Psycho-Babble Medication Thread 730582

Shown: posts 1 to 24 of 24. This is the beginning of the thread.

 

Diff between anxiety, akathesia, dysphoric mania?

Posted by blueberry1 on February 6, 2007, at 19:23:38

How do you tell the different between anxiety, akathesia, and dysphoric mania? When I read descriptions of them, I swear I have all of them, mixed in with anhedonic withdrawn depression. Can't tell one from the other. Since the only med I am taking is 5mg cymbalta (that's right, 5mg), I can't see it being akathesia unless I have become really sensitive.

I'm just real nervous. Can't relax. Hard to be in a conversation. Feel disconnected. Mind racing with worries, worries that I recognize as being ridiculous and silly, so I try to talk myself calm with reality but it doesn't work. Even in the face of plenty of evidence the worries are stupid and groundless they just go on.

No real physical symptoms except for a butterflies-in-the-stomach kind of feeling. No panic at all. I appear calm on the outside to anyone looking at me. But on the inside I am a wreck.

This was all there to a small extent before cymbalta, but has been massively magnified on cymbalta, even at just 5mg.

If I could figure out if I have anxiety, or if this anxiety is a component of my depression, or if this is a dysphoric soft bipolar mania sparked by cymbalta, or if this is some sort of soft paranoia, it would sure help in knowing what direction to go with meds. Cymbalta has helped in two ways...haven't had a crying spell in a while, though I feel close sometimes; and my afternoon sinking fatigue is gone. One bad side effect...sex drive is through the roof. Too much. Not normal. Can't get it off my mind.

How do you tell the difference?

 

Re: Diff between anxiety, akathesia, dysphoric man » blueberry1

Posted by yxibow on February 6, 2007, at 20:24:19

In reply to Diff between anxiety, akathesia, dysphoric mania?, posted by blueberry1 on February 6, 2007, at 19:23:38

> How do you tell the different between anxiety, akathesia, and dysphoric mania? When I read descriptions of them, I swear I have all of them, mixed in with anhedonic withdrawn depression. Can't tell one from the other. Since the only med I am taking is 5mg cymbalta (that's right, 5mg), I can't see it being akathesia unless I have become really sensitive.
>
> I'm just real nervous. Can't relax. Hard to be in a conversation. Feel disconnected. Mind racing with worries, worries that I recognize as being ridiculous and silly, so I try to talk myself calm with reality but it doesn't work. Even in the face of plenty of evidence the worries are stupid and groundless they just go on.
>
> No real physical symptoms except for a butterflies-in-the-stomach kind of feeling. No panic at all. I appear calm on the outside to anyone looking at me. But on the inside I am a wreck.
>
> This was all there to a small extent before cymbalta, but has been massively magnified on cymbalta, even at just 5mg.
>
> If I could figure out if I have anxiety, or if this anxiety is a component of my depression, or if this is a dysphoric soft bipolar mania sparked by cymbalta, or if this is some sort of soft paranoia, it would sure help in knowing what direction to go with meds. Cymbalta has helped in two ways...haven't had a crying spell in a while, though I feel close sometimes; and my afternoon sinking fatigue is gone. One bad side effect...sex drive is through the roof. Too much. Not normal. Can't get it off my mind.
>
> How do you tell the difference?

From all my experience with akathisia, that's not akathisia. Akathisia is a side effect, mostly of neuroleptics, rarely of SSRIs, I don't know if I've heard of it with Cymbalta but I suppose its possible. 5mg would be a placebo in most individuals, but we all vary.


Akathisia is the feeling that you have to either a) move, even if there is a brick wall in front of you, or b) lie on the floor writhing because you feel you have to move even if there is a brick wall in front of you. It is a movement side effect / disorder.


"I'm just real nervous. Can't relax. Hard to be in a conversation. Feel disconnected. Mind racing with worries, worries that I recognize as being ridiculous and silly, so I try to talk myself calm with reality but it doesn't work."


Definately sounds like some sort of OCD like anxiety. Its very hard to stop pure obsessions, or "garbage thoughts" racing through the mind. As a lifetime sufferer of OCD, I can sympathize that there are times that they flare up, and Cymbalta just isn't covering it like Luvox. On the other hand Cymbalta does more for my MDD, so I guess it was a better choice from my psychiatrist. They're not as intrusive for me as it sounds like for you.


In general those kinds of thoughts, other than attempting to block them with Luvox or Anafranil, become worse when one pays more attention to them or microanalyzes them. And I know that's difficult to do when they get roaring up. Perhaps some work with relaxation therapy with your doctor would help you to focus better. (It's not just hocus pocus).


Yes, you could have a PRN prescription for Xanax 0.5 at those moments, and I do have such a thing standing, but a) you don't really want to be operating heavy machinery and b) in the long run while I'm not saying that better living through chemistry sometimes is a necessary thing, knowing how to relax in a situation is something you will be able to recall again and again.


I hope you feel better

-- Jay

 

Re: Diff between anxiety, akathesia, dysphoric man

Posted by Phillipa on February 6, 2007, at 22:00:38

In reply to Re: Diff between anxiety, akathesia, dysphoric man » blueberry1, posted by yxibow on February 6, 2007, at 20:24:19

As usual it sounds to me like Blueberry and I have the same thing. Thanks Jay I was thinking of cutting back on luvox tonight. Now I will up it as I'm supposed to do. Love Phillipa

 

Re: Diff between anxiety, akathesia, dysphoric man » yxibow

Posted by SLS on February 7, 2007, at 6:00:47

In reply to Re: Diff between anxiety, akathesia, dysphoric man » blueberry1, posted by yxibow on February 6, 2007, at 20:24:19

> > How do you tell the different between anxiety, akathesia, and dysphoric mania? When I read descriptions of them, I swear I have all of them, mixed in with anhedonic withdrawn depression. Can't tell one from the other. Since the only med I am taking is 5mg cymbalta (that's right, 5mg), I can't see it being akathesia unless I have become really sensitive.
> >
> > I'm just real nervous. Can't relax. Hard to be in a conversation. Feel disconnected. Mind racing with worries, worries that I recognize as being ridiculous and silly, so I try to talk myself calm with reality but it doesn't work. Even in the face of plenty of evidence the worries are stupid and groundless they just go on.
> >
> > No real physical symptoms except for a butterflies-in-the-stomach kind of feeling. No panic at all. I appear calm on the outside to anyone looking at me. But on the inside I am a wreck.
> >
> > This was all there to a small extent before cymbalta, but has been massively magnified on cymbalta, even at just 5mg.
> >
> > If I could figure out if I have anxiety, or if this anxiety is a component of my depression, or if this is a dysphoric soft bipolar mania sparked by cymbalta, or if this is some sort of soft paranoia, it would sure help in knowing what direction to go with meds. Cymbalta has helped in two ways...haven't had a crying spell in a while, though I feel close sometimes; and my afternoon sinking fatigue is gone. One bad side effect...sex drive is through the roof. Too much. Not normal. Can't get it off my mind.
> >
> > How do you tell the difference?
>
>
>
> From all my experience with akathisia, that's not akathisia. Akathisia is a side effect, mostly of neuroleptics, rarely of SSRIs, I don't know if I've heard of it with Cymbalta but I suppose its possible. 5mg would be a placebo in most individuals, but we all vary.
>
>
> Akathisia is the feeling that you have to either a) move, even if there is a brick wall in front of you, or b) lie on the floor writhing because you feel you have to move even if there is a brick wall in front of you. It is a movement side effect / disorder.
>
>
> "I'm just real nervous. Can't relax. Hard to be in a conversation. Feel disconnected. Mind racing with worries, worries that I recognize as being ridiculous and silly, so I try to talk myself calm with reality but it doesn't work."
>
>
> Definately sounds like some sort of OCD like anxiety. Its very hard to stop pure obsessions, or "garbage thoughts" racing through the mind. As a lifetime sufferer of OCD, I can sympathize that there are times that they flare up, and Cymbalta just isn't covering it like Luvox. On the other hand Cymbalta does more for my MDD, so I guess it was a better choice from my psychiatrist. They're not as intrusive for me as it sounds like for you.
>
>
> In general those kinds of thoughts, other than attempting to block them with Luvox or Anafranil, become worse when one pays more attention to them or microanalyzes them. And I know that's difficult to do when they get roaring up. Perhaps some work with relaxation therapy with your doctor would help you to focus better. (It's not just hocus pocus).
>
>
> Yes, you could have a PRN prescription for Xanax 0.5 at those moments, and I do have such a thing standing, but a) you don't really want to be operating heavy machinery and b) in the long run while I'm not saying that better living through chemistry sometimes is a necessary thing, knowing how to relax in a situation is something you will be able to recall again and again.
>
>
> I hope you feel better

Me too.

I agree with Jay. It is more likely a dysphoric or depressive reaction with attendant anxiety associated with the Cymbalta. In your most current writings, I don't "see" racing thoughts or, rather, the jumping from one topic to another. There is continuity. This is inconsistent with mania. I believe that your "racing thoughts" are the result of a hyperarousal that can occur with anxiety. The only thing that argues for hypomania is hypersexuality. The question is, is it hypersexuality, or a return of a normal sex drive? It might also be a transient rebound of some sort.

I guess I am in a bit of a quandry trying to identify the effect that Cymbalta is having on you, but these effects are not at all consistent with akathisia. Akathisia involves an interminable and intense resltlessness. People are unable to sit still, they rock back-and-forth at the torso. They are also unable to stand still. Aside from pacing, they shift their weight constently from foot to foot as if they are walking in place. See if you can find a copy of the Barnes Akathisa Scale.


- Scott

 

Re: Diff between anxiety, akathesia, dysphoric man

Posted by fiftylager on February 7, 2007, at 7:39:50

In reply to Re: Diff between anxiety, akathesia, dysphoric man » yxibow, posted by SLS on February 7, 2007, at 6:00:47

I am bipolar and have dysphoric mania's/mixed episodes. I also suffer from extreme anxiety and there are differences. I have to add that AD's put me into these states almost immediatly.

When it's dysphoric mania/hypomanic there is definitely an issue with sleep. It takes me forever to fall asleep and when I do I sleep very lightly with non-stop dreams and wake up constanly looking at the clock. I usually catch 4 hours sleep. I just feel wired. Whereas, I normally need a nap a day or have a huge energy loss midday, I don't have that when in the manic state. I don't just feel nervous. I feel agitated and feel everyone can see it. I feel I can't be around people. I'm extremely irritated and sensitive to noise/ and touch. I do get the racing thoughts. I feel like I have this surge of energy in my body but I can't do anything with it. I sometimes experience derealizaton, where you feel like your almost in a dream. I also get a compulsion to write things down over and over and constantly search the internet for answers. I feel like I am completely losing my mind and heading for a breakdown. I also with break down and start crying for no reason. I go from pacing the floor to laying in my bed staring out the window.

When I'm suffering anxiety which is almost a daily thing, and very dibilitating in itself. I have a constant feeling something bad is going to happen. I worry constantly but it's more a constant worry about things than racing thoughts.
I get a weight on my chest and often a lump in my throat. With anxiety though it is sometimes difficult I can function. When dysphoric mania hits I can't cope.

It can be very difficult to figure out which it is, unless you've suffered both because the symptoms you read about overlap but there is a difference when you actually feel it. I hope this helped you somewhat because whether it is mania or anxiety they both are horrible to experience. Also, whether I am in a dysphoric mania or anxiety clonazepam helps, however when dysphoric I need a larger dose. And when dysphoric the clonazepam won't help me to sleep as well as when I'm suffering anxiety. Take care.

Crissi

 

Re: Diff between anxiety, akathesia, dysphoric mania?

Posted by polarbear206 on February 7, 2007, at 8:24:20

In reply to Diff between anxiety, akathesia, dysphoric mania?, posted by blueberry1 on February 6, 2007, at 19:23:38

> How do you tell the different between anxiety, akathesia, and dysphoric mania? When I read descriptions of them, I swear I have all of them, mixed in with anhedonic withdrawn depression. Can't tell one from the other. Since the only med I am taking is 5mg cymbalta (that's right, 5mg), I can't see it being akathesia unless I have become really sensitive.
>
> I'm just real nervous. Can't relax. Hard to be in a conversation. Feel disconnected. Mind racing with worries, worries that I recognize as being ridiculous and silly, so I try to talk myself calm with reality but it doesn't work. Even in the face of plenty of evidence the worries are stupid and groundless they just go on.
>
> No real physical symptoms except for a butterflies-in-the-stomach kind of feeling. No panic at all. I appear calm on the outside to anyone looking at me. But on the inside I am a wreck.
>
> This was all there to a small extent before cymbalta, but has been massively magnified on cymbalta, even at just 5mg.
>
> If I could figure out if I have anxiety, or if this anxiety is a component of my depression, or if this is a dysphoric soft bipolar mania sparked by cymbalta, or if this is some sort of soft paranoia, it would sure help in knowing what direction to go with meds. Cymbalta has helped in two ways...haven't had a crying spell in a while, though I feel close sometimes; and my afternoon sinking fatigue is gone. One bad side effect...sex drive is through the roof. Too much. Not normal. Can't get it off my mind.
>
> How do you tell the difference?


Blueberry,

This is exactly what I went through. This kind of anxiety is paralyzing. Remember what you read in that link I sent your way. Anxiety, Paranoia if it is intensified, a mood stabilizer will eliminate this and will enable your AD to work the way it should. Your missing an important ingredient. Do a search on Pubmed on Dr Akiskal for related articles.

Polarbear

 

Re: Diff between anxiety, akathesia, dysphoric mania?

Posted by polarbear206 on February 7, 2007, at 8:28:05

In reply to Re: Diff between anxiety, akathesia, dysphoric mania?, posted by polarbear206 on February 7, 2007, at 8:24:20

> > How do you tell the different between anxiety, akathesia, and dysphoric mania? When I read descriptions of them, I swear I have all of them, mixed in with anhedonic withdrawn depression. Can't tell one from the other. Since the only med I am taking is 5mg cymbalta (that's right, 5mg), I can't see it being akathesia unless I have become really sensitive.
> >
> > I'm just real nervous. Can't relax. Hard to be in a conversation. Feel disconnected. Mind racing with worries, worries that I recognize as being ridiculous and silly, so I try to talk myself calm with reality but it doesn't work. Even in the face of plenty of evidence the worries are stupid and groundless they just go on.
> >
> > No real physical symptoms except for a butterflies-in-the-stomach kind of feeling. No panic at all. I appear calm on the outside to anyone looking at me. But on the inside I am a wreck.
> >
> > This was all there to a small extent before cymbalta, but has been massively magnified on cymbalta, even at just 5mg.
> >
> > If I could figure out if I have anxiety, or if this anxiety is a component of my depression, or if this is a dysphoric soft bipolar mania sparked by cymbalta, or if this is some sort of soft paranoia, it would sure help in knowing what direction to go with meds. Cymbalta has helped in two ways...haven't had a crying spell in a while, though I feel close sometimes; and my afternoon sinking fatigue is gone. One bad side effect...sex drive is through the roof. Too much. Not normal. Can't get it off my mind.
> >
> > How do you tell the difference?
>
>
>
>
> Blueberry,
>
> This is exactly what I went through. This kind of anxiety is paralyzing. Remember what you read in that link I sent your way. Anxiety, Paranoia if it is intensified, a mood stabilizer will eliminate this and will enable your AD to work the way it should. Your missing an important ingredient. Do a search on Pubmed on Dr Akiskal for related articles.
>
> Polarbear


www.pubmed.gov

 

Re: Diff between anxiety, akathesia, dysphoric mania?

Posted by munificentexegete on February 8, 2007, at 21:34:08

In reply to Re: Diff between anxiety, akathesia, dysphoric mania?, posted by polarbear206 on February 7, 2007, at 8:28:05

if the source of the anxiety is the AD then it is drug induced anxiety or akathisia in a mild form.

 

Re: Diff between anxiety, akathesia, dysphoric man » munificentexegete

Posted by yxibow on February 9, 2007, at 3:28:41

In reply to Re: Diff between anxiety, akathesia, dysphoric mania?, posted by munificentexegete on February 8, 2007, at 21:34:08

> if the source of the anxiety is the AD then it is drug induced anxiety or akathisia in a mild form.


I'm just curious as a nonconfrontational question, have you experienced akathisia? I mean ****-kicking, I don't care if there is a wall in front of me because I'm going to break it down and run because I've been given Compazine or some other lovely phenothiazine?


Sure, it could be mild akathisia, but it really sounds more like anxiety or some form of dysphoria as was also suggested. There is a vast difference, even mild, between anxiety and akathisia.


One is a biochemical / genetic disorder or one induced by medication, perhaps (or even caffeine), the other is a movement disorder that is definately induced by medication.

It is dopaminergically based and not mostly GABA or 5HT regulated like other classic anxiety disorders.

-- Jay

 

Re: Diff between anxiety --yxibow

Posted by munificentexegete on February 9, 2007, at 5:05:08

In reply to Re: Diff between anxiety, akathesia, dysphoric man » munificentexegete, posted by yxibow on February 9, 2007, at 3:28:41

> > if the source of the anxiety is the AD then it is drug induced anxiety or akathisia in a mild form.

> I'm just curious as a nonconfrontational question, have you experienced akathisia? I mean ****-kicking, I don't care if there is a wall in front of me because I'm going to break it down and run because I've been given Compazine or some other lovely phenothiazine?

I've heard stories that they use drugs to torture people with mental illnesses like psychosis so that they kill themselves or others, but I thought they were just stories?

 

Re: Diff between anxiety --yxibow

Posted by kaleidoscope on February 9, 2007, at 14:15:00

In reply to Re: Diff between anxiety --yxibow, posted by munificentexegete on February 9, 2007, at 5:05:08

I believe that a tendency has appeared on psycho-babble to overuse the term akathisia. Although akathisia-like symptoms have been reported as a side effect of antidepressants, the term akathisia generally refers to a unique form of intense motor restlessness induced by neuroleptics/antipsychotics.

K

 

Re: Diff between anxiety -- kaleidoscope

Posted by munificentexegete on February 9, 2007, at 15:14:37

In reply to Re: Diff between anxiety --yxibow, posted by kaleidoscope on February 9, 2007, at 14:15:00

> I believe that a tendency has appeared on psycho-babble to overuse the term akathisia. Although akathisia-like symptoms have been reported as a side effect of antidepressants, the term akathisia generally refers to a unique form of intense motor restlessness induced by neuroleptics/antipsychotics.
>
> K

hello kaleidoscope, that's a nice name. so antidepressants don't cause akathisia?

 

Re: Diff between anxiety -- kaleidoscope » munificentexegete

Posted by kaleidoscope on February 9, 2007, at 15:32:55

In reply to Re: Diff between anxiety -- kaleidoscope, posted by munificentexegete on February 9, 2007, at 15:14:37

>hello kaleidoscope, that's a nice name

Thanks :)

>so antidepressants don't cause akathisia?

Akathisia-like symptoms *have* been reported as a side effect of SSRIs and other antidepressants. It is not not clear to what extent AD-induced akathisia-like symptoms are the same as neuroleptic-induced akathisia however. Certainly, true akathisia is much more likely with neuroleptics than it is with antidepressants. More commonly, ADs cause side effects which superficially resemble akathisia eg. anxiety, hypomania etc.

The purpose of my above post was mainly to point out the recent tendency on p-babble to (incorrectly) use the term akathisia to refer to virtually any agitated/restless state. I think it is more appropriate that the term akathisia is reserved as a description for the uniquely intense and distressing motor restlessness induced by neuroleptic drugs, or, exceptionally, serotonergic antidepressants. Casual use will render the term meaningless.

K

 

Re: Diff between anxiety -- kaleidoscope

Posted by munificentexegete on February 9, 2007, at 16:20:13

In reply to Re: Diff between anxiety -- kaleidoscope » munificentexegete, posted by kaleidoscope on February 9, 2007, at 15:32:55

> >hello kaleidoscope, that's a nice name
>
> Thanks :)
>
> >so antidepressants don't cause akathisia?
>
> Akathisia-like symptoms *have* been reported as a side effect of SSRIs and other antidepressants. It is not not clear to what extent AD-induced akathisia-like symptoms are the same as neuroleptic-induced akathisia however. Certainly, true akathisia is much more likely with neuroleptics than it is with antidepressants. More commonly, ADs cause side effects which superficially resemble akathisia eg. anxiety, hypomania etc.
>
> The purpose of my above post was mainly to point out the recent tendency on p-babble to (incorrectly) use the term akathisia to refer to virtually any agitated/restless state. I think it is more appropriate that the term akathisia is reserved as a description for the uniquely intense and distressing motor restlessness induced by neuroleptic drugs, or, exceptionally, serotonergic antidepressants. Casual use will render the term meaningless.
>
> K

you are right.

 

Re: Diff between anxiety --yxibow » munificentexegete

Posted by yxibow on February 9, 2007, at 18:38:06

In reply to Re: Diff between anxiety --yxibow, posted by munificentexegete on February 9, 2007, at 5:05:08

> > > if the source of the anxiety is the AD then it is drug induced anxiety or akathisia in a mild form.
>
> > I'm just curious as a nonconfrontational question, have you experienced akathisia? I mean ****-kicking, I don't care if there is a wall in front of me because I'm going to break it down and run because I've been given Compazine or some other lovely phenothiazine?
>
> I've heard stories that they use drugs to torture people with mental illnesses like psychosis so that they kill themselves or others, but I thought they were just stories?
>
>

Mm... I feel that is coming a little out of left field. But that's just my perception, I wasn't tortured, I just had a natural reaction to a phenothiazine. My point, if I left out anything, was that I had a 104 degree fever and could not stop vomiting. Compazine is the most common treatment, although there is also Tigan and other less harsh neuroleptic-like agents. And not as fast working, and incredibly expensive, would be IV ondansetron or granisetron, the 5HT3 blockers.

-- tidings.

 

Re: Diff between anxiety --yxibow

Posted by munificentexegete on February 9, 2007, at 20:06:26

In reply to Re: Diff between anxiety --yxibow » munificentexegete, posted by yxibow on February 9, 2007, at 18:38:06

> would be IV ondansetron or granisetron, the 5HT3 blockers.
>

hmmm... would you have developed akathisia from those meds?

 

Re: Diff between anxiety --yxibow » munificentexegete

Posted by yxibow on February 9, 2007, at 21:01:33

In reply to Re: Diff between anxiety --yxibow, posted by munificentexegete on February 9, 2007, at 20:06:26

> > would be IV ondansetron or granisetron, the 5HT3 blockers.
> >
>
> hmmm... would you have developed akathisia from those meds?


No, I would have developed a considerable medical bill and it is unlikely you find 5HT3 blockade medication outside of chemotherapy treatment, because of its extreme expense of manufacture because of its low volume use and supply and demand.


If Kytril really stopped viral/bacterial induced vomiting and it was used widely, I suppose it would go down from $25 a pill, or who knows what by IV drip.


But for the common garden variety upset stomach, there is a slight silver lining if you believe some research into ginger, it is in fact a weak 5HT3 blockade agent. I use it exactly for that purpose. Because most of your serotonin of course is in your gut.

 

Re: antiemetics -- yxibow

Posted by munificentexegete on February 9, 2007, at 21:20:37

In reply to Re: Diff between anxiety --yxibow » munificentexegete, posted by yxibow on February 9, 2007, at 21:01:33

> > > would be IV ondansetron or granisetron, the 5HT3 blockers.
> > >
> >
> > hmmm... would you have developed akathisia from those meds?
>
>
> No, I would have developed a considerable medical bill and it is unlikely you find 5HT3 blockade medication outside of chemotherapy treatment, because of its extreme expense of manufacture because of its low volume use and supply and demand.
>

aren't some of the benzos like Lorazepam antiemetics too, or are they ineffective by comparison?

 

Re: antiemetics -- yxibow » munificentexegete

Posted by yxibow on February 10, 2007, at 1:14:54

In reply to Re: antiemetics -- yxibow, posted by munificentexegete on February 9, 2007, at 21:20:37

> > > > would be IV ondansetron or granisetron, the 5HT3 blockers.
> > > >
> > >
> > > hmmm... would you have developed akathisia from those meds?
> >
> >
> > No, I would have developed a considerable medical bill and it is unlikely you find 5HT3 blockade medication outside of chemotherapy treatment, because of its extreme expense of manufacture because of its low volume use and supply and demand.
> >
>
> aren't some of the benzos like Lorazepam antiemetics too, or are they ineffective by comparison?


Lorazepam alone I think would be ineffective, but you are correct, there are citations of lorazepam being used adjunctively with medications including 5HT3 blockade agents.


5HT3 receptors are in the CTZ (chemoreceptor trigger zone) and on vagal nerve terminals in the periphery.


From the Kytril PI: "In the ferret animal model, a single granisetron injection prevented vomiting due to high-dose cisplatin or arrested vomiting within 5 to 30 seconds." (cisplatin is an emetogenic material)


Old antiemetics are still used, Reglan, Tigan, but they do carry a risk of TD over an extended period of time (especially Reglan I think.) The D2 activity and possibly at higher doses the 5HT3 activity of Reglan contributes to its effectiveness in the CTZ. Tigan while potent in the CTZ for whatever reason does not carry the D2 potency of Reglan.


Other uses of 5HT3 blockade drugs today include postoperative nausea and vomiting. As well as all the other drugs mentioned. Sometimes scopolamine transdermally is used.


Dramamine and Benadryl have some effectiveness alone as anti-emetics in postoperative nausea/vomiting and I imagine in other situations.

 

Re: antiemetics -- yxibow

Posted by munificentexegete on February 10, 2007, at 4:13:00

In reply to Re: antiemetics -- yxibow » munificentexegete, posted by yxibow on February 10, 2007, at 1:14:54

>>>>> would be IV ondansetron or granisetron, the 5HT3 blockers.

>>>> hmmm... would you have developed akathisia from those meds?

>>> No, I would have developed a considerable medical bill and it is unlikely you find 5HT3 blockade medication outside of chemotherapy treatment, because of its extreme expense of manufacture because of its low volume use and supply and demand.

>> aren't some of the benzos like Lorazepam antiemetics too, or are they ineffective by comparison?

> Lorazepam alone I think would be ineffective, but you are correct, there are citations of lorazepam being used adjunctively with medications including 5HT3 blockade agents.

>Sometimes scopolamine transdermally is used.

tonight i'll have a ginger beer and skip the potatoes well at least any sprouting ones, eggplants, tomatoes, and peppers.


 

Re: antiemetics -- yxibow » munificentexegete

Posted by kaleidoscope on February 10, 2007, at 14:53:20

In reply to Re: antiemetics -- yxibow, posted by munificentexegete on February 9, 2007, at 21:20:37

>Aren't some of the benzos like lorazepam antiemetics too, or are they ineffective by comparison?

The purpose of lorazepam is mainly to create amnesia and to reduce distress. The amnesia prevents anticipatory vomiting prior to future chemotherapy cycles.

K

 

Re: akathisia -- kaleidoscope

Posted by munificentexegete on February 10, 2007, at 16:49:40

In reply to Re: antiemetics -- yxibow » munificentexegete, posted by kaleidoscope on February 10, 2007, at 14:53:20


> The purpose of lorazepam is mainly to create amnesia and to reduce distress. The amnesia prevents anticipatory vomiting prior to future chemotherapy cycles.
>
> K

your right again.

kaleidoscope, you seem to know a lot about akathisia and medicine in general... what causes akathisia in serotogenic drugs? from all accounts it seems to be identical to the akathisia from neuroleptics; i've read no accounts that distinguish it from any other version of akathisia. the only other substances that I can think of that causes akathisia are nerve toxins like vx or sarin, organophosphate poisoning, and pesticides and from memory these substances cause extensive damage to the cholinergic system resulting in the extreme symptoms of anxiety, cognitive impairment, insomnia, and movement urges?

 

Re: akathisia -- kaleidoscope » munificentexegete

Posted by yxibow on February 10, 2007, at 21:42:45

In reply to Re: akathisia -- kaleidoscope, posted by munificentexegete on February 10, 2007, at 16:49:40

>
> > The purpose of lorazepam is mainly to create amnesia and to reduce distress. The amnesia prevents anticipatory vomiting prior to future chemotherapy cycles.
> >
> > K
>
> your right again.
>
> kaleidoscope, you seem to know a lot about akathisia and medicine in general... what causes akathisia in serotogenic drugs? from all accounts it seems to be identical to the akathisia from neuroleptics; i've read no accounts that distinguish it from any other version of akathisia. the only other substances that I can think of that causes akathisia are nerve toxins like vx or sarin, organophosphate poisoning, and pesticides and from memory these substances cause extensive damage to the cholinergic system resulting in the extreme symptoms of anxiety, cognitive impairment, insomnia, and movement urges?


Well SSRIs downregulate dopamine which could cause a blockade similar to the dopamine blockade in neuroleptics.

 

Re: akathisia -- yxibow

Posted by munificentexegete on February 11, 2007, at 2:47:29

In reply to Re: akathisia -- kaleidoscope » munificentexegete, posted by yxibow on February 10, 2007, at 21:42:45

>> kaleidoscope, you seem to know a lot about akathisia and medicine in general... what causes akathisia in serotogenic drugs? from all accounts it seems to be identical to the akathisia from neuroleptics; i've read no accounts that distinguish it from any other version of akathisia. the only other substances that I can think of that causes akathisia are nerve toxins like vx or sarin, organophosphate poisoning, and pesticides and from memory these substances cause extensive damage to the cholinergic system resulting in the extreme symptoms of anxiety, cognitive impairment, insomnia, and movement urges?

> Well SSRIs downregulate dopamine which could cause a blockade similar to the dopamine blockade in neuroleptics.

I haven't got to the end of it yet, however, i came across diquat/paraquat poisoning (herbicide) which induces akathisia, and organophosphate (pesticide) poisoning which also induces akathisia. and these all seem to work by blocking acetylcholinesterase and increasing ACh activity. and of course phenothiazines are both an antipsychotic and a pesticide. so my intial thoughts were that akathisia was probably due to antiacetylcholinesterase action. that said there isn't as much research on vx or organophosphates, so the effect these agents have on other systems such as dopamine isn't well documented and they may well interact with dopamine as well, in fact I suspect they do.

NMS seems to be almost identical to the reaction described from high doses of nerve toxins like vx or sarin, where acetylcholinesterase is blocked by the nerve toxins resulting in an oversupply of ACh and continuous muscle contractions including loss of control of the breathing muscles. although i haven't seen a trial of pralidoxime for NMS.

if akathisia was related to antiacetylcholinesterase activity then atropine should provide instantaneous relief, and while this is true of NMS and dystonias, it is generally only seen as having a low impact and partly efficacious for akathisia. So I suspect another physiology for akathisia... it could well be a dopamine phenomenom.


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.