Posted by yxibow on January 15, 2007, at 0:24:24
In reply to do you need a neuroleptic?, posted by med_empowered on January 14, 2007, at 16:40:12
> The Cogentin is only going to *mask* the initial EPS. Over time, you may still develop tardive dyskinesia, which the abilify itself will partially mask. This means that if you do develop TD (and the odds are worse for someone with bipolar vs. schizophrenia, and early EPS is a *bad* sign), you will not notice it at first, and when/if the drug is withdrawn or your dosage gets lower, your abnormal movements could actually get **worse**, not better.
>
> I'm not trying to scare you, but these drugs are not to be played with, and your doctor is playing with them--without informing you of the risks, or offering any alternatives.
>
> In some people, TD goes away or the symptoms get better. For some people, the symptoms remain and they can be crippling; sever TD/tardive dystonia (a related problem) can disable people, forcing them to use wheel chairs.
>
> Good luck.
They will mask the effects and you are right to note that early strong effects can produce TD but it is not a forgone conclusion. We don't know how atypicals will create a lesser or worse TD than old line neuroleptics but there have been several studies of those on atypicals and aggregate data suggest about 2% per year (which can be extrapolated to weaker agents and probably less formation). It isn't quite cumulative although that has been the general thought. Sometimes switching from one to another remits TD, this still holds with atypicals.
TD roughly remits in 1/3 of the cases, goes no further in another 1/3, and may become worse in the following 1/3.
Prudent use of the MED (minimum effective dose) of any neuroleptic or for that matter any psychotropic is always advised and is advised by Wirshing and Wirshing, who are experts on movement disorders such as TD.
Still for the short term management of Bipolar disorder, atypicals are indicated if the severity of the condition is warranted. It would be cruel to give any antipsychotic and not offer management of EPS, whether it is an anticholinergic or a benzodiazepine.
I agree, that, if their doctor-patient relationship decides that it is too strong of a medication there are other treatments out there as I suggested including still lithium, Depakote, and a variety of things. I don't believe the doctor is "playing" with medications, that sort of characterizes the doctor patient relationship as a sandbox -- one doesn't know the extent of how severe the BP is. Still, phrased differently, yes, there are other alternatives, mostly AEDs that can be used as primary medications with perhaps a smaller dose of a less strong neuroleptic as an adjuctive.-- tidings
poster:yxibow
thread:721839
URL: http://www.dr-bob.org/babble/20070113/msgs/722412.html