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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by jasmineneroli on October 2, 2009, at 22:16:06
Anybody have ideas as to which anti-psychotic has the lowest S/E profile?
Especially regarding Histamine 1 receptors.
I'm struggling with Seroquel XR (150mg), due to incredible sedative effects, and fluid retention.
Believe that a lot of the sedation is caused by Histamine 1 antagonism (???).It also appears to be causing ultra rapid cycling between hypo-mania to angry depression. So I'm not sure it's having any therapeutic effect yet. I've been taking it for 4 weeks.
Anyone have ideas?
Thx a million.
J
PS: I started on Neurontin 900mg per day, 2 weeks ago.
Posted by morganator on October 2, 2009, at 22:48:42
In reply to Which anti-psychotics are CLEANEST?, posted by jasmineneroli on October 2, 2009, at 22:16:06
There is no clean antipsychotic in my opinion. Maybe Abilify will help you? Zyprexa may work well and it may not be as sedating.
Why were you taking seroquel in the first place?
Posted by Zyprexa on October 3, 2009, at 4:58:28
In reply to Which anti-psychotics are CLEANEST?, posted by jasmineneroli on October 2, 2009, at 22:16:06
Have you tried risperdal?
Posted by bleauberry on October 3, 2009, at 7:28:59
In reply to Which anti-psychotics are CLEANEST?, posted by jasmineneroli on October 2, 2009, at 22:16:06
Amisulpride cleanest.
All others have multiple functions and cannot be classified as clean. But then, in psychiatry, it may well be we don't want clean. SSRIs are clean. TCAs are dirty. But which are generally viewed as gold standard?
In terms of not hitting histamine so hard, probably Abilify or Risperdal. Zyprexa is in my opinion the best overall in the entire class. It has significant histamine action, but not anywhere close to seroquel, and tends to develop tolerance within a month or so to that effect.
For mood stabilization, I know of no better AP than Zyprexa, if one is going to choose an AP agent with that hoped outcome.
Posted by jasmineneroli on October 3, 2009, at 9:27:19
In reply to Re: Which anti-psychotics are CLEANEST?, posted by morganator on October 2, 2009, at 22:48:42
> There is no clean antipsychotic in my opinion. Maybe Abilify will help you? Zyprexa may work well and it may not be as sedating.
* Hmmmm, I'm afraid of the weight gain on Zyprexa. Abilify interests me.
> Why were you taking seroquel in the first place?
* A new Pdoc told me I have "a mood disorder that needs stabilizing". When pressed for a more definitive dx, he said, Bipolar 2, or Bipolar Mixed States, or maybe agitated depression with anxiety.(I also have chronic insomnia). He said it didn't matter, his treatment modality would be the same - an anti-psychotic, a mood stabilizer & a AD. I have refused the AD at present.
Thanks for your input!
J
Posted by jasmineneroli on October 3, 2009, at 9:52:44
In reply to Re: Which anti-psychotics are CLEANEST? » jasmineneroli, posted by Zyprexa on October 3, 2009, at 4:58:28
> Have you tried risperdal?
* No, Seroquel is the first AP I've been on. Doesn't Risperdal have more chance of TD than the others? Is it a high risk for TD?
Thx
J
Posted by jasmineneroli on October 3, 2009, at 10:39:15
In reply to Re: Which anti-psychotics are CLEANEST?, posted by bleauberry on October 3, 2009, at 7:28:59
> Amisulpride cleanest.
* Wow. I just researched this drug - it sounds PERFECT for me (no Serotonergic function, no CYP450 metabolism, no Histamine, Yay!). But I'm very disappointed to find it's not FDA approved, so not available here. I'm pretty sure I won't be able to convince my new Pdoc to prescribe/special order this.
> All others have multiple functions and cannot be classified as clean. But then, in psychiatry, it may well be we don't want clean.
* What do you mean by this, BB? When I think of clean, I think of few or no S/E's.
>SSRIs are clean. TCAs are dirty. But which are generally viewed as gold standard?
* For me, I had trouble with every SSRI/SNRI I tried, in terms of side effects, and diminishing therapeutic value, over time.
> In terms of not hitting histamine so hard, probably Abilify or Risperdal. Zyprexa is in my opinion the best overall in the entire class. It has significant histamine action, but not anywhere close to seroquel, and tends to develop tolerance within a month or so to that effect.
* Abilify is interesting me more & more, however I'm concerned about high affinity to Histamine 1.
I found the below-quoted statement on a website. Is this accurate??
"Abilify works in a very sophisticated way: it travels to the specific brain areas, where the levels of serotonin and dopamine are too high or too low, and it returns the amounts of the mentioned neurotransmitters into balance by either reducing or increasing their amount."
> For mood stabilization, I know of no better AP than Zyprexa, if one is going to choose an AP agent with that hoped outcome.* Mood stabilization is a desired outcome, as is anti-anxiety and relief of very agitated, angry depression that I turn on myself to self-injure.
Zyprexa has always terrified me, re: weight-gain.I know I'm trying to find the "perfect drug" (or drugS).Thank you SO much for your response BB. It's helping me clear my mind.
J
Posted by Phillipa on October 3, 2009, at 12:12:43
In reply to Re: Which anti-psychotics are CLEANEST? » bleauberry, posted by jasmineneroli on October 3, 2009, at 10:39:15
Just curious you taking an antidepressant also for the depression or just the mood stabalizer and antiphychotic. I think from what I've read I once took seroquel 50 lips and skin dried out a week after stopping and only took 24 hours it knocked me out. Doc discontinued it was in the hospital and just kept the benzos. Abilify know a guy taking 2.5mg of it and with other meds doing fine. Phillipa
Posted by jasmineneroli on October 3, 2009, at 14:05:33
In reply to Re: Which anti-psychotics are CLEANEST? » jasmineneroli, posted by Phillipa on October 3, 2009, at 12:12:43
> Just curious you taking an antidepressant also for the depression or just the mood stabalizer and antiphychotic.
*I'm just taking the AP and Mood Stabilizer right now. I've been given a prescription for Pristiq, but didn't want to start so many new drugs all at once. (I was on Effexor for a year, with lots of S/E's that got worse. Some mood & anxiety improvement on Effexor, but I had an episode of self-injury whilst on it. Took me 2 months to taper off it, even then had brain zaps & headaches all the time. So I'm leary of Pristiq at the moment). Think use of SSRI's & SNRI's may have started my mood-cycling. Don't know for sure. Was off all meds for 6 months, but hit very severe agitated depression in July. Raging at myself in the mirror again. Wanting to cut/scratch myself again. Pretty bad.
> Abilify know a guy taking 2.5mg of it and with other meds doing fine. Phillipa
* Yeah, I may look at really low dose Abilify too.
Thx for your input.J
Posted by jasmineneroli on October 3, 2009, at 14:08:03
In reply to Re: Which anti-psychotics are CLEANEST? » Phillipa, posted by jasmineneroli on October 3, 2009, at 14:05:33
........... any opinion on Geoden's "cleanliness"?
Effective on rapid-cycling Bipolar 2/Mixed States?
Thx.J
Posted by morganator on October 3, 2009, at 20:09:19
In reply to Re: Which anti-psychotics are CLEANEST? » morganator, posted by jasmineneroli on October 3, 2009, at 9:27:19
Why no AD??? The potential long term side effects can be worse for antipsychotics and mood stabilizers, at least in my opinion and experience. I had similar issues as you when I was 22 and took prozac(this was before I knew I was bipolar) and after 3 weeks I woke up one day and felt like better than I had felt in years. Then, when I was 27 I started Zoloft and was on it by itself for 7 years.
You may be robbing yourself of feeling good by not taking an antidepressant.
Also, I started sleeping great when Prozac worked for me. I slept great for all the years I took Zoloft as well.
I would seriously consider Prozac or Zoloft and stop all antipsychotic treatment. Maybe add a low dose of lithium or depakote. You never know, an AD alone along with regular exercise, a good diet, and therapy.
Abilify can be very effective but it is a very powerful medication with potential health risks. I would choose an AD over Abilify any day.
Posted by morganator on October 3, 2009, at 20:12:48
In reply to Re: Which anti-psychotics are CLEANEST? » bleauberry, posted by jasmineneroli on October 3, 2009, at 10:39:15
I take back much of what I said in my last post about AD's. I should have read through this thread more carefully. My bad.
Posted by morganator on October 3, 2009, at 20:31:41
In reply to Re: Which anti-psychotics are CLEANEST? » bleauberry, posted by jasmineneroli on October 3, 2009, at 10:39:15
I think by cleanest BB meant that it is more selective, targeting one neurotransmitter. Lexapro, for example, is the cleanest of SSRIs because it only selectively inhibits the reuptake of serotonin, whereas Zoloft has some affinity for dopamine and norepinephrine. Prozac antagonizes the 5ht2c serotonin receptor, causing an increase in norepinephrine and dopamine in the prefrontal cortex(at least that is what I remeber). So you can see how some medications that are "dirtier" may work better because they are working on more neurotransmitters.
Posted by Phillipa on October 3, 2009, at 20:39:50
In reply to Re: Which anti-psychotics are CLEANEST?, posted by morganator on October 3, 2009, at 20:31:41
Seriously I never knew what a dirty med is thought inferior. But from what you said the dirtier the more neurotransmitters the med hits? Phillipa
Posted by Zyprexa on October 3, 2009, at 22:29:21
In reply to Re: Which anti-psychotics are CLEANEST? » Zyprexa, posted by jasmineneroli on October 3, 2009, at 9:52:44
I'm not sure if risperdal was a risk for TD. When I was on it I didn't get any shakes or twitches. On the other had it was not very effective for my real simptoms. Zyprexa is probbably the most effective AP I ever took, it had no TD and I've been taking it for 11 years. The only undesirable effect it had was the weight gain, and it may have given me Diabetes. Not sure about the diabettes because it has gone away and I still take the same dose. I was first diagnosed with diabettes when I started geodon and had gone low on the zyprexa. I was never diagnoses when I took it before the geodon. Geodon gave me realy bad blured vision which increased with dose, I was on a very high dose of it, and it also didn't do much for my paranoia. Abilify did the oposite for my diabetes, it gave me realy low blood sugars so I was eating sugar all the time so I would not pass out. I found that when I would walk to the bathroom I would almost pass out in the short distance. Abilify also gave me realy bad TD, I could not hold my hands still enough to do sodering at work and ultimatly lost my job because of the abilify. Perphenazine which I started about 2-3 years ago is the best AP I have tried other than zyprexa. It give me a little tD, shaky hands, but no weight gain or diabettes. It also controls rapid thought, and helps me think clearly. So those are my two favorite AP, zyprexa and perphenazine(the Sandoz version of generic)(didn't like the other generic and have not tried the brand). Not sure of others I took in hospital, but one of them gave me NMS, where I could not stop swallowing. My suspision it that it may have me haldol. But I don't realy have any records to look at.
Posted by jasmineneroli on October 4, 2009, at 14:31:08
In reply to Re: Which anti-psychotics are CLEANEST?, posted by morganator on October 3, 2009, at 20:09:19
> Why no AD???
* Well I kinda answered that in my above post. Not ruling out an AD as yet, just postponing it, due to starting 2 new meds. BTW Have been on 9 diff. meds previously, and gave EVERYTHING a good trial length of time. S/E's stopped most of them, or "poop-out".
> I slept great for all the years I took Zoloft as well.*This would be the only SSRI I'd try.
> I would seriously consider Prozac or Zoloft and stop all antipsychotic treatment.
* I was terrified of starting an AP, didn't want to at all.
> You never know, an AD alone along with regular exercise, a good diet, and therapy.
* Was doing all the above,for over a year, but still ended up with symptoms AND the S/E's. So I dropped the AD's and tried just the the last 3 suggestions. 6 months later I'm back with hypo-mania and agitated depression and self-injury :(
Posted by jasmineneroli on October 4, 2009, at 14:32:12
In reply to Re: Which anti-psychotics are CLEANEST?, posted by morganator on October 3, 2009, at 20:12:48
Posted by jasmineneroli on October 4, 2009, at 14:35:08
In reply to Re: Which anti-psychotics are CLEANEST?, posted by morganator on October 3, 2009, at 20:31:41
> I think by cleanest BB meant that it is more selective, targeting one neurotransmitter. Lexapro, for example, is the cleanest of SSRIs because it only selectively inhibits the reuptake of serotonin, whereas Zoloft has some affinity for dopamine and norepinephrine. Prozac antagonizes the 5ht2c serotonin receptor, causing an increase in norepinephrine and dopamine in the prefrontal cortex(at least that is what I remeber). So you can see how some medications that are "dirtier" may work better because they are working on more neurotransmitters.
* That makes sense now, thanks. I always think in terms of few side effects when I think of "clean" vs "dirty".
I appreciate the time you've taken to give me feedback.
J
Posted by jasmineneroli on October 4, 2009, at 14:44:31
In reply to Re: Which anti-psychotics are CLEANEST? » jasmineneroli, posted by Zyprexa on October 3, 2009, at 22:29:21
> I'm not sure if risperdal was a risk for TD. When I was on it I didn't get any shakes or twitches. On the other had it was not very effective for my real simptoms. Zyprexa is probbably the most effective AP I ever took, it had no TD and I've been taking it for 11 years. The only undesirable effect it had was the weight gain, and it may have given me Diabetes. Not sure about the diabettes because it has gone away and I still take the same dose. I was first diagnosed with diabettes when I started geodon and had gone low on the zyprexa. I was never diagnoses when I took it before the geodon. Geodon gave me realy bad blured vision which increased with dose, I was on a very high dose of it, and it also didn't do much for my paranoia. Abilify did the oposite for my diabetes, it gave me realy low blood sugars so I was eating sugar all the time so I would not pass out. I found that when I would walk to the bathroom I would almost pass out in the short distance. Abilify also gave me realy bad TD, I could not hold my hands still enough to do sodering at work and ultimatly lost my job because of the abilify. Perphenazine which I started about 2-3 years ago is the best AP I have tried other than zyprexa. It give me a little tD, shaky hands, but no weight gain or diabettes. It also controls rapid thought, and helps me think clearly. So those are my two favorite AP, zyprexa and perphenazine(the Sandoz version of generic)(didn't like the other generic and have not tried the brand). Not sure of others I took in hospital, but one of them gave me NMS, where I could not stop swallowing. My suspision it that it may have me haldol. But I don't realy have any records to look at.
* People seem to really like Zyprexa. Do you remember what dose of Zyprexa you took? I'm terrified of Zyprexa weight gain. Seroquel presents the same fear, but I'm on a relatively low dose at 150mg.
*How about your Risperdal dose?
* Appreciate the feedback on Geodon & Abilify. Seems Geodon is really unpopular.
* Never heard of the perphenazine before - will check it out.Thanks for you input!
J
Posted by psychobot5000 on October 4, 2009, at 15:05:31
In reply to Re: Which anti-psychotics are CLEANEST? » Zyprexa, posted by jasmineneroli on October 4, 2009, at 14:44:31
This table has receptor-binding data for most antipsychotics. Personally, my money would be on Geodon, as it's the only antipsychotic I've taken that doesn't make me feel like my mind is wading through cottage-cheese.
http://www.nature.com/npp/journal/v28/n3/fig_tab/1300027t1.html
Posted by jasmineneroli on October 4, 2009, at 20:49:12
In reply to Re: clean antipsychotics (binding data) » jasmineneroli, posted by psychobot5000 on October 4, 2009, at 15:05:31
> This table has receptor-binding data for most antipsychotics. Personally, my money would be on Geodon, as it's the only antipsychotic I've taken that doesn't make me feel like my mind is wading through cottage-cheese.
>
> http://www.nature.com/npp/journal/v28/n3/fig_tab/1300027t1.htmlThank you SO MUCH! This is a very interesting table to me, for several reasons.
I have always (anecdotally, from my own experiences with AD's) felt that Histamine 1 receptor affinity = weight gain, mostly through increased appetite. It is also causes the most sedation/brain fog.
Seroquel @ 150mg is driving me nuts, re drowsiness, brain fog & zero mental energy/drive for anything. Sure it makes me sleep and has removed my anxiety, but it leaves me so brain-dead & flat!
I'm wondering why some days, though, I've felt agitated depressed, and earlier on, felt hypo-manic with loads of pressured speech???
I'm looking at Geodon for it's better weight gain/sedation profile & Abilify possibly. Especially at low doses.
Zyprexa may be too heavy hitting for me.
Thanks again.
J
Posted by Zyprexa on October 6, 2009, at 2:03:34
In reply to Re: Which anti-psychotics are CLEANEST? » Zyprexa, posted by jasmineneroli on October 4, 2009, at 14:44:31
I still take the zyprexa and the perphenazine. I have not taken the risperdal in 11 years since starting the zyprexa. I've been on one dose or anouther of zyprexa for almost the whole 11 years. The dose that worked the best without other APs is 10mg zyprexa. Which is what I take now. Ever since the abilify, I've been doing worse and needing a higher dose of zyprexa for quite some time, up to 50mg/day. While the geodon I decreased the zyprexa to doses of 5mg or less. I'm sure if I had gone compleatly off the zyprexa I would have had a very bad time.
Posted by jasmineneroli on October 6, 2009, at 9:19:46
In reply to Re: Which anti-psychotics are CLEANEST? » jasmineneroli, posted by Zyprexa on October 6, 2009, at 2:03:34
I know this sounds like a very vain question, but did you gain weight on the lower (10mg) dose of Zyprexa? Did you find it sedating?
And how did the Geodon/Zyprexa combo work for you?
I go to a new Pdoc next week, for a 2nd opinion, and would like to go armed with info. So this discussion is very helpful. Thank you.
J
Posted by ricker on October 6, 2009, at 12:14:11
In reply to Re: Which anti-psychotics are CLEANEST? » Zyprexa, posted by jasmineneroli on October 6, 2009, at 9:19:46
I've been taking zyprexa for several months and find it to be the smoothest with minimal side-effects other than modest weight gain. Like my p/doc says, do you want to feel happy and heavy, or sad and slim?
I think most of the a/typical's will cause weight gain to some degree so I'm quite happy with zyprexa.... eating healthy and exercise will help not only with weight, but overall mood enhancement.Regards, Rick
Posted by Zyprexa on October 7, 2009, at 12:13:58
In reply to Re: Which anti-psychotics are CLEANEST? » Zyprexa, posted by jasmineneroli on October 6, 2009, at 9:19:46
Yes I gained weight on 10mg zyprexa. I'm 5'10" and was 150 lbs before the zyprexa and now 220. No the geodon / zyprexa combo did not work.
This is the end of the thread.
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