Psycho-Babble Medication Thread 1113209

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Neuroleptic weight gain dose dependend? Linearly?

Posted by Lamdage22 on January 3, 2021, at 6:41:42

Hey guys,

Im 210 and not tall (but some muscle), but yeah, I really hope to lose some weight. I have been reducing Seroquel from 1000 to currently 650 in a period of two years. I want to almost eliminate Seroquel Prolong during daytime. I have handled the last reduction from 700 to 650 better than expected. Maybe I can go 600 soon.

Can I expect the weight gain effects to lessen linearly with reduction of dosage?

 

Re: Neuroleptic weight gain dose dependend? Linearly?

Posted by undopaminergic on January 4, 2021, at 6:47:09

In reply to Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 3, 2021, at 6:41:42

> Hey guys,
>
> Im 210 and not tall (but some muscle), but yeah, I really hope to lose some weight. I have been reducing Seroquel from 1000 to currently 650 in a period of two years. I want to almost eliminate Seroquel Prolong during daytime. I have handled the last reduction from 700 to 650 better than expected. Maybe I can go 600 soon.
>
> Can I expect the weight gain effects to lessen linearly with reduction of dosage?
>

Does Seroquel block central histamine H1-receptors linearly with dose? I'm thinking the dose-response curve flattens with increasing dose.

Seroquel is a poor anti-psychotic, so if it is the neuroleptic aspect that keeps you from reducing the dose faster, you could advantageously replace it with any of a number of agents that have a higher ratio of dopamine/serotonin to histamine blockade. Personally, I'd go with a benzamide, ie. amisulpride or sulpiride (maybe tiapride too).

-undopaminergic

 

Re: Neuroleptic weight gain dose dependend? Linearly?

Posted by Lamdage22 on January 4, 2021, at 6:55:58

In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by undopaminergic on January 4, 2021, at 6:47:09

I like how tiaprid sounds. The sulpirides, nah, please no Tardive Dyskinesia! Is Tiaprid less harmful metabolically than Seroquel? How sedating is it? Will a high dose put me to sleep?

 

Re: Neuroleptic weight gain dose dependend? Linearly?

Posted by Lamdage22 on January 4, 2021, at 7:02:11

In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 4, 2021, at 6:55:58

Tiaprid: High Prolactin: Lower Testosterone! Back to topic please.

 

Re: Neuroleptic weight gain dose dependend? Linearly?

Posted by undopaminergic on January 4, 2021, at 7:33:48

In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 4, 2021, at 6:55:58

> I like how tiaprid sounds. The sulpirides, nah, please no Tardive Dyskinesia!

What makes you think "sulpirides" are particularly liable to induce TD? Seems the opposite to me, based on eg:
https://pubmed.ncbi.nlm.nih.gov/6236286/
cite: "Sulpiride differs pharmacologically in several respects from conventional neuroleptics, and has not been convincingly shown to cause tardive dyskinesia. Among currently available treatments, it may therefore be considered a drug of choice for treatment of tardive dyskinesia.".

That said, I also saw a case report suggesting amisulpride at a low dose caused TD.

In any case, someone mentioned here that even clozapine can cause TD, so *no* neuroleptic is totally safe in this respect. This includes quetiapine (Seroquel); one case report is entitled "Early-onset tardive dyskinesia in a neuroleptic-naive patient exposed to low-dose quetiapine.".

> Is Tiaprid less harmful metabolically than Seroquel?

Of course. It's hard to find something delivering such a powerful dysmetabolic "punch" in exchange for such a low antipsychotic efficacy.

> How sedating is it? Will a high dose put me to sleep?
>

Almost certainly not. The benzamides are very "clean" in that they don't affect a multitude of non-targeted receptors such as histamine or acetylcholine. For some reason, although dopamine is crucial in promoting wakefulness, dopamine antagonists do not seem to induce sleepiness, although I'm sure it can happen in some cases. So, if you're looking for a hypnotic, stay with Seroquel.

-undopaminergic

 

Re: Neuroleptic weight gain dose dependend? Linearly?

Posted by undopaminergic on January 4, 2021, at 7:50:20

In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 4, 2021, at 7:02:11

> Tiaprid: High Prolactin: Lower Testosterone! Back to topic please.

Yeah, if you are afraid of prolactin, avoid benzamides and risperidone; they require active transport to enter the CNS, so peripheral concentrations will be higher than central. The pituitary, which produces more prolactin the more dopamine is antagonised, is peripheral.

-undopaminergic

 

Re: Neuroleptic weight gain dose dependend? Linearly?

Posted by Lamdage22 on January 4, 2021, at 9:10:49

In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by undopaminergic on January 4, 2021, at 7:50:20

So would you say the weight gain is linearly dose dependent?

 

Re: Neuroleptic weight gain dose dependend? Linearly?

Posted by undopaminergic on January 4, 2021, at 10:18:03

In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 4, 2021, at 9:10:49

> So would you say the weight gain is linearly dose dependent?
>

As I said in my first reply, no, I don't think it is linear -- I think the dose-response curve flattens with higher doses. To illustrate what I mean, let's say 25 mg achieves 33% central histamine H1 blockade, 50 mg achieves 50%, 100 mg does 75%, 150 mg 85%, and 200 90%, 500 mg 95%, 1000 mg 98%, etc.

Note that the numbers are just taken out of the air, but I think you see what I mean.

It's the same with methylphenidate and dopamine transporter transporter blockade.

I have a prescription of just 25 mg as needed for sleep! It's hard to believe such a dose would do anything, but I imagine the doctor has experience suggesting otherwise... or she wouldn't have prescribed it.

-undopaminergic

 

Re: Neuroleptic weight gain dose dependend? Linearly?

Posted by Lamdage22 on January 4, 2021, at 10:31:59

In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by undopaminergic on January 4, 2021, at 10:18:03

Thanks. Do I understand it correctly, that I don't see as much of a weight gain reduction until I reach lowerish doses? 800 or 1000 doesn't make much of a difference, but 600 or 400 does more so?

 

Re: Neuroleptic weight gain dose dependend? Linearly?

Posted by Lamdage22 on January 4, 2021, at 10:32:58

In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by undopaminergic on January 4, 2021, at 10:18:03

Is the weight gain caused by histamine antagonism?

 

Re: Neuroleptic weight gain dose dependend? Linearly?

Posted by Petermartin on January 4, 2021, at 13:33:58

In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 4, 2021, at 10:32:58

Have you looked into Berberine at all? It's an OTC supplement that many diabetics use instead of Metformin. Some take it along with. Studies have shown both Metformin and Berberine can help limit antipsychotic weight gain.

 

Re: Neuroleptic weight gain dose dependend? Linearly?

Posted by Lamdage22 on January 4, 2021, at 20:39:01

In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Petermartin on January 4, 2021, at 13:33:58

Thanks. But the problem is they both lower Testosterone. My level is already lower than I'd like. I do take Metformin anyway, but I don't want to lower T even more. I am looking into Chromium now.

> Have you looked into Berberine at all? It's an OTC supplement that many diabetics use instead of Metformin. Some take it along with. Studies have shown both Metformin and Berberine can help limit antipsychotic weight gain.
>
>

 

Re: Neuroleptic weight gain dose dependend? Linearly?

Posted by Lamdage22 on January 5, 2021, at 7:39:49

In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 4, 2021, at 20:39:01

So it basically looks a bit like the 3 lines that are ontop of the others if x=dosage and y=weight gain?
https://images.app.goo.gl/gtrhjjhdXJgw6GjXA

 

Re: Neuroleptic weight gain dose dependend? Linearly?

Posted by undopaminergic on January 5, 2021, at 7:50:47

In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 4, 2021, at 10:31:59

> Is the weight gain caused by histamine antagonism?

That's how I understand it. If nothing else, it is sedative and stimulates appetite. Perhaps through a general sedative effect, it lowers the rate of metabolism, but I'm no expert on it. The more awake, excited, and active you are, the faster you burn calories. That's how exercise and stimulants work to lose weight.

> Thanks. Do I understand it correctly, that I don't see as much of a weight gain reduction until I reach lowerish doses? 800 or 1000 doesn't make much of a difference, but 600 or 400 does more so?
>

Yes, if my assumptions are correct.

It occurs to me now, that if I were you, I would probably experiment with low-dose (0.5--2 mg) flupenthixol, as it has been shown to have an antidepressant as well as antipsychotic effect. Another interesting possibility is beta2-adrenergic agonists for weight loss; they increase blood-flow to muscles, and probably for that reason, they are somewhat anabolic. They increase pulse, but are actually good for the heart (even better than beta1-antagonists), perhaps because the heart is a muscle and will benefit from enhanced perfusion.

-undopaminergic

 

Re: Neuroleptic weight gain dose dependend? Linearly?

Posted by Lamdage22 on January 5, 2021, at 8:04:08

In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by undopaminergic on January 5, 2021, at 7:50:47

It could be like that. That would mean that I need some more patience! I will look into those drugs. With most drugs however, I find something detrimental that deters me from using them. I always look into things though!

I think it is 5ht2c antagonism that produces weight gain.

 

Re: Neuroleptic weight gain dose dependend? Linearly?

Posted by Lamdage22 on January 5, 2021, at 8:09:45

In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 5, 2021, at 8:04:08

Yeah, flupenthixol has a higher dyskinesia risk than seroquel and adrenergic agonist probably causes anxiety. Already anxious! I think my best bet is to continue with Seroquel and gradually decrease it.

 

Re: Neuroleptic weight gain dose dependend? Linearly?

Posted by undopaminergic on January 5, 2021, at 8:45:25

In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 5, 2021, at 7:39:49

> So it basically looks a bit like the 3 lines that are ontop of the others if x=dosage and y=weight gain?
> https://images.app.goo.gl/gtrhjjhdXJgw6GjXA
>

My first thought was that my German wasn't up to the task. Then I realised you must mean *if* the X *were* dosage and the Y weight gain? Well then, yes, something like that.

-undopaminergic

 

Re: Neuroleptic weight gain dose dependend? Linearly?

Posted by undopaminergic on January 5, 2021, at 8:56:21

In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 5, 2021, at 8:04:08

>
> I think it is 5ht2c antagonism that produces weight gain.

5-HT2C antagonism enhances dopamine release. I don't see why that would lead to weight gain, but on another note, 5-HT2C *agonism* is probably the mechanism through which SSRIs induce apathy. And despite this agonism, SSRI are known not infrequently to produce weight gain, especially paroxetine.

Anyway, as far as I've been able to determine, there are no good (ie. reasonably potent and selective) 5-HT2C antagonists clinically available. I've tried agomelatine and sertindole, but noticed no benefit, and I had to quit the sertindole because it clogged up my nasal passages like nothing I'd ever experienced before.

-undopaminergic

 

Re: Neuroleptic weight gain dose dependend? Linearly?

Posted by Lamdage22 on January 5, 2021, at 9:19:44

In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by undopaminergic on January 5, 2021, at 8:45:25

Right. If it were. Subjunctive.

 

Re: Neuroleptic weight gain dose dependend? Linearly?

Posted by undopaminergic on January 5, 2021, at 9:52:15

In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 5, 2021, at 9:19:44

> Right. If it were. Subjunctive.

Oh, subjunctive! I had thought it was "conjunctive", because that is the term used in Swedish and German.

-undopaminergic

 

Re: Neuroleptic weight gain dose dependend? Linearly?

Posted by undopaminergic on January 5, 2021, at 10:02:20

In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 5, 2021, at 8:09:45

> Yeah, flupenthixol has a higher dyskinesia risk than seroquel

Certainly, but we are talking about 0.5 up to 2 mg. With 4+ you easily get EPS, and in my experience also anorgasmia that is worse than that of SSRIs. To be conservative, I should probably say 0.5 up to 1 mg. Larger doses can also be anti-histaminergic, but at low doses it is more stimulating than sedating.

> and adrenergic agonist probably causes anxiety.

I don't think anxiety, but possibly nervousness, as from caffeine, and if you have adrenergic tremor. it may be worsened.

> Already anxious! I think my best bet is to continue with Seroquel and gradually decrease it.
>

What happens if you "go too fast"? Do you get paranoia or hallucinations?

-undopaminergic

 

Re: Neuroleptic weight gain dose dependend? Linearly?

Posted by Lamdage22 on January 5, 2021, at 10:05:20

In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by undopaminergic on January 5, 2021, at 9:52:15

Subjunctive is the english equivalent of the german Konjunktiv. It isnt always used thd same way, but it is similar. This has been my course of study for a year. Translation (English-German). I have a motivation problem though. The other students are moving at lightspeed compared to me.

 

Re: Neuroleptic weight gain dose dependend? Linearly?

Posted by Lamdage22 on January 5, 2021, at 10:07:11

In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by undopaminergic on January 5, 2021, at 10:02:20

Paranoia

> What happens if you "go too fast"? Do you get paranoia or hallucinations?
>
> -undopaminergic
>

 

Re: Neuroleptic weight gain dose dependend? Linearly?

Posted by Christ_empowered on January 5, 2021, at 12:48:31

In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 5, 2021, at 10:07:11

just jumping in here...

i don't think it is a linear relationship. a former psychiatrist told me she had given up issuing new prescriptions for olanzapine, mainly because she'd seen even low doses cause serious problems. frightening tidbit: she told me that she'd seen zyprexa cause metabolic disorders, even without massive weight gain. --stay up on your lab work, please--

all of the tranquilizers are associated with at least a bit of weight gain, except maybe moban and geodon, both of which have other, serious adverse effects for people/patients to contend with, of course.

have you ever been given a trial of the newer d2 partial agonists? they're -not- wonder drugs or anything, but maybe worth a shot, perhaps?

 

Re: Neuroleptic weight gain dose dependend? Linearly?

Posted by Lamdage22 on January 5, 2021, at 12:57:16

In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Christ_empowered on January 5, 2021, at 12:48:31

I do.

> . --stay up on your lab work, please--

Yeah, Abilify=Akathisia. I'm not trying conventional psychmeds anymore. I have tried many many many and what I have learned is: Don't try!

> have you ever been given a trial of the newer d2 partial agonists? they're -not- wonder drugs or anything, but maybe worth a shot, perhaps?


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