Psycho-Babble Medication Thread 1112392

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Re: Suggestions on treating Tardive Dyskinesia TD?

Posted by Hugh on November 2, 2020, at 10:57:52

In reply to Suggestions on treating Tardive Dyskinesia TD?, posted by SLS on October 30, 2020, at 14:46:52

Pyridoxal-5-phosphate (P5P) is the activated form of B6.

https://pubmed.ncbi.nlm.nih.gov/25866243/

 

Hugh?

Posted by Christ_empowered on November 2, 2020, at 11:33:43

In reply to Re: Suggestions on treating Tardive Dyskinesia TD?, posted by Hugh on November 2, 2020, at 10:57:52

hi. so, this better form of B6...

any ideas on how to dose it vs old school?

I'm (thankfully...) currently TD- and EPS-free, probably in large part because of heavy-handed supplementation. I take 2 B-100 tabs per day, so that gives me 200mgs/old school B6.

doing well with it, but I -have- noticed that if I skip (I order mine, so sometimes I find myself without for a day or two...), I get a little antsy. I"m thinking it provides a buffer against relatively mild akathisia from the aripiprazole, but...I dunno. how could i know?

anyway...is it safer? high dose B6 seems to provide a mood lift along with some relief from neuroleptic toxicity, but I'm not comfortable taking higher doses than what I'm consuming, currently.

thanks.

 

Re: Hugh? Christ_empowered

Posted by Hugh on November 2, 2020, at 11:48:27

In reply to Hugh?, posted by Christ_empowered on November 2, 2020, at 11:33:43

P5P does boost my mood. I ruminate less while taking it. I've never noticed anything from B6. The highest dose I've taken is 50 mg. I'd suggest starting on a lower dose. Take it in the morning on an empty stomach. These are the two brands I've used:

https://www.swansonvitamins.com/swanson-premium-p-5-p-pyridoxal-5-phosphate-coenzymated-vitaminb-6-20-mg-60-caps

https://www.vitaminshoppe.com/p/p-5-p-pyridoxal-5-phosphate-50-mg-100-tablets/vs-1266

 

Re: Suggestions on treating Tardive Dyskinesia TD?

Posted by rjlockhart37 on November 2, 2020, at 18:14:54

In reply to Suggestions on treating Tardive Dyskinesia TD?, posted by SLS on October 30, 2020, at 14:46:52

i may be out to lunch, i thought they used cogentin to treat it. It's used to treatt parkinson's and i took cogentin in a psych long time ago

 

Re: Suggestions on treating Tardive Dyskinesia TD?

Posted by rjlockhart37 on November 2, 2020, at 18:19:44

In reply to Re: Suggestions on treating Tardive Dyskinesia TD?, posted by rjlockhart37 on November 2, 2020, at 18:14:54

actually no, it worses it. It's used for parkinson's but from the google search for cogentin and tartive dyskensia, it's saying over again, it makes it worse. That's really wierd, i took it in a psych to fight off side effects from zyprexa at 30mg

https://www.hcplive.com/view/measuring-tardive-dyskinesia-against-drug-induced-parkinsonism-

 

Re: Suggestions on treating Tardive Dyskinesia TD?

Posted by Lamdage22 on November 3, 2020, at 4:36:48

In reply to Re: Suggestions on treating Tardive Dyskinesia TD?, posted by rjlockhart37 on November 2, 2020, at 18:19:44

Hmm, I heard that Clozapine is the only AP that is completely devoid of this side effect. Do you need an AP right now, Scott? Are you on one?

 

Re: Suggestions on treating Tardive Dyskinesia TD?

Posted by Lamdage22 on November 3, 2020, at 6:22:22

In reply to Re: Suggestions on treating Tardive Dyskinesia TD?, posted by Lamdage22 on November 3, 2020, at 4:36:48

The potential of being disfigured for life by TD would deter me from using APs, especially if there is no psychosis present. Maybe the psychiatrist can work out an alternative plan. I too stay away from certain drugs for this reason, I can lose fat, but I can't lose disfiguring face or leg movements. At least not as of now.

 

clozpine causes TD, too

Posted by Christ_empowered on November 3, 2020, at 9:14:30

In reply to Re: Suggestions on treating Tardive Dyskinesia TD?, posted by Lamdage22 on November 3, 2020, at 4:36:48

i don't have solid data on how frequent it is, but...yeah: clozapine can and does cause TD.

in addition, some experts have noticed a definite withdrawal/discontinuation syndrome associated with clozapine, just as one has been noted with those who stop lithium. in both cases, the 'symptoms' can get hellish for a time, often worse than when treatment began. and with clozapine, there seems to be a lot of akathisia popping up after withdrawing the drug, which...

is frightening. clozapine is somewhat unique, but remember: the 'atypicals' are blockbuster drugs, especially in the US. the problems that pop up with stopping clozapine probably overlap with the misery caused by rapid discontinuation (maybe -any- discontinuation?) of any and all neuroleptics, especially the 'atypicals,' so...

lots and lots of people on heavy tranquilizers 'off label.' massive cost$, all around.

ugh. on a personal level, i do think some people should be on a daily tranquilizer, hopefully at the lowest effective dose (something of a pipe dream in the face of 'experts' who want 'dosage optimizations' -- read: as much as the patient can tolerate, often with a side of cogentin to get to the 'right dosage...').

maybe family doctors should handle chronic mental illness? i doubt they could mess it up any worse than the psych industry has...

 

Re: clozpine causes TD, too

Posted by Lamdage22 on November 3, 2020, at 12:41:35

In reply to clozpine causes TD, too, posted by Christ_empowered on November 3, 2020, at 9:14:30

> i don't have solid data on how frequent it is, but...yeah: clozapine can and does cause TD.

Oh. I didn't know. But Clozapine is still the least likely to do that, right?

> in addition, some experts have noticed a definite withdrawal/discontinuation syndrome associated with clozapine, just as one has been noted with those who stop lithium. in both cases, the 'symptoms' can get hellish for a time, often worse than when treatment began. and with clozapine, there seems to be a lot of akathisia popping up after withdrawing the drug, which...

Most Psychmeds are this way. Clozapine and Zyprexa make you feel particularly cozy so yeah, I think they are worse to withdraw than others, but not THAT much worse. Other Psychmeds are bad, too in that regard.

The individual in question has depression, possibly bipolar. So I surmise that she won't ever be psychotic unless manic and she is not certain to become manic on an AD either. It's just a possibility. So I would try to go with a mood stabilizer/antidepressant combo and leave the antipsychotics away.

 

Re: Suggestions on treating Tardive Dyskinesia TD? SLS

Posted by jay2112 on November 3, 2020, at 20:47:42

In reply to Suggestions on treating Tardive Dyskinesia TD?, posted by SLS on October 30, 2020, at 14:46:52

Propranolol, Amantadine, and clonidine.

 

Re: Suggestions on treating Tardive Dyskinesia TD? undopaminergic

Posted by SLS on November 6, 2020, at 13:06:51

In reply to Re: Suggestions on treating Tardive Dyskinesia TD? SLS, posted by undopaminergic on October 31, 2020, at 4:17:40

> Beware though that these drugs, through the same mechanism of action, can worsen depression, especially anhedonia and apathy, but probably attention, concentration, and energy levels too.

Thanks. I didn't think of that. Is this commonly reported?


- Scott

 

Re: Suggestions on treating Tardive Dyskinesia TD? undopaminergic

Posted by SLS on November 6, 2020, at 13:08:00

In reply to Re: Suggestions on treating Tardive Dyskinesia TD?, posted by undopaminergic on October 31, 2020, at 4:20:27

> >
> > a decent multi-vitamin. manganese...I forget the recommended dosage...
> >
>
> Be very careful with manganese. It can produce a condition known as manganism, which is like a form of Parkinson's disease that doesn't respond to treatment.
>
> -undopaminergic
>


Whoa.

Thanks.

 

Re: Suggestions on treating Tardive Dyskinesia TD? jay2112

Posted by SLS on November 6, 2020, at 13:10:35

In reply to Re: Suggestions on treating Tardive Dyskinesia TD? SLS, posted by jay2112 on November 3, 2020, at 20:47:42

> Propranolol, Amantadine, and clonidine.

Amantadine sounds interesting. I would be concerned that clonidine would cause depression.


- Scott

 

Re: Suggestions on treating Tardive Dyskinesia TD?

Posted by jay2112 on November 6, 2020, at 17:09:40

In reply to Re: Suggestions on treating Tardive Dyskinesia TD? jay2112, posted by SLS on November 6, 2020, at 13:10:35

> > Propranolol, Amantadine, and clonidine.
>
> Amantadine sounds interesting. I would be concerned that clonidine would cause depression.
>
>
> - Scott

I found amantadine to have a good antidepressant quality. Not as robust as the standard stimulants, but works well in a mix with antidepressants and a stimulant. May work well against t.d. I actually found amphetamine to be a good med to fight t.d. (Even though it is a suspected cause.) Yes, clonidine does have that depression-inducing quality, but in small doses, I found it useful for akathisia. That is the most intolerable aspect of EP symptoms, for me, anyway.

I was also thinking, amitriptyline has a strong anti-cholinergic profile, which may be also effective for depression. But, treatment response vs. side effects. Hmmmm..

Jay

 

Re: Suggestions on treating Tardive Dyskinesia TD? SLS

Posted by undopaminergic on November 7, 2020, at 3:17:03

In reply to Re: Suggestions on treating Tardive Dyskinesia TD? undopaminergic, posted by SLS on November 6, 2020, at 13:06:51

> > Beware though that these drugs, through the same mechanism of action, can worsen depression, especially anhedonia and apathy, but probably attention, concentration, and energy levels too.
>
> Thanks. I didn't think of that. Is this commonly reported?
>
>
> - Scott

Well, my concern is more based on intuition, but the top Google result for a query about "tetrabenazine side effects" reads: <<Commonly reported side effects of tetrabenazine include: drowsiness, sedated state, bradykinesia, hypertonia, muscle rigidity, depression, exacerbation of depression, akathisia, and restlessness. Other side effects include: dysphagia, anxiety, and dizziness.>>.

-undopaminergic

 

Re: Suggestions on treating Tardive Dyskinesia TD? jay2112

Posted by undopaminergic on November 7, 2020, at 3:22:33

In reply to Re: Suggestions on treating Tardive Dyskinesia TD?, posted by jay2112 on November 6, 2020, at 17:09:40

> > > Propranolol, Amantadine, and clonidine.
> >
> > Amantadine sounds interesting. I would be concerned that clonidine would cause depression.
> >
> >
> > - Scott
>
> I found amantadine to have a good antidepressant quality. Not as robust as the standard stimulants, but works well in a mix with antidepressants and a stimulant. May work well against t.d. I actually found amphetamine to be a good med to fight t.d. (Even though it is a suspected cause.) Yes, clonidine does have that depression-inducing quality, but in small doses, I found it useful for akathisia. That is the most intolerable aspect of EP symptoms, for me, anyway.
>
> I was also thinking, amitriptyline has a strong anti-cholinergic profile, which may be also effective for depression. But, treatment response vs. side effects. Hmmmm..
>

Amantadine can also augment antidepressants in animal models of depression.

It may have been the trigger for an intense hypomanic episode I had in late 2007 to early 2008.

Memantine can be a stronger alternative to amantadine. Structurally, these agents are very similar; memantine is dimethyl-amantadine.

-undopaminergic

 

Re: Suggestions on treating Tardive Dyskinesia TD? SLS

Posted by ed_uk2010 on November 9, 2020, at 16:17:09

In reply to Suggestions on treating Tardive Dyskinesia TD?, posted by SLS on October 30, 2020, at 14:46:52

Hi Scott,

It doesn't sound like your friend suffers from psychosis or mania. As a result, I would suggest avoidance of all antipsychotics completely.

Reason: mild TD often resolves eventually... at least in those who are not elderly.

I do not recommend any medication aimed at treating the symptoms, because the meds which can suppress the symptoms (eg. other antipsychotics) risk worsening the course of TD.

Anticholingergics can (at times) aggravate TD so are usually avoided.

Hopefully, it's possible to treat her depression without antipsychotics. This could resolve the situation in time.

 

Re: Suggestions on treating Tardive Dyskinesia TD? ed_uk2010

Posted by SLS on November 9, 2020, at 20:56:49

In reply to Re: Suggestions on treating Tardive Dyskinesia TD? SLS, posted by ed_uk2010 on November 9, 2020, at 16:17:09

> Hi Scott,
>
> It doesn't sound like your friend suffers from psychosis or mania. As a result, I would suggest avoidance of all antipsychotics completely.
>
> Reason: mild TD often resolves eventually... at least in those who are not elderly.
>
> I do not recommend any medication aimed at treating the symptoms, because the meds which can suppress the symptoms (eg. other antipsychotics) risk worsening the course of TD.
>
> Anticholingergics can (at times) aggravate TD so are usually avoided.
>
> Hopefully, it's possible to treat her depression without antipsychotics. This could resolve the situation in time.

Thanks, Ed. I didn't know that mild TD can resolve on its own over time. I'll let her know what everyone has said here. Her depression appears to me to be double-depression, but her dysthymia is pretty bad. She has no quality of life. Her previous doctor began giving her Abilify. She was on it for several years. More recently, she tried Latuda. The tongue movements began afterwards, but there had been a number of years separating the two treatments.

What do you think of the VMAT2 inhibitors for treating TD?

I hate watching anyone suffer, but particularly people who live in the torturous altered state of consciousness that we call mental illness.


- Scott

 

Re: Suggestions on treating Tardive Dyskinesia TD? SLS

Posted by linkadge on November 10, 2020, at 19:00:08

In reply to Re: Suggestions on treating Tardive Dyskinesia TD? ed_uk2010, posted by SLS on November 9, 2020, at 20:56:49

>What do you think of the VMAT2 inhibitors for >treating TD?

I dunno. Is there any link between VMAT inhibitors and increased risk of depression? (aka reserpine?)

I'd prefer to use something like magnesium, b6, vitamin e, or gabapentin.

Green tea can block DOPA induced dyskinesias (at least in mice).

Linkadge

 

Re: Suggestions on treating Tardive Dyskinesia TD? SLS

Posted by ed_uk2010 on November 13, 2020, at 18:45:22

In reply to Re: Suggestions on treating Tardive Dyskinesia TD? ed_uk2010, posted by SLS on November 9, 2020, at 20:56:49

>>I didn't know that mild TD can resolve on its own over time.

Yes it can :) Especially in younger people. It often gets temporarily worse when antipsychotics are stopped completely, but then gradually better over time.

>What do you think of the VMAT2 inhibitors for treating TD?

I've seen tetrabenazine used but no one stayed on it. It tends to cause depression. I can't imagine it having a use in mild TD.

Most of those with TD who need an ongoing antipsychotic for psychotic illness tend to end up on quetiapine... or if severely unwell, clozapine. But those who aren't psychotic are probably best using alternative meds rather than APs.

 

Re: Suggestions on treating Tardive Dyskinesia TD?

Posted by Lamdage22 on November 16, 2020, at 6:18:10

In reply to Re: Suggestions on treating Tardive Dyskinesia TD? SLS, posted by ed_uk2010 on November 13, 2020, at 18:45:22

Agree

> But those who aren't psychotic are probably best using alternative meds rather than APs.

 

Re: Suggestions on treating Tardive Dyskinesia TD? ed_uk2010

Posted by SLS on November 23, 2020, at 20:31:09

In reply to Re: Suggestions on treating Tardive Dyskinesia TD? SLS, posted by ed_uk2010 on November 13, 2020, at 18:45:22

> >>I didn't know that mild TD can resolve on its own over time.
>
> Yes it can :) Especially in younger people. It often gets temporarily worse when antipsychotics are stopped completely, but then gradually better over time.
>
> >What do you think of the VMAT2 inhibitors for treating TD?
>
> I've seen tetrabenazine used but no one stayed on it. It tends to cause depression. I can't imagine it having a use in mild TD.
>
> Most of those with TD who need an ongoing antipsychotic for psychotic illness tend to end up on quetiapine... or if severely unwell, clozapine. But those who aren't psychotic are probably best using alternative meds rather than APs.

Thanks, Ed.

I'll pass along your perspectives to my friend.

Q: How many VMAT2 inhibitors have you seen prescribed? Of these, did anyone elect to remain on the medication?

Thanks again.

- Scott

 

I almost forgot to thank you folks for your help.

Posted by SLS on December 10, 2020, at 11:55:05

In reply to Re: Suggestions on treating Tardive Dyskinesia TD? ed_uk2010, posted by SLS on November 23, 2020, at 20:31:09

Thank you.

:-)


- Scott

 

Re: Suggestions on treating Tardive Dyskinesia TD?

Posted by Lamdage22 on December 31, 2020, at 6:31:14

In reply to Re: Suggestions on treating Tardive Dyskinesia TD?, posted by Lamdage22 on November 16, 2020, at 6:18:10

Hello Scott,

there may be a correlation of low manganese and TD. That is what my orthomolecular book says. There is something on pubmed.

 

Re: Suggestions on treating Tardive Dyskinesia TD?

Posted by Lamdage22 on December 31, 2020, at 8:20:27

In reply to Re: Suggestions on treating Tardive Dyskinesia TD?, posted by Lamdage22 on December 31, 2020, at 6:31:14

https://psycnet.apa.org/record/1977-23692-001
https://pubmed.ncbi.nlm.nih.gov/912611/

Might be worth a shot before trying meds with their own side effects.


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