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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 4 to 28 of 28. Go back in thread:
Posted by SLS on October 24, 2010, at 14:05:05
In reply to Re: Atypicals No Better Than First Generation Per Stud » SLS, posted by linkadge on October 24, 2010, at 12:44:10
> I don't want to negate your experiences, but the research has simply not shown that atypicals are at all superior for negative symptoms either.
Well, that's why I tried to frame my words such that they be applied to my experiences only. It is tempting for me to generalize my own experiences to the majority, but the only thing I have to go by is how these drugs affected me personally. Like you, I found perphenazine to be relative inoffensive. However, I definitely felt as if my mind were somehow being filtered so that I could could not concentrate on my thoughts. I know that sounds good at first, but my consciousness felt like it was stuck in mud. It is interesting to see how differently two people can feel on the same drug. However, it confounds the efforts made to understand and treat mental illness.
- Scott
Posted by Christ_empowered on October 24, 2010, at 14:40:01
In reply to Re: Atypicals No Better Than First Generation Per Stud » linkadge, posted by SLS on October 24, 2010, at 14:05:05
I mean, its one thing when they're very careful with the dosage of perphenazine (or other old-school AP); its quite another when you have some hospital shrink who just drugs people up with the cheapest available drug (yes, it happened to me).
I think a lot of the "conventional" neuroleptics would probably have a much better reputation if docs had given them in small tranquilizing doses back in the day instead of dosing all the way up to EPS/Parkinson's as a matter or routine.
That said: I've been on what I think was relatively low-dose Haldol, along with Ativan and Benadryl (hospital situation, not my idea). When I got switched over to Risperdal the next day, I immediately felt somewhat better...when I got switched over to Abilify, I felt even better.
Posted by linkadge on October 24, 2010, at 15:53:15
In reply to I think dosing is an issue..., posted by Christ_empowered on October 24, 2010, at 14:40:01
Well, the funny thing too is that some of the "typicals" such as perphenazine and thioridazine (taken off the market) actually have moderate 5-ht2 antagonism.
See:
Linkadge
Posted by rogerk on October 24, 2010, at 16:33:04
In reply to Atypicals No Better Than First Generation Per Stud, posted by Phillipa on October 23, 2010, at 23:45:41
dude i just posted this. lol
thanks for jacking it!
Posted by sigismund on October 24, 2010, at 16:58:34
In reply to I think dosing is an issue..., posted by Christ_empowered on October 24, 2010, at 14:40:01
>instead of dosing all the way up to EPS/Parkinson's as a matter or routine.
In the 70s there was a school of thought that held that by increasing the dose greatly the risk of EPS was diminished. That's how you ended up with 50mg (or something) haloperidol a day
Posted by maxime on October 24, 2010, at 19:29:36
In reply to Re: I think dosing is an issue... » Christ_empowered, posted by sigismund on October 24, 2010, at 16:58:34
> >instead of dosing all the way up to EPS/Parkinson's as a matter or routine.
>
> In the 70s there was a school of thought that held that by increasing the dose greatly the risk of EPS was diminished. That's how you ended up with 50mg (or something) haloperidol a dayThat is what I going to say. When Thorazine was first used they were giving patients 1000mg! No wonder the patients just sat there drooling. I have been on 50 mg of Thorazine and it was very good for calming me and keeping hallucinations at bay (when I am REALLY depressed I suffer from hallucinations).
I think like all meds, some people will respond well to the older APs while others will respond to the new generation of APs.
Posted by Christ_empowered on October 24, 2010, at 20:59:02
In reply to Re: I think dosing is an issue... » sigismund, posted by maxime on October 24, 2010, at 19:29:36
Yeah, the author of "Mad in America" writes about neuroleptic dosing in a couple chapters.
Apparently, docs in France used around 100mgs/day Thorazine, docs in the UK up to 300mgs/day, and docs in the US...sometimes a couple grams, although there was huge variation between patients and docs. Docs in the US were more inclined to see evidence of Parkinson's as a biological indicator of "successful" therapy, whereas it seems that European docs were really just looking to calm people down and get them to do talk therapy, vocational rehab, or just be quiet.
Posted by SLS on October 25, 2010, at 5:08:06
In reply to I think dosing is an issue..., posted by Christ_empowered on October 24, 2010, at 14:40:01
> I mean, its one thing when they're very careful with the dosage of perphenazine (or other old-school AP); its quite another when you have some hospital shrink who just drugs people up with the cheapest available drug (yes, it happened to me).
>
> I think a lot of the "conventional" neuroleptics would probably have a much better reputation if docs had given them in small tranquilizing doses back in the day instead of dosing all the way up to EPS/Parkinson's as a matter or routine.
>
> That said: I've been on what I think was relatively low-dose Haldol, along with Ativan and Benadryl (hospital situation, not my idea). When I got switched over to Risperdal the next day, I immediately felt somewhat better...when I got switched over to Abilify, I felt even better.
>
>Just remember what was the target population when the antipsychotics first were discovered. They were used primarily for severe schizophrenia, many suffers of which were chronically institutionalized. I think the dosage guidelines were formulated empirically for these subjects rather than people with depression or anxiety.
It is not unusual for the clinical properties of a drug to become better elucidated as it is used over the years. I would be interested to see something describing the dosage differences used between the severest forms of schizophrenia versus affective or anxiety disorders for both old and new neuroleptics.
- Scott
Posted by bleauberry on October 25, 2010, at 17:22:11
In reply to Atypicals No Better Than First Generation Per Stud, posted by Phillipa on October 23, 2010, at 23:45:41
The way these researchers gathered their data and interpreted it is so full of flaws an entire book could be written on it.
Also, do you know the purpose of the study? Who was behind it? Why they pursued it? Who funded it and why? No, we don't. Yellow flag.
You'll be hard pressed in the real world to find anyone that agrees with this study. The best source would be to ask patients, which they didn't do. A visit to pbabble would have yielded much more accurate results than what they did.
Sorry, but when it comes to meds like Zyprexa and Abilify, sometimes Ziprasidone or Seroquel or Risperdal, and definitely Amisulpride, the old ones don't even come close to the superior effects on depression these newer ones have.
It's fun to surf and look at studies though. Best to take them with a grain of salt. They never give you enough details in an abstract to fully judge the entire thing. Crucial details are usually left out of those abstracts.
Posted by Phillipa on October 25, 2010, at 20:00:15
In reply to Re: Atypicals No Better Than First Generation Per Stud, posted by bleauberry on October 25, 2010, at 17:22:11
The studies are from a site I subscribe to and offer testing for doctors, nurses, and pharmacists at the end of each which I do not include for my own privacy issues as they contain the test questions and my personal amount of CME's I have from online testing. Site recommended to me by my internist who uses it to obtain his CME's Phillipa
Posted by ed_uk2010 on October 26, 2010, at 15:34:24
In reply to Re: Atypicals No Better Than First Generation Per Stud, posted by bleauberry on October 25, 2010, at 17:22:11
>Also, do you know the purpose of the study? Who was behind it? Why they pursued it? Who funded it and why? No, we don't. Yellow flag.
....so like the studies which suggest that atypicals are superior?
Posted by maya3 on October 26, 2010, at 15:38:55
In reply to Re: I think dosing is an issue..., posted by linkadge on October 24, 2010, at 15:53:15
Linkadge, do you happen to know when and why thioridazine was taken off the market?Thanks,
Maya.
Posted by bleauberry on October 26, 2010, at 17:22:43
In reply to Re: Atypicals No Better Than First Generation Per Stud » bleauberry, posted by ed_uk2010 on October 26, 2010, at 15:34:24
> >Also, do you know the purpose of the study? Who was behind it? Why they pursued it? Who funded it and why? No, we don't. Yellow flag.
>
> ....so like the studies which suggest that atypicals are superior?
>I don't use those studies either. They are good for curiosity, and for sort of putting things in perspective within a larger picture. But I do not at all put any significant weight on them.
Posted by linkadge on October 26, 2010, at 17:29:42
In reply to Re: I think dosing is an issue... » linkadge, posted by maya3 on October 26, 2010, at 15:38:55
In Canada, thioridazine was taken off (about 3-4 years ago ?) due to cardiac effects (I think QTc prolongation).
Linkadge
Posted by Phillipa on October 26, 2010, at 20:56:21
In reply to Re: I think dosing is an issue..., posted by linkadge on October 26, 2010, at 17:29:42
I thought thorazine was still available? Phillipa ps shows how long it's been since nursing if not as we used it. But not often
Posted by Christ_empowered on October 26, 2010, at 20:59:35
In reply to Re: I think dosing is an issue... » linkadge, posted by Phillipa on October 26, 2010, at 20:56:21
thorazine (chlorpromazine) is still around, but Mellaril (thioridazine) isn't, at least not in the US or canada. I guess now that its old, off-patent, and there are lots of other options, there wasn't really any justification in keeping it on the market.
Posted by ed_uk2010 on October 27, 2010, at 17:19:39
In reply to Re: I think dosing is an issue... » linkadge, posted by maya3 on October 26, 2010, at 15:38:55
Thioridazine was discontinued in the UK in 2005 due to the elevated risk of cardiac arrhythmias. Melleril was very widely used here for many years, and was prescribed like the atypicals are now for a variety of non-psychotic conditions. The more things change the more they stay the same.
Posted by Maxime on October 27, 2010, at 17:28:16
In reply to Re: I think dosing is an issue... » linkadge, posted by Phillipa on October 26, 2010, at 20:56:21
> I thought thorazine was still available? Phillipa ps shows how long it's been since nursing if not as we used it. But not often
Not Thorazine ....thioridazine. Two different meds. I still take Thorazine at times and it is my emergency if I have a hypertensive reation.
Posted by Phillipa on October 27, 2010, at 19:35:31
In reply to Re: I think dosing is an issue... » Phillipa, posted by Maxime on October 27, 2010, at 17:28:16
No wonder so many med errors even by pharmacists spellings to close. Thorazine is also used for intractible hiccups and I knew you had taken it. Must google this other spelling. Thanks Phillipa
Posted by Phillipa on October 27, 2010, at 20:30:14
In reply to Re: I think dosing is an issue... » Phillipa, posted by Maxime on October 27, 2010, at 17:28:16
If it's mellaril we used it for schizophrenia or acute manic phase of bipolar. What happened to the barbituates? and miltowns which were available and what I was given when first had panic anxiety. Was also given by ob-gyn two seconals in false labor in the hospital and nothing wrong with my third child?. Phillipa
Posted by ed_uk2010 on October 28, 2010, at 14:13:29
In reply to Re: I think dosing is an issue... » Maxime, posted by Phillipa on October 27, 2010, at 20:30:14
>What happened to the barbituates?
Short acting barbiturates such as Seconal are very dangerous in overdose. As a result, they fell out of favour once doctors became familiar with benzodiazepines.
Posted by Phillipa on October 28, 2010, at 20:18:26
In reply to Re: I think dosing is an issue... » Phillipa, posted by ed_uk2010 on October 28, 2010, at 14:13:29
Ed yes so why are they now using atypical antipsychotics that have diabetes and weight gain etc. I just don't get it. PJXX
Posted by Maxime on October 28, 2010, at 20:21:52
In reply to Re: I think dosing is an issue... » ed_uk2010, posted by Phillipa on October 28, 2010, at 20:18:26
> Ed yes so why are they now using atypical antipsychotics that have diabetes and weight gain etc. I just don't get it. PJXX
Because they think new is better.
Posted by Phillipa on October 28, 2010, at 21:45:32
In reply to Re: I think dosing is an issue... » Phillipa, posted by Maxime on October 28, 2010, at 20:21:52
Yup and you know what was amazing that miltown and valium age 24 had me well in a short time. I then cold turkeyed the miltown not a single side effect either the doc was shocked. I asked him why. Phillipa
Posted by ed_uk2010 on October 29, 2010, at 1:49:06
In reply to Re: I think dosing is an issue... » Phillipa, posted by Maxime on October 28, 2010, at 20:21:52
> > Ed yes so why are they now using atypical antipsychotics that have diabetes and weight gain etc. I just don't get it. PJXX
>
> Because they think new is better....and because there aren't many other options.
This is the end of the thread.
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