Posted by kerry B on July 2, 2000, at 20:30:28
In reply to Re: Antipsychotic round-up, posted by Cam W. on July 2, 2000, at 12:28:19
> Kerry (Abby, James & Scott) - I really don't know Kerry's case from outside this thread, but the initial post by Abby summarizing Kerry's med experience makes me wonder if the Risperdal &/or Zyprexa were causing an EPS reaction. Did the doctors say that it was EPS?
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> Both traditional antipsychotics and lithium can cause types of movement disorders, but they are different. Tremors caused by lithium are rapid and fine in amplitude, whereas EPS tremors are more course or jerky. Was it the Zyprexa and Risperdal causing the EPS or was it lithium causing a pseudo-EPS?
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> Another variable that could be factored into this equation is that the Zyprexa could "unmask" EPS or TD caused by previous traditional antipsychotic use. I have seen this on a number of occasions where Zyprexa has been blamed for causing TD (tardive dyskinesia) within the first week of it's use. This seems to occur rarely when a person is taken off a traditional antipsychotic and an anticholinergic (for the EPS) and placed on one of the atypical antipsychotics. The traditional antipsychotic and anticholinergic are masking the TD and when these drugs are taken away the TD becomes noticeable. Since the Zyprexa was the last drug started before the appearance of the TD it gets blamed for causing the TD. I have also seen this happen when someone was switched to Risperdal and even to Clozaril.
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> Scott is right. Your next step may be Clozaril, but I would be inclined to try a low dose of Zyprexa again without the lithium. Perhaps the Zyprexa with another mood stabilizer (eg Depakote, Lamictal, Topamax) may be a strategy. This is just a guess.
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> It is really difficult to guess what to do when we do not know all of the particulars in a case and didn't see the reactions to the medications. So, I would not make any definitive recommendations in this case, as this is too complex to give any kind of blanket advice.
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> Scott - As for treating EPS. My personal choice is to always drop the offending antipsychotic and use one of the new atypicals. Of course, this is the action that should be taken in a perfect world. Sometimes there isn't the option of switching for several reasons. Other than that, the anticholinergics are really to only effective therapy that I can think of at the moment. There are several anticholinergics on the market and it may be prudent to try another if one is causing too many side effects.
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> Hope this makes sense (if not, tell me and I will try again) - Cam
Hi Cam,
Thanks for all that info. I am going to put it to my doctor or health team. Still waiting for them to contact me. I am using the public health system but have never had this much trouble with them before. They have always been prompt. Maybe they have overload. Private Psychs are soooo expensive and I am not really in a position to be able to afford it at the moment. Scripts cost the earth.
Scott asked what exactly the meds I am on at the moment: Lithium 1,000mg and lately stelazine 8mg and the valium, i only take 2.5mg as I don't like it.
I have also been on pimozide in the past but don't really remember. There is so much I don't remember. I felt like some sort of guinea pig at the beginning as they were always trying out different drugs, to which most of them I had the side effects, EPS, TD and dystonia? so maybe I just have a low tolerance to these drugs, I have told them repeatedly but they seem to shrug it off.
It's been a nightmare lately and I just don't know where to turn. They are sure that the diagnosis id right, schizoaffective as that also includes Bipolar and the schizo part of it.
I have never been up on this stuff even though I have been going through this for a few years, onset 1995. Nobody ever really explained to me what was going on, they'd just put me in hospital and try out all this stuff. It's noy until now, with the help from all of you that it is sinking in. Thanks. I will wait for them to contact me today. I am going to be very disappointed if nothing is done. I can't stand what I'm going through at the moment, moods, psychosis and the rest. I will wait...................kerry
poster:kerry B
thread:38901
URL: http://www.dr-bob.org/babble/20000630/msgs/39069.html