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Old 07-16-2018, 01:55 PM #11
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Default Re: Surprising new research on schizophrenia meds

hi. i take a moderate dose of abilify. as tranquilizers go, im glad its available. the only older tranquilizer ive taken was haldol, in a hospital. -nightmare- hardcore akathisia. the solution? perphenazine (trilafon, an older tranquilizer). no, thanks.

the TD advantage of the 'atypicals' really depends on the individual drug and the other drugs in the line up. if you look at conversion charts, taking a standard dose 'atypical' is like taking a low to moderate dose of older drugs. one big problem...

for whatever reason(s), back in the day, shrinks would call lots of people "Schizophrenic," and proceed to drug them up with massive doses of old tranquilizers. it was worse in hospitals, but common in outpatient, too. 20mgs/Haldol was once standard. thing is...that's roughly the equivalent of 1,000mgs/Thorazine, and most people only need 200-600+/- Thorazine (or equivalents) daily. some need less, some need more, but...overall, it really doesn't take much to help with agitation and psychosis.

abilify is somewhat unusual in that its really similar to the older drugs in terms of where it goes in the brain cells, but the D2 partial agonism thing often equals improved tolerability (overall, not for everyone). -all- the other tranqs gave me akathisia, then abilify got the job done w/o the crushing depression and akathisia. and yet...

even abilify has downsides. i had stiff gait, until I started popping massive doses of antioxidants and B-vitamins. that helps, tremendously. plus, because abilify has a unique mechanism of action, weird things can happen, especially with other psych drugs in the mix.
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Old 07-16-2018, 08:34 PM #12
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Default Re: Surprising new research on schizophrenia meds

Some of the older meds are like torture. Some are very popular here, for anxiety and sleep. They are often used at first option when someone comes in new at hospital with psychosis. Because they are "safe".

Clozapin is an atypical though. It's just food for thought I think, that they tell us all the new meds are safe. Like they always did when the old meds were new.

I'd rather take Risperdal (the only antipsychotic that didn't make me panicky) than Geodon or Seroquel that makes me that. On the other hand, our healthcare's favorite for sleep and anxiety, Nozinan, an old type med related to Thorazine, makes me anxious as well. So... for me all are out anyway.

Also I think the study said Clozaril was also the med most patients agreed with, so it cannot be like Haldol.

Of course the patient should get the med that suits them the best. If someone really has schizophrenia I do understand taking risks with health because it is worth it. But giving them out right and left for anxiety and sleep??.. Ugh.

I'm where benzos are phased out and they are actually taken off the market. The plan is to only keep those who have more use than just for mental stuff, like severe ET and epilepsy. All the others will go and be made near impossible to get as a psych patient. So then the off label prescription of neuroleptics will go up even more. There will me no new patients put on benzos and most of the old ones are "reviewed". We already had several deaths because people couldn't stand losing their meds they had for years. Others turn to the black market. Makes me mad. Where does it put me that get anxious from what they use for anxiety, when they take MY benzos for good? They CT'd me twice. Had to find new doctors that are more allowing. But when this one is prevented by law to prescribe to me, then what? Sigh.

Plus my antidepressant that I need will potentiate neuroleptics by an unknown number. Could be as small as double. Could be as bad as 20 times.

Sometimes I really hate psychiatry.
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Old 07-16-2018, 08:37 PM #13
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Default Re: Surprising new research on schizophrenia meds

Here is someone talking against the study anyway...

Is the Schizophrenia Mortality Study in The Lancet CREDIBLE? - AHRPAHRP
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Old 07-17-2018, 03:29 AM #14
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Default Re: Surprising new research on schizophrenia meds

Quote:
Originally Posted by -jimi- View Post
Here is someone talking against the study anyway...

Is the Schizophrenia Mortality Study in The Lancet CREDIBLE? - AHRPAHRP
Ah thanks - so not the study I linked to (which is later and seems more balanced)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471960/

Can't access the full Finnish paper but this statement seems on the face of it to be highly questionable and you would think needs further analysis:

Quote:
The Finnish study found no pronounced differences in heart deaths between the different atypicals, but patients on clozapine had a substantially lower risk of suicide while those on Seroquel were more likely to kill themselves.
Thing is typically in modern practice this may simply reflect patterns of prescribing, generally Seroquel (or similar atypicals) would be the treatment of choice for first episode and acute psychosis, which I would have thought are more likely to be riskier in terms of suicide risk anyway than people who are on longer term management for chronic psychotic conditions like Schizophrenia, who may still be on some of the older antipsychotics but who would, by definition, be 'better managed' and overall less of a suicide risk.
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Old 08-08-2018, 01:12 AM #15
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Default Re: Surprising new research on schizophrenia meds

What people get prescribed depends on a lot of factors — some obvious and others not so much — like psychotropic naiveté vs x number of partial response/failed med trials, pre-existing heath conditions, symptomology, trial and error response to each med weighed against any observable side effects, what a patient's insurance is willing to pay for/not pay for, both the quality and time period of the doctor's medical education, e.g. I've worked with some doctors in their 60's & 70's who much more favored older antipsychotics (toss up on if that's due to believing they're "better" meds vs. that's just what they know). I'm sure there are others I'm blanking on, but I'd say that's a good start.

Also, obviously take it with a grain of salt but also keep it in mind: I've worked on an acute inpatient psych unit for 8 years at a well known and respected psych hospital in MA and with a few exceptions most of the doctors I've worked with don't start with Seroquel as the primary antipsychotic for severe manic/psychotic episodes; it's frequently either Risperdal or Zyprexa. One seen it get used more in the >800mg range for "mood stabilization" or 25mg/50mg/100mg for a non-benzo anxiety and/or sleep med.

Honestly, I think the only antipsychotics that suck more than Seroquel, especially for full blown mania/psychosis are Saphris (which I've seen used < 5x in 8 years and all failed; might actually just be a black cherry flavored tictac) and Abilify (which is like the Zima/Smirnoff Ice of the antipsychotic world).
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Old 08-08-2018, 01:27 AM #16
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Default Re: Surprising new research on schizophrenia meds

Quote:
Originally Posted by still_crazy View Post
hi. i take a moderate dose of abilify. as tranquilizers go, im glad its available. the only older tranquilizer ive taken was haldol, in a hospital. -nightmare- hardcore akathisia. the solution? perphenazine (trilafon, an older tranquilizer). no, thanks.

the TD advantage of the 'atypicals' really depends on the individual drug and the other drugs in the line up. if you look at conversion charts, taking a standard dose 'atypical' is like taking a low to moderate dose of older drugs. one big problem...

for whatever reason(s), back in the day, shrinks would call lots of people "Schizophrenic," and proceed to drug them up with massive doses of old tranquilizers. it was worse in hospitals, but common in outpatient, too. 20mgs/Haldol was once standard. thing is...that's roughly the equivalent of 1,000mgs/Thorazine, and most people only need 200-600+/- Thorazine (or equivalents) daily. some need less, some need more, but...overall, it really doesn't take much to help with agitation and psychosis.

abilify is somewhat unusual in that its really similar to the older drugs in terms of where it goes in the brain cells, but the D2 partial agonism thing often equals improved tolerability (overall, not for everyone). -all- the other tranqs gave me akathisia, then abilify got the job done w/o the crushing depression and akathisia. and yet...

even abilify has downsides. i had stiff gait, until I started popping massive doses of antioxidants and B-vitamins. that helps, tremendously. plus, because abilify has a unique mechanism of action, weird things can happen, especially with other psych drugs in the mix.
Second generation antipsychotics are, at best, no better than first generation (just different side effect profiles) and as worst, worse due to going from movement/parkinsonism side effects to metabolic/cardiac

Also, it's actually pretty difficult to accurately and fairly compare "potency" between typical and atypical antipsychotics largely due to typicals being 95-100% D2 antagonism/blockade vs. atypicals, which are either much less D2 antagonism (or none at all) and more broad-spectrum including 5HT2A agonism/antagonism/cholinergic/histaminergic, etc.
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Old 08-13-2018, 08:22 PM #17
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Default Re: Surprising new research on schizophrenia meds

In hosp here they feel the new gen is to finicky so they start people on Haldol or Trilafon because those have a longer record. A good record I wonder then? But no one wants to answer that. LOL.
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