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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 4 to 28 of 28. Go back in thread:
Posted by cybercafe on August 24, 2002, at 21:45:37
In reply to Re: Does EPS go away? , posted by JohnX2 on August 24, 2002, at 13:23:29
> I think the risk of TD for new generation APs is much greater when the meds are taken at very strong doses (for anti-manic/anti-psychotic activity). Seems at the lower doses useful for more for anxiety/depression the lack of potent dopaminergic blockade lowers the risk of TD considerably (at least that's my understanding).i don't really worry about being on them long enough to get TD -- i'm sure something better will be out soon enough
what i am concerned about is irreversible EPS
Posted by judy1 on August 24, 2002, at 22:38:26
In reply to Re: Does EPS go away? , posted by cybercafe on August 24, 2002, at 21:45:37
I thought my EPS wouldn't go away (but I have been off and on APs for years) but my symptoms have gradually diminished. Sometimes if I have extreme stresses in my life it is more noticeable. What are you taking and at what dose? take care, judy
Posted by cybercafe on August 25, 2002, at 0:53:33
In reply to Re: Does EPS go away? » cybercafe, posted by judy1 on August 24, 2002, at 22:38:26
> I thought my EPS wouldn't go away (but I have been off and on APs for years) but my symptoms have gradually diminished. Sometimes if I have extreme stresses in my life it is more noticeable. What are you taking and at what dose? take care, judy
zyprexa 5 mg ... so the symptoms went away while you were off antipsychotics? or on them?thanks for replying :)
Posted by judy1 on August 25, 2002, at 13:04:30
In reply to Re: Does EPS go away?, posted by cybercafe on August 25, 2002, at 0:53:33
They gradually went away when I stopped the AP. 5 mg is pretty low, but I would hope this is a temporary drug for you (like any AP), because that is the only way I will take them. take care- judy
Posted by action_jackson on August 27, 2002, at 0:06:44
In reply to Does EPS go away? , posted by cybercafe on August 23, 2002, at 12:23:24
The more you need medicine, and ...
the lower your sex drive / energy by nature ...
the greater your risk ...
of long term detriment.
Drop the shit now while you can ...
I have been there done that ... 1 man's opinion.
Chad
ps you won't find as much as you should on "Pubmed" on the danger of that antipsychotic shit in non-manics / non psychotics ... because most tardive drug induced movement disorder victims are psychiatric patients who are unable to fight back against Dr's who silence them...
Sounds corny - but truly the incidence of tardive EPS is quite underreported even with the "new" ones ...
The stuff is bad for you anyway - shortens life - promotes Parkison's, diabetes....
Bad shit - and like the older ones, the new ones will soon be reserved for psychosis and mania only - because dopamine depleted psychiatric patients are highly susceptible to tardive drugs induced movement disorders ...
Chad
I may expose a few bad folks in UCLA area soon - I was fortunate ... I think ... ; )
Chad
Posted by action_jackson on August 27, 2002, at 0:08:50
In reply to Re: Does EPS go away? , posted by action_jackson on August 27, 2002, at 0:06:44
A more appropriate title to last post ...
Chad
Posted by denise528 on August 27, 2002, at 10:32:58
In reply to DON'T WAIT TO GET TARDIVE MOVEMENTS, posted by action_jackson on August 27, 2002, at 0:08:50
So, as you are so against anti-psychotics because of your own experiences. What alternatives are you suggesting for a severely depressed person for whom normal ADs won't work. You keep ranting on about antipsychotics but you don't offer any alternatives.
Denise
Posted by judy1 on August 27, 2002, at 12:20:43
In reply to Re: DON'T WAIT TO GET TARDIVE MOVEMENTS, posted by denise528 on August 27, 2002, at 10:32:58
I'll assume you've been on every class of AD- ssri's. maoi's, tca's and combos? and therapy added? I worry about the dangers of APs also (even the new ones), but there are times when i am psychotic when i do have to take them temporarily. there have been studies done with non-psychotic patients that found that a benzo added to the ad was just as effacacious as an AP added to an ad (and no nasty TD or EPS). If you still feel like they are helping you a great deal, then i hope that you take small 'vacations' every once in a while and stay at the lowest possible dose (and watch for any side effects). take care, judy
Posted by judy1 on August 27, 2002, at 12:22:55
In reply to Re: Does EPS go away? , posted by action_jackson on August 27, 2002, at 0:06:44
I think you did an excellent job on your web page and wish you well- judy
Posted by action_jackson on August 28, 2002, at 1:31:23
In reply to Re: Does EPS go away? » action_jackson, posted by judy1 on August 27, 2002, at 12:22:55
Thanks Judy.
That is interesting the studies you mentioned using benzo's for a/p's as add'on for those not meeting FDA criteria for antipsychotics.
Note: Because I ran into trouble (and chose to research some) - I noticed that some think that intermittent a/p use may be as dangerous or moreso than continuous. I have no idea - but thought I would mention it since you mentioned concern about future use of a/p's.
Denise: I am glad that Zyprexa helps - definitely it is pretty popular and sounds like you must be one of those who does better with it than alternatives.
Curious - have you tried the MAOI's - and also SSRI + stimulants? LIke you said sometimes atypical a/ps are used for TRD, and also stimulants used for that sometimes also...
Sincerely,Chad / and previous names.... :)
Posted by denise528 on August 29, 2002, at 5:35:28
In reply to Thanks Judy : ) also Denise ..., posted by action_jackson on August 28, 2002, at 1:31:23
Chad,
I'm curious did you used to go by the id of "Old School"?
To answer your question, SSRIs used to work really well for me as did tryciclics but third time round they just won't seem to work no matter what we add to it, tried small doses of lamictal and lithium. I have asked my doctor about MAOIs and he said that they won't work for my type of depression (I don't suffer from atypical depression).
I've also asked him about adding a stimulant and he won't let me try it, I did try adding Adrafinil which I mail ordered but this didn't seem to do much.
I've even asked two Psychiatrists and my Doctor about ECT I feel that desperate but they say its too drastic and that it probably wouldn't help my type of depression anyway.
Can I ask you, you seem very much against antipsychotic drugs, what experiences have you had with them personally, what did you take, how much did you take, for how long and what were the side effects?
Thanks for responding.
Denise
Posted by action_jackson on August 30, 2002, at 2:18:46
In reply to action_jackson, posted by denise528 on August 29, 2002, at 5:35:28
Hi Denise -
> Chad,
>
> I'm curious did you used to go by the id of "Old School"?Nope - but I know about him. I was posting mostly between Nov 2001 and Mar 2002. I trialed low dose amisulpride in Jan 2002, which ended after termination with tardive movements.
My time on the board then overlapped "Old School" - who preceded me by a couple months in developing a tardive movement disorder from "risperidone" (Risperdal). Risperdal is increasingly recognized as being fairly prone to produce tardive movement disorder. So I did read some of his posts after my problem began - and it sounded to me like his Dr, like mine - negligently failed to inform of risk. And like myself - "Old School" had NO diagnosis consistent with use of these dangerous A/P's. Unfortunately it will take a great many people being hit with chronic movement disorders before these dangerous drugs are prescribed more appropriately by Dr's - who so far bear little burden for there errors in this area (prescribing "atypicals" seems so far to tend to get them off the hook in terms of negligent rx's).
> To answer your question, SSRIs used to work really well for me as did tryciclics but third time round they just won't seem to work no matter what we add to it, tried small doses of lamictal and lithium. I have asked my doctor about MAOIs and he said that they won't work for my type of depression (I don't suffer from atypical depression).
>
> I've also asked him about adding a stimulant and he won't let me try it, I did try adding Adrafinil which I mail ordered but this didn't seem to do much.
>
If you don't mind answering - why won't he let you try a stimulant? I'm not sure what type of depression you are referring to - but it sounds like maybe "bipolar depression" or "major depression"? Unless you have swings to mania - I don't understand why a Dr. would object to a trial ... Well suited for types of TRD with low energy, dysthymia, etc...
> I've even asked two Psychiatrists and my Doctor about ECT I feel that desperate but they say its too drastic and that it probably wouldn't help my type of depression anyway.Do you mind answering what kind of depression?
>
> Can I ask you, you seem very much against antipsychotic drugs, what experiences have you had with them personally, what did you take, how much did you take, for how long and what were the side effects?
>
Amisulpride, 3.5 week trial in Jan 2002. I will go back and try to follow with a link - I posted on it quite a bit here in past. Dose was very low. Let me check for link ...Chad
http://www.socialfear.com/
Posted by action_jackson on August 30, 2002, at 2:31:43
In reply to Re: action_jackson, posted by action_jackson on August 30, 2002, at 2:18:46
Denise - there are several posts I made in Jan - April (search amisulpride / tardive) - I took for 3.5 weeks at low dose. Worsened over months (zyprexa a few days given to me "to help" by Dr. Robert Gerner - made things worse). So in my case "tic" and maybe myoclonus apply - but I noticed someone else just now getting this same crap (perhaps) with Risperdal.
In my case - I have resumed Klonopin which seems (fingers crossed) to "treat" the movements quite well - movements due to a brain lesion apparently...
the link I found ...
(I got a lot of bullshit from amisulpride and zyprexa dr's (and referred neurologists) trying to cover their ass and make me think I had no problem - took me getting from all of them to get diagnosis from movement specialist.
Posted by action_jackson on August 30, 2002, at 2:33:54
In reply to Denise , posted by action_jackson on August 30, 2002, at 2:31:43
Wanted to re-title subject of previous message.
Posted by cybercafe on August 30, 2002, at 10:28:12
In reply to Tardive tic + mycolonus, risperdal, amisulpride, posted by action_jackson on August 30, 2002, at 2:33:54
so how long did you have EPS for before you stopped taking the AP? .... and what exactly is a tic, is it possible to not notice that you have one or is it very noticable?i find that zyprexa does wonders for my agitation and replaces it with a feeling of calm and peace... but of course i wonder if i might not be equally well on a safer 5HT2 antagonist like serzone/nefadozone or remeron/zispin/mirtazapine
Posted by denise528 on August 30, 2002, at 11:24:46
In reply to Re: Tardive tic + mycolonus, risperdal, amisulpride » action_jackson, posted by cybercafe on August 30, 2002, at 10:28:12
Cybercafe,
I was thinking of the same thing. Zyprexa really seems to help me, calms me down, clears my head and makes me think more rationally. So I too was considering maybe trying Serzone which apparently a 5HT2 antagonist but somebody else on here was saying that they had been on both (Zoe I think) and that Serzone was hell and that Zyprexa really helped her. So it put me off a bit, still I suppose it's worth a try.
Denise
Posted by denise528 on August 30, 2002, at 11:32:15
In reply to Tardive tic + mycolonus, risperdal, amisulpride, posted by action_jackson on August 30, 2002, at 2:33:54
Chad,
Thanks again for getting back to me.
I'm not sure why my psychiatrist won't prescribe a stimulant, I think it's because he doestn't want me trying too many at once or possible because I had a seizure (first time ever) when I was on a high dose of Prothiaden and Prozac.
As far as ECT goes, I've asked two psychiatrists about this, one says its too extreme and it doestn't always work anyway (he thinks I suffer from cyclothimia (I don't agree with him) and the other says it wouldn't work for my kind of depression, didn't say what kind of depression I had but I did mention feelings of depersonalisation and he said it wouldn't be good for that.
Basicly I just think I'm very depressed and anxious about being depressed, I know I'm not atypical as my mood doestn't react to outside forces so it has to be endogoneous.
Denise
Posted by cybercafe on August 30, 2002, at 12:45:31
In reply to Re: Tardive tic + mycolonus, risperdal, amisulpride, posted by denise528 on August 30, 2002, at 11:24:46
> I was thinking of the same thing. Zyprexa really seems to help me, calms me down, clears my head and makes me think more rationally. So I too was considering maybe trying Serzone which apparently a 5HT2 antagonist but somebody else on here was saying that they had been on both (Zoe I think) and that Serzone was hell and that Zyprexa really helped her. So it put me off a bit, still I suppose it's worth a try.
... yeah it's worth getting some more opinions, anyway...
hmmm when you say hell, you mean she was even more agitated on serzone?
Posted by action_jackson on August 31, 2002, at 1:11:50
In reply to Re: Tardive tic + mycolonus, risperdal, amisulpride » action_jackson, posted by cybercafe on August 30, 2002, at 10:28:12
Cybercafe -
> so how long did you have EPS for before you stopped taking the AP?I started beginning Jan, at 50mg amisulupride, terminated late Jan, tapering down over month 50, 25, 12, 10, 6 then stopped.
I was ignorant of "acute dystonic reactions" when it was prescribed to me. I started getting these acute dystonic reactions starting about 6 days after starting amisulpride, and at roughly 3-5 day intervals afterwards, but moreso toward late Jan. Foot tapping, then jaw dystonia, lips, tongue, neck, leg, quite a variety!!! :)
When I completely stopped amisulpride - the chronic stuff set in, which was mainly the orofacial region (jaw chatter, dystonic type repetitive movements of jaw and tongue). Much lesser and sporadic neck, back, leg movements.
My movements later (including some later appearing ones - all were considered "complex" and "atypical" - probably because of dopamine blockade combined with increased dopamine release (a feature of amisulpride, and also serotonin and DA agnoism in concurrent Nardil low dose I was taking at time). Plus I am relatively young male with affective distorder (SP) - the highest risk group for hyperkinetic, dystonic type movements (in my case "tardive dystonic tic" may be the most primary diagnosis of movements"Well - I don't want to go into all the nitty gritty (I have already!! :) ), but the above seemed to perhaps improve a bit over 4 months - then in a moment of mental blackout I listened to a new Dr. who told me to take 2.5 Zyprexa at night which "helps tardive *antyhing*". Somehow, someway - I listened to this guy enough to take in sum 2.5mg total over 3 days (1/3 tablet over 3 different days). A week later I developed involuntary neck movements and additional movments extending to my limbs, trunk, etc.
I have no movement disorder history - and my SP has been quite well treated for over 6 years. I have worked steadily as a professional about 8 years - until last Jan - and probably will restart soon where I left off if things go OK as I now am going back closer to my SP treatment as it stood before. I got a movement diagnosis - which was not easy - those speciality neurologists (movement disorder specialists) are very very booked up - forget even getting into a good big clinic unless you have a year or 2 to wait...
.... and what exactly is a tic, is it possible to not notice that you have one or is it very noticable?
There are "simple" and "complex" tics - can be as simple as occasional eye blinking, complex as to include muscles all over the body, in contuinous repetitive patterns - is supprressible somewhat - up to a point only - and can include vocal (does not apply to me) - this most severe of "Complex Tic Disorder" is called "Tourette's Syndrome" which youu've probably heard of. People with Tourette's and no good treatment - well if you have seen it - you will know that it does not look very pleasant to have such a problem...
Movements disorders are really hard to learn about - I think in retrospect - the way to learn it quick is to see all kinds of stuff on video - the way Dr's probably learn it. Reading about it just is very very difficult. There are so many types of movements, and often there is combination anyway ("complex") - which was diagnosed in my case BTW. The easiest TD to see is the classic type that schizophrenics get after many years of high dose a/p. Those guys do not get TD easy - when they finally do - it takes a "classic" form usually - and is the kind that most Dr's are able to see and diagnosis - but is not the kind usually appearing in affective disorder patients getting TD or other Tardive Momvment Disorders after low dose use of A/P - even sometimes for extremely short period of time - such as with me.
> i find that zyprexa does wonders for my agitation and replaces it with a feeling of calm and peace... but of course i wonder if i might not be equally well on a safer 5HT2 antagonist like serzone/nefadozone or remeron/zispin/mirtazapine
>
a/p's are also called "major tranquilizers" - compared to benzodiapines like Xanax which are called "minor tranquilizers" - and both tend to have the qualities you describe...Serzone does have some partial 5ht-2 blockade like zyprexa - but lacks D2 blockade - which is a big part of the antidepressant and antianxiety effect of Zyprexa. Serzone is probably better for anxiety than depression on average. I don't think it is really used much by itself for depression - is considered pretty weak for that purpose I believe, taken alone. I think some people find Serzone agititing rather than calming - seems like that varies person to person.
In my case, I found it axiogenic alone, but axiolytic with 50mg Zoloft ... and I always found Serzone pretty mild - more to tweak an SSRI or something than to use all alone.Remeron is interesting but it seems like hardly anybody stays on it for very long due to various side effects which might appear right away or after several weeks of use...
Posted by action_jackson on August 31, 2002, at 1:18:05
In reply to Re: Tardive tic + mycolonus, risperdal, amisulpride, posted by denise528 on August 30, 2002, at 11:24:46
I think Zoloft 50mg + Klonopin is a good antidepressant / axiolytic - and tends to be a bit sedating - I think the effect is pretty similar to a drug like Zyprexa and I think is healthier also. Both Zoloft and Klonopin have a long half life - like Zyprexa...
Zoloft 50 + Serzone - this is one time where I liked serzone - it seemed, for me, to improve antidperssant and antianxiety effect of Zoloft - and reduce Zoloft sexual dystunction - also increased sociability... (I have primary SP).
Chad
http://www.socialfear.com/> Cybercafe,
>
> I was thinking of the same thing. Zyprexa really seems to help me, calms me down, clears my head and makes me think more rationally. So I too was considering maybe trying Serzone which apparently a 5HT2 antagonist but somebody else on here was saying that they had been on both (Zoe I think) and that Serzone was hell and that Zyprexa really helped her. So it put me off a bit, still I suppose it's worth a try.
>
> Denise
Posted by action_jackson on August 31, 2002, at 1:29:53
In reply to Re: Action Jackson, posted by denise528 on August 30, 2002, at 11:32:15
Denise -
possible because I had a seizure (first time ever) when I was on a high dose of Prothiaden and Prozac.
>
> Basicly I just think I'm very depressed and anxious about being depressed, I know I'm not atypical as my mood doestn't react to outside forces so it has to be endogoneous.
>
How is your energy? What about a low dose trial of Parnate? Is powerful antidepressant better for meloncholic depression than Nardil - and less for anxiety than Nardil. At low dose side effects are usually very low with Parnate and is very stimulating med.How about Effexor? Have you tried that? It is also powerful antidepressant - sometimes good for anxiety too except not usuually Social Anxiety (my diagnosis).
Parnate + Klonopin, or Effexor + Klonopin - those will probably leave most people still pretty activated and could take off some anxiety...
Just some thoughts... Good luck...
Chad
http://www.socialfear.com/> Denise
Posted by LostBoyinNC1 on September 1, 2002, at 17:55:17
In reply to Re: action_jackson, posted by action_jackson on August 30, 2002, at 2:18:46
> Hi Denise -
>
> > Chad,
> >
> > I'm curious did you used to go by the id of "Old School"?
>
> Nope - but I know about him. I was posting mostly between Nov 2001 and Mar 2002. I trialed low dose amisulpride in Jan 2002, which ended after termination with tardive movements.
>
> My time on the board then overlapped "Old School" - who preceded me by a couple months in developing a tardive movement disorder from "risperidone" (Risperdal). Risperdal is increasingly recognized as being fairly prone to produce tardive movement disorder. So I did read some of his posts after my problem began - and it sounded to me like his Dr, like mine - negligently failed to inform of risk. And like myself - "Old School" had NO diagnosis consistent with use of these dangerous A/P's. Unfortunately it will take a great many people being hit with chronic movement disorders before these dangerous drugs are prescribed more appropriately by Dr's - who so far bear little burden for there errors in this area (prescribing "atypicals" seems so far to tend to get them off the hook in terms of negligent rx's).Hey dude, how are you doing? I just want to correct a few details here. I was diagnosed with EPS from low dose Seroquel (50 mg) last fall, not Risperdal. I was never diagnosed with TD or anything that bad. I continued having problems with mild, residual EPS up until this past summer. Amantadine helped it a lot and this MAOI Parnate I switched to recently seems to have really helped the EPS, all MAOIs are potently dopaminergic.
My EPS symptoms included the following:
1) "numb tongue"
2) tightness feeling on the back of my head and neck
3) generally tight, mildly contracted muscles pretty much everywhere, thighs, upper arms, etc.
4) small muscle pops and twitches, particularly at night for an hour or two after I took my Seroquel dose.
5) loss of muscle tone
6) Worsened depression, the Seroquel interferes with the antidepressant effect I get from ADs. Ive found all atypical anti-psychotics "block" the antidepressant effect I was getting from the AD I was originally on.
By the end of the month on 50 mg Seroquel I began having the additional problems:
1) tightness in the throat, mild difficulty swallowing
2) Extreme muscle weakness, right side became weak. My right grip became weak. I developed mild dropfoot on my right leg/foot.
3) Affective flattening, like my mood became very very flat. Ive found all atypicals flatten me out a lot.
4) Muscle stiffness, muscles felt mildly contracted ALL the time.
After I went off the Seroquel, the above symptoms "rebounded" or became worse than on the Seroquel. This is when I was formally dxed with EPS. My Pdoc gave me a manual muscle test, where he moved my arms around at the elbow joint and my right arm was stiff and ratchety feeling, while my left arm was loose and totally normal feeling. He told me EPS oftentimes hits you worse on one side. In my case, it hit me on my dominant (right) side.
I also even developed mild problems walking for a short period. My walking gait became very stiff. I found Amantadine got rid of that problem fast and it hasnt really come back.
I was advised by both my family doctor and my psychiatrist to immediately get off the Seroquel which I did.
I used OTC benadryl for a long time afterwards. I found that after I took 50 mg benadryl, Id get tremendous amounts of muscle pops and twitches. Id just sit there and "twitch, twitch, pop, pop." Amantadine helped to shut that down alot.
People who must continue taking anti-psychotics despite EPS type symptoms usually are advised to coadminister an anti-cholinergic drug like Cogentinor Artane. I didnt even know that until this past fall. ECT can also help neuroleptic induced movement disorders.
In fact there is an article in the August issue of "Psychiatric Times" about ECT for neurological conditions. ECT can be used for parkinsons disease and is quite effective for that, supposedly. ECT is very dopaminergic and loosens up tight, contracted muscles. Thus anyone with severe EPS or neuroleptic induced movement disorders might well consider a session of bilateral or bifrontal ECT to "juice" their muscles and loosen up. Gets the dopamine flowing good again, while simultaneously combatting psychosis.
And it wasnt even my psychiatrist who suggested ECT to me, after I developed EPS. It was my family doctor, who told me that ECT can help BOTH depression and neuroleptic induced movement problems.
LostBoyinNC
Posted by cybercafe on September 1, 2002, at 22:30:53
In reply to Re: action_jackson, posted by LostBoyinNC1 on September 1, 2002, at 17:55:17
Hey lostboy, it's interesting that you posted your symptoms. Is there any definitive test you can put yourself through to measure the existence or severity of EPS? Or whether it may become irreverible (last more than 2 months after discontinuation)?
hugs and kisses ;)
cybercafe
Posted by action_jackson on September 2, 2002, at 0:27:40
In reply to Re: action_jackson » LostBoyinNC1, posted by cybercafe on September 1, 2002, at 22:30:53
Hi Lostboy -
I'm glad the Parnate helps, and the amantadine also.
Tardive means "drug induced, >1 month chronic involuntary movements" - which it sounds like you have since you take drugs to block the movements. Tardive movement disorders - even very severe ones - can be "masked" or "treated" so that symptoms go away. But these are all tardive movement disorders if they were non-existant until caused by drug(s) - and remain chronic over 1 month (or is it 2 months Cybercafe?) - anyway ....
Your symptoms sound pretty severe to me. I think your Dr. is saying "EPS" because it is non-descript - and can imply "acute" movements which are transient and go away permanaently (acute meaning <3 days before never appearing again or being a "drug sensitive" newfound movemment)...
Chad
http://www.socialfear.com/
> Hey lostboy, it's interesting that you posted your symptoms. Is there any definitive test you can put yourself through to measure the existence or severity of EPS? Or whether it may become irreverible (last more than 2 months after discontinuation)?
>
> hugs and kisses ;)
>
> cybercafe
Posted by denise528 on September 2, 2002, at 11:27:45
In reply to Lost Boy - You have Tardive movement disorder(s), posted by action_jackson on September 2, 2002, at 0:27:40
.
This is the end of the thread.
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