Psycho-Babble Medication Thread 1112392

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Re: Suggestions on treating Tardive Dyskinesia TD?

Posted by SLS on October 30, 2020, at 15:25:04

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

I forgot about these:


***** There are two new drugs approved specifically for treating TD *****

1. valbenazine (Ingrezza)
2. deutetrabenazine (Austedo)


Your doctor has hopefully discussed this with you. They are probably prohibitively expensive. I dont know. Below, I wrote a brief descripton of the mechanism of action.

Both of these drugs have the same novel mechanism of actions that doesnt involve dopamine receptors. TD presumably occurs because postsynaptic dopamine receptors become super-sensitive when they are blocked by an antipsychotics for too long. The mechanism of action of the new drugs involves preventing the presynaptic neuron from releasing too much dopamine into the synaptic cleft, which would otherwise overstimulate the postsynaptic receptors (the ones that became super-sensitive because of antipsychotic use). This is accomplished inside the presynaptic neuron by preventing dopamine from refilling the releasing vessicles. Technically, these drugs are both VMAT2 inhibitors.

In other words, the neuron cant spit because its mouth is dry.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6040721/

If you dont get anything else out of this techinical crap, just remember the spitting.


- Scott

 

Re: Suggestions on treating Tardive Dyskinesia TD?

Posted by Christ_empowered on October 30, 2020, at 23:21:45

In reply to Re: Suggestions on treating Tardive Dyskinesia TD?, posted by SLS on October 30, 2020, at 15:25:04

i don't know anything about the new td drugs. they are ridiculously expen$ive, which should not be the case (a) and should not be a barrier (b), but...


? I dunno how it plays out in "the real world," obviously.

Orthomolecular has been a godsend for me. deal is...the focus is not on a single agent. If I recall correctly, OM cocktails for existing TD (vs prevention) would probably look something like this...

vitamin E (I've had better results with natural form...) 1600 IU...at least 3 grams C (ideally, dosed throughout the day...) a potent B-complex (think b-50 or b-100, again: 2+ times per day, with food. I'm lazy, so its all about the time release B-100 tabs)...

some flavor B3 (niacin, niacinamide, "no flush niacin;" you have options) 3,000 mgs/daily seems to be standard, after relatively brief titration. the C should -at least- match the B3 dosage.

some research indicates taurine might be helpful. 4 grams/taurine daily has been used in conjunction with the newer tranquilizers for more rapid and complete symptom relief. amino acid, so try it on an empty stomach.

if sleep is an issue, melatonin (10mgs/nightly) has shown some promise in TD. some researchers are concerned about metabolic ill effects. B3 megadoses also boost melatonin levels, over time.

a decent multi-vitamin. manganese...I forget the recommended dosage...

on top of the B-complex, b6. has been used to relieve akathisia, reduced AIMS scores in some trials.

and then...

honestly, it seems just about every antioxidant, ever. seriously. some more so than others. gingko biloba has fans (and a little bit of data, it seems).

i hope this helps. :-)

 

Re: Suggestions on treating Tardive Dyskinesia TD?

Posted by Lamdage22 on October 31, 2020, at 2:12:09

In reply to Re: Suggestions on treating Tardive Dyskinesia TD?, posted by Christ_empowered on October 30, 2020, at 23:21:45

1600 IU Vitamin E is pretty hefty. I would watch it.

 

Re: Suggestions on treating Tardive Dyskinesia TD?

Posted by Lamdage22 on October 31, 2020, at 2:12:49

In reply to Re: Suggestions on treating Tardive Dyskinesia TD?, posted by Lamdage22 on October 31, 2020, at 2:12:09

But orthomolecular has been a godsent for me as well.

 

Re: Suggestions on treating Tardive Dyskinesia TD?

Posted by Lamdage22 on October 31, 2020, at 4:01:23

In reply to Re: Suggestions on treating Tardive Dyskinesia TD?, posted by Lamdage22 on October 31, 2020, at 2:12:49

Like a lasting godsent. Not like a 3 month trazodone boost, but a permanent boost.

 

Re: Suggestions on treating Tardive Dyskinesia TD? SLS

Posted by undopaminergic on October 31, 2020, at 4:17:40

In reply to Re: Suggestions on treating Tardive Dyskinesia TD?, posted by SLS on October 30, 2020, at 15:25:04

> A friend of mine has been diagnosed as having Tardive Dyskinesia. She is being treated for depression (possibly bipolar). She took Abilify for a number of years, but has been off of it for at least a year. More recently, she has tried Latuda and Vraylar. Her symptoms so far are limited to some minor tongue movements.
>
> What do you think?
>
> 1. Using another AP?

APs can mask the symptoms, and therefore can offer some relief, but since they are also the *cause* of TD, I would worry they could make it worse.

> 2. Using an anticholinergic medication?

From what I've read, anticholinergics are effective for early antipyramidal symptoms, but not for tardive dyskinesia.

> 3. Alternative treatments - Vitamins? Supplements? Anti-oxidants?
>
> That's about all I know.

That is pretty much what I know too.

> ***** There are two new drugs approved specifically for treating TD *****
>
> 1. valbenazine (Ingrezza)
> 2. deutetrabenazine (Austedo)
>
>
> Your doctor has hopefully discussed this with you. They are probably prohibitively expensive. I dont know. Below, I wrote a brief descripton of the mechanism of action.
>
> Both of these drugs have the same novel mechanism of actions that doesnt involve dopamine receptors.
>

They affect dopamine receptors indirectly, by depleting presynaptic dopamine stores.

There is nothing novel about their mechanism of action. Reserpine has been known for ages, and tetrabenazine has also been known for a long time. In other words, the new agents you mention sound like "me too" drugs to me.

> TD presumably occurs because postsynaptic dopamine receptors become super-sensitive when they are blocked by an antipsychotics for too long.
>

That is the best theory.

> The mechanism of action of the new drugs involves preventing the presynaptic neuron from releasing too much dopamine into the synaptic cleft, which would otherwise overstimulate the postsynaptic receptors (the ones that became super-sensitive because of antipsychotic use). This is accomplished inside the presynaptic neuron by preventing dopamine from refilling the releasing vessicles. Technically, these drugs are both VMAT2 inhibitors.
>

Right.

> In other words, the neuron cant spit because its mouth is dry.
>

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.

-undopaminergic

 

Re: Suggestions on treating Tardive Dyskinesia TD?

Posted by undopaminergic on October 31, 2020, at 4:20:27

In reply to Re: Suggestions on treating Tardive Dyskinesia TD?, posted by Christ_empowered on October 30, 2020, at 23:21:45

>
> 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

 

Re: Suggestions on treating Tardive Dyskinesia TD?

Posted by Lamdage22 on November 1, 2020, at 5:47:52

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

I would say, yes! I don't know if it helps for TD, but it does help with mental health. D3, B12, (B-Complex), K2 MK7 all trans, algae oil, possibly iron, blueberries (great antioxidants for mood and motivation, at least for me). Magnesium. Iodine. And I also like Boswellia. Of course we are all different, but those are the best ones for me. If you take much algae oil (which you may have to to get an effect), some E would be good, too.

Dosage is key, too much will make you sick. So blood tests would be best. I don't think insurance covers it though. I actually saved money, because I haven't been in hospital in a long time! The insurance's money, but I saved it anyway. I think if this would be done more routinely, the cost of blood tests would go down. And days spent in a hospital possibly, too. Maybe not for each and every patient, but for a good number of them.


> 3. Alternative treatments - Vitamins? Supplements? Anti-oxidants?

 

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.


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