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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 July 2, 2022, at 11:40:14
I thought about it and...
do non-neuroleptic sedatives have any specific benefits in Schizophrenia and related disorders? I mean...they're still -just sedatives- , but...
isn't that what a lot of the agitated among us really need, anyway?
I remember some references to studies in the 60s-early 80s, but..low quality, the very definition of Schizophrenia was apparently a lot more broad back then...
plus...if I recall, those were short term. The one I remember off the top of my head was just for the prodromal phase. Valium did about as well as Prolixin, but I forget if the people were on stable neuroleptics or...?? as-needed antipsychotic treatment was tried, here and there...70s, maybe? E. Fuller Torrey says its disastrous. some more recent studies seem to show a subset of people who just bust out the neuroleptics for a couple of weeks at a time, here and there...other than that, good to go.
tolerance would be an issue. dosage escalation. and...doctor preference. I think librium, valium would probably be better...but it seems that ativan, xanax, and klonopin are the top benzodiazepines in the US. why? -shrug- szasz says psychiatry runs on dogma and trends.
blah. what do y'all think?
Posted by undopaminergic on July 2, 2022, at 12:40:31
In reply to sedatives, not neuroleptics?, posted by Christ_empowered on July 2, 2022, at 11:40:14
>
> blah. what do y'all think?I read that opioids have antipsychotic effects. They are heavy duty sedatives.
I don't think benzodiazepines have any *specific* effect in schizophrenia, but they can still be helpful.
-undopaminergic
Posted by Christ_empowered on July 2, 2022, at 22:32:36
In reply to Re: sedatives, not neuroleptics?, posted by undopaminergic on July 2, 2022, at 12:40:31
yeah...I skimmed some info The Google brought up about opioids in psychotic disorders. One was interesting...case report, shrink justified using oxycodone (is that OxyContin?) by pointing to the "pain" of Schizophrenia. OK. I mean...go for it, I just think the justification is a bit over the top. moving on...
it seems that the -sort- of sedation is important. benzodiazepines calm people down, but there's also the issue of rage reactions and disinhibition, so aggressive and violent behavior goes up (aggregate...obviously, not most people).
Opioids cause sedation mixed with some of the "de-activation" found with neuroleptics. Unlike neuroleptics, there's a euphoric element. The case study mentions occasional TD from morphine?
thanks.
Posted by undopaminergic on July 3, 2022, at 0:27:23
In reply to Re: sedatives, not neuroleptics?, posted by Christ_empowered on July 2, 2022, at 22:32:36
> One was interesting...case report, shrink justified using oxycodone (is that OxyContin?) ...
>Yes, OxyContin is a sustained-release formulation of oxycodone.
> The case study mentions occasional TD from morphine?
Weird! I've never heard of junkies getting movement disorders from their drug.
> thanks.
No problem.
-undopaminergic
Posted by Christ_empowered on July 5, 2022, at 8:00:27
In reply to Re: sedatives, not neuroleptics?, posted by undopaminergic on July 3, 2022, at 0:27:23
yeah...I kind of wish I had -not- lost the link. oops. :-(
I do OK with aripiprazole, so I'm not really whining/complaining or anything, its just...
with the supplement line up, the biggest "players" for me seem to be "anti-anxiety" (to be fair, -very- few supplements seem to be tested mostly in severe diagnostic label groups).
ashwagandha, niacinamide, l-theanine, passion flower...
maybe its part of what helps me keep my overall psych drug intake lower than in years past?
just...wondering...not so much for me, personally, but for those with the Schizophrenia label in general...
if perhaps -some- would be better off just taking sedatives (non-neuroleptic types) than dealing with major tranquilizers? I'm fortunate in that abilify gets the job done and I don't have eps or td, etc...
but man oh man...at best, 2 out of 3 people/patients have a robust initial response. that's...over 60 years after Thorazine, decades into deinstitutionalization.
-progress- ugh.
Posted by rjlockhart37 on July 6, 2022, at 23:39:52
In reply to sedatives, not neuroleptics?, posted by Christ_empowered on July 2, 2022, at 11:40:14
i've been on librium and valium, there least or lesser euphoria than others such as atvian and xanax
Posted by Christ_empowered on July 7, 2022, at 6:01:21
In reply to Re: sedatives, not neuroleptics?, posted by rjlockhart37 on July 6, 2022, at 23:39:52
yeah...I've always thought Librium, in particular, could be helpful in more severe categories. sedating, low potency, easier to reduce the dosage (gradually!) because of the long half life...
would probably ease low level akathisia and some minor EPS, at least for a season (obviously, TD will develop in any number of patients on any neuroleptic, always and forever, sadly...).
the other thing...when I tried Librium, I found that it had stronger muscle relaxing qualities, which I found helpful. Apparently its been used in combo pills for muscle strains and headaches? makes sense...
but yeah. I don't think psych drugs should cause constant, never ending punishment...so I don't see why there's this never ending emphasis on 0 abuse potential, always...
but I don't mean sedatives to pursue euphoria. I mean...
it stands to reason that -especially- in Schizophrenia -- a rather vague diagnosis that covers a lot of ground -- at least some people might be able to minimize or taper off neuroleptics and just go for sedation until perhaps even that will not be necessary.
Posted by SLS on July 7, 2022, at 7:47:51
In reply to sedatives, not neuroleptics?, posted by Christ_empowered on July 2, 2022, at 11:40:14
> I thought about it and...
>
> do non-neuroleptic sedatives have any specific benefits in Schizophrenia and related disorders? I mean...they're still -just sedatives- , but...
>
> isn't that what a lot of the agitated among us really need, anyway?
>
> I remember some references to studies in the 60s-early 80s, but..low quality, the very definition of Schizophrenia was apparently a lot more broad back then...
>
> plus...if I recall, those were short term. The one I remember off the top of my head was just for the prodromal phase. Valium did about as well as Prolixin, but I forget if the people were on stable neuroleptics or...?? as-needed antipsychotic treatment was tried, here and there...70s, maybe? E. Fuller Torrey says its disastrous. some more recent studies seem to show a subset of people who just bust out the neuroleptics for a couple of weeks at a time, here and there...other than that, good to go.
>
> tolerance would be an issue. dosage escalation. and...doctor preference. I think librium, valium would probably be better...but it seems that ativan, xanax, and klonopin are the top benzodiazepines in the US. why? -shrug- szasz says psychiatry runs on dogma and trends.
>
> blah. what do y'all think?.
Sleep alone is critical to attack mental illnesses and prevent neurodegenerative diseases (Alzheimer's Disease; Parkinson's Disease).
My thoughts on the choice of hypnotics are that they:
1. Not produce physiological dependence and a withdrawal syndrome. I find that the "Z" drugs fit this description.
2. Of great importance is that a hypnotic not distort sleep architecture in a manner that reduces delta (slow-wave) sleep that is generally seen in stage 4 sleep.
* In depression, the onset of REM sleep occurs at 1 hour rather than the 1 1/2 hours for healthy volunteers. Depression is also associated with more time spent in REM. When one night's total sleep deprivation is found to produce a brief period of improvement the next morning, the suppression of REM sleep is probably involved among the mechanisms of action of antidepressant. Abrupt discontinuation of MAOIs, and to a lesser degree, TCAs, often produce intense dreaming as a REM rebound effect. I also experienced a hypnagogic state such that I experienced dreaming while being mostly awake. This is a withdrawal effect that results from the build up of "REM pressure".
- Scott
This is the end of the thread.
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