Shown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by inanimate peanut on July 4, 2010, at 18:53:56
If most of the antipsychotics work on 5HT receptors similar to most SSRIs in addition to the other work they do on D receptors, etc., why do antipsychotics work so much faster than antidepressants? Maybe their non-5HT effects work more quickly and then the 5HT action follows on later, but if that is the case then their efficacy should improve around weeks 4-6, which doesn't seem to be the case. Also, I've been told that I only need to trial APs for 2 weeks whereas anti-depressants trial for 4-6 weeks. Does anyone have any clue why this is the case?
Posted by linkadge on July 4, 2010, at 19:32:38
In reply to why do antipsychotics work faster than antideps?, posted by inanimate peanut on July 4, 2010, at 18:53:56
Hmm, thats an interesting question. I've never heard of that assertion.
Linkadge
Posted by Christ_empowered on July 4, 2010, at 20:32:29
In reply to why do antipsychotics work faster than antideps?, posted by inanimate peanut on July 4, 2010, at 18:53:56
The earliest tranquilizer, thorazine, was spotted when they noticed how calm it made rats (or something...the phenothiazines were tested on animals). Then they used it in pre-operative sedation, then as a sleeping pill, and then some shrinks got the idea to experiment on mental patients.
I think you're underestimating the profound action of a D2 blockade. That's where the "tranquilization" really comes in. If you look at the older neuroleptics, some of them barely touch anything but D2--I'm thinking here of haloperidol, fluphenazine, etc. Its all about the drug-induced Parkinsonian state, with effects ranging from apathy and indifference (at what I guess would be "tranquilizer" or "anxiolytic" doses) to full fledged tremors, shuffling gait, and even drooling (ahh yes, the "chemical straight jacket").
So..that's my theory; its all in the D2 blockade, although some (nozinan, seroquel, neulactil, zyprexa, clozapine, so on and so forth) have a lot more going on.
Its worth noting that shrinks sometimes don't use the less sedating ones or say they "don't work" like the other ones. I'm thinking here of Moban (not used much in schizophrenia--more for ODD teens) and Abilify (more a Bipolar drug than a schizophrenia drug). Weird.
Just my thoughts...
Posted by weatherfreak on July 4, 2010, at 20:33:00
In reply to why do antipsychotics work faster than antideps?, posted by inanimate peanut on July 4, 2010, at 18:53:56
That's a very good question. AP drugs like Zyprexa, Geodon/Zeldox and to a lesser extent seroquel work like lightning on me within 2 hours to 2 days, but SSRI/SNRI's that have actually worked on me quickly took at least 5 days discounting side effects for both.
Zyprexa actually took 2 hours and there was no change in it's effect on me after 3 months. Awful for me and boy did I stack on the weight.
Posted by Phillipa on July 4, 2010, at 21:36:32
In reply to Re: why do antipsychotics work faster than antideps? » inanimate peanut, posted by weatherfreak on July 4, 2010, at 20:33:00
When you say work do you mean feel them? As in about an hour or less the one time took seroquel 12.5mg had me asleep. Same with xanax or other benzos work really quickly. Phillipa
Posted by inanimate peanut on July 4, 2010, at 22:39:29
In reply to Re: why do antipsychotics work faster than antideps?, posted by Phillipa on July 4, 2010, at 21:36:32
I'm just wondering because Geodon worked for me within 24 hours, and I don't necessarily think I'm that big of an exception. I'm not necessarily talking about the sedating properties working within hours, but I'm talking about the actual mood alteration happening with antipsychotics within hours to days vs. weeks for anti-depressants. For instance, they just had me try Zyprexa for 2 weeks and considered that a full trial whereas a full trial of nortriptyline will likely be 6 weeks or so. If it was just because antipsychotics, unlike the anti-depressants we have now, operate on dopamine, then we would still expect them to work *better* in 4-6 weeks when the serotonin action kicked it too. We don't see that though that I've experienced or heard on here or elsewhere. There doesn't seem to be a two-tiered response to antipsychotics. If they're working on the same receptors for serotonin, why does one work so much faster than the other?
Posted by ed_uk2010 on July 5, 2010, at 0:57:10
In reply to why do antipsychotics work faster than antideps?, posted by inanimate peanut on July 4, 2010, at 18:53:56
>If most of the antipsychotics work on 5HT receptors similar to most SSRIs in addition to the other work they do on D receptors, etc., why do antipsychotics work so much faster than antidepressants?
APs can certainly work rapidly to produce a sedative-type effect..... but in the treatment of serious psychotic disorders such as schizophenia, improvement in core psychotic symptoms can take several weeks.
Posted by inanimate peanut on July 5, 2010, at 15:19:11
In reply to Re: why do antipsychotics work faster than antideps?, posted by ed_uk2010 on July 5, 2010, at 0:57:10
Does that mean if I'm doing a trial of an antipsychotic that it needs the same 4-6 weeks trial that I would give to an antidepressant (using it for bipolar depression)?
Posted by ed_uk2010 on July 5, 2010, at 16:22:54
In reply to Re: why do antipsychotics work faster than antidep » ed_uk2010, posted by inanimate peanut on July 5, 2010, at 15:19:11
> Does that mean if I'm doing a trial of an antipsychotic that it needs the same 4-6 weeks trial that I would give to an antidepressant (using it for bipolar depression)
I think it's almost impossible to make a blanket statement about how many weeks represents an adequate trial. Assuming that an AP is well tolerated, you should probably give it at least one month.
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