Posted by xbunny on February 5, 2007, at 6:22:12
In reply to Re: typical antipsychotics, posted by alienatari on February 4, 2007, at 21:59:01
> I know of the risk, he has told me of the risk and Ive read alot about the problems with combining haloperidol with lithium. LIke I was saying before, my Pdoc is well experienced and is in Research. I trust him. I dont want to change him he is not a bad psychatrist.
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> I cant try amoxapine because If i do that i have to stop clomipramine and I have severe OCD I dont want that to make things worse as I am on a high dose of clomip (200mg).
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> Anyway maybe Clozapine is the only thing left for me. *shrugs*
>There are many typical antipsychotics, I would say try roughly one from each major group and one of each subgroup of phenothiazine since that is the largest major group. Since you have already tried haldol (a high potency, low sedation, high eps, non phenothiazine), I would try a low potency phenothiazine next. Despite the connotation of the chemical cosh etc I reckon chlorpromazine (thorazine, largactil) is a reasonable first phenothiazine as it is fairly midrange with regards to the side effects of the group as an entirety (I reckon at least), since you say you have already taken chlorpromazine you might examine why you didnt persist with it. If chlorpromazine seemed promising but some side effect was too bothersome (ie EPS or sedation) then you could try another phenothiazine from a group which exchanges that side effect (ie melleril if the EPS was too much, or perphenazine if the sedation was too much). Remember EPS can sometimes be managed with anticholinergics and sedation often becomes tolerable eventually so a promising drug is often worth perserving with. I found the drug stelazine surprisingly tolerable I cant remember where it fits in the grouping if I recall it might be a reasonable alternative to perphenazine if you go in that direction.
You say you are also on chlomipramine for OCD. Are you sure that is helping it? I also have OCD like symptoms and took chlomipramine for nearly year, in retrospect I found it didnt really help. I also found that changing antipsychotics improved the OCD symptoms no end. Zyprexa particularly worsens these symptoms in me and I got a noticeable reduction when I transfered to a different drug, that said I found all antipsychotics increased these symptoms and after quitting them entirely the symptom was considerably reduced. I am not suggesting you do that however I am saying that my experience is that antipsychotics can aggravate OCD. Similarly you say you have "anxiety/paranoia" and valium doesnt touch it and that haldol only touches other positive symptoms but not the anxiety/paranoia. I would try to differentiate if it all possible between the anxiety and paranoia. It is my experience that antipsychotics can aggravate anxiety, again my experience but this effect is not just limited to the low sedation, high potency drugs like haldol or flupenthixol (which it tends to be documented for), but for all the antipsychotics I have tried.
You say your dr is in research, surely he would be amply qualified to recommend you a potential typical antipsychotic.
You also say you have tried all the atypicals, have you tried Amisulpride? Its a very novel drug and I think worth trying.
For me the antidepressant mirtrazapine was a good drug for its anxiety reduction and mood enhancement and combined with an antipsychotic well, its very sedating and the weight gain can be severe (especially when combined with an antipsychotic). My CPN used to say that pretty much all of her clients who took an antidepressant with an antipsychotic regarded mirtrazapine as thier favourite choice (of course she might have just been saying that!). All others (including chlomipramine) increased my psychotics symptoms.
Hope this is of some benefit.Bunny
poster:xbunny
thread:729551
URL: http://www.dr-bob.org/babble/20070201/msgs/729894.html