Posted by gregg on January 1, 2002, at 18:44:08
In reply to Re: Cam:antipsychotic question » gregg, posted by Cam W. on January 1, 2002, at 18:16:38
Cam,
Thanks for your thorough response. I've often wondered why clinical trials can show a med to work great, with subsequent "real world" experience showing that it isn't as good as expected or has some bad side effect. Being the cynical type, I assumed that the researchers, whose research funding often comes from the manufacturer, were simply not receptive to negative findings. Your point about the added stresses of the "real world" might, however, be a better explaination for this.
Thanks
Gregg
> Gregg - I have seen Seroquel™ (quetiapine) added to both atypical and psychotic depressions, with varying degrees of success. Sometimes it added too much excess drowsiness, sometimes did nothing at all, and sometimes brought people "back to the world of the living and functioning." As I have only seen relatively few cases Seroquel used in depression (10 to 20 cases), and the fact that I no longer work closely with the psychiatrists, I am not as privy to a lot of the pdoc decisions as I used to be.
>
> The problem with Seroquel monotherapy is that the drug works like a charm when used alone in a hospital setting. Many (probably most) psychiatrists and hospital clinical pharmacists will, and do, disagree with me on the next point.
>
> "I" feel that when the hospital boys (and girls) are able to stabilize someone with psychosis (usually schizophrenia or schizoaffective disorder) on Seroquel, seeming all thought processes clear up, and functioning dramatically improves. The problems seem to start when the person loses the relative sanctity, safety, and security of the psych ward. The person, more often than not, is place back in the community (ie. thrown back to the wolves), back to the same environment, with the same associated stresses, that help to promote the most recent psychotic break. "I" believe it is this environment, with it's past memories, that overwhelm the activity of the Seroquel, and contribute to another relapse.
>
> Perhaps the reason for this is that Seroquel just doen't have enough D2 receptor blocking ability. Perhaps there is a lower range of consistent block that is required before environmental stressors can again overwhelm the brain, and psychosis rears it's ugly head.
>
> The reason I like seeing Seroquel used with other atypicals is that one can usally get away with lower doses of the others. This is important, especially when reaching doses of 6mg/day of Risperdal™ (risperidone) and 30mg/day (or so) of Zyprexa™ (olanzapine), in which cases the risk of EPS becomes significantly greater.
>
> While I have no scientific evidence of the above (which is probably why the pdocs won't listen to me on this issue - but I got 'em thinkin'), I have read a study showing that using Seroquel and Clozaril™ (clozapine) together, it seems (in this small study) that those who used both drugs in combination, as opposed to using Clozaril alone, gain less weight, while having as good or better control of the psychosis.
>
> I wish the dumbass drug companies (there go a few more job opportunities < sigh >) would drops their egos (and some of their potential profits) to try combinations like this, to see if we can get combinations of drugs (not just antipsychotics) that will maximize efficacy, while minimizing adverse effects.
>
> Cam (stepping down off his soapbox, shaking the clouds from his hair, and going off to check the want ads, again)
poster:gregg
thread:87920
URL: http://www.dr-bob.org/babble/20011222/msgs/88478.html