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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by theo on September 4, 2008, at 19:46:42
Compared to other newer antipsychotics?
Posted by lelanda on September 4, 2008, at 20:08:17
In reply to Is Abilify pretty safe concerning tardive dys?, posted by theo on September 4, 2008, at 19:46:42
I have been on Abilify for a year now and have had no problems with TD. The highest I went was 10mg and was very restless in the evening, but that diminished at 5 mg.
Posted by theo on September 4, 2008, at 20:18:32
In reply to Re: Is Abilify pretty safe concerning tardive dys?, posted by lelanda on September 4, 2008, at 20:08:17
Do you take your Abilify in the evening?
Posted by lelanda on September 4, 2008, at 20:56:25
In reply to Re: Is Abilify pretty safe concerning tardive dys? » lelanda, posted by theo on September 4, 2008, at 20:18:32
I take it at bedtime cause it makes me sleepy.
Posted by Nadezda on September 4, 2008, at 22:27:45
In reply to Is Abilify pretty safe concerning tardive dys?, posted by theo on September 4, 2008, at 19:46:42
I'm not sure where it stands now. The last time I talked to my pdoc, he was concerned about the issue for abilify, because it seemed from the literature and his practice that it was more likely to cause TD than other atypicals, even possibly at lower doses.
I decided to stay on abilify at a low dose, but he's suggested that I take a two-three week breakf once a year to see if the symptoms become manifest.
I'm not sure how the clinical picture has developed since then (it's been a fairly long time). So far, luckily I haven't had any problems. However, the drug can mask the symptoms until they become more intense-- thus the reason for the once a year break.
Just something to be aware of, should you notice anything.
It can also cause akathesia, which could be the restlessness that lelanda was experiencing. That might fade after a while, though. It's a different thing from TD.
Nadezda
Posted by med_empowered on September 6, 2008, at 12:59:52
In reply to Re: Is Abilify pretty safe concerning tardive dys?, posted by Nadezda on September 4, 2008, at 22:27:45
my doc says abilify is the "cleanest atypical on the market" and that it only rarely causes TD. Then again...I've stopped taking the Abilify since my mania subsided, so I guess I'm not putting too much stock into what he says.
Once, when I was on Abilify for a couple months, I quit suddenly and had jerks and twitches for a couple weeks after withdrawal. They went away, but it was a frightening experience.
Abilify has been linked to TD, NMS, and "tardive akathisia"--a kind of akathisia that can persist long after the medication is withdrawn. I think its creepy that Abilify is so new but there's already at least one case of Tardive akathisia; usually, tardive akathisia is seen with severe tardive dyskinesia and is a late stage complication of neuorleptic use.
So...I don't know. The manufacturer-funded trials make it seem clean, but those trials way under-reported/under-estimated akathisia and may also have painted Abilify as being more weight-neutral than it actually is....it can take years for a drug's TD potential to be known, and with all the factors that go into developing TD (diagnosis of patient, gender,age, time on medication, previous treatments, co-medications, etc.), it can be really hard to say "Abilify has an annual TD rate of xxx%"
I'd just say..if you can avoid taking Abilify or any other antipsychotic, you might want to do that.
Posted by yxibow on September 7, 2008, at 3:51:11
In reply to Is Abilify pretty safe concerning tardive dys?, posted by theo on September 4, 2008, at 19:46:42
> Compared to other newer antipsychotics?
> Compared to other newer antipsychotics?
All atypicals have been pretty much established to have a risk of up to 5% per year for an unknown point and varies by individual, affective disorder (greater) or non-affective (e.g. schizophrenia, lesser).
That being said Abilify has about a 10% or greater chance of EPS (temporary and manageable with other medications, another word for side effects, especially akathisia)
The only known AP to have a significant risk in this category at the moment from what I know is Risperdal (and I suppose Invega)
The strength of D2 (and this isn't quite scientific because Zyprexa does have a low Ki [higher intensity] at D2 but I don't know that it grabs intensly like Risperdal or typicals) is probably:Risperdal/Invega->Abilify, Geodon-> Zyprexa, Seroquel.
And if you include the intense management of Clozaril, there have been no proven significant cases of people who have not taken any APs before or have had little exposure -- in fact it has been shown to improve TD for those who have.
That being said the risk of TD could be extrapolated about 0.1% for Seroquel, 0.5% for Zyprexa (there was an actual British Journal of Psychiatry study I forget) and it goes up more greater for the others.
Its unknown of course for anybody and the benefits have to outweight the risks for taking any atypical.
That being said, dose is also an issue that may affect it -- the MED (minimum effective dose) is always regarded as the best.
-- tidings
Jay
Posted by iforgotmypassword on September 7, 2008, at 10:55:36
In reply to Re: Is Abilify pretty safe concerning tardive dys? » theo, posted by yxibow on September 7, 2008, at 3:51:11
on aripirpazole and movement disorder symptoms have no absracts available free to the general public, and there are lots. i think that's a reason to worry in and of itself.
also, considering how new the drug is, the short amount of time for these articles to spring up in significant numbers is likely also very significant. not that i would gather that it's not a complicated situation.
i'm still open to the possibility that aripiprazole may help some movement disorders.
Posted by med_empowered on September 7, 2008, at 12:10:29
In reply to Re: Is Abilify pretty safe concerning tardive dys? » theo, posted by yxibow on September 7, 2008, at 3:51:11
hey. OK, I did some reading...no one really knows how likely Abilify is to cause TD. On the one hand, it doesnt' seem to cause nearly as much dopamine upregulation as, say, Haldol...and dopamine upregulation may be part of what causes TD. (Dopamine upregulation happens when your brain creates new dopamine receptors in response to the hardcore dopamine blocking induced by antipsychotics).
Its good that Abilify doesn't cause much dopamine upregulation but...apparently, Zyprexa causes about as much Dopamine upregulation as Haldol, but causes considerably less TD.
In the few caes described online, it seemed like Abilify was more likely to cause TD in people with affective disorders and also in people who were on multiple meds (in one case, the docs thought the addition of Cymbalta may have messed with Abilify's partial dopamine agonism).
Also...in many of these cases, it seems like the TD reverses itself upon discontinuation, often quickly. This is bizarre b/c although TD often goes away, it usually takes a while...some of these patients had TD disappearing over the course of a couple weeks. This is odd 1) because it often takes months to years for TD to go away and 2) because TD usually gets *worse* for a while upon discontinuation, not better.
Abilify is sometimes used to treat TD. This makes sense: Abilify is hardcore potent; 30mgs gives you over 90% d2 occupancy. If it weren't for the partial agonism @ dopamine receptors, Abilify would be like a modern-day Prolixin. My guess is that the Abilify is able to suppress the TD w/o causing much in the way of EPS.
What scares me more than TD with Abilify is the possibility of Tardive Akathisia. Akathisia is apparently **really** common Abilify, so it stands to reason that long-term treatment could make the akathisia permanent. Tardive akathisia is pretty difficult to diagnose and there aren't any reliable treatments, except for tranquilizers.Good luck!
Posted by Phillipa on September 7, 2008, at 12:23:39
In reply to Abilify, TD..., posted by med_empowered on September 7, 2008, at 12:10:29
Med meaning benzodiazepines? Phillipa
Posted by Zyprexa on September 11, 2008, at 10:46:05
In reply to Re: Is Abilify pretty safe concerning tardive dys?, posted by Nadezda on September 4, 2008, at 22:27:45
When I was taking abilify, my hands started to shake realy badly. I would have a hard time at work. I have the shakes just as bad now that I'm on perphenazine. It sort of comes and goes. My doctor thinks it comes from drinking. But I'm not convinced. I didn't have it from the period in between the the two meds. I was trying to convince my doctor of all this today.
Posted by yxibow on September 11, 2008, at 12:52:53
In reply to Re: Abilify concerning tardive dys?, posted by Zyprexa on September 11, 2008, at 10:46:05
> When I was taking abilify, my hands started to shake realy badly. I would have a hard time at work. I have the shakes just as bad now that I'm on perphenazine. It sort of comes and goes. My doctor thinks it comes from drinking. But I'm not convinced. I didn't have it from the period in between the the two meds. I was trying to convince my doctor of all this today.
Both are more potent in their own categories (typical, atypical) -- perphenazine is at least 10 times more strong than Thorazine and Abilify is contrary to its initial concept of partial D2, stronger than most atypicals in terms of EPS.- Jay
Posted by Zyprexa on September 12, 2008, at 18:45:14
In reply to Re: Abilify concerning tardive dys? » Zyprexa, posted by yxibow on September 11, 2008, at 12:52:53
So are you saying its highly posible the Abilify could have given me the shaky hands?
You are saying that Abilify has a lot of EPS, in the Atypicals?
Posted by yxibow on September 13, 2008, at 2:04:25
In reply to Re: Abilify concerning tardive dys? » yxibow, posted by Zyprexa on September 12, 2008, at 18:45:14
> So are you saying its highly posible the Abilify could have given me the shaky hands?
>
> You are saying that Abilify has a lot of EPS, in the Atypicals?For some -- it is about as strong as Geodon at D2 I think, but then every person reacts differently. I'm only going on my scale of how I reacted to different atypicals.
I believe I read in various case reports or the like that Abilify does have a potential of around 10% EPS symptoms like akathisia especially but then again, that's just a fuzzy memory of it, everyone is different.
I guess my point is that it is probably stronger than Zyprexa/Seroquel for many.
-- Jay
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