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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by blueberry on November 26, 2006, at 5:53:55
Problem:
For the first hour after waking from an 8 hour sleep, I have awful symptoms described in the next paragraph. Most of them go away on their own, but not completely. When I go to bed at night, these symptoms are absent. If I get only 5 hrs sleep, these symptoms are very minor. Something goes wrong in the last half of sleep.Physical Symptoms:
Parkinsons in fingers and thumbs...they shake a lot. As the day progresses, it slowly improves, but they are still shakey all day. The only time it is completely gone is a few hours after taking an evening 2.5mg zyprexa dose. The rest of my body is jittery just a tiny bit at waking and goes away. All day, if I move my arm, I can see the muscles in my breast area twitching on their own. All day, if I look in a mirror, I can see the little muscles in the bags under the eyes twitch uncontrollably when I move any other facial muscle. There is random twitching of other small muscles from time to time.Mental Symptoms:
I can go to bed feeling fairly fine. The best I will feel all day is at night before bed. I take 2.5mg zyprexa at about 5pm. I've tried dosing at various other times and it makes no difference.
When I wake, there is an overwhelming feeling of free-floating fear. Depression and anxiety are bad at waking, improve somewhat throughout the morning, then there is a depressive crash in the afternoon, followed by a decent mood in evening...this pattern repeats fairly reliably every day, and does not seem much influenced by changing eating patterns.Is this stuff EPS? Tardive? Hypoglycemia? Depression? Anxiety? Something gone wrong with zyprexa?
Prozac made all of the above problems even worse and created more new ones. But since it has been removed, the problems are still there.
I have been on 10mg-20mg prozac for 10 years. I have been on 2.5mg-5mg zyprexa for 10 years, mostly 5mg. None of the above symptoms showed up until year 8 (2005). They didn't exist before that.
Posted by blueberry on November 26, 2006, at 6:31:33
In reply to Is this Tardive, EPS, Hypoglycemia, or What?, posted by blueberry on November 26, 2006, at 5:53:55
The information below was gathered from my own google research and I was dismayed to see how exactly it describes me. I forgot to mention in my previous post stuff about puckering and pursing of the lips. Even all my anxiety and inability to sit still fits. I have to always be moving and can't relax. It looks to me what I'm dealing with is tardive dyskinesia and tardive akathisia, mixed in with depression and anxiety, and maybe even some hypoglycemia. Not cool. Apparently the only treatments are to control symptoms, not repair, and they include valium, ativan, or klonopin.
"Tardive dyskinesia is a serious neurological disorder caused by the long-term use of dopamine antagonists. Some drugs that are not intended to affect dopamine, such as SSRI antidepressants, may also cause tardive dyskinesia."
"Tardive dyskinesia is characterized by repetitive, involuntary, purposeless movements. Features of the disorder may include grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, and rapid eye blinking. Patients with Parkinson's disease have difficulty moving, while patients with tardive dyskinesia have difficulty NOT moving."
"Tardive akathisia involves painful feelings of inner tension and anxiety and a compulsive drive to move the body. In the extreme, the individual undergoes internal torture and can no longer sit still. Tardive tourettism is a tic disorder that can closely mimic Tourette Syndrome, sometimes to the point where the two can only be distinguished by the details of their onsets."
"Tardive dyskinesia most commonly occurs in patients with psychiatric conditions who are treated with antipsychotic medications for many years. Some estimates suggest that it occurs in 15-30% of patients receiving treatment with antipsychotic neuroleptic medications for 3 months or longer. Other estimates suggest that with each year of neuroleptic use, 5% of the patients will show signs of tardive dyskinesia, i.e., 5% after one year, 10% after two years, 15% after three years with no clear upper limit. Eventually, according to these estimates, if on the drugs long enough, the majority of patients will develop the disorder.[2]""Cigarette smokers also have a higher prevalence of tardive dyskinesia."
"Tardive dyskinesia can become a thoroughly debilitating social handicap."
Any sugggestions would be much appreciated. Especially if they are natural.
Posted by Quintal on November 26, 2006, at 9:30:39
In reply to Re: Is this Tardive, EPS,..My Own Diagnosis, posted by blueberry on November 26, 2006, at 6:31:33
Have you asked your pdoc for his opinion? If you suspect your problems are movement disorders due to damage caused by antipsychotic drugs then you need to see a pdoc ASAP. They have anticholinergic drugs and dopamine agnosts to help with these problems, but the treatment depends on the severity of your symptoms.
This happened to a friend of mine and I think she was treated with Procyclidine and it went away eventually, but she had only been taking Risperidal for a few months.
Q
Posted by blueberry on November 26, 2006, at 10:07:45
In reply to Re: Is this Tardive, EPS,..My Own Diagnosis » blueberry, posted by Quintal on November 26, 2006, at 9:30:39
> Have you asked your pdoc for his opinion? If you suspect your problems are movement disorders due to damage caused by antipsychotic drugs then you need to see a pdoc ASAP. They have anticholinergic drugs and dopamine agnosts to help with these problems, but the treatment depends on the severity of your symptoms.
>
> This happened to a friend of mine and I think she was treated with Procyclidine and it went away eventually, but she had only been taking Risperidal for a few months.
>
> QLike I said, several (4) psychiatrists have been useless. They are getting paid way too much to do basically a guessing game. I could make the same guesses blindfolded. My faith in them is very low at this point. They all have such high credentials too, and some really blank stares.
I guess anticholinergics are a remote possibility, but three dopamine agonists have already been tried and they seriously worsened my depression.
Posted by Quintal on November 26, 2006, at 10:31:19
In reply to Re: Is this Tardive, EPS,..My Own Diagnosis » Quintal, posted by blueberry on November 26, 2006, at 10:07:45
Have you tried self-medicating with Benadryl (diphenhydramine)?
Q
Posted by Phillipa on November 26, 2006, at 11:37:27
In reply to Re: Is this Tardive, EPS,..My Own Diagnosis » blueberry, posted by Quintal on November 26, 2006, at 10:31:19
Blueberry you never complained or mentioned this til after the ECT? Could they be connected? And not to insult you as you are brillient to me could you have forgotten when they started? Love Phillipa
Posted by blueberry on November 26, 2006, at 17:20:32
In reply to Re: Is this Tardive, EPS,..My Own Diagnosis, posted by Phillipa on November 26, 2006, at 11:37:27
> Blueberry you never complained or mentioned this til after the ECT? Could they be connected? And not to insult you as you are brillient to me could you have forgotten when they started? Love Phillipa
Actually Phillipa this stuff started in early 2005. I never complained about it. I've been fighting it ever since and all docs want to do is raise the doses even higher. And yes, things have gotten worse after ECT.
One thing did work in 2005...Kira St Johns Wort. I took 600mg of it along with 20mg prozac and 5mg zyprexa and every symptom I have disappeared...all of it, the depression, anxiety, tardive stuff, weirdness upon waking, everything gone. It was great. The problem was I think I ran into the early stages of serotonin syndrome at about the 6 week mark and backed away quickly. As the SJW wore off, all the symptoms that had been gone started to come back again.
Posted by Phillipa on November 26, 2006, at 19:18:52
In reply to Re: Is this Tardive, EPS,..My Own Diagnosis » Phillipa, posted by blueberry on November 26, 2006, at 17:20:32
Blueberry so can you modify it so they work? Love Phillipa
Posted by yxibow on November 27, 2006, at 4:40:27
In reply to Re: Is this Tardive, EPS,..My Own Diagnosis » Phillipa, posted by blueberry on November 26, 2006, at 17:20:32
> > Blueberry you never complained or mentioned this til after the ECT? Could they be connected? And not to insult you as you are brillient to me could you have forgotten when they started? Love Phillipa
>
> Actually Phillipa this stuff started in early 2005. I never complained about it. I've been fighting it ever since and all docs want to do is raise the doses even higher. And yes, things have gotten worse after ECT.
>
> One thing did work in 2005...Kira St Johns Wort. I took 600mg of it along with 20mg prozac and 5mg zyprexa and every symptom I have disappeared...all of it, the depression, anxiety, tardive stuff, weirdness upon waking, everything gone. It was great. The problem was I think I ran into the early stages of serotonin syndrome at about the 6 week mark and backed away quickly. As the SJW wore off, all the symptoms that had been gone started to come back again.
>
>Have you ever had your doctor or any psychopharmacologist do an AIMS exam ?
They're generally done on a 6 month interval for long term neuroleptic usage but you should be able to request one from your doctor and they should know what it is. Its just a subjective set of movements that a doctor does to evaluate a patient.
One thing to remember about TD is that the more one is aware of it happening, the least likely it is actually TD but more of an EPS syndrome -- the two are on a continuum of sorts and several experts in the field generally say self-awareness is a key that it is not TD. (i.e., someone has to point it out.)
Serotonin downregulates dopamine -- it is possible that the toxic combination of SJW (it is not benign in this combination) with serotonergic agents not only precipitated serotonin syndrome but also reduced the dopamine activity, hence reducing the symptoms.
As asked before, have you challenged it with Benadryl (diphenyhdramine) ? Anticholinergics generally help EPS but usually antagonize TD. Or you could have your doctor write a script for Akineton, Artane, or the rather sedating Cogentin.
Clonazepam may help. Propranolol can help certain EPS.
-- Jay
Posted by blueberry on November 27, 2006, at 17:48:19
In reply to Re: Is this Tardive, EPS,..My Own Diagnosis » blueberry, posted by yxibow on November 27, 2006, at 4:40:27
Excellent information. Wow. Thank you very much for that. Very helpful. Right off the bat I think I need to try some benadryl just to see if it helps and to gather some clues. The AIMS test is something I didn't know about and am very glad you took the time to share it with me. Thanks again. You spent some time and thought on that post and I appreciate it very much.
Posted by Jost on November 27, 2006, at 18:42:18
In reply to Re: Is this Tardive, EPS,..My Own Diagnosis » yxibow, posted by blueberry on November 27, 2006, at 17:48:19
But blueberry, definitely consult a Pdoc-- even if you don't trust them as much as you did-- cause this isn't something you want to take lightly.
Esp. since the symptoms have been persistent for a while.
Check it out, and the AIMS test is actually a very important diagnostic step-- great advice to make sure your pdoc does it.
Jost
Posted by med_empowered on November 28, 2006, at 1:58:05
In reply to Re: Is this Tardive, EPS,..My Own Diagnosis, posted by Jost on November 27, 2006, at 18:42:18
you could try going to a neurologist...they tend to be thorough, honest, and they cut through alot of the self-serving BS shrinks sometimes throw out there. See what they have to say.
Metabolic issues could be the problem, or a factor...I imagine you'd want to do blood sugar testing and go to a doc for a thorough check up.
You might want to consult a p-doc, but...p-docs I think are useless; you need *real doctors* at this point, so I think you should try them first, see what they have to say, and if you check out fine physically (no tardive akathisia or EPS or metabolic issues), then maybe do another round of p-doc stuff, if you want.
Good luck!
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