![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 7 to 31 of 38. Go back in thread:
Posted by SLS on February 6, 2007, at 18:33:39
In reply to Re: J+J and Janssen in trouble over Risperdal, posted by linkadge on February 6, 2007, at 14:32:30
> Risperdal just brought be down. The other atypicals at least had some more antidepressant effect (for me).
>
> Risperidal also gave me this weird sensation like I was two half people living in the same body. It was like I was present in both my hemispheres but they were not communicating.
>
> Really messed up, and freaky.
How long were you on it? Just curious.
- Scott
Posted by Jay on February 6, 2007, at 19:15:11
In reply to Re: J+J and Janssen in trouble over Risperdal, posted by med_empowered on February 5, 2007, at 17:20:02
I think this "Risperdal Backlash' is based more on how they marketed the med, rather then any problems with the med itself. I'd also point to caution of posting such one-sided info on here, as many people may be on this drug, and it will not only scare them extremely , but could cause them to stop the drug, and cause very disastourus results.
I've heard a number of very good uses of Risperdal from everybody from pdocs to family docs. Risperdal used at a dose of 1-2 mg for a few days can stop dysphoric mania in it's tracks. Small doses of .5 mg's of Risperdal help with certain problems like SAD and Chronic Fatigue. It seems to work excellent for BP2-3. I've been on up to a 4mg a day dose of Risperdal for many years for my BP2 and GAD, with great results. I may even need to turn to the med again in the future. My *only* reasoning for stopping it was to take a more sedating atypical, as I was having some real problems dealing with a very stressful situation at my job which prevented me from sleeping good.
Yes, there may be finer points to argue over most medications, and psych meds are no exception. But, I will testify even for myself, that I as well as many millions are living proof these drugs work well in helping to give-back to a tattered life, and getting back on your feet.
IMHO,
Jay
Posted by linkadge on February 6, 2007, at 19:50:11
In reply to Re: J+J and Janssen in trouble over Risperdal » linkadge, posted by SLS on February 6, 2007, at 18:33:39
About 3 weeks @ 1mg. It also gave me the worst akathesia, worse than seroquel @75 or zyprexa @ 5mg.
Linkadge
Posted by linkadge on February 6, 2007, at 19:51:11
In reply to Risperdal has been a life-saver for me..ALL, posted by Jay on February 6, 2007, at 19:15:11
I agree, one mans curse could be another mans cure. If it works for you then just take all else with a grain of salt.
Linkadge
Posted by SLS on February 7, 2007, at 5:31:28
In reply to Re: J+J and Janssen in trouble over Risperdal, posted by linkadge on February 6, 2007, at 19:50:11
> About 3 weeks @ 1mg. It also gave me the worst akathesia, worse than seroquel @75 or zyprexa @ 5mg.
I can see that happening, of course. I would just like to point out that some neuroleptics produce anxiety as a startup side effect rather than akathisia.
I agree with Jay, and hope that these drugs do not become demonized in the same way benzodiazepines were. With what else we have available, I don't think they deserve it.
- Scott
Posted by Jay on February 7, 2007, at 10:04:57
In reply to Re: J+J and Janssen in trouble over Risperdal, posted by SLS on February 7, 2007, at 5:31:28
Yep..Scott and Link, I certainly don't think people should just take the drugs if problems show up, and that people shouldn't be afraid to be critical. Like you said Linkadge, it mostly depends on individual reactions. And Scott, I was very much thinking of the demon/fear stirred up over benzo use in this case. So, basically, I think we'd all agree, start low and go slow, and don't shrug off any side effects. Actually, in the post where I read about (an exception from above) using 2 or so mg of Risperdal at once for a few days, being somewhat useful for dysphoric mania, the author (a pdoc) said they had the same experience with a 2-3 day script of Haldol, at about 5mg. Interesting, because these two meds have some chemical connections.
Best,
Jay
Posted by Chairman_MAO on February 7, 2007, at 11:18:32
In reply to Re: J+J and Janssen in trouble over Risperdal, posted by linkadge on February 6, 2007, at 14:32:30
No one drug should be "brought down", because I believe we should have a free-market economy. It's just that the so-called "antipsychotics" should have to compete with morphine, benzodiazepines, etc. which can be just as effective in the treatment of psychosis, if not more so. And the "patient" can still think!
However, I will agree with you that risperidone is the most horrid of all of the "atypicals". Gynecomastia and other endocrine problems are far too common, viz. they happen at all! The only reason the atypicals are "safer" with regard to tardive dyskinesia AFAIK is that they bind more weakly to and/or dissocate more rapidly from D2 receptors. That's it. There's nothing magical, except perhaps with cloazpine, which is IMHO the only one of the whole class of those drugs anyone should try, as if you have to get to the aypticals, you might as well use the best one.
But far fewer people should be prescribed these things than are. Seroquel seems to be the most benign, but also mostly ineffective for treatment of schizophrenia (which, incedentally, is an obsolete and stigmatizing diagnostic category that should be abandoned).Of course, we live in an age where, despite the fact that acetaminophen/paracetamol is now known to cause liver damage at _therapeutic doses_ in _otherwise healthy individuals_, it is still considered preferable to morphine, which is non-toxic.
Posted by med_empowered on February 7, 2007, at 15:05:57
In reply to Re: J+J and Janssen in trouble over Risperdal » linkadge, posted by Chairman_MAO on February 7, 2007, at 11:18:32
I agree. Think about it: the only reason a drug company can make $$$ off of something as unpleasant as Risperdal is b/c of the RX drug system. We're giving docs waaaay too much power here.
Consumers end up with all costs--some medication costs, doctor costs, costs of side effects, so on and so forth. We should be allowed to purchase and use (or NOT purchase and refrain from using) any drug(s) we see fit. Think about ADHD...amphetamines are old, and cheap. If they were over-the-counter, consumers would probably avoid Adderall XR and what not and go for generic versions...drug costs would be reduced, and we wouldn't have to pay doctors for visits that are solely designed to give us a permission slip("prescription") to have meds that would otherwise be illegal.
In mexico, a lot of pharmacies have doctors on hand--not for controlled rx's, but for basic stuff. So if you come in with minor problems--infections, allergies, colds, whatever--the doc will do a quick consult and recommend some meds to you, and you're done. That's it. Here, you have to make an appointment, pay lots of money to the doc, and then the prescription is likely to be for some expen$ive new drug that doesn't actually benefit the consumer, but does benefit the doctor and drug companies. Its a ridiculous situation.
Posted by Sebastian on February 8, 2007, at 19:15:25
In reply to Re: J+J and Janssen in trouble over Risperdal, posted by med_empowered on February 7, 2007, at 15:05:57
I have to agree with a lot of the things you people are saying.
Risperdal, made me worse than I was. I started holucinating on it, my mucles were stiff as a board when on it, made me hungry, and I thought the TV was talking to me. had some weird thoughts on that drug.
I don't work for zyprexa or nothing, but its the most helpfull med I ever took. For most of my symptoms. I even wonder if I ever would have ended up in the hospital 3 times, if they had just given me that one first.
Ivan
Posted by munificentexegete on February 8, 2007, at 20:55:22
In reply to Re: J+J and Janssen in trouble over Risperdal, posted by med_empowered on February 6, 2007, at 9:57:32
> One study I read compared zyprexa (dosed based on clinical judgement) to fixed-dose Haldol, 5mgs, with prophylactic benztropine.
to how much zyprexa?
5mg Haldol is almost twice as much required to induce serious eps, you would have to compare it to about 30mg of zyprexa to make a valid comparison.
>they can also create some tremendous problems, and many people with psychotic disorders can do well without them.
they don't fix an imbalance and they do result in permanent damage to brain structure and indeed every organ in one's body.
Posted by Dinah on February 9, 2007, at 14:06:54
In reply to Re: J+J and Janssen in trouble over Risperdal, posted by munificentexegete on February 8, 2007, at 20:55:22
Risperdal has been a godsend for me. It is calming without making me drowsy. And it's calming in a bone deep way that benzos just can't mimic. I'm often less tearful on it, although I'm not sure whether it's because it has antidepressant qualities or if it's mainly anxiety that causes my depression.
If I use it regularly, I tend to lose touch with my emotions. And it's not great for my diabetes. So it's not without costs.
I have used between .25 mg and 1.5 mg a day, I think, with .25 mg being the norm for me when I use it. When I don't need it I don't use it, and I have no problems with withdrawal.
I find it a bit energizing, but it doesn't cause that creepy itchy jumpy feeling that anything with NE does for me.
I think results vary widely from person to person. But whatever it offers appears to be exactly what I need.
Posted by Dinah on February 9, 2007, at 14:39:19
In reply to Re: J+J and Janssen in trouble over Risperdal » munificentexegete, posted by Dinah on February 9, 2007, at 14:06:54
That was a general comment, not a reply to anyone in particular.
Posted by munificentexegete on February 9, 2007, at 15:03:42
In reply to Re: J+J and Janssen in trouble over Risperdal » munificentexegete, posted by Dinah on February 9, 2007, at 14:06:54
> Risperdal has been a godsend for me. It is calming without making me drowsy. And it's calming in a bone deep way that benzos just can't mimic. I'm often less tearful on it, although I'm not sure whether it's because it has antidepressant qualities or if it's mainly anxiety that causes my depression.
>
> If I use it regularly, I tend to lose touch with my emotions. And it's not great for my diabetes. So it's not without costs.
>
> I have used between .25 mg and 1.5 mg a day, I think, with .25 mg being the norm for me when I use it. When I don't need it I don't use it, and I have no problems with withdrawal.
>
> I find it a bit energizing, but it doesn't cause that creepy itchy jumpy feeling that anything with NE does for me.
>
> I think results vary widely from person to person. But whatever it offers appears to be exactly what I need.
>isn't the damage from risperdal cumulative, so that if tardive dyskinesia develops after say 100mg of risperdal, then it doesn't matter how low the dose is?
Posted by linkadge on February 10, 2007, at 11:44:50
In reply to Re: low dose risperdal -- Dinah, posted by munificentexegete on February 9, 2007, at 15:03:42
>they don't fix an imbalance
They do and they don't. In the case of a medication which can say, ameliorate an overactive HPA axis, improve sleeping patterns, or improve social function, one is likely to see subsequent improvements in other aspects of brain health. Some studies suggest that treatment with certain agents can prevent hippocampal volume loss associated with mood disorders.
It is hard to say that the drug doesn't get to the root cause, when nobody really knows what the root cause is.
>they do result in permanent damage to brain >structure and indeed every organ in one's body
That is simply not true. The verdict is not in on the newer antipsychotics yet. While they may cause symptomatic movement problems, there is not much conclusive evidence that they cause irreversable brain dammage, let alone dammage to every organ in the body.
There are risks involved in treatment of course, just as there are risks involved in lack of treatment.
It is fair to say that a patient should be fully informed about risks, but unfair to blow risks out of proportion.
Linkadge
Posted by munificentexegete on February 10, 2007, at 16:10:16
In reply to Re: low dose risperdal -- Dinah, posted by linkadge on February 10, 2007, at 11:44:50
>>they don't fix an imbalance
> They do and they don't.which imbalance do they fix?
>>they do result in permanent damage to brain structure and indeed every organ in one's body
> That is simply not true.
> The verdict is not in on the newer antipsychotics yet.http://www.contac.org/contaclibrary/medications22.htm
> It is fair to say that a patient should be fully informed about risks
once TD is proved, it is simply as bad as a typical AP.
Posted by cb_psy on February 11, 2007, at 5:41:25
In reply to J+J and Janssen in trouble over Risperdal, posted by halcyondaze on February 5, 2007, at 14:41:53
Ive read that it has antidepressant and anti anxiety effects at lower dosage.
"The only receptor subtype that risperidone is likely or known to saturate at these lower doses (0.5-1 mg/day) is the 5-HT2A receptor" (Schotte et al, 1996; Nyberg et al, 1999; Talvik-Lofti et al, 2000).
Posted by linkadge on February 11, 2007, at 11:42:57
In reply to Re: low dose risperdal -- Dinah, posted by munificentexegete on February 10, 2007, at 16:10:16
>which imbalance do they fix?
Like I said, antipschotic treatment can oftentimes be associated with a normalization of the HPA axis. Some researchers think that psychosis in some people is fundimentally caused by HPA axis abnormalities, hence the strong antipsychotic actions of antiglutacortacoid drugs like RU-486.
>http://www.contac.org/contaclibrary/medications22>.htmA single case of something does not proove anything. The woman was taking lithium too, which has occasionally been asociated with TD. It is impossable to say that everybody treated with atypical antipsychotics is going to develop TD, even if there have been some cases of it.
There are going to be risks involved in treatment of any disease. The decision to take a medication or not is based on the personal cost/benifit ratio.
>once TD is proved, it is simply as bad as a >typical APIts not a matter of being proven or not. You have proved that TD *can* occur. That does not proove that TD will occur in any given patient.
Just as any given side effect for any drug will not occur in all patients.
Linkadge
Posted by Dinah on February 11, 2007, at 14:36:45
In reply to Re: low dose risperdal -- Dinah, posted by linkadge on February 11, 2007, at 11:42:57
Hmmm... That makes sense. I've long thought, from things totally unrelated from emotional disorders, that my HPA axis was involved in whatever was wrong with me.
Posted by rina on February 11, 2007, at 14:44:22
In reply to Re: J+J and Janssen in trouble over Risperdal, posted by SLS on February 7, 2007, at 5:31:28
> > About 3 weeks @ 1mg. It also gave me the worst akathesia, worse than seroquel @75 or zyprexa @ 5mg.
>
> I can see that happening, of course. I would just like to point out that some neuroleptics produce anxiety as a startup side effect rather than akathisia.
>
> I agree with Jay, and hope that these drugs do not become demonized in the same way benzodiazepines were. With what else we have available, I don't think they deserve it.
>
>
> - Scott
can someone tell me what akathesia is?
Posted by munificentexegete on February 11, 2007, at 15:24:42
In reply to Re: low dose risperdal -- Dinah, posted by linkadge on February 11, 2007, at 11:42:57
>>which imbalance do they fix?
> Like I said, antipschotic treatment can oftentimes be associated with a normalization of the HPA axis. Some researchers think that psychosis in some people is fundimentally caused by HPA axis abnormalities, hence the strong antipsychotic actions of antiglutacortacoid drugs like RU-486.
many people have many hypotheses about many things, some people think including myself that time travel is possible, although there is no reproducable evidence supporting the cause of psychosis meaning it is merely an unsupported hypothesis at best, not scientific fact.
> A single case of something does not proove anything. The woman was taking lithium too, which has occasionally been asociated with TD. It is impossable to say that everybody treated with atypical antipsychotics is going to develop TD, even if there have been some cases of it.
do you really think there is only one case of TD with risperdal. EPS, NMS, TD, dystonias, akathisia, parkinsonism its all there in risperidone and any side effect profile worth its salt points it out. I just pointed out that court cases have been won meaning it is also legal fact too.
> There are going to be risks involved in treatment of any disease. The decision to take a medication or not is based on the personal cost/benifit ratio.
what disease?
>> once TD is proved, it is simply as bad as a typical AP
> Its not a matter of being proven or not. You have proved that TD *can* occur. That does not proove that TD will occur in any given patient.most of the studies assume EPS including TD occurs and try to point out that it produces relatively less incidence of EPS/TD. They change the doses to make it seem this way.
> Just as any given side effect for any drug will not occur in all patients.
i think it is fairly well established that risperdal causes EPS including TD. So the next issue it what is the max single dose that can induce serious eps, i think it is about aorund 5 to 6 mg depending on size weight and sex of the patient. Then what is the risk of tardive dyskinesias from long term treatment, it may be a 2% chance with 300mg, 20% chance @ 600mg and a 50% chance at 900 mg (there hasn't been enough long term studies to confirm these numbers yet). then doctors and patients could make informed choices at least regarding the potential for serious permanent brain disease from antipsychotic medication. is psychosis even a medical issue?
Posted by linkadge on February 11, 2007, at 16:51:44
In reply to Re: low dose risperdal -- linkadge, posted by munificentexegete on February 11, 2007, at 15:24:42
For starters, nobody is forcing you to take any of these drugs. If you don't believe they are safe, then don't take them, no harm done.
>many people have many hypotheses about many >things, some people think including myself that >time travel is possible, although there is no >reproducable evidence supporting the cause of >psychosis meaning it is merely an unsupported >hypothesis at best, not scientific fact.
I am not saying that any one identifyable cause of psychosis has ever been established, nor do I think there will ever be. I am simply saying that people's suffering is real. Considering the lack of viable alternatives, I think the judicious use of antipsychotics is warrented.
>do you really think there is only one case of TD >with risperdal. EPS, NMS, TD, dystonias, >akathisia, parkinsonism its all there in >risperidone and any side effect profile worth >its salt points it out. I just pointed out that >court cases have been won meaning it is also >legal fact too.
Yes. it is a legal fact that these drugs *can* cause neurological problems. Just as cases have been won on the issue of antidepressnats causing people to commit suicide. Again, this does not conclude that everybody who takes these drugs will have this side effect.
>what disease?
It really doesn't matter what you want to call it, disease or otherwise. If you are saying that suffering is not real just because it cannot be observed under a microscope then I think we have lost the point.
>most of the studies assume EPS including TD >occurs and try to point out that it produces >relatively less incidence of EPS/TD. They change >the doses to make it seem this way.
I don't understand.
>i think it is fairly well established that >risperdal causes EPS including TD.
No. It is well established that risperidal *can* cause TD. The *numerical* indicence has not been established. I took risperidal, I did not develop TD. So therefore it is not true that risperidal causes TD in everybody.
>So the next issue it what is the max single dose >that can induce serious eps, i think it is about >aorund 5 to 6 mg depending on size weight and >sex of the patient. Then what is the risk of >tardive dyskinesias from long term treatment, it >may be a 2% chance with 300mg, 20% chance @ >600mg and a 50% chance at 900 mg
But, nobody takes that much risperidal.
>then doctors and patients could make informed >choices at least regarding the potential for >serious permanent brain disease from
>antipsychotic medication.>is psychosis even a medical issue?
Maybe not. But unforunately, there are no other established treatments for the problem. If it is not a medical issue what do you recomend? Excorcism? Studies suggest that these problem tend to get worse over time.
Linkadge
Posted by munificentexegete on February 11, 2007, at 18:53:18
In reply to Re: low dose risperdal -- linkadge, posted by linkadge on February 11, 2007, at 16:51:44
> For starters, nobody is forcing you to take any of these drugs. If you don't believe they are safe, then don't take them, no harm done.
true, however, most people will come into contact with these drugs on an involuntary basis at some point in their life such as in the foster care system, in a nursing homes, and even in the teen screen process.
>> many people have many hypotheses about many things, some people think including myself that time travel is possible, although there is no reproducable evidence supporting the cause of psychosis meaning it is merely an unsupported hypothesis at best, not scientific fact.
>I am not saying that any one identifyable cause of psychosis has ever been established, nor do I think there will ever be. I am simply saying that people's suffering is real. Considering the lack of viable alternatives, I think the judicious use of antipsychotics is warrented.
on a voluntary basis, with proper elucidation of the true risks, meaning proper independent long term studies, I agree with you. but that sounds like an alternative universe to the one we currently live in.
>> do you really think there is only one case of TD with risperdal. EPS, NMS, TD, dystonias, akathisia, parkinsonism its all there in risperidone and any side effect profile worth its salt points it out. I just pointed out that court cases have been won meaning it is also legal fact too.
> Yes. it is a legal fact that these drugs *can* cause neurological problems.
yes, it is an established medical and legal fact that all antipsychotics typical and atypical cause EPS including TD.
> Just as cases have been won on the issue of antidepressnats causing people to commit suicide.
sad isn't it when many studies conclude the risk of suicide is higher with an AD than without.
> Again, this does not conclude that everybody who takes these drugs will have this side effect.
however, everyone is exposed to the risk of developing serious neurological damage with these drugs. it is about calculating the probablities given the size of the dose and the length of treatment.
>> what disease?
> It really doesn't matter what you want to call it, disease or otherwise. If you are saying that suffering is not real just because it cannot be observed under a microscope then I think we have lost the point.
well if it isn't a disease, then that means it isn't a medical issue doesn't it?
>> most of the studies assume EPS including TD occurs and try to point out that it produces relatively less incidence of EPS/TD. They change the doses to make it seem this way.
> I don't understand.
for example EPS is generally thought to be a dopamine receptor issue, so they compare a dose of new antipsychotic that induces a dopamine block of 50%, to a dose of old antipsychotic that blocks 80%+ of dopamine.
although as a side note much EPS could also be due to anticholinesterase activity hence why atropine is often a successful treatment for things like dystonias.
>> i think it is fairly well established that risperdal causes EPS including TD.
> No. It is well established that risperidal *can* cause TD. The *numerical* indicence has not been established. I took risperidal, I did not develop TD. So therefore it is not true that risperidal causes TD in everybody.
however, you were exposed to a risk of developing TD. That risk is exacerbated by increased doses and the total amount of risperidone injested. actually you have almost certainly incurred brain decay from the risperidone, although you have not yet incurred enough damage for the damage to be obvious. As has been established, every milligram of antipsychotic causes progressive irreversible neurological damage, in the same way that a neurological disease would cause if say you had Parkinson's disease.
>> So the next issue it what is the max single dose that can induce serious eps, i think it is about aorund 5 to 6 mg depending on size weight and sex of the patient. Then what is the risk of tardive dyskinesias from long term treatment, it may be a 2% chance with 300mg, 20% chance @ 600mg and a 50% chance at 900 mg
> But, nobody takes that much risperidal.
every milligram injested causes neurological damage, if overtime the total amount of risperidone injested by a patient from the time they first start taking the medication is more than say 100mg, that would be taking 2mg for 50 days, there may be a 0.05% chance that neurological decay caused by the risperidone displays as TD.
with cumulative dose of 300mg, say 2 mg for 150 days the risk of TD may be 3%, and so on. 3% is a very high probablity given the seriousness of TD for only consuming 300mg, but that is the risk I have seen from some studies of risperidone in the elderly.
>> is psychosis even a medical issue?
> Maybe not. But unforunately, there are no other established treatments for the problem. If it is not a medical issue what do you recomend?Excorcism?
well if psychosis is not a disease it falls outside the ambit of the medical profession, as a result medical intervention can never be justified on an involuntary basis.
on a voluntary basis, by contrast, a person should be free to pursue as many different treatment alternatives, for whatever non disease they have, as they desire.
> Studies suggest that these problem tend to get worse over time.
what problem are we talking about precisely, a disease, or something else?
Posted by linkadge on February 11, 2007, at 20:06:15
In reply to Re: low dose risperdal -- linkadge, posted by munificentexegete on February 11, 2007, at 18:53:18
>true, however, most people will come into >contact with these drugs on an involuntary basis >at some point in their life such as in the >foster care system, in a nursing homes, and even >in the teen screen process.
I don't agree with using medications in such ways.
>on a voluntary basis, with proper elucidation of >the true risks, meaning proper independent long >term studies, I agree with you. but that sounds >like an alternative universe to the one we >currently live in.
Well, thats what boards like this are for. I agree that doctors don't educate patients fully about the risks of the drugs they push. I was not made aware about some of the side effects of drugs which harmed me.
>yes, it is an established medical and legal fact >that all antipsychotics typical and atypical >cause EPS including TD.No. It is an established fact that they *can* cause TD and EPS. Like I said before, if they caused TD and EPS in everybody who took them, then I would have got TD or EPS from them which I didn't.
>sad isn't it when many studies conclude the risk >of suicide is higher with an AD than without.It is difficult to say, because many of the studies which concluded an increased risk of suicide were short term studies. It is not clear how they affect the rate of suicide in the long term.
>however, everyone is exposed to the risk of >developing serious neurological damage with >these drugs. it is about calculating the >probablities given the size of the dose and the >length of treatment.
That sounds fair.
>well if it isn't a disease, then that means it >isn't a medical issue doesn't it?Regardless of wheather it is a medical issue, it is a problem. For many people with this "manifestation", there is little apparent other way to improve symptoms. Even if it isn't a medical disease, if a medicine can aid in the treatment, and is justified in its risks, then it makes sense to take it.
>for example EPS is generally thought to be a >dopamine receptor issue, so they compare a dose >of new antipsychotic that induces a dopamine >block of 50%, to a dose of old antipsychotic >that blocks 80%+ of dopamine.Yes. Atypicals have less binding to dopamine receptors that typical antipsychotics. They also bind more loosely to the receptor.
>although as a side note much EPS could also be >due to anticholinesterase activity hence why >atropine is often a successful treatment for >things like dystonias.I had no idea that antipsychotics had binding to cholinsterase.
>However, you were exposed to a risk of >developing TD. That risk is exacerbated by >increased doses and the total amount of >risperidone injested.True.
>actually you have almost certainly incurred >brain decay from the risperidone, although you >have not yet incurred enough damage for the >damage to be obvious.Not necessarily. The side effects from many medications are not always linear. Damage occurs when the drug ofsets natural chemistry so much that dammage occurs. The brain is able to deal with a variety of toxins so long as they don't acumulate to high enough doses. Like bacteria. Your body can deal with germs so long as the they are not at too high a level, and you won't get sick.
The progression of TD may also depend on things like antioxidant enzyme status. Nutritional status. Level of neuroprotective growth factors etc. The level of the growth factor BDNF, is often related to the development of brain dammage after the administration of neurotoxins.
>As has been established, every milligram of >antipsychotic causes progressive irreversible >neurological damage, in the same way that a >neurological disease would cause if say you had >Parkinson's disease.
I don't think that has been established. If it has, you would be able to easily present me with data that specifically shows that all antipsychotics induce brain damamge at *all* doses (including low doses).
>every milligram injested causes neurological >damage,
There is absolutely no data to support that claim. That is like saying that valproate damamges the liver at all doses, which is not true. Yes, valproate can dammage the liver, but many people take high doses of valproate for long periods of time without any evidence of liver damamge.
>if overtime the total amount of >risperidone >injested by a patient from the time they first >start taking the medication is more than say >100mg, that would be taking 2mg for 50 days, >there may be a 0.05% chance that neurological >decay caused by the risperidone displays as TD.
It does't work that way. Like I said before, the brain is able to deal with toxic agents quite well, so long as the dose is low, and its defences are high. Dammage only occurs when the system is overwhelmed.
Think of it this way. There are pesticides which are anticholinsterase inhibitors. They raise levels of acetycholine so high that the result is neurological dammage. But, low doses of anticholinsterase inhibitors are in many foods you eat. Green tea inhibits acetycholinsterase. Yet green tea is highly neuroprotective. So you cannot say that acetycholinsterase inhibition causes dose dependant neurotoxicity.
>with cumulative dose of 300mg, say 2 mg for 150 >days the risk of TD may be 3%, and so on. 3% is >a very high probablity given the seriousness of >TD for only consuming 300mg, but that is the >risk I have seen from some studies of >risperidone in the elderly.
I don't think it works that way. Show me one study that concludes that the occurance of TD is related to cumulative drug ingested, and not maximum daily dose.
>well if psychosis is not a disease it falls >outside the ambit of the medical profession, as >a result medical intervention can never be >justified on an involuntary basis.
I never agree with the use of these drugs on an involtentary basis.
>on a voluntary basis, by contrast, a person >should be free to pursue as many different >treatment alternatives, for whatever non disease >they have, as they desire.
While there may not be direct proof that schizophrenia is a medical illness, there is no proof that it is not a medical illness.
>what problem are we talking about precisely, a >disease, or something else?It doesn't matter. People need solutions.
Linakdge
Posted by munificentexegete on February 12, 2007, at 4:55:50
In reply to Re: low dose risperdal -- linkadge, posted by linkadge on February 11, 2007, at 20:06:15
>> on a voluntary basis, with proper elucidation of the true risks, meaning proper independent long term studies, I agree with you. but that sounds like an alternative universe to the one we currently live in.
> Well, thats what boards like this are for. I agree that doctors don't educate patients fully about the risks of the drugs they push. I was not made aware about some of the side effects of drugs which harmed me.
yes, doctors should be upfront when a patient comes to them with anxiety or some other non disease, and point out that from a medical point of view they don't have anything wrong with them. then they should point out that drug treatments are the highest risk route for dealing with problems in living. then objectively detail all the potential risks of the medication. a significant problem is the drug company research is as far from objective and independent as anything I've ever seen.
>> yes, it is an established medical and legal fact that all antipsychotics typical and atypical cause EPS including TD.
> No. It is an established fact that they *can* cause TD and EPS. Like I said before, if they caused TD and EPS in everybody who took them, then I would have got TD or EPS from them which I didn't.you are right.
>> sad isn't it when many studies conclude the risk of suicide is higher with an AD than without.
> It is difficult to say, because many of the studies which concluded an increased risk of suicide were short term studies. It is not clear how they affect the rate of suicide in the long term.I have been looking for some good research on antidepressants, you know things like the dose impact on serotonin levels, overall receptor occupancy, akathisia risk at different doses, however, there is a seeming black hole in this regard. is there a good site for this sort of research?
>> well if it isn't a disease, then that means it isn't a medical issue doesn't it?
> Regardless of wheather it is a medical issue, it is a problem. For many people with this "manifestation", there is little apparent other way to improve symptoms. Even if it isn't a medical disease, if a medicine can aid in the treatment, and is justified in its risks, then it makes sense to take it.
Well understanding that problems in living are not medical diseases is an important understanding to reach. At the moment people incorrectly believe they have a medical condition when they get anxious or depressed, they see their doctor and he incorrectly tells them it is due to a chemical imbalance and then goes on to talk about reuptake mechanisms.
That approach is misleading as a person then incorrectly believes they have a medical condition which they medication for, when in reality they do not.
If they have biological depression on the other hand, then they can take blood and spinal fluid tests and measure their serotonin and dopamine levels to prove the existence of a disease that needs treatment.
problems in living are confused with medical disease all the time.
>> for example EPS is generally thought to be a dopamine receptor issue, so they compare a dose of new antipsychotic that induces a dopamine block of 50%, to a dose of old antipsychotic that blocks 80%+ of dopamine.
> Yes. Atypicals have less binding to dopamine receptors that typical antipsychotics. They also bind more loosely to the receptor.
less binding and loosness are hard to understand, are you referring to receptor occupancy, reversible vs irreversible binding, or half life or a combination thereof?
>> although as a side note much EPS could also be due to anticholinesterase activity hence why atropine is often a successful treatment for things like dystonias.
> I had no idea that antipsychotics had binding to cholinsterase.http://cat.inist.fr/?aModele=afficheN&cpsidt=15105808
>> actually you have almost certainly incurred brain decay from the risperidone, although you have not yet incurred enough damage for the damage to be obvious.> Not necessarily. The side effects from many medications are not always linear. Damage occurs when the drug ofsets natural chemistry so much that dammage occurs. The brain is able to deal with a variety of toxins so long as they don't acumulate to high enough doses. Like bacteria. Your body can deal with germs so long as the they are not at too high a level, and you won't get sick.
That would be a good outcome, except for that to hold true low dose therapy should never result in TD. However, this isn't the case, not even for risperidone.
http://ajp.psychiatryonline.org/cgi/content/full/157/7/1150
so extrapolating from that study evey single milligram is causing brain damage.
> The progression of TD may also depend on things like antioxidant enzyme status. Nutritional status. Level of neuroprotective growth factors etc. The level of the growth factor BDNF, is often related to the development of brain dammage after the administration of neurotoxins.
I guess it may depend on many things like a persons height, weight sex and age, however, the main factors affecting the development and progression of tardive dyskinesia is obviously the size of the daily dose as well as the total amount of the drug consumed since beginning treatment.
>> As has been established, every milligram of antipsychotic causes progressive irreversible neurological damage, in the same way that a neurological disease would cause if say you had Parkinson's disease.
> I don't think that has been established. If it has, you would be able to easily present me with data that specifically shows that all antipsychotics induce brain damamge at *all* doses (including low doses).
> There is absolutely no data to support that claim.> That is like saying that valproate damamges the liver at all doses, which is not true. Yes, valproate can dammage the liver, but many people take high doses of valproate for long periods of time without any evidence of liver damamge.
that's another discussion.
>> with cumulative dose of 300mg, say 2 mg for 150 days the risk of TD may be 3%, and so on. 3% is a very high probablity given the seriousness of TD for only consuming 300mg, but that is the risk I have seen from some studies of risperidone in the elderly.
> I don't think it works that way. Show me one study that concludes that the occurance of TD is related to cumulative drug ingested, and not maximum daily dose.here read the section on TD from Janssen's web site (page 2) http://www.janssen.com/active/janus/en_US/assets/common/company/pi/risperdal.pdf;jsessionid=W4L3A
>> well if psychosis is not a disease it falls outside the ambit of the medical profession, as a result medical intervention can never be justified on an involuntary basis.
> I never agree with the use of these drugs on an involtentary basis.>> on a voluntary basis, by contrast, a person should be free to pursue as many different treatment alternatives, for whatever non disease they have, as they desire.
> While there may not be direct proof that schizophrenia is a medical illness, there is no proof that it is not a medical illness.
You'll have to elaborate on that one, I don't quite understand that point. Schizophrenia is not a medical disease, it is not a medical condition, it is a medical delusion.
Posted by Phillipa on February 12, 2007, at 18:36:30
In reply to Re: low dose risperdal -- linkadge, posted by munificentexegete on February 12, 2007, at 4:55:50
To the best of my knowledge the serotonin in blood is not indicative to the brain or the serotonin in the spinal fluid. Most is in the gut. Love Phillipa
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