Psycho-Babble Medication Thread 772161

Shown: posts 1 to 14 of 14. This is the beginning of the thread.

 

can we talk Typical Antipsychotics?

Posted by bipolarspectrum1 on July 26, 2007, at 16:34:31

Hi,
I need something to combine with divalproex acid, depakote, for my bipolar (mixed states)...

it seems antipsychotics are the best so far, but im not happy with the side-effect profile of the atypicals...

does anyone have any experience with the typicals?

which ones are not sedating?
which ones have bad eps and all that movement stuff?

 

Re: can we talk Typical Antipsychotics? » bipolarspectrum1

Posted by Squiggles on July 26, 2007, at 17:20:28

In reply to can we talk Typical Antipsychotics?, posted by bipolarspectrum1 on July 26, 2007, at 16:34:31

> Hi,
> I need something to combine with divalproex acid, depakote, for my bipolar (mixed states)...
>
> it seems antipsychotics are the best so far, but im not happy with the side-effect profile of the atypicals...
>
> does anyone have any experience with the typicals?
>
> which ones are not sedating?
> which ones have bad eps and all that movement stuff?

Mixed states is a very severe and serious state
in the bipolar spectrum. I was fortunate enough to get professional assistance from my pharmacist and my doctor on how to get out of this phase. It was done with monotherapy-- relatively gradual increase in lithium bicarbonate. It was a delicate procedure but within 24 hours it worked.
I was also on clonazepam and thyroxine.

Some psychiatrists now like to use atypicals and polypharmacy-- that may work for some people. Also, keep in mind that mixed states is a transient period of bipolarity, and the atypicals may not be required chronically. In my case, it was due to a weak preparation of lithium which Health Canada had announced around the same time. I had never had mixed states before, except 25 years ago, prior to the initiation into lithium treatment-- and then stable since then. So, certain conditions out of the ordinary might induce mixed states, would be my guess.

I was successfully stabilized without them.

Squiggles

 

Re: can we talk Typical Antipsychotics?

Posted by big time on July 26, 2007, at 17:53:11

In reply to Re: can we talk Typical Antipsychotics? » bipolarspectrum1, posted by Squiggles on July 26, 2007, at 17:20:28

i have bipolar 1 and have taken haldol, which i guess is one of the classic antipsychotics. not fun. wouldn't recommend it. lots of akathesia and feeling like lead. if you can think of the part of you that one might call your "soul", you will be completely cut off from that.

 

Re: can we talk Typical Antipsychotics? » big time

Posted by Squiggles on July 26, 2007, at 17:59:58

In reply to Re: can we talk Typical Antipsychotics?, posted by big time on July 26, 2007, at 17:53:11

> i have bipolar 1 and have taken haldol, which i guess is one of the classic antipsychotics. not fun. wouldn't recommend it. lots of akathesia and feeling like lead. if you can think of the part of you that one might call your "soul", you will be completely cut off from that.

Haldol for bipolar? I thought that went out
of circulation a long time ago.

I read about it in Robert Whittaker's book as well as Healy's and others-- it's an old drug
used for many types of mental illness. I would think we have become a little more specialized now.

Hope you found something better.

Squiggles

 

Re: can we talk Typical Antipsychotics? » Squiggles

Posted by Phillipa on July 26, 2007, at 18:03:41

In reply to Re: can we talk Typical Antipsychotics? » big time, posted by Squiggles on July 26, 2007, at 17:59:58

Squiggles up the board Jay the Bravest was asking the same question good discussion from Link and he. Evidently they are using the typicals again. Love Phillipa

 

Re: can we talk Typical Antipsychotics?

Posted by big time on July 26, 2007, at 18:19:34

In reply to Re: can we talk Typical Antipsychotics? » big time, posted by Squiggles on July 26, 2007, at 17:59:58

> > i have bipolar 1 and have taken haldol, which i guess is one of the classic antipsychotics. not fun. wouldn't recommend it. lots of akathesia and feeling like lead. if you can think of the part of you that one might call your "soul", you will be completely cut off from that.
>
> Haldol for bipolar? I thought that went out
> of circulation a long time ago.
>
> I read about it in Robert Whittaker's book as well as Healy's and others-- it's an old drug
> used for many types of mental illness. I would think we have become a little more specialized now.
>
> Hope you found something better.
>
> Squiggles
>
>

my pdoc was old school. this was seven years ago. i had a very severe case with florid psychosis. even so. i much prefer zyprexa, which is what i take now. also, i think lithium is better overall, which is why i take so much lithium now.

 

Re: can we talk Typical Antipsychotics? » Squiggles

Posted by linkadge on July 26, 2007, at 18:25:31

In reply to Re: can we talk Typical Antipsychotics? » big time, posted by Squiggles on July 26, 2007, at 17:59:58

>I would think we have become a little more >specialized now

Not in my opinion. Have you read the CATIE study? Large study done by the NIMH. Essentially said that atypicals were no more effective for negative symptoms or positive symptoms than the comparitor typical AP, perphenazine. They also mentioned that the side effect profile was different though not necessarily better. The older drug, perphenazine was not associated with more movement issues, or metabolic issues.


See:

http://www.nimh.nih.gov/healthinformation/catie_qa.cfm

Contrary to expectations, movement side effects (rigidity, stiff movements, tremor, and muscle restlessness) primarily associated with the older medications were not seen more frequently with perphenazine than with the newer drugs. The advantages of olanzapine — in symptom reduction and duration of treatment — over perphenazine were modest and must be weighed against the increased side effects of olanzapine.

Thus, taken as a whole, the newer medications have no substantial advantage over the older medication used in this study. An important issue still to be considered is individual differences in patient response to these drugs.


Linkadge


 

Re: can we talk Typical Antipsychotics?

Posted by linkadge on July 26, 2007, at 18:26:41

In reply to Re: can we talk Typical Antipsychotics? » Squiggles, posted by Phillipa on July 26, 2007, at 18:03:41

So basically, CATIE says that a patient could pay pennies for perphenazine and probably do just as well as paying twice their rent for seroquel.

Linkadge

 

Re: can we talk Typical Antipsychotics? » linkadge

Posted by Squiggles on July 26, 2007, at 20:00:25

In reply to Re: can we talk Typical Antipsychotics?, posted by linkadge on July 26, 2007, at 18:26:41

> So basically, CATIE says that a patient could pay pennies for perphenazine and probably do just as well as paying twice their rent for seroquel.
>
> Linkadge

Why am i not surprised? It will have to take
some time for the outcome to become indubitable--
that's the way it is in marketing today for many
products. In the meantime, do your homework.

Squiggles

 

Re: can we talk Typical Antipsychotics?

Posted by bipolarspectrum1 on July 26, 2007, at 20:19:54

In reply to Re: can we talk Typical Antipsychotics? » linkadge, posted by Squiggles on July 26, 2007, at 20:00:25

Thanx for the replies,

I suffer mixed states nonstop and it seems that divalproex with an atypical is the most stable ive ever been...

but these atypicals are just not tolerable... i have tried all five..

I think i am going to ask for perphenazine, as it was chosen for the CATIE study due to its relatively mild side effect profile...

 

the 'typicals'...

Posted by med_empowered on July 26, 2007, at 20:57:01

In reply to Re: can we talk Typical Antipsychotics?, posted by bipolarspectrum1 on July 26, 2007, at 20:19:54

here's the thing: since the "atypicals" have come on the scene, some docs have acted as if all the old drugs ("typicals") are essentially the same, with the only differences being potency. Not true.
Perphenazine (Trilafon), for instance, has moderate potency, so it was a good choice for the CATIE study. Haldol as comparator has made atypicals look very good in trials b/c hi-dose haldol is almost bound to cause pronounced EPS/akathisia, and it unblinds trials once some patients have hardcore dystonic reactions and lots of others don't.
There are others to consider, too. Loxapine is considered "partly atypical," as is moban. Amoxapine (Asendin) is a TCA antidepressant that is partly metabolized into loxapine. The drug compares well to risperidone as an atypical-ish drug, and can lift mood.
Also, watch the dose. Very low doses of perphenazine, for instance, might be all you need; the higher you go up, the higher the risk of initial and late-onset problems, including TD. With bipolar, one good thing is that the use of neuroleptics can usually be limited to discrete periods.
Have you tried a benzo-type tranquilizer? They can be very helpful for problems across the board, including mixed states and psychosis. Klonopin and Ativan are popular; Valium is sometimes also used.

 

Re: the 'typicals'...

Posted by bipolarspectrum1 on July 26, 2007, at 23:05:20

In reply to the 'typicals'..., posted by med_empowered on July 26, 2007, at 20:57:01

Thx for the reply,

The benzos dont act well on my mixed mania.. and they can often make me very depressed..

I called my pdoc and asked for perphenazine, i think hes mentioned it before so i believe he has experience with it...

I know many mood specialists dont shy away from the typicals.. i have a major problem with sedation from the atypicals, seroquel and zyprexa make me sleep for 12 hours... i hope perphenzaine isnt the same..

> here's the thing: since the "atypicals" have come on the scene, some docs have acted as if all the old drugs ("typicals") are essentially the same, with the only differences being potency. Not true.
> Perphenazine (Trilafon), for instance, has moderate potency, so it was a good choice for the CATIE study. Haldol as comparator has made atypicals look very good in trials b/c hi-dose haldol is almost bound to cause pronounced EPS/akathisia, and it unblinds trials once some patients have hardcore dystonic reactions and lots of others don't.
> There are others to consider, too. Loxapine is considered "partly atypical," as is moban. Amoxapine (Asendin) is a TCA antidepressant that is partly metabolized into loxapine. The drug compares well to risperidone as an atypical-ish drug, and can lift mood.
> Also, watch the dose. Very low doses of perphenazine, for instance, might be all you need; the higher you go up, the higher the risk of initial and late-onset problems, including TD. With bipolar, one good thing is that the use of neuroleptics can usually be limited to discrete periods.
> Have you tried a benzo-type tranquilizer? They can be very helpful for problems across the board, including mixed states and psychosis. Klonopin and Ativan are popular; Valium is sometimes also used.

 

Re: the 'typicals'...

Posted by linkadge on July 27, 2007, at 9:40:20

In reply to Re: the 'typicals'..., posted by bipolarspectrum1 on July 26, 2007, at 23:05:20

My uncle has some experience with perphenazine and risperadone.


Asked him straight out to compare he seemed to prefer perphenazine in terms of being slightly more relaxing. He seemed to think the risperidone made him feel a little more agitated/wonkey. I don't know if by agitated he was experiencing akathesa or not.

Linkadge

 

Re: the 'typicals'...

Posted by bipolarspectrum1 on July 27, 2007, at 23:41:12

In reply to Re: the 'typicals'..., posted by linkadge on July 27, 2007, at 9:40:20

> My uncle has some experience with perphenazine and risperadone.
Thanx for the post,

I definately find risperidone makes me feel wonkey, like im in some kind of weird zone...i think this has to do with its high affinity for one of the serotonin receptors, i forget exactly which one...

> Asked him straight out to compare he seemed to prefer perphenazine in terms of being slightly more relaxing. He seemed to think the risperidone made him feel a little more agitated/wonkey. I don't know if by agitated he was experiencing akathesa or not.
>
> Linkadge


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.