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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Christ_empowered on January 27, 2015, at 9:01:16
I don't know why I'm obsessed with this, lol. can't be healthy or productive.
I take 30/Abilify. My former shrink (she moved) told me she's never seen TD w/ Abilify, but she had seen it w/ Zyprexa and sometimes w/ Seroquel. She said she treated TD w/ amantidine (I think) and vitamin E.
I dunno. I'm on Abilify 30 for the long haul. I do Orthomolecular in hopes of preventing TD. SO far...I've been on Abilify w/ OM for about 4-5 years, and I'm doing well. Even my moderate stiff gait has mysteriously given way to a normal, comfortable walk.
I thought that lower potency= less TD, but then it appeaers that Zyprexa is less TD-making than some other atypicals, and its moderate potency I think. Also, based on the few case reports I've read, adding other drugs to the mix complicates things. Lithium, Depakote= more EPS, more TD. Antidepressants=more akathisia, more TD. Ugh.
Also...I'm one of those people who needs his high dose atypical. Just the way it is. But, when I'm in the mental health place, I see all these ads for Abilify w/ an AD for people with (presumably) much less severe issues, and I think...
...didn't this already happen? I mean, on a smaller scale, in the 60s-80s, before the TD lawsuits and everything? Triavil, for instance, was a hit w/ family docs. Eskatrol, too.
Ugh. Just some random questions+thoughts...
Posted by ed_uk2010 on January 27, 2015, at 10:06:35
In reply to TD rates for the atypicals, posted by Christ_empowered on January 27, 2015, at 9:01:16
>I take 30/Abilify. My former shrink (she moved) told me she's never seen TD w/ Abilify, but she had seen it w/ Zyprexa and sometimes w/ Seroquel.
TD isn't especially common with any of the above in young people such as yourself. It's much more common in the elderly. Or in anyone, with haloperidol...
Since you've established that you need Abilify, and there isn't currently any alternative which is likely to be safer or more effective, I think you do the right thing to keep taking it.
>I thought that lower potency= less TD, but then it appears that Zyprexa is less TD-making than some other atypicals, and its moderate potency I think.
TD with atypicals isn't related to the potency; each atypical is pharmacologically distinct. The concept of potency compares the number of milligrams required for antipsychotic efficacy. It's a very crude measure really - and isn't particularly useful now that more is understood about the receptor profiles of the various drugs.
>Antidepressants=more akathisia, more TD. Ugh.
I think the risk of adding ADs to Abilify is minimal, and probably has little or no effect on the risk of TD.
I don't think that Depakote or therapeutic levels of lithium are related to TD. Movement issues can occur at toxic levels of lithium, or if it's combined with high doses of haloperidol.
If you were to develop TD, it's extremely unlikely to just appear as a severe condition.... suddenly, one day, out of the blue. Most likely, it would initially be very mild. In the beginning, it often consists of small involuntary movements around the mouth or of the tongue. Due to your insight and understanding, you wouldn't miss this stage. During this phase, if you were to stop Abilify, the TD would probably go away in time. That's where your age comes in again. TD is much more likely to be permanent in the elderly.
The thing is, even if were unfortunate enough to develop TD on Abilify, you would still presumably need an antipsychotic. Switching to quetiapine or clozapine would be an option.
Posted by ed_uk2010 on January 27, 2015, at 10:35:29
In reply to TD rates for the atypicals, posted by Christ_empowered on January 27, 2015, at 9:01:16
Hi again,
I forgot to say... I know you're using OM to try and improve your health and hopefully reduce the risk of TD. I know you take a B complex, vitamin D3, extra niacinamide and vitamin C. B6 is supposed to be useful and you take that. Do you take vitamin E too? I know it's been looked at with respect to treatment and prevention of TD, but with mixed results and uncertainty. I believe most vitamin E supplements are alpha tocopheryl acetate only, which may be bad for your health at high doses in isolation. Some people take mixed tocopherols instead. Is this something you've considered?
Also, there is some research into the herb ginkgo biloba and TD. I don't know whether this would be something worth taking - what do you think? Interestingly, both vitamin E and ginkgo inhibit haloperidol from inducing TD in rats.
Other points of interest:
Melatonin supplements were effective for TD in one trial.
There is a small amount of evidence that EPA-containing fish oil 2g/day is useful in TD. Since it's also thought to be useful in psychosis, depression and cardiovascular health, amongst other things, it would seem potentially valuable for you to take it if you don't already.
Some countries prescribe quercetin supplements for TD, as an antioxidant.
I note that you've sometimes mentioned having problems with residual depression in spite of your current treatment. There is some evidence that folic acid and zinc are helpful in depression. I don't know whether you take a B complex with or without folate. You might want to consider these supplements. They are normally very inexpensive. Zinc gluconate is normally taken as 15mg-30mg per day (in terms of elemental zinc). Folic acid could be taken at around 400mcg per day, or temporarily up to 800mcg. Prescribed doses for severe deficiency are much high, normally 5mg per day.
Posted by ed_uk2010 on January 27, 2015, at 11:08:01
In reply to TD rates for the atypicals, posted by Christ_empowered on January 27, 2015, at 9:01:16
Resveratrol, an antioxidant present in red grapes, reduced the risk of TD in rats treated with fluphenazine from 70% to 30%....
I like red grape juice (and red wine for that matter...)
Perhaps you could make red grape juice part of your diet?
Posted by Christ_empowered on January 27, 2015, at 11:09:47
In reply to Re: TD rates for the atypicals, posted by ed_uk2010 on January 27, 2015, at 10:35:29
Hey, ed_uk...
I do take vitamin E. I take the "natural form," plus mixed tocopherols. 1,000 IU per day. I get about 400mgs/day B6, between B-100 plus additional B6 capsules.
The melatonin thing is interesting. I do take zinc, when I think about it...30mgs of something called "OptiZinc." zinc methionine or something.
The depressive symptoms are probably due to stress and such. I take 100mgs/Lamictal. I may have to ask about something for concentration issues, but I'm hesitant.
Thanks for your posts.
Posted by ed_uk2010 on January 27, 2015, at 11:15:21
In reply to Re: TD rates for the atypicals, posted by Christ_empowered on January 27, 2015, at 11:09:47
>I may have to ask about something for concentration issues, but I'm hesitant.
What sort of concentration issues do you have? You need to avoid stimulants because they can induce psychosis, and you don't want to end up needing more antipsychotics. Omega-3 fish oil and ginkgo biloba are supposed to be good for concentration so they might help the concentration problems too.
Posted by Phillipa on January 27, 2015, at 16:53:09
In reply to Re: TD rates for the atypicals, posted by Christ_empowered on January 27, 2015, at 11:09:47
CE that's a lot of B6. Phillipa
Posted by zonked on January 28, 2015, at 23:56:05
In reply to TD rates for the atypicals, posted by Christ_empowered on January 27, 2015, at 9:01:16
I'm sorry if this isn't on topic but I just wanted to say, I give you a lot of credit, I've seen your posts over the years and *even if* I had your symptom profile (which includes psychosis no?) I am not sure I could bring myself to take *any* antidopaminergic drugs.
Apparently there are some (perhaps *truly*) antipsychotic drugs in the pipeline which don't touch dopamine and instead hit glutamate receptors.
Hopefully there will be much better treatments for psychosis in the future that don't work by inducing a kind of chemical parkinsons.
In the meantime, your concern is well-founded. I truly hope someday I don't see people walking around obese, with diabetes, shaking because they are treating their disorder...
-z
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