Posted by munificentexegete on February 15, 2007, at 7:42:15
In reply to Re: low dose risperdal -- linkadge, posted by linkadge on February 14, 2007, at 18:55:44
>>Sure, however, there is nothing physically wrong with them, anxiety in the absence of biological markers is just a feeling nothing more is it not? There should be biological markers in the case of chronic pain: epinephrine, norepinephrine, cortisol levels, and beta-endorphins, insulin production, glucagon, growth hormone, prolactin, heart rate, blood pressure, vagal tone, oxygen saturation, breathing, intracranial pressure, and sweating can all be >used to measure the stress response and pain. I am sure there are many more markers for pain.
> Unfortunately these are not always practical diagnostic markers. It is possible for an individual to experience chronic pain in the absence of such indicators.
How is that possible? Pain is a pathophysiological process. Some of the chemicals involved include prostaglandins and a protein called cyclooxygenase 2 (COX-2), these can be measured. It also affects other metabolic pathways and systems operating within the body, it can be identified directly or indirectly, you can test for it with the test I listed above, there are probably many more. A doctor has many lab test to prove the presence and persistence, even the severity of pain.
> I would not deny a person medication for chronic pain based on the fact that no test indicates they are in pain. That could be a grave mistake.
Let's take asprin, it binds to COX2 proteins and stops them from producing protaglandins. If you measured the patient's prostaglandins and found that their levels were not elevated, then prescribing asprin would not reduce the patient's pain, and by disrupting the patient's normal biochemical pain process, actually cause it to malfunction and not operate to produce pain as appropriate, in addition what if the patient dies from internal bleeding from the asprin?
> The same thing goes with depression. I believe there are probably dozens of biochemical imbalances which have not yet been fully discovered let alone have accurate diagnostic tests for.
Yes, however, isn't altering the serotoninergic system when there is no evidence of abnormality introducing iatrogentic disease?
>> Well the doctor isn't really there to deal with anything other than medical issues are they?
> Yes, they are there to deal with medical issues. Due to the unfortunate imperfections of modern science however, they must also work within the realm of presumed medical illnesses. Its like Parkinson's disease. You can treat Parkinson's without seeing anything but physical symptoms. There are no accurate "dopamine" tests or anything to indicate Parkinson's. The same thing goes with Alzheimer's. You cannot truly diagnose Alzheimer's until after death. But doctors will still medicate for what they presume is Alzheimer's. Is that wrong. Maybe some would say so, but I wouldn't.
Well actually the pathophysiology of both Parkinson's and Alzheimer's are well documented. There are two components to consider. The first is diagnosis. In the case of Parkinson's can be diagnosed by physical symptoms such as slowness in movement as well as resting tremor together with MRIs to confirm the existence of damage to the substantive nigra portion of the brain as well as urine, blood, or spinal tests as well as PET scans to confirm changes in the patient's dopamine levels or dopamine receptor performance. The same can be said of Alzheimer's disease where a diagnosis can be made on the basis of biomarker tests such as Beta-amyloid measured in cerebrospinal fluid, Tau protein measured in cerebrospinal fluid, and neural thread protein/AD7C-NTP measured in cerebrospinal fluid and in urine. This can be augmented with FDDNP PET scans and psychological testing. Those tests are necessary to confirm the diagnosis. What a surgeon's scalpel can do to the dead, PET can easily or even more accurately do to a living brain.
Now moving on to the treatment of Parkinson's disease, there are several options. Depending on which part of the dopaminergic system is identified as damaged, dopamine agonists and levodopa may be used. Treatment of Parkinson's with Atropine without evidence that ACh levels are too high, is unsupported. The treatment of Alzheimer's without evidence that ACh levels being too low is also unsupported with the some of the drugs like donepezil acting as nerve toxins, although reversible in nature.
>> If you prescribe medications for a non disease isn't that malpractice? If your doctor prescribed you chemotherapy if you didn't have cancer; would that be malpractice?
> It would only be malpractice if there wasn't good reason to suspect it was cancer. If all the conventional diagnostic tests were utilized and pointed to cancer, then chemotherapy is indicated.
Yes, they would need to provide evidence to support their diagnosis, if the patient died, would that be manslaughter as well?
> Unfortunately, in depression, there are no usefully diagnostic tests, because it is very unlikely that it is one single disease. Not all depressed patients are hypersecretors of cortisol. Not all blood tests, or even post mortem tests indicate low levels of monoamines. But it would be unethical to assume that a person's suffering is artificial just because science lacks the tools to identify the problem.
Sure there are, how many times have you read about Ki bindings, receptor occupancy, even receptor firing rates, dopamine levels, etc, there are literally hundreds of potential diagnostics. Finding disease in a healthy patient without evidence is a medical delusion.
> You do realize, that even if a spinal fluid test indicates low serotonin, that SSRI's or MAOI's are not correcting the problem. So, even for those who can be identified by monoamine tests, all medications are still only working on a symptomatic level. As such, there is no such thing as anyones disease being more physical than another's.
Well if a problem with the serotogenic system is identified, the SSRIs and MAOIs help the brain to increase its use of available serotonin by blocking the reuptake of serotonin. MAOI's work by inhibiting the enzyme monoamine which then stops serotonin and other chemicals from being broken down by the brain.
>> Trigger for what? Delusions (retreating into fantasy worlds, overactive imaginations and apparently even using metaphors in one's speech is a sign of delusion), voices (doesn't everyone have an internal dialog),> How much do these people have to suffer for somebody to help them out? You can excuse their disease, but what does that do? When I was a child, I used to look at my grandfather with Parkinson's and ask my mother "why doesn't he just keep his hands still??"
What are they suffering from? Overactive imaginations and internal dialog? Your grandfather obviously had Parkinson's, however, that has a pathophysiology that can be identified. Can you show me any evidence that anyone diagnosed with schizophrenia has a disease, that their brain will somehow decay overtime, can you show me the malfunctioning or damage to the dopaminergic or serotogenic system, can you show me a gene that proves the disease, can you show me any evidence of any pathophysiology at all? something more than imagination and internal dialog? You don't expect me to trust a diagnosis made without any evidence at all do you? By that definition of disease every human on this planet has schizophrenia. Is medicine a matter of trust, or is it based on science? When we see disease in healthy individuals without any evidence then we have moved from medical science to a medical delusion.
> If you are able to mentally write off the symptoms of schizophrenia, then clearly you do not have it, and should never need antipsychotic medication.
Does a doctor need to have had a disease to diagnose it? He does however need medical evidence to support a medical diagnosis.
> But, why do that to people who do have the disorder?
What disorder? Schizophrenia is a medical delusion.
> If they kill themselves because of their delusions, would you still blame that on an "overactive imagination". Clearly there are degrees of the illness, but trying to write off human suffering is not right IMHO. Everybody knows that these people deserve better than antipsychotics. But what?
People have suicidal thoughts from problems in living, intense stress and severe depression are medically identifiable and treatable. Imagination and internal dialog are not.
There have been many studies performed on the extreme violence induced by akathisia. I believe it is the neurological disease most likely to trigger violence and suicide in otherwise calm and tranquil people, and it occurs in more than 75% of patients injected with 10ml of haloperidol. If you wanted a healthy person to commit suicide, giving them a single medium to large dose of antipsychotic is the only medication I can think of that would be most likely to elicit a suicidal response. I wonder what the suicide rate would be for healthy people from a single dose of haloperidol at 10, 20, 30 and 40mg, do you think we would reach the Ld50, not from toxicity, but from suicide? Btw 40mg is seen as a therapeutics dose for a persons diagnosed with “schizophrenia”.
On the other hand, if you have the PET scan / lab results in front of you and can see the overactivity of the dopaminergic system, then you may well in such a circumstance be justified in suggesting such a medication.
>> paranoia (being scared is a natural emotion like anxiety or depression), disorganised speech (not having perfect grammar is apparently a sign of disease), talking too quickly, showing too much emotion, showing too little emotion, talking too slowly, blunted emotions, having a messy haircut, wearing “odd” clothes, facial hair, not doing the dishes, quirky personality, not working for extended periods of time, not agreeing with the government.
> Let those who can get by without drugs do so.
Medical intervention is only justified if evidence of a medical disease exists.
>>With a migraine there is probably something to measure I would have thought, I could be wrong though, however, I would imagine there would be some enzyme or some identity to be traced, even the pain and stress markers that I listed above would probably be enough to guide a doctor in identifying a true migraine patient from a morphine addict.
> You don't treat migraines with morphine. They can be treated with other drugs which are generally not abusable. Patients generally don't fake migraines to get on triptans, beta blockers, or anticonvulsants. Just as most people don't fake depression to get on SSRI's. SSRI's are not that good. I found SSRI' therapy very disagreeable, even when I was very depressed.
Many prescription medications are abused and painkillers and stimulants like ritalin are among the most common. How does a doctor know he is treating a bonafide disease and a bonafide patient as opposed to a malingerer or an addict? As a patient all I would have to do is complain about a migraine, then he'll eventually get to the barbituates, morphine, codine, or whatever else I have in mind.
> Sure, there could be some as yet unidentified biological cause of all migrane. Unfortunately, we *do not( have any test which identifies migrane with a high degree of accuracy.
Well there are many established causes of migraines such as head trauma, influenza, encephalitis, tumors etc, however, in the absence of any known diseases I think you would have to test for evidence of pain and stress biomarkers in order to confirm a diagnosis and target the pain relief medication.
>>Otherwise couldn't we all just see the doctor for our weekly barbituate script?> I would not want to live life on barbiturates. I do not find sedatives enjoyable at all, they make me depressed, and use them as infrequently as possible. I am fortunate that they are there when I need them, and am glad that a doctor trusts me to prescribe them, since I know we could go through 1000s of tests and come up with no identifiable cause of anxiety.
Are you sure, how many tests have you had done? If it is that much of a problem in your life, surely you would have had a PET scan by now to look at how all of your receptors are functioning? How many did you have before you were prescribed any medications? I wouldn't take a drug that effected my serotonin system without evidence it was diseased, otherwise I would be introducing extra disease into my body.
> Why should the few people who abuse these drugs ruin it for the rest?
They don't, testing ensures an actual disease is treated. Feeling anxiety is also a natural emotion, are you sure that you are not just a naturally anxious person?
>> Problem is if you compare an equivalent dopamine block in an atypical v typical comparison one gets all the traditional side effects + a lot of new ones from blocking all the other receptors as well. So they are if anything more potent and more dangerous than the old ones,> Not necessarily. We have not yet identified significant negative consequence of say histamine blockade, or 5-ht2a receptor blockade. This does not mean that the drugs are perfectly safe, it just means that it by conventional tests, they could be safer than traditional drugs. For instance, 5-ht1a agonists generally have little toxicity. In very high doses they can cause hypothermia, but many food substances are 5-ht1 agonists, such as olemide.
You are smart enough to know they are almost certainly more toxic, we just don't have the comprehensive independent research as the drug companies sponsor the trials.
>> Risperidone does have a particularly short half life while olanzapine has a medium half life which could build up in the brain tissue over a couple of days. So this means that psychiatrists can up the doses of Atypicals as high as they wish whenever they wish, and the neurological damage they can exact is now even more severe.
> High doses of atypicals are very rarely used for anxiety disorders. In low doses, drugs like risperidal probably achieve their so called anti-anxiety effect through serotonin receptor blockade. I never said the drugs were perfectly safe.
I can see a use for short term use of them if tests provide evidence of abnormal overactivity in the dopamine and serotonin systems but how often is that likely to occur?
>> Notwithstanding the half life issue, they are portraying more potent and toxic drugs as less potent and less toxic to gain acceptance when they are not that at all.> We do not know whether the drugs are more toxic, or less toxic at this point. Only time will tell.
Drug companies will never sponsor trials to properly compare the typical to atypicals, although you know and I both know atypicals have a significantly greater receptor activity and are thus far “dirtier” than typicals. There is no proof that the atypicals are less toxic for a given level of dopamine blockade either. In the absence of any proper head to head comparisons with equivalent D2 blockades, I will lay the gauntlet down and suggest that notwithstanding the long half life typicals, the atypicals are more toxic and more potent chemicals that take toxic nerve seizing medications to new levels, I redub them the first of the antibrain family.
>> I believe they are the presenting to us a pack of wolves and via the design of the research studies, dressing them as sheep.You could be right.
> That's a high rate of TD for a 1mg daily dose for less than a full year of treatment, think about it! I wonder what the 1 year TD score would be at a dose of 6mg+?
> But that rate was not accounting for the the dyskinesias people had on startup. The study highlights said that dyskinesias dropped in some patients switched from typicals.
Yes it was, they measured “persistent emergent dyskinesias”.
> When I took risperidal for anxiety, I took like 0.25-0.5 mg.
Against your will or with your consent?
>>They have all been shown to cause TD
>Yes that is a possibility.
>> pointed to a study regarding low dose risperidone as this thread is about risperidone, and is often seen by many to be one of the least damaging atypicals, but TD data exists for all APs atypical or typical and all the drug company information admits as much.
> I personally didn't think that study was all that scarry.
Really, do you like horror flicks then? Seen “firestarter” :)?
>> Although as has been already shown the atypicals also come with a whole new array of side effects from their wider receptor profile and effects, including more significant metabolic disorders such as diabetes and heart disease.
> Again, I never said they were perfectly safe. There are risks to treatment as well as risks to nontreatment. I understand that sorting things out can be maddening.
Safe, they one of the most toxic medications available and applied to people without evidence of disease as mood stabilisers, anxiety medication or even for better “sleep architecture”. The term neuroleptic chemotherapy is in wide use. Used on persons without identifiable disease, IMHO they are nothing short of the worst example of medicine in modern history. Just because a series of nerve toxins affects dopamine, serotonin, and ardenaline receptors doesn't make them good medications to use on healthy people without evidence of disease. IMHO the iatrogenic neurological disease these medications cause is unprecedented; a universe of devastation.
>> I think you'll agree that when the drug company itself admits this to be the case in their drug information pamphlet, then it is fairly well established.
> I never doubted that TD is a possible side effect of antipsychotic treatment.
Agreed then.
>> Of course it is. Without any medical evidence that schizophrenia is real, it can only be an imaginary disease. Without evidence seeing an imaginary disease in a healthy patient is a medical delusion.
> Well then I guess alzheimers, migrane, parkinsons etc, CFS, are just medical delusions too.
They all have specific pathophysiologies that can be identified with relevant medical tests. There is no doubt that those diseases can be identified in a patient.
> There is medical evidence that schizophrenia is a medical disease. There are usually a number of physical alterations/abnormalities of the brain's of those with schizophrenia, namely hippocampal and temporal lobe abnormalities, grey matter abnormalities. Disorder of the prefrontal cortex, mitochonidial dysfunction, abnormalities of glutamatergic function. Abnormalties in intracellular activity, PKC, GSK-3b, GAP-43, calcuium, etc. Those who research the genetics and anatomy of schizophrenia have little doubt that it is a disease, however there is not a whole lot of take home points from these findings, nor any clear tests to identify it in living patients.
Unlike Alzeihmer's and Parkinson's, Schizophrenia does not have any proven pathology. There is literally no lab test for schizophrenia. Those abnormalities you mentioned may indeed exist in a patient diagnosed with schizophrenia, however, they do not define Schizophrenia. Ironically if the pathophysiology if schizophrenia were to be identified it would be reclassified as a neurological disease and treated by neurologists. Although I can guarantee you that day will never come, as the pathology of an overactive imagination is not a disease and so it will never be discovered. IMHO Schizophrenia is nothing short of the biggest delusion in medical history.
>> Now we have moved from the scientifically based world of medical science into the alternate universe of theoretical medicine.> Nobody is forcing you to believe that this is in fact a disease. If you want to believe that schizophrenia is just a figment of the imagination, then go right ahead.
Thanks I refuse to agree to a delusion. I need some medical evidence.
> This affliction will still continue to plague humanity whether people want to believe that it a result of some brain abnormality, or possession by spawn of Lucifer.
I don't consider an overactive imagination, or having internal dialog a disease, a plague or even a problem. We all have imagination, we all have internal dialog. Sure we might have some problems, get fired from work, break up with our girlfriends, and our internal dialog might change to being more negative, our feelings from happy to scared, but that is a normal human brain reacting in a normal way to the pressures of normal life. Some people even retreat into an imaginary world as a coping mechanism, but that still a disease does not make. A doctor is a medical scientist, he demands evidence that disease exists or he can no longer be defined as a doctor.
>> From reality to imaginary, from fact to fiction we go. We can hypothesize that a person may have some sort of unknown disease, however, such a disease is hypothetical, imaginary, unproved, unsupported, not based on evidence, not scientific fact.> Of course it is not a scientific fact. There are a lot of things in life that we respond to without having to beforehand establish them as scientific fact.
*Gasps in shock*
>> A person cannot be diagnosed with an imaginary theoretical disease, it is an unsupportable diagnosis, it is not medical science.
It is supportable, just not 100% conclusive. There are a lot of things in life that are not 100% conclusive. Scientists are still in the realm of collecting data and formulating hypothesis about many of these problems. But in the meantime, I urge you to establish a treatment modality which is more efficacious than the one at present.
Can we diagnose everyone schizophrenic and treat them to antipsychotic medication? They all have imagination, and all have internal dialog? We can say we are not 100% certain, however, early treatment prevents worsening of the disease. Perhaps we should add antipsychotic medication into the water supply?
> But, if you feel there is nothing wrong, then this conversation is pointless. If your reason for visiting this site is simply to tell us that we are all perfectly healthy people, then your comment is duely noted.
No, I find medicine an infinitely fascinating topic of interest, and this site is a valuable source of information. However, I do think that some areas of medicine seemed to have blurred the line between evidence based science and fantasy, and so I bring an interesting perspective as do you.
>Without evidence of disease we cannot ever be justified in treating anyone against their will;
I agree with you 110%.
thumbs up
>>Horrifying stuff when you consider that risperidone now has a FDA warning for diabetes. Is involuntary treatment of a patient by a doctor without evidence of disease a criminal activity?
>I think that anybody has the legal right not to take medication if they so choose. But legality is a separate issue.
Never mind probably a legal not medical question anyway.
>> The medical profession, the psychiatrists are the main culprits but gps do it too, shouldn't be allowed to go around diagnosing people with imaginary diseases and treating them for it by giving them pesticides, lobotomies or electricity, but that's exactly what they do.
> For starters I don't even think the lobotomy occurs anymore. So we can scratch that one off the list. I agree with you 100% that people should never be treated against their will. But for those who concentually want to be treated with antipsychotics, antidepressants, or ECT, I believe they should have the right.Sure lobotomies still occur in Australia, UK, and most states of America to the best of my knowledge. However, I am saddened when I read all the posts of a patient who had “an eating disorder” who within 2 months is on antipsychotics, or someone else is on them for insomnia, or even for people who find they chat to themselves every now and find themselves feeling scared and alone. Do they deserve to be diagnosed with imaginary diseases and treated with some of the most toxic medications available?
>Sometimes the best medicine is no medicine at all.
I agree.
>How can you help someone without a disease?
> Thats a good question. I don't know why TCA antidepressants worked when they did. I don't know why sedatives work. Do I not have a disease? I don't really care. I'm here because medications have helped me in the past.
Is it possible you did have a problem with serotonin and so the antidepressants worked as a result?>> from a medical point of view you can't, in fact if you treat a healthy person, then you run the risk of introducing iatrogenic disease in an otherwise healthy person.
> What is your definition of a healthy person? When I was getting 2 hours of sleep, vomiting from anxiety, crying 3+ hours a day, shaking, eating nothing, hiding in a corner and actively suicidal, I suppose there was nothing at all wrong with me. Just a healthy person going about their daily living. All I care was that the medications helped me to get better.
I am sorry to hear you went through all that. I am sure that in that state your receptors, and catecholamine levels would have been all over the place even your glucose levels would have been much lower than usual, with good testing I feel confident they could have identified problems and treated you with the best medications for your condition. That combined with therapy would have been a good solution imho.
>> If a patient feels depressed or anxious then they shouldn't necessarily think that it is due to a disease.
I agree.
>> If there is something genuinely wrong with the patient, it will be possible to find it, there will be changes in brain structure or activity, enzyme, chemicals, t cell or cortisol changes, something indicating that something is amok with the body or brain.
> Sorry, but I totally disagree with you. There are *no* conventional diagnostic tests for depressive or anxiety disorders. Like I said above, only a fraction of depressed patients show cortisol abnormalities. There is some evidence of regional brain hypofunction in depressed patients, but it is not unique to depression, ie it occurs in all sorts of other psychiatric disorders. The levels of monoamine metabolities in the cerebral spinal fluid is only a measure of monoamine breakdown, it says nothing about how well a particular monoamine is functioning. It says nothing about the integrity or responsiveness of the receptors.
Like i said before, you know the technology they use for testing the drugs is available, MRI, Pet, urine, blood. Everything you ever wanted to identify even the tiniest abnormality in your brain or body. They can even show all the chemical changes and receptor activities that occur in response to social stimulus for example, you can literally see that some people have a negative impact on our brain's chemistry.
>>Without any hard evidence, it is not possible to confirm a diagnosis of disease and treating a medical delusion may only serve to injure an otherwise healthy patient.
> Or it may help. I was diagnosed with depression without any "hard" evidence. I was not injured by treatment, and I believe the treatment aided in my recovery. I am no longer on any medications.
Maybe you were just lucky? What about those that die from the iatrogenic disease such treatments methodology certainly introduces?
>>Once a patient starts taking the antipsychotics they can measure all manner of iatrogenic disease, including brain, blood and heart diseases.> I reiterate. Those are possible side effects. There is no data to prove that all patients will get such side effects.
We both know what they really do to a brain.
poster:munificentexegete
thread:730044
URL: http://www.dr-bob.org/babble/20070213/msgs/733012.html