![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by jackflash2 on July 12, 2001, at 22:01:41
Can you suffer brain damage as a result of using Thorazine? I've been on it for the past four months and it is difficult to think clearly and to act. I am off of it now. I'm bipolar--bipolar 1--I take it in addition to lithium. It's hard as hell to function and to think clearly. Hopefully this is a temporary side-effect. I am currently moving towards using Neurontin and Depakote.
John
Posted by Else on July 14, 2001, at 5:54:19
In reply to Thorazine and brain damage, posted by jackflash2 on July 12, 2001, at 22:01:41
Long-term use of most APs can cause brain damage (tardive diskinesia). From what I read, it happens mostly to elderly women who have been taking these drugs for many years. Since Thorazine is very sedating, you would expect it to impair thinking but I have never heard of this as a long term result of AD use. However, Thorazine is one of the drugs most likely to produce tardive dyskinisia (which is unsightly and irreversable). I surprised that doctors still prescribe this, especially to bipolar patient who are at greater risk. Maybe you doc only intends to keep you on these for a short time. If not, I would be concerned.
> Can you suffer brain damage as a result of using Thorazine? I've been on it for the past four months and it is difficult to think clearly and to act. I am off of it now. I'm bipolar--bipolar 1--I take it in addition to lithium. It's hard as hell to function and to think clearly. Hopefully this is a temporary side-effect. I am currently moving towards using Neurontin and Depakote.
>
> John
Posted by Else on July 14, 2001, at 6:27:08
In reply to Thorazine and brain damage, posted by jackflash2 on July 12, 2001, at 22:01:41
This is an article about TD with pictures. It does however bear repeating that youger people are less at risk, especially if they have been using low doses for short time periods.
http://www.nature.com/nm/voting/lecture.html
> Can you suffer brain damage as a result of using Thorazine? I've been on it for the past four months and it is difficult to think clearly and to act. I am off of it now. I'm bipolar--bipolar 1--I take it in addition to lithium. It's hard as hell to function and to think clearly. Hopefully this is a temporary side-effect. I am currently moving towards using Neurontin and Depakote.
>
> John
Posted by judy1 on July 14, 2001, at 9:18:02
In reply to Thorazine and brain damage, posted by jackflash2 on July 12, 2001, at 22:01:41
I try to avoid posts like these, they greatly upset me. Yes, Thorazine is one of the worst offenders of TD, it is a drug I was forced to take during a hospitalization 10 years ago for a manic episode. I, too, am shocked that your pdoc is using an older AP- unless you are not having success with atypical ones? If your episodes are mainly manic (I am also dxed bipolar 1) then you should be happier using depakote over lithium. Neurontin really has no effect in people with our disorder, most of the trials show little difference between that and placebo in people with bipolar 1. The perk of course is there are little or no side effects. If you have access to a psychiatrist who specializes in bipolar disorder (and they are usually current with their choice of medication) then I think you will find it worthwhile to seek a second opinion. Major Universities with Depts. of Psychiatry are the best choices. I wish you all the best- judy
Posted by Elizabeth on July 15, 2001, at 17:03:05
In reply to Re: Thorazine and brain damage, posted by Else on July 14, 2001, at 5:54:19
> Long-term use of most APs can cause brain damage (tardive diskinesia).
TD is irreversible in some cases, but more often than not it goes away, or at least improves after a while, if you go off the offending drug. It's a common but incorrect belief that it's always permanent.
Also, you might be surprised to learn that in studies of neuroleptics, some patients who were on placebo got movement disorders. Also, some people
It's possible that people with schizophrenia may be at increased risk;
> From what I read, it happens mostly to elderly women who have been taking these drugs for many years.Older women are more at risk, yes. And the risk increases the longer you take the drug.
It used to be that psych hospitals were full of people with bizarre movement disorders. Today when an antipsychotic is needed they mostly use the atypicals (Zyprexa, Risperdal, Seroquel, Geodon, etc.), and extrapyramidal symptoms are much less common. Atypical APs do have the potential to cause EPS or TD, but the risk is much lower than the risk from older drugs such as Thorazine and Haldol.
BTW, sometimes antipsychotics are good for short-term use in mania.
-elizabeth
Posted by Else on July 17, 2001, at 6:47:45
In reply to Re: Thorazine and brain damage » Else, posted by Elizabeth on July 15, 2001, at 17:03:05
I don't disagree with you on any of this. I can be a bit brutal when giving an explanation so maybe I should stop trying. My point is, I would not give something like Thorazine a chance knowing what I know. As unlikely as permanent TD may be, there is no guarantee it wont happen and I don't find this is a risk worth taking given the other options availlable.
> > Long-term use of most APs can cause brain damage (tardive diskinesia).
>
> TD is irreversible in some cases, but more often than not it goes away, or at least improves after a while, if you go off the offending drug. It's a common but incorrect belief that it's always permanent.
>
> Also, you might be surprised to learn that in studies of neuroleptics, some patients who were on placebo got movement disorders. Also, some people
> It's possible that people with schizophrenia may be at increased risk;
> > From what I read, it happens mostly to elderly women who have been taking these drugs for many years.
>
> Older women are more at risk, yes. And the risk increases the longer you take the drug.
>
> It used to be that psych hospitals were full of people with bizarre movement disorders. Today when an antipsychotic is needed they mostly use the atypicals (Zyprexa, Risperdal, Seroquel, Geodon, etc.), and extrapyramidal symptoms are much less common. Atypical APs do have the potential to cause EPS or TD, but the risk is much lower than the risk from older drugs such as Thorazine and Haldol.
>
> BTW, sometimes antipsychotics are good for short-term use in mania.
>
> -elizabeth
Posted by Elizabeth on July 18, 2001, at 0:40:29
In reply to Re: Thorazine and brain damage, posted by Else on July 17, 2001, at 6:47:45
> I don't disagree with you on any of this. I can be a bit brutal when giving an explanation so maybe I should stop trying. My point is, I would not give something like Thorazine a chance knowing what I know. As unlikely as permanent TD may be, there is no guarantee it wont happen and I don't find this is a risk worth taking given the other options availlable.
I don't, either. I can't envision a circumstance when it would be better to take that risk rather than at least using one of the newer antipsychotics with which the risk seems to be much decreased. I certainly wouldn't want to take Thorazine (although I did take Mellaril once for insomnia -- it was a little too effective -- and Compazine several times for n&v).
-elizabeth
Posted by Else on July 18, 2001, at 14:00:40
In reply to Re: Thorazine and brain damage » Else, posted by Elizabeth on July 18, 2001, at 0:40:29
I took a phenothiazine called Histantil once as a sleeping aid, I don't know if that's the US name. It is chemically related to Thorazine although it is marketed as an anti-emetic. The generic product is called promethazine I think. Anyway. It knocked me out cold for 18 hours and I was depressed for 3 or for days after that. I hate these drugs. And I only took 1 pill of the smallest dose possible (25 mg). I can only nimagine what Thorazine must be like.
> > I don't disagree with you on any of this. I can be a bit brutal when giving an explanation so maybe I should stop trying. My point is, I would not give something like Thorazine a chance knowing what I know. As unlikely as permanent TD may be, there is no guarantee it wont happen and I don't find this is a risk worth taking given the other options availlable.
>
> I don't, either. I can't envision a circumstance when it would be better to take that risk rather than at least using one of the newer antipsychotics with which the risk seems to be much decreased. I certainly wouldn't want to take Thorazine (although I did take Mellaril once for insomnia -- it was a little too effective -- and Compazine several times for n&v).
>
> -elizabeth
Posted by MB on July 18, 2001, at 14:45:14
In reply to Re: Thorazine and brain damage, posted by Else on July 18, 2001, at 14:00:40
> I took a phenothiazine called Histantil once as a sleeping aid, I don't know if that's the US name. It is chemically related to Thorazine although it is marketed as an anti-emetic. The generic product is called promethazine I think. Anyway. It knocked me out cold for 18 hours and I was depressed for 3 or for days after that. I hate these drugs. And I only took 1 pill of the smallest dose possible (25 mg). I can only nimagine what Thorazine must be like.
I wish there was a way to block the antihistaminic action of these psychotropic drugs. Remeron would have been perfect for me if it hadn't have been for the antihistamine sedation. I guess an H-1 agonist (to counteract the H-1 blocking action of these drugs) would make a person miserable. Wouldn't it cause allergic-type reactions? Hmmmm...I wish there was a way....
parenthetically, can you believe my doctor switched me to Remeron when I told him Paxil was making me too tired and that I was gaining weight? Do these guys even listen?
Posted by Elizabeth on July 18, 2001, at 17:53:50
In reply to Re: Thorazine and brain damage, posted by Else on July 18, 2001, at 14:00:40
> I took a phenothiazine called Histantil once as a sleeping aid, I don't know if that's the US name. It is chemically related to Thorazine although it is marketed as an anti-emetic. The generic product is called promethazine I think.
Phenergan is the common brand name in the US. Promethazine is a phenothiazine but isn't much of a dopamine antagonist like Thorazine is, which is why it's not used as an antipsychotic. It's just a very strong antihistamine.
> Anyway. It knocked me out cold for 18 hours and I was depressed for 3 or for days after that.
Sounds like you should avoid centrally-acting ("drowsy") antihistamines, then.
> I hate these drugs. And I only took 1 pill of the smallest dose possible (25 mg). I can only nimagine what Thorazine must be like.
Thorazine would probably be different (in a not-necessarily-pleasant way) since it's a dopamine antagonist (that's what makes it an antipsychotic) as well as an antihistamines. Some phenothiazines are more sedating than others (Thorazine is one of the more sedating ones); the sedation is due to various pharmacologic actions.
-elizabeth
Posted by Else on July 18, 2001, at 18:48:54
In reply to Re: Thorazine and brain damage » Else, posted by MB on July 18, 2001, at 14:45:14
My doc suggested Seroquel when I told him Zoloft was making me apathetic and indifferent. No, they don't.
> > I took a phenothiazine called Histantil once as a sleeping aid, I don't know if that's the US name. It is chemically related to Thorazine although it is marketed as an anti-emetic. The generic product is called promethazine I think. Anyway. It knocked me out cold for 18 hours and I was depressed for 3 or for days after that. I hate these drugs. And I only took 1 pill of the smallest dose possible (25 mg). I can only nimagine what Thorazine must be like.
>
> I wish there was a way to block the antihistaminic action of these psychotropic drugs. Remeron would have been perfect for me if it hadn't have been for the antihistamine sedation. I guess an H-1 agonist (to counteract the H-1 blocking action of these drugs) would make a person miserable. Wouldn't it cause allergic-type reactions? Hmmmm...I wish there was a way....
>
> parenthetically, can you believe my doctor switched me to Remeron when I told him Paxil was making me too tired and that I was gaining weight? Do these guys even listen?
Posted by Else on July 18, 2001, at 18:56:26
In reply to Re: Thorazine and brain damage » Else, posted by Elizabeth on July 18, 2001, at 17:53:50
Wouldn't dopamine blockade cause further sedation? I figured since drugs like amphetamines promote alertness by stimulating dopamine and noradrenaline release, then blocking these receptors would do the opposite (make you drowsy) regardless of antihistamine effect. Of course I know very little about anti-psychotics so I'm only guessing. I just saw my brother look like a vegetable on Risperdal and assumed it was sedation since he wasn't psychotic, just hysterical (in the vaguest sense of the word, he threw little tantrums and my parents wanted to make him more manageable). Anyway.
> > I took a phenothiazine called Histantil once as a sleeping aid, I don't know if that's the US name. It is chemically related to Thorazine although it is marketed as an anti-emetic. The generic product is called promethazine I think.
>
> Phenergan is the common brand name in the US. Promethazine is a phenothiazine but isn't much of a dopamine antagonist like Thorazine is, which is why it's not used as an antipsychotic. It's just a very strong antihistamine.
>
> > Anyway. It knocked me out cold for 18 hours and I was depressed for 3 or for days after that.
>
> Sounds like you should avoid centrally-acting ("drowsy") antihistamines, then.
>
> > I hate these drugs. And I only took 1 pill of the smallest dose possible (25 mg). I can only nimagine what Thorazine must be like.
>
> Thorazine would probably be different (in a not-necessarily-pleasant way) since it's a dopamine antagonist (that's what makes it an antipsychotic) as well as an antihistamines. Some phenothiazines are more sedating than others (Thorazine is one of the more sedating ones); the sedation is due to various pharmacologic actions.
>
> -elizabeth
Posted by Elizabeth on July 18, 2001, at 20:26:49
In reply to Re: Thorazine and brain damage » Else, posted by MB on July 18, 2001, at 14:45:14
> I wish there was a way to block the antihistaminic action of these psychotropic drugs.
Some are more antihistaminic than others. Haldol, Stelazine, and Moban are some of the less sedating antipsychotics. Desipramine is the least antihistaminic of the tricyclic antidepressants (although protriptyline is probably more activating).
> Remeron would have been perfect for me if it hadn't have been for the antihistamine sedation.
How much Remeron were you on.
> I guess an H-1 agonist (to counteract the H-1 blocking action of these drugs) would make a person miserable. Wouldn't it cause allergic-type reactions?
Yes, that's one thing histamine does. Opioids, for example, cause histamine release (to varying degrees) which is why a lot of people get itchy on them. Promethazine, diphenhydramine, doxepin, and other antihistamines can be used to prevent the itching.
> parenthetically, can you believe my doctor switched me to Remeron when I told him Paxil was making me too tired and that I was gaining weight? Do these guys even listen?
I take it your question is a rhetorical one. < g >
-elizabeth
Posted by MB on July 18, 2001, at 21:14:49
In reply to Re: Thorazine and brain damage » MB, posted by Elizabeth on July 18, 2001, at 20:26:49
> > I wish there was a way to block the antihistaminic action of these psychotropic drugs.
>
> Some are more antihistaminic than others. Haldol, Stelazine, and Moban are some of the less sedating antipsychotics. Desipramine is the least antihistaminic of the tricyclic antidepressants (although protriptyline is probably more activating).Hey Elizabeth,
I'll have to remember that (above list of less sedating meds). Here are the antihistaminic drugs I've tried: amitryptaline, nortryptaline, olanzapine, thorazine (in my aforementioned act of recreational stupidity < g >), and Remeron. How do those compare to the drugs you mentioned above in terms of antihistaminic action? I have a feeling I'll need to see a pdoc soon for medication (as much as I hate meds, it's been six months off of them, and I've held on as long as I think I can), and might consider the drugs you mentioned (that is, if the doc insists on a tricyclic or neuroleptic).
> > Remeron would have been perfect for me if it hadn't have been for the antihistamine sedation.
>
> How much Remeron were you on.I started at 15mg and moved up to 30mg. Probably not enough for the noradrenergic effect to cancel the antihistamine effect, but I was so zombified from the 30mg that I was scared to go any higher. Also, I was too fatigued to make the twice daily trips to the grocery store necessary to keep my kitchen stocked with food < g >.
> > I guess an H-1 agonist (to counteract the H-1 blocking action of these drugs) would make a person miserable. Wouldn't it cause allergic-type reactions?
>
> Yes, that's one thing histamine does. Opioids, for example, cause histamine release (to varying degrees) which is why a lot of people get itchy on them. Promethazine, diphenhydramine, doxepin, and other antihistamines can be used to prevent the itching."Got so high, I scratched 'til I bled...," Kurt Cobain.
> > parenthetically, can you believe my doctor switched me to Remeron when I told him Paxil was making me too tired and that I was gaining weight? Do these guys even listen?
>
> I take it your question is a rhetorical one. < g >Yeah, just whining as usual...
Posted by Elizabeth on July 19, 2001, at 12:18:42
In reply to Re: Thorazine and brain damage, posted by Else on July 18, 2001, at 18:56:26
> Wouldn't dopamine blockade cause further sedation?
It's not exactly sedation. I've taken antipsychotic drugs (Moban, droperidol) that weren't very sedating for me, but made me very passive in a way that's hard to describe. Then there have been others that didn't have much of the immobilising effect, but just made me feel tired and sleep a lot (Zyprexa, Mellaril). None of them did any good for me.
Seroquel for SSRI-associated apathy? That's interesting. If you do try it, please let me know what the outcome is. When I tried it, Seroquel didn't seem to do much of anything except make me tired. Unfortunately (since I was using it for insomnia), I kept having to increase the dose every few days to maintain the effect.
> I figured since drugs like amphetamines promote alertness by stimulating dopamine and noradrenaline release, then blocking these receptors would do the opposite (make you drowsy) regardless of antihistamine effect.
It's weirder than just being drowsy. It's a sensation that I've never experienced other than on certain antipsychotic drugs.
> I just saw my brother look like a vegetable on Risperdal and assumed it was sedation since he wasn't psychotic, just hysterical (in the vaguest sense of the word, he threw little tantrums and my parents wanted to make him more manageable).
And they gave him Risperdal for that? Did it help at all? I'd think more along the lines of a stimulant, an SSRI, Buspar, clonidine, lithium, or an anticonvulsant.
-elizabeth
Posted by Elizabeth on July 19, 2001, at 12:28:35
In reply to Re: Thorazine and brain damage, posted by MB on July 18, 2001, at 21:14:49
> Here are the antihistaminic drugs I've tried: amitryptaline, nortryptaline, olanzapine, thorazine (in my aforementioned act of recreational stupidity < g >), and Remeron. How do those compare to the drugs you mentioned above in terms of antihistaminic action?
In order of sedation, I'd say that olanzapine > thorazine > amitriptyline > nortriptyline.
Remeron can be very sedating at low doses (7.5-15 mg) but becomes less so at higher doses (30 mg or more).
I'd like it if there were a tricyclic that was an antihistamine without having anticholinergic effects. Those two seem to be tied up together, though.
> I have a feeling I'll need to see a pdoc soon for medication (as much as I hate meds, it's been six months off of them, and I've held on as long as I think I can), and might consider the drugs you mentioned (that is, if the doc insists on a tricyclic or neuroleptic).
I think some of the other atypical antipsychotics, like Seroquel and Geodon, are less sedating than Zyprexa (olanzapine). Those are probably better to try than older drugs like Haldol and Moban, which carry an increased risk of movement disorders.
> I started at 15mg and moved up to 30mg. Probably not enough for the noradrenergic effect to cancel the antihistamine effect, but I was so zombified from the 30mg that I was scared to go any higher.
Going higher makes it *less* sedating. Personally I had no problem with 30-75 mg, but some people are more sensitive to antihistamine sedation than others.
> Also, I was too fatigued to make the twice daily trips to the grocery store necessary to keep my kitchen stocked with food < g >.
I'm less clear on this, but I think the appetite stimulation from Remeron might decrease with increasing doses, too. I didn't gain any weight or experience an increase in appetite on Remeron. (This was a bad thing, since I was very depressed and hadn't been eating.)
> "Got so high, I scratched 'til I bled...," Kurt Cobain.
Exactly! And it's even weirder: some addicts *like* the itching because they associate it with the heroin rush.
I'd sort of be interested in treating drug addicts if I ever get my act together and get through medical school. Addiction is weird in an ineresting way, and I know it's hard for addicts to find doctors (or anyone else) who don't regard them as the scum of the earth and don't believe in making them suffer as much as possible.
> Yeah, just whining as usual...
I'm hardly in any position to criticise you for whining. :)
-elizabeth
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.