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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by jimmygold70 on February 12, 2001, at 18:29:17
I’ve suffered from anxiety disorders from many years so far. My diagnoses vary: Social Phobia (Consensus), Borderline Personality Disorder without temper outbursts (Psychologist), Avoidant Personality Disorder (Psychiatrist I), Schizoid Personality Disorder (Psychologist, Psychiatrist II), Obsessive-Compulsive Personality Disorder (Psychiatrist III).
In short, all clinicians agree that I have an anxiety disorder, most agree that I fall in cluster C, and my psychologist, that seems to be the most knowledgeable of all, Also puts me in Cluster B.
I have tried all sorts of medications: SSRIs (practically each and every), MAOI (phenelzine), RIMA (moclobemide), NARI (reboxetine), SNRI (venlafaxine), Novel (nefazodone,mianserin), Benzodiazepines (clonazepam,alprazolam,alprazolam XR).
I had some, but not overwhelming success with the SSRIs, and I still take sertraline. Anything that acted on the noradrenergic system seemed a failure. Benzodiazepines were good but made me so forgetful in effective doses and ineffective in lower doses.
Then, I suddenly come to know that sulpiride, which is available here in Israel, might be of help. My psychologist also insists that he sees it as helpful in similar situations, but, unfortunately, he cannot prescribe anything…
My psychiatrist (No. III, the last one) insists that I should not take sulpiride, since it will cause me tardive dyskinesia. He has good reasons to believe that – my grandfather of my mother’s side took haloperidol in low doses for Bipolar for many years, and ended up with TD. My father took thioridazine in a low dose for a very short time for acute hypomanic episode, and had severe extrapyramidal symptoms. My psychiatrist insists that, regardless of my genetics, sulpiride is supposed to be effective but harmful in the long term, so he refused to prescribe it.
Eventually, after many efforts, I managed to put my hand on sulpiride, and it does seem to work better than anything else before. I take 50mgx2 (probably the lowest dose possible). I have taken it for a couple of days with no side effects so far.
Now, my plan is to use it for a month and see if it works. However, if I discover that it does (and so it looks so far) – I have a problem. No, it’s very easy to say “don’t take it – why take the risk ?”. But it might be the only available treatment that does work for me. In that case, I might look for two other senior psychiatrists, that would act as a “committee”, and see what they see (BTW I got the idea from the ECT approval here in Israel - you need 3 MDs to sign in order to get it…).
1. What do you think ?
2. Have you seen any similar cases ?
3. Is there really any serious concern for TD with sulpiride in low doses ?
4. Are there any early signs for TD development (i.e. tremor) on sulpiride?
5. And the most important Question (!) – In case sulpiride does work for me, can you think of another drug with similar pharmacology (olanzapine ??? anything ?!) that might help me with lower incidence of EP symptoms ?Thanks a lot !!!
Jimmy
Posted by JahL on February 12, 2001, at 19:16:36
In reply to Sulpiride, Tardive Dyskinesia and Me, posted by jimmygold70 on February 12, 2001, at 18:29:17
> I’ve suffered from anxiety disorders from many years so far. My diagnoses vary: Social Phobia (Consensus), Borderline Personality Disorder without temper outbursts (Psychologist), Avoidant Personality Disorder (Psychiatrist I), Schizoid Personality Disorder (Psychologist, Psychiatrist II), Obsessive-Compulsive Personality Disorder (Psychiatrist III).
> I have tried all sorts of medications: SSRIs (practically each and every), MAOI (phenelzine), RIMA (moclobemide), NARI (reboxetine), SNRI (venlafaxine), Novel (nefazodone,mianserin), Benzodiazepines (clonazepam,alprazolam,alprazolam XR).> Then, I suddenly come to know that sulpiride, which is available here in Israel, might be of help. My psychologist also insists that he sees it as helpful in similar situations, but, unfortunately, he cannot prescribe anything…
> My psychiatrist (No. III, the last one) insists that I should not take sulpiride, since it will cause me tardive dyskinesia. He has good reasons to believe that – my grandfather of my mother’s side took haloperidol in low doses for Bipolar for many years, and ended up with TD. My father took thioridazine in a low dose for a very short time for acute hypomanic episode, and had severe extrapyramidal symptoms. My psychiatrist insists that, regardless of my genetics, sulpiride is supposed to be effective but harmful in the long term, so he refused to prescribe it.
> Eventually, after many efforts, I managed to put my hand on sulpiride, and it does seem to work better than anything else before. I take 50mgx2 (probably the lowest dose possible). I have taken it for a couple of days with no side effects so far.
> Now, my plan is to use it for a month and see if it works. However, if I discover that it does (and so it looks so far) – I have a problem. No, it’s very easy to say “don’t take it – why take the risk ?”. But it might be the only available treatment that does work for me. In that case, I might look for two other senior psychiatrists, that would act as a “committee”, and see what they see (BTW I got the idea from the ECT approval here in Israel - you need 3 MDs to sign in order to get it…).
> 1. What do you think ?Personally speaking, the benefits from Sulpiride were apparent almost immediately and did not increase with time.
> 2. Have you seen any similar cases ?Sulpiride is the only drug to help with my social phobia. I take 150mg every morning.
> 3. Is there really any serious concern for TD with sulpiride in low doses ?
The psychiatrist who prescribed it said there was no cause 4 concern due to its specifity for (I think) D3 receptors. Other pdocs I have seen since have concurred with this opinion. However I've seen at least one article that says in practise Sulpiride is just as likely to cause TD as conventional APs.
Personally I'm a little concerned; it's not a drug I intend being on forever.
> 4. Are there any early signs for TD development (i.e. tremor) on sulpiride?
Apparently you should watch out for fine tongue vermiculations. I think this is so for APs generally.
> 5. And the most important Question (!) – In case sulpiride does work for me, can you think of another drug with similar pharmacology (olanzapine ??? anything ?!) that might help me with lower incidence of EP symptoms ?
Amisulpride?
Jah.
Posted by AndrewB on February 13, 2001, at 3:15:44
In reply to Sulpiride, Tardive Dyskinesia and Me, posted by jimmygold70 on February 12, 2001, at 18:29:17
Jimmy,
Neuroleptics commonly cause TD with long range use at high doses and can on occassion cause it at low doses. Sulpiride and amiuslpride are both known to cause much less and incidence of extrapyramidal symptoms than older neuroleptics in high doses. My impression is that TD is also not very common when they are used in high doses. I haven't heard of any cases of TD being caused by low doses of sulpiride or its cousin amisulpride. I've used amisulpride for over a year and a half without side effects. It is common for p-docs to lump the side effects of high dose neuroleptics such as sulpiride with the low dose use of them. This doesn't make since though because low dose neuroleptics like sulpiride work in what can most simply be described as in an physiological opposite manner of the high doses. Whereas the high doses are blocking a receptor that can thus cause TD, low doses are actually (indirectly) stimulating them.
Glad the sulpiride helps. Don't be afraid to try a higher dose.
Anyway- if it eases your mind- Memantine, an NMDA agonist, prevents neuroleptic TD. You can add it on if necessary. It is safe and without side effects.
AndrewB
Posted by JohnX on February 15, 2001, at 3:54:56
In reply to Re: Sulpiride, Tardive Dyskinesia and Me, posted by AndrewB on February 13, 2001, at 3:15:44
> Jimmy,
>
> Neuroleptics commonly cause TD with long range use at high doses and can on occassion cause it at low doses. Sulpiride and amiuslpride are both known to cause much less and incidence of extrapyramidal symptoms than older neuroleptics in high doses. My impression is that TD is also not very common when they are used in high doses. I haven't heard of any cases of TD being caused by low doses of sulpiride or its cousin amisulpride. I've used amisulpride for over a year and a half without side effects. It is common for p-docs to lump the side effects of high dose neuroleptics such as sulpiride with the low dose use of them. This doesn't make since though because low dose neuroleptics like sulpiride work in what can most simply be described as in an physiological opposite manner of the high doses. Whereas the high doses are blocking a receptor that can thus cause TD, low doses are actually (indirectly) stimulating them.
>
> Glad the sulpiride helps. Don't be afraid to try a higher dose.
>
> Anyway- if it eases your mind- Memantine, an NMDA agonist, prevents neuroleptic TD. You can add it on if necessary. It is safe and without side effects.
>
> AndrewBAndrew,
Are you saying that Memantine prevents neuroleptic
TD while taking the other med? Or can it help when
taken *after* TD happens?Greatly appreciate a reply.
-john
Posted by Sunnely on February 18, 2001, at 1:25:23
In reply to Sulpiride, Tardive Dyskinesia and Me, posted by jimmygold70 on February 12, 2001, at 18:29:17
Hi Jimmy,
Virtually all older generation of antipsychotics, including sulpiride, have been reported to cause TD.
Sulpiride, a substituted benzamide, developed in France, was first used clinically in the field of gastroenterology (anti-ulcer) in 1966. (Metoclopramide or Reglan, an anti-ulcer drug, is also a substituted benzamide but without antipsychotic effect. This drug has also been reported to cause TD.) Sulpiride is the oldest and the most widely used of the substituted benzamides. This group of antipsychotics selectively block D2/D3 receptors. Other antipsychotic drugs belonging to this group include remoxipride, raclopride, emonapride, and amisulpride. Sulpiride is widely used in Europe as an antipsychotic but never exported in the U.S. as it was presumed that its effectiveness was not impressive and it produced more extrapyramidal symptoms (EPS) than expected. As an antipsychotic, it requires higher doses (600 - 1800 mg/day) as it does not readily cross the blood-brain barrier but at these doses, produces pronounced increase in prolactin level. In smaller doses, it may have an antidepressant effect.
In general, the risk factors for future development of TD with the use of antipsychotic drugs include the following:
1. AGE - elderly. The incidence of TD (rate of occurrence of new cases in a given period) per year in young adults is 5% while 30% after one year in the elderly. Age is the most common consistent risk factor for TD.
2. SEX - Female. Women appear to have a higher prevalence rate (number of existing cases at any given time) of SEVERE TD than men. Evidence suggests, however, that this is limited to the geriatric age range.
3. PSYCHIATRIC DIAGNOSES - Those with OBS (Organic Brain Syndrome) including dementing diseases such as Alzheimer's, neurological disorders, affective disorders (depression and bipolar disorder higher than schizophrenia) are at risk for TD.
4. DOSAGE AND DURATION of antipsychotic use - The higher the dose and the longer the duration, the higher the chance of developing TD. "Intermittent (or Targeted)" antipsychotic treatment appears to pose higher risk for TD than "continuous low-dose" antipsychotic treatment.
5. Concurrent use of ANTICHOLINERGIC drugs.
6. EARLY SIGNS OF EPS such as parkinsonism, acute akathisia, dystonic reactions.
7. SMOKING - Associated with increase prevalence of TD. Hypothesis is that nicotine stimulates dopamine release from the nigrostriatal neurons. On the other hand, it was suggested that there is an inverse (opposite) relationship between smoking and the prevalence of Parkinson's disease.
8. ALCOHOLICS - Schizophrenics with history of alcohol abuse have significantly higher TD scores than nonabusers.
9. DIABETICS on antipsychotics have higher risk for TD than nondiabetics on antipsychotics.
10. UNKNOWN INDIVIDUAL FACTORS - Possibly a genetically determined vulnerability plays an essential part.
===============================================
> I’ve suffered from anxiety disorders from many years so far. My diagnoses vary: Social Phobia (Consensus), Borderline Personality Disorder without temper outbursts (Psychologist), Avoidant Personality Disorder (Psychiatrist I), Schizoid Personality Disorder (Psychologist, Psychiatrist II), Obsessive-Compulsive Personality Disorder (Psychiatrist III).
>
> In short, all clinicians agree that I have an anxiety disorder, most agree that I fall in cluster C, and my psychologist, that seems to be the most knowledgeable of all, Also puts me in Cluster B.
>
> I have tried all sorts of medications: SSRIs (practically each and every), MAOI (phenelzine), RIMA (moclobemide), NARI (reboxetine), SNRI (venlafaxine), Novel (nefazodone,mianserin), Benzodiazepines (clonazepam,alprazolam,alprazolam XR).
>
> I had some, but not overwhelming success with the SSRIs, and I still take sertraline. Anything that acted on the noradrenergic system seemed a failure. Benzodiazepines were good but made me so forgetful in effective doses and ineffective in lower doses.
>
> Then, I suddenly come to know that sulpiride, which is available here in Israel, might be of help. My psychologist also insists that he sees it as helpful in similar situations, but, unfortunately, he cannot prescribe anything…
>
> My psychiatrist (No. III, the last one) insists that I should not take sulpiride, since it will cause me tardive dyskinesia. He has good reasons to believe that – my grandfather of my mother’s side took haloperidol in low doses for Bipolar for many years, and ended up with TD. My father took thioridazine in a low dose for a very short time for acute hypomanic episode, and had severe extrapyramidal symptoms. My psychiatrist insists that, regardless of my genetics, sulpiride is supposed to be effective but harmful in the long term, so he refused to prescribe it.
>
> Eventually, after many efforts, I managed to put my hand on sulpiride, and it does seem to work better than anything else before. I take 50mgx2 (probably the lowest dose possible). I have taken it for a couple of days with no side effects so far.
>
> Now, my plan is to use it for a month and see if it works. However, if I discover that it does (and so it looks so far) – I have a problem. No, it’s very easy to say “don’t take it – why take the risk ?”. But it might be the only available treatment that does work for me. In that case, I might look for two other senior psychiatrists, that would act as a “committee”, and see what they see (BTW I got the idea from the ECT approval here in Israel - you need 3 MDs to sign in order to get it…).
>
> 1. What do you think ?
> 2. Have you seen any similar cases ?
> 3. Is there really any serious concern for TD with sulpiride in low doses ?
> 4. Are there any early signs for TD development (i.e. tremor) on sulpiride?
> 5. And the most important Question (!) – In case sulpiride does work for me, can you think of another drug with similar pharmacology (olanzapine ??? anything ?!) that might help me with lower incidence of EP symptoms ?
>
> Thanks a lot !!!
> Jimmy
Posted by grapebubblegum on February 18, 2001, at 6:48:51
In reply to Re: Sulpiride, Tardive Dyskinesia and Me » jimmygold70, posted by Sunnely on February 18, 2001, at 1:25:23
All of you in this thread seem very knowledgeable. Here is a quote from Jimmy that I want to comment on:
(quote): "I had some, but not overwhelming success with the SSRIs, and I still take sertraline. Anything that acted on the
noradrenergic system seemed a failure. "My question is: since I don't know exactly what you are saying (I have tried to learn about the various receptors but sort of got lost) could this be the reason that I have had relative success with Zoloft but totally bombed out in a major way when I tried Luvox?
More importantly, though, would you guys please check out my question that no one has responded to, posted on 2/16, called "Panic attack meds: this Z or that Z?" Thank you. If anyone can give me a clue about this I will be grateful.
This is the end of the thread.
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