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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 56 to 80 of 85. Go back in thread:
Posted by Lamdage22 on January 7, 2021, at 8:41:27
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 7, 2021, at 8:11:56
How likely is Tiaprid to cause high prolactin?
Posted by Christ_empowered on January 7, 2021, at 11:40:18
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by undopaminergic on January 7, 2021, at 5:49:34
just...jumping in here...
i thought -maybe- a D2 partial agonist could be your 1 neuroleptic. I don't know about the newer ones, but Abilify is surprisingly high potency...once you hit the fda-approved max of 30mgs/daily, over 90% of D2 receptors are "occupied" or whatever the experts call it. The only reason people don't twitch and feel horrible like with Haldol or Prolixin is because of the D2 partial agonism, it seems.
that is all. no one is suggesting there is a wonder drug out there, or a pill for every ill. the other potential (possible) upside of a D2 partial agonist is that, at least with Abilify, animal studies show less D2 upregulation, following long term administration. so...assuming that's at all true of human consumption, there -might- possibly be less risk of tardive syndromes, especially tardive psychosis.
i wish you well. my -personal suggestion- would be to try to get down to 1 tranquilizer. in addition to the increase in overall neuroleptic exposure one gets from 2+ at once, some data suggests more risks, overall.
Posted by Lamdage22 on January 7, 2021, at 12:10:45
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Christ_empowered on January 7, 2021, at 11:40:18
I tried Abilify, it was very unpleasant. Yeah the long term goal is just 1 Neuroleptic. My mood is low. Isolation doesnt help!
Posted by undopaminergic on January 7, 2021, at 12:12:03
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 7, 2021, at 8:41:27
> How likely is Tiaprid to cause high prolactin?
Well, as I understand it, tiapride is comparable to amisulpride and sulpiride, which are particularly likely to elevate prolactin among antipsychotics. But I don't think you'd actually notice it, unless you take very high doses.
-undopaminergic
Posted by Lamdage22 on January 7, 2021, at 12:47:53
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by undopaminergic on January 7, 2021, at 12:12:03
Yeah, Risperdal gave me "b*tch t*ts". You see, I have tried quite a few medications. Too many.
Posted by undopaminergic on January 8, 2021, at 5:05:55
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 7, 2021, at 12:47:53
> Yeah, Risperdal gave me "b*tch t*ts". You see, I have tried quite a few medications. Too many.
>Apparently, you are more sensitive to elevated prolactin than I am. It makes sense that this happened with risperidone, because, as I mentioned before, it (and the benzamides/-prides) requires active transport across the blood-brain-barrier, meaning that the peripheral concentrations will be higher than the central. In other words, it produces more elevated prolactin per unit of antipsychotic effect than other neuroleptics.
-undopaminergic
Posted by Lamdage22 on January 8, 2021, at 5:20:59
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by undopaminergic on January 8, 2021, at 5:05:55
Risperdal was essentially a Placebo for me. It calmed me slightly, but no antipsychotic effect. I think I tried more meds than you think!
Posted by undopaminergic on January 8, 2021, at 5:39:21
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 8, 2021, at 5:20:59
> Risperdal was essentially a Placebo for me. It calmed me slightly, but no antipsychotic effect. I think I tried more meds than you think!
>I don't really have any pre-conceived ideas of how many medications you tried. I know you've tried more than I know of. And I expect that you were less afraid of trials before your experience with Nardil.
Interesting that you find Seroquel has antipsychotic effects but Risperdal not. Usually it is the other way around. But I personally feel trimipramine is more antipsychotic than clozapine.
-undopaminergic
Posted by Lamdage22 on January 8, 2021, at 5:41:46
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by undopaminergic on January 8, 2021, at 5:39:21
Yeah, and side effects considered, Trazodone is my best antidepressant. Equal or better than Venlafaxine. Those are the two I benefit from at low dose.
We are all very different although we have similar problems!
Posted by Lamdage22 on January 8, 2021, at 5:46:50
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 8, 2021, at 5:41:46
Psychiatry needs a way of telling who will react well and who will have a bad reaction to each med. That would be a game changer!
Posted by Lamdage22 on January 8, 2021, at 5:54:35
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 8, 2021, at 5:46:50
I am concerned about movement disorders. I will have my psychiatrist take a look! At the tongue, right? What else can be done to check the risk?
Posted by Christ_empowered on January 8, 2021, at 18:03:44
In reply to Re: Neuroleptic weight gain dose dependend? Linearly?, posted by Lamdage22 on January 8, 2021, at 5:54:35
I think there are a couple of more or less standardized examinations for TD. The AIMS test is the big one, I think. I don't think it has to be a doctor who does it...nurses can, with appropriate training. -if- someone has movements that meet the criteria for TD, etc. there's also an AIMS scale, so then both the treatment provider and the person being treated have any idea of how severe the movement disorder is at the moment, compared to other cases.
problem: neuroleptics both cause TD and suppress the movements. Way back when, common 'treatment' for both TD and what doctors would now recognize as drug-induced akathisia involved increasing the dosage, often to massive amounts. With TD, this -did- suppress movements (not just TD, either), but often led to the development of severe, sometimes crippling TD. and with akathisia...well, that just shut people up, so they stopped pacing and complaining. psychiatry...-sigh-
the fda has approved...2 new drugs for TD, I think. both are (as one would expect) ridiculously expensive in the US. I don't know anything about adverse effects, long term anything, etc. sorry about that.
as neuroleptics are tapered and discontinued, movements can show up that were suppressed. sometimes, it -is- true TD and that will require some sort of treatment (the 'alternative' health people still recommend E, I think also B6, melatonin...honestly, it seems that every antioxidant, ever, could potentially help). Some cases of withdrawal-emergent movement disorders just...go away, or at least get better, over time.
sorry about all this. i had tics and such...I think it was part drug-induced (all "atypicals," btw) and also part severe anxiety...combined, it was just...rough, let's put it that way. now, I'm facial tic free and still stuck on an 'atypical,' so...maybe all the antioxidants, etc. do help?
ok. I hope things get better for you. :-)
Posted by Lamdage22 on January 9, 2021, at 1:19:41
In reply to AIMS test, posted by Christ_empowered on January 8, 2021, at 18:03:44
Thanks, CE,
yeah I heard that Zyprexa is more of an TD offender than Seroquel. Right now my goal is to reduce Seroquel though. Yeah antioxidants may help. I also heard about Manganese helping.
Posted by undopaminergic on January 9, 2021, at 6:23:33
In reply to Re: AIMS test, posted by Lamdage22 on January 9, 2021, at 1:19:41
> Thanks, CE,
>
> yeah I heard that Zyprexa is more of an TD offender than Seroquel.Probably, but it is also a more potent antipsychotic.
> Right now my goal is to reduce Seroquel though. Yeah antioxidants may help. I also heard about Manganese helping.
>Be careful with megadoses of manganese. You don't want manganism; it's worse than Parkinson's!
-undopaminergic
Posted by Lamdage22 on January 9, 2021, at 20:42:31
In reply to Re: AIMS test, posted by undopaminergic on January 9, 2021, at 6:23:33
> > Thanks, CE,
> >
> > yeah I heard that Zyprexa is more of an TD offender than Seroquel.
>
> Probably, but it is also a more potent antipsychotic.So you think if the potency is accounted for, it is not more of an offender?
> > Right now my goal is to reduce Seroquel though. Yeah antioxidants may help. I also heard about Manganese helping.
> >
>
> Be careful with megadoses of manganese. You don't want manganism; it's worse than Parkinson's!How much is safe?
>
Posted by undopaminergic on January 10, 2021, at 0:19:52
In reply to Re: AIMS test, posted by Lamdage22 on January 9, 2021, at 20:42:31
> > > Thanks, CE,
> > >
> > > yeah I heard that Zyprexa is more of an TD offender than Seroquel.
> >
> > Probably, but it is also a more potent antipsychotic.
>
> So you think if the potency is accounted for, it is not more of an offender?Right.
> > > Right now my goal is to reduce Seroquel though. Yeah antioxidants may help. I also heard about Manganese helping.
> > >
> >
> > Be careful with megadoses of manganese. You don't want manganism; it's worse than Parkinson's!
>
> How much is safe?I don't know. It probably depends on the current state, whether that is shortage or excess. Of course, it also depends on how well it is absorbed, which may depend on the form in which it is taken.
-undopaminergic
Posted by Christ_empowered on January 10, 2021, at 14:17:50
In reply to Re: AIMS test, posted by undopaminergic on January 10, 2021, at 0:19:52
I never did the manganese thing. I mean, I read about it, on Orthomolecular sites, and...for some reason, I was more inclined to go with Hoffer-style protocols (C, E, b-100, B3, etc.), plus handfuls of "extra" antioxidants (green tea extract, grape seed extract, alpha lipoic acid, that kind of thing....). My (discount) multi-vitamin has a good bit of manganese in it, along with 100% of all the minerals, so...I think I'm covering my bases, personally (?).
and with neuroleptics...in the short term, higher potency agents cause more akathisia, more EPS, less sedation, fewer anticholingeric adverse effects than low(er) potency agents. In the US, perphenazine is still somewhat popular, even though everybody and their mama is on an 'atypical' for...something. Its a moderate potency phenothiazine (same chemical class as good ole Thorazine, ugh), so it can get the job done without the Parkinsonism of, say, Haldol or Stelazine...and also without the sedation and general "make it stop!" - feeling of Thorazine.
Long term...cumulative neuroleptic exposure seems to be the -key- factor. That's why the experts have found ways to estimate the Thorazine-equivalent for neuroleptics, old and new, so (hopefully...) dosing doesn't get out of control, like back in the day.
even at equivalent dosages, some drugs are worse than others. Haldol is just plain neurotoxic. A metabolite of haloperidol might be partly responsible for its high, high rate of TD.
sad fact? it seems that, long term, there hasn't been much progress in terms of TD risk. Thorazine at up to 600mgs/daily -still- compares well with the 'atypicals,' although I do think some newer drugs are better for quality of life, mood, anxiety, that kind of thing.
olanzapine is moderate potency, if I recall. less dysphoria than many older drugs, lots more metabolic problems. long term, the TD risk might be lower...I seem to recall a long term study in which they dosed monkeys up with haloperidol or olanzapine, and the monkeys had far, far more brain changes with haloperidol than with olanzapine.
aripiprazole was believed to be a low risk agent at first, but now that everybody is on it for whatever indication, more and more cases of TD are popping up. :-( ugh. just can't win, it seems...
Posted by Lamdage22 on January 10, 2021, at 23:24:21
In reply to Re: AIMS test, posted by undopaminergic on January 10, 2021, at 0:19:52
> > How much is safe?
>
> I don't know. It probably depends on the current state, whether that is shortage or excess. Of course, it also depends on how well it is absorbed, which may depend on the form in which it is taken.THere is neither shortage nor excess. There is some room for more Manganese. I have difficulty deciding wether to take 2 or 4 mg
Posted by Lamdage22 on January 10, 2021, at 23:26:30
In reply to Re: AIMS test, posted by Christ_empowered on January 10, 2021, at 14:17:50
>. :-( ugh. just can't win, it seems...
WIth Neuroletpics, you can't
Posted by Lamdage22 on January 11, 2021, at 0:40:59
In reply to Re: AIMS test, posted by Lamdage22 on January 10, 2021, at 23:26:30
My blood level was 12mcg/l with 14 being the highest healthy level. What should I do? Keep the dose the same or add 2mg of Manganese? I really want to do something that makes movement disorders less likely. Which foods contain Manganese?
Posted by Lamdage22 on January 11, 2021, at 0:41:23
In reply to Re: AIMS test, posted by Lamdage22 on January 11, 2021, at 0:40:59
Lowest healthy is 6,5
Posted by Lamdage22 on January 11, 2021, at 1:28:50
In reply to Re: AIMS test, posted by Lamdage22 on January 11, 2021, at 0:41:23
So I make some weird movements with my mouth when I lift. I really don't want Tardive Dyskinesia or any other weird movement disorder!
What can I do? Ingrezza? I don't want to take damage.
Posted by undopaminergic on January 11, 2021, at 3:14:09
In reply to Tardive Dyskinesia while working out?, posted by Lamdage22 on January 11, 2021, at 1:28:50
> So I make some weird movements with my mouth when I lift. I really don't want Tardive Dyskinesia or any other weird movement disorder!
> What can I do? Ingrezza? I don't want to take damage.If TD is caused by dopamine deficiency which is caused by neuroleptics, then a dopamine-depleting agent such as Ingrezza (or other reserpine-like drug) is likely only to make it worse.
I guess you'll just have to do with the supplements, and hope it doesn't get worse.
Try not to get paranoid (or super-worried) about TD. Many people do some mannerism when they lift weights. Eg. they grunt (not sure that is the right word for it) or make various kinds of breathing-related noises, especially with heavier weights, and it can be pretty loud.
-undopaminergic
Posted by Lamdage22 on January 11, 2021, at 3:16:19
In reply to Re: Tardive Dyskinesia while working out?, posted by undopaminergic on January 11, 2021, at 3:14:09
Thanks,
do you think tyrosine or phenylalanine would help? Or any dopamine precursors?
Posted by undopaminergic on January 11, 2021, at 4:38:20
In reply to Re: Tardive Dyskinesia while working out?, posted by Lamdage22 on January 11, 2021, at 3:16:19
> Thanks,
>
> do you think tyrosine or phenylalanine would help? Or any dopamine precursors?Maybe. Dopamine in general is good for psychomotor function. But for me, not even L-dopa helped (for symptoms like apathy, not TD).
-undopaminergic
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Dr. Bob is Robert Hsiung, MD,
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