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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by LostBoyinNCBecksDark on November 8, 2007, at 22:42:06
The atypical anti-psychotics are oftentimes portrayed to rarely cause TD, EPS and other traditional neuroleptic side effects. There is now at least once case of Abilify induced TD:
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=16816781&dopt=AbstractPlus
CNS Spectr. 2006 Jun;11(6):435-9.Links
Aripiprazole-related tardive dyskinesia.
Maytal G, Ostacher M, Stern TA.Psychiatric Consultation Service, Massachusetts General Hospital, Boston, MA 02114, USA. gmaytal@partners.org
The low prevalence of extrapyramidal symptoms associated with atypical antipsychotics has led to their widespread use during the past decade. Aripiprazole, the newest medication in this class, has been associated with extrapyramidal symptoms (eg, akathisia) and with improvement of tardive dyskinesia (TD), but to date it has not been associated with the development of TD. We report a case of TD associated with the use of aripiprazole 15 mg/day for 18 months for refractory depression. Symptoms of TD resolved within several weeks of discontinuation of aripiprazole."
Eric
Posted by Phillipa on November 9, 2007, at 10:33:58
In reply to Abilify caused a case of Tardive dyskinesia, posted by LostBoyinNCBecksDark on November 8, 2007, at 22:42:06
I won't take an antipsychotic if I'm not psychotic of course that's me Phillipa
Posted by yxibow on November 9, 2007, at 19:45:43
In reply to Re: Abilify caused a case of Tardive dyskinesia » LostBoyinNCBecksDark, posted by Phillipa on November 9, 2007, at 10:33:58
> I won't take an antipsychotic if I'm not psychotic of course that's me Phillipa
There's reasons for severe anxiety disorder complexes, I certainly don't like taking Seroquel but I am for the moment. I'm not psychotic.
Posted by Phillipa on November 9, 2007, at 20:29:16
In reply to Re: Abilify caused a case of Tardive dyskinesia » Phillipa, posted by yxibow on November 9, 2007, at 19:45:43
I know a unique set of circumstances. Hope you didn't take offense. Know you need it. Love Phillipa
Posted by Zyprexa on November 12, 2007, at 13:43:07
In reply to Abilify caused a case of Tardive dyskinesia, posted by LostBoyinNCBecksDark on November 8, 2007, at 22:42:06
Abilify gave me a mild case of TD too. Shaky hands, and mucile twitches, which are going away now that I've been off it for 6 months.
Posted by clipper40 on November 17, 2007, at 17:26:14
In reply to Re: Abilify caused a case of Tardive dyskinesia, posted by Zyprexa on November 12, 2007, at 13:43:07
How do you know it was TD? I had shaky hands and muscle twitches from Prozac. I'm curious because I'm considering adding on Abilify but I'm really scared of TD.
Posted by yxibow on November 18, 2007, at 2:53:03
In reply to Re: Abilify caused a case of Tardive dyskinesia » Zyprexa, posted by clipper40 on November 17, 2007, at 17:26:14
> How do you know it was TD? I had shaky hands and muscle twitches from Prozac. I'm curious because I'm considering adding on Abilify but I'm really scared of TD.
It wouldn't surprise me to have such side effects from Prozac, it isn't the most clean SSRI being one of the earlier ones, but then a lot of medications can be said to correlate with twitching.
I continue to take Seroquel even after 6 years and a tic diagnosis. I'm sensitive to medications though, TD with atypicals is still rare but something that is informed consent, meaning you're informed about its true but remote possibility and you consent as opposed to being forced to take it in a hospital.
I worry about it too to the point of possibly obsessing about it (even though its a reality, yet my functionality is quite better) and wonder if eventually I will switch to Clozaril which has had to date nearly nil TD and TDy despite all the other problems that it carries (it actually can improve TD cases)
Statistics are hard to go on, some say atypicals carry 5% per year of TD risk, but only Risperdal has had a proven track record of TD so far, with isolated case reports in other atypicals. Then again I recall a BJP journal study of a number of patients on Zyprexa with 1/2% per year. Its true, there is no crystal ball, but regular AIMS exams, which are just subjective muscle tests by your doctor who should be familiar with it minimize the risk of developing potential cases.
It also takes a psychiatrist very familiar with movement disorders or a neurologist to determine what is a tic, TD, or TDy (Tardive Dystonia) and that's the problem with case reports -- they're not double blind studies, isolated opinions written in journals.
Generally TD is something that happens late in treatment (Tardive) -- the best advice from movement disorder experts is to use the minimum effective dose of any neuroleptic.
TD recovery has roughly 30/30/30 -- 1/3 will completely recover, 1/3 will stay the same, and 1/3 will unfortunately get worse in some way.
Ultimately it is a choice of functionality versus less function without it, depending on the reason for its use.
As for potency, its roughly (no real guideline) {Risperdal, Invega} -> {Geodon, Abilify}, Zyprexa* (does have high D2 blockade) -> and Seroquel.
Posted by clipper40 on November 18, 2007, at 7:37:38
In reply to Re: Abilify caused a case of Tardive dyskinesia » clipper40, posted by yxibow on November 18, 2007, at 2:53:03
Thanks for all of the info. I didn't even know about AIMS exams, Tardive Dystonia or Clozaril's record against TD.
Have you been getting the AIMS exams? If so, wouldn't that ease your mind about your tic not being significant?
I think my pdoc mentioned something about prolactin levels and TD. I think he said that raised levels precede that kind of trouble. I could be remembering it wrong though.
Posted by yxibow on November 18, 2007, at 9:37:58
In reply to Re: Abilify caused a case of Tardive dyskinesia » yxibow, posted by clipper40 on November 18, 2007, at 7:37:38
> Thanks for all of the info. I didn't even know about AIMS exams, Tardive Dystonia or Clozaril's record against TD.
Yes -- Clozaril has its other faults in blood monitoring programs (automatic discontinuation with low white blood cell count in 1-2% of people) but it is a choice of last resort and does have such a record of improvement of movement disorders.
Tardive Dystonia can be worse in a sense of recovery potential but has the advantage (if there is anything in neurological conditions) of being controllable to an extent (similar to things tics are controllable with).
>
> Have you been getting the AIMS exams?Yes I got them more than necessary in the past, I haven't gotten one lately because I think my doctor has changed his views on just how often I should. Besides I recently saw a neurologist.
If so, wouldn't that ease your mind about your tic not being significant?
Oh its significant to me when it gets bad, though not enough to qualify "bad cases", but the orofacial tic has a mind of its own and although it is partly psychological it is definately physical and disconcerting not to mention modestly painful.
I am going to try out a fitted mouth guard, not because it happens all the time but I prefer to keep my enamel. In fact it has happened less frequently though when I think about it it happens more.
Its unfortunately part of me for an unknown time which just raises my OCD level even if it is real and uncomfortable. Continuing Seroquel which is necessary for my functionality exacerbates it. Its circular.
I still believe it was due to multiple changes in Seroquel and Zyprexa and how high of a dose of Seroquel I was on at the beginning but frankly the neurology staff couldn't come to a conclusion on that just as nobody yet has come to a full conclusion on my visual and auditory somatoform disorder (I'm not psychotic).
I have remained a medical mystery there for 6 years to the day, but that's a whole different story.
>
> I think my pdoc mentioned something about prolactin levels and TD. I think he said that raised levels precede that kind of trouble. I could be remembering it wrong though.Prolactin levels effect your sexuality and sexual function. Generally raised amounts decrease arousal and increase sexual dysfunction. Some atypicals have a greater chance of that. I haven't heard of any causality towards TD.
But don't take my case as any outcomes from neuroleptics -- I am very medication sensitive as of late. Plenty of people have been on Seroquel since its debut 10 years ago.
Posted by clipper40 on November 18, 2007, at 20:36:37
In reply to Re: Abilify caused a case of Tardive dyskinesia » clipper40, posted by yxibow on November 18, 2007, at 9:37:58
Definitely sounds like the slight risk of taking Seroquel is worth the benefit to you.
Night guard is a good idea. I have one. I have the hard kind. I used to have the soft kind, which I prefer. With the soft ones, you prevent the jaw clenching as much as the grinding of teeth surfaces.
It must be very reassuring to know that you're a medical mystery to your doctors.
I'm very med sensitive too, much more so than when I was younger. Makes these drug trials that much more fun!
C40
Posted by Zyprexa on November 19, 2007, at 21:26:17
In reply to Re: Abilify caused a case of Tardive dyskinesia » Zyprexa, posted by clipper40 on November 17, 2007, at 17:26:14
I'm not one hundred percent sure this is what the deffinition of TD is. But all I took it my hands became shakier and shakier, so bad I had trubles working with my hands. It was deffinitly uncontrolable. Also started getting mucile twitches in legs and arms. I still have some of this, but it is all getting better, over the last 6 months, since stoping the abilify.
Posted by clipper40 on November 19, 2007, at 22:02:19
In reply to Re: Abilify caused a case of Tardive dyskinesia, posted by Zyprexa on November 19, 2007, at 21:26:17
> I'm not one hundred percent sure this is what the deffinition of TD is. But all I took it my hands became shakier and shakier, so bad I had trubles working with my hands. It was deffinitly uncontrolable. Also started getting mucile twitches in legs and arms. I still have some of this, but it is all getting better, over the last 6 months, since stoping the abilify.
I guess you really have to assume the worst here. Better safe than sorry!
Posted by yxibow on November 20, 2007, at 0:27:16
In reply to Re: Abilify caused a case of Tardive dyskinesia, posted by Zyprexa on November 19, 2007, at 21:26:17
> I'm not one hundred percent sure this is what the deffinition of TD is. But all I took it my hands became shakier and shakier, so bad I had trubles working with my hands. It was deffinitly uncontrolable. Also started getting mucile twitches in legs and arms. I still have some of this, but it is all getting better, over the last 6 months, since stoping the abilify.
Pseudoparkinsonism, which in some cases can last beyond the treatment period of time. It is a common EPS with neuroleptics and I've lived with it, fortunately not as bad a case as it sounds with you. You can take a beta blocker like propranolol or other palliatives to lessen this shaking. It does not sound anything like TD but then I'm not a neurologist. The twitching is probably also linked.
Posted by Zyprexa on November 20, 2007, at 7:31:22
In reply to Re: Abilify caused a case of Tardive dyskinesia, posted by yxibow on November 20, 2007, at 0:27:16
I was taking toprol xl while on abilify.
Posted by yxibow on November 20, 2007, at 14:02:08
In reply to Re: Abilify caused a case of Tardive dyskinesia, posted by Zyprexa on November 20, 2007, at 7:31:22
> I was taking toprol xl while on abilify.
Metoprolol is cardioselective -- it favors the heart. Propranolol is non-cardioselective and older and favors peripheral (limbs) as well and thats why its a better choice for shaking. If you are one of the people who are depressed by it there are some other choices I haven't personally tried, atenolol and nadolol.
Clonidine might work although I don't think so particularly.
Anticholinergics such as Artane would work -- Akineton would have been a better choice as it is less drowsy but the manufacturer dropped it :(. I have the last supply in the known universe except for Peru apparently, but anyhow.
There are a few other esoteric things which I forget at the moment that can also help shaking, including bromocriptine and L-dopa but those are usually reserved for violent cases.
This is the end of the thread.
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