for you time ... know that it is very much appreciate.Best Regards,
Marty
Posted by MARTY on March 24, 2006, at 23:28:37
In reply to Procyclidine (anticholinergics) with Antipsychotic, posted by MARTY on March 24, 2006, at 16:39:41
I guess my message was too long. I had great hope that someone knowledgeable in the subject could give me their advices/opinions.There's no one who have tried to understand what's happening to me; GP, PDOC, pharmacist, people I know.. everyone just listen to me 2 minutes and told me "how weird. I dont know. sorry for you" .. Asking here was my last hope.
Hope someone will answer me.. :S
Marty
Posted by med_empowered on March 26, 2006, at 14:21:24
In reply to Re: PLZ HELP ME :~(, posted by MARTY on March 24, 2006, at 23:28:37
hi! OK, here's my first problem: you're not psychotic. That makes the use of an antipsychotic kind of..troublesome. You don't even have Bipolar I disorder (where neuroleptic use is sometimes helpful). I think you should try dropping the atypicals.
Some people react poorly to APs, even the atypical ones. I had severe akathisia on 2.5mgs/day of Zyprexa. I decided to stop taking any and all antipsychotics instead of trying to medicate around the problem--adding drugs on top of drugs can really just create new problems.
WHy won't your doc RX clonazepam anymore? Yes, it is a controlled substance, but its also a tried-and-true treatment for problems like yours. Risperdal *IS NOT* well-established as a treatment for problems like yours, and it seems to be highly problematic. Unless you have a substance abuse problem, there's really not good reason to withdraw well-tolerated, efective treatment (also, clonazepam is much CHEAPER than risperdal, something you and your insurance company would both appreciate). My suggestion would be to find another doctor, since this one seems to be perfectly comfortable putting you through hell for no good reason.
Other suggestions: withdraw the atypical (but keep taking the anti-cholinergic for a little while after withdrawal), try to get on Klonopin or something similar for the anxiety, and do lots of talk therapy. Also, I know it sounds fruity and new-agey, but maybe consider nutritional and alternative methods to complement your medications; at the very least, they'll probably be harmless (and certainly more pleasant than Risperdal). At the very best, they could be quite helpful.
Good luck!
Posted by MARTY on March 26, 2006, at 16:03:33
In reply to Re: PLZ HELP ME :~(, posted by med_empowered on March 26, 2006, at 14:21:24
> hi! OK, here's my first problem: you're not psychotic. That makes the use of an antipsychotic kind of..troublesome. You don't even have Bipolar I disorder (where neuroleptic use is sometimes helpful). I think you should try dropping the atypicals.
==
In fact I'm diagnosed Bipolar 2 and they feared I could fall in many with my AD since I have an history have done so in the past.To date the AP is the only thing that help my depression. When I try to withdraw from it I fall almost instantly into suicidal depression.
:(
==
> Some people react poorly to APs, even the atypical ones. I had severe akathisia on 2.5mgs/day of Zyprexa. I decided to stop taking any and all antipsychotics instead of trying to medicate around the problem--adding drugs on top of drugs can really just create new problems.==
I'm sorry to heard that you've suffered from Akathesia. I got some for like 3 days and found it to be just a terrible experience to live.I agree to people having problems with AP. Personnally I think those meds are very dangerous and I fear them a lot. My opinion is there are making PERMANENT change to users dopaminergic neurons/receptors. The longer you take it the more change it's making, but technically I think that is start to modify you neurology even from day 1. Permanent (tardive) Dystonia, tardive Akathesia and the permenent Extrapyramid syndrome are proof of that.
==
> WHy won't your doc RX clonazepam anymore? Yes, it is a controlled substance, but its also a tried-and-true treatment for problems like yours. Risperdal *IS NOT* well-established as a treatment for problems like yours, and it seems to be highly problematic. Unless you have a substance abuse problem, there's really not good reason to withdraw well-tolerated, efective treatment (also, clonazepam is much CHEAPER than risperdal, something you and your insurance company would both appreciate). My suggestion would be to find another doctor, since this one seems to be perfectly comfortable putting you through hell for no good reason.
>
> Other suggestions: withdraw the atypical (but keep taking the anti-cholinergic for a little while after withdrawal), try to get on Klonopin or something similar for the anxiety, and do lots of talk therapy. Also, I know it sounds fruity and new-agey, but maybe consider nutritional and alternative methods to complement your medications; at the very least, they'll probably be harmless (and certainly more pleasant than Risperdal). At the very best, they could be quite helpful.===
About the Clonazepam thing here's what I think:
http://www.dr-bob.org/babble/20060322/msgs/624829.htmlI've been reading about some nutritional strategy againt depression and anxiety; I'm looking forward to try soon.
Alternative methods are also interesting but I tend to have difficultier to stick with some of them like yoga and everything that demands discipline. I've tried a lot of natural product with not much results. The one usage I found interesting is to countinterac the sexual side effect on AD, AP.
===
> Good luck!=== Thank you. Even if AP is helping my depression I may decide to gradually withdraw from them and search another cocktail that would be effective without atypicals... I'll keep your arguments of favor of stoping them in working the dilem...
Thanks a lot..
BTW: Any idea why you are the only one who respond ? is it because my post was WAY too long ? or is there any reason ? this was my all time first post in a forum.
Hope you're well
~Marty
Posted by ed_uk on March 26, 2006, at 17:18:50
In reply to Procyclidine (anticholinergics) with Antipsychotic, posted by MARTY on March 24, 2006, at 16:39:41
Hi M
Have you tried a lower dose of procyclidine? You could try 2.5mg once or twice daily. It might reduce your symptoms with less side effects.
ed
Posted by MARTY on March 26, 2006, at 18:12:32
In reply to Re: Procyclidine (anticholinergics) with Antipsychotic » MARTY, posted by ed_uk on March 26, 2006, at 17:18:50
Hi Ed,Thats exactly what i'll try to do :)
Nice to hear that others think it could work even at this low dose.
> Hi M
>
> Have you tried a lower dose of procyclidine? You could try 2.5mg once or twice daily. It might reduce your symptoms with less side effects.
>
> ed
Posted by ed_uk on March 26, 2006, at 19:03:35
In reply to Re: Procyclidine (anticholinergics) with Antipsychotic, posted by MARTY on March 26, 2006, at 18:12:32
Hi M
I work in a pharmacy. I've noticed that most people who take procyclidine take low doses.
Ed
Posted by MARTY on March 27, 2006, at 6:47:09
In reply to Re: Procyclidine (anticholinergics) with Antipsychotic » MARTY, posted by ed_uk on March 26, 2006, at 19:03:35
Ahhh.. now that's some news I can use :)
I've stopped it, waiting to get back to normal then I'll try 2.5 like to said..Thanks for the tips
Marty> Hi M
>
> I work in a pharmacy. I've noticed that most people who take procyclidine take low doses.
>
> Ed
Posted by ed_uk on March 27, 2006, at 14:18:55
In reply to Re: Procyclidine (anticholinergics) with Antipsychotic, posted by MARTY on March 27, 2006, at 6:47:09
Hi,
2.5mg procyclidine (Kemadrin) twice a day is common. Much higher doses used to be necessary because patients were given massive doses of typical neuroleptics. Now that atypical antipsychotics are more frequently used, lower doses of procyclidine are appropriate. I'd try taking 2.5mg once daily in the morning if I were you :)
Regards
Ed
Posted by MARTY on March 27, 2006, at 21:10:13
In reply to Re: Procyclidine (anticholinergics) with Antipsychotic » MARTY, posted by ed_uk on March 27, 2006, at 14:18:55
I try this starting tomorow morning.Thanks Ed
Marty> Hi,
>
> 2.5mg procyclidine (Kemadrin) twice a day is common. Much higher doses used to be necessary because patients were given massive doses of typical neuroleptics. Now that atypical antipsychotics are more frequently used, lower doses of procyclidine are appropriate. I'd try taking 2.5mg once daily in the morning if I were you :)
>
> Regards
>
> Ed
Posted by ed_uk on March 28, 2006, at 15:01:43
In reply to Re: Procyclidine (anticholinergics) with Antipsychotic, posted by MARTY on March 27, 2006, at 21:10:13
Let us know how it goes :)
Ed
Posted by ramsea on March 30, 2006, at 21:06:37
In reply to Re: Procyclidine (anticholinergics) with Antipsychotic » MARTY, posted by ed_uk on March 28, 2006, at 15:01:43
I just wanted to respond to your question about no one answering your questions re: procyclidine etc. Really forums on the net are not reliable. one time you will get lots of responses and another equally good, well-put, even urgent message may receive nothing. it is almost always not personal, it is just the way it works.
i agree you have a problem that must be explored and experimented with by a competent doctor---do get another one if you can't get more help! and it's great to ask in forums like this, just keep badgering until you get a reply from someone somewhere--but of course it is not professional advice. anyway--take care. ramsea
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