Posted by jay on October 25, 2002, at 3:40:22
In reply to How do antipsychotics work on anxiety? (nm), posted by utopizen on October 24, 2002, at 11:56:49
I agree with Octopus above, and just wanted to add a few more things from personal experience. I think that smaller than normal doses of the 'atypical antipsychotics' can work well and synergistically with a good antidepressant dose, especially on a more severe 'agitated' anxiety. There may be some people who are very uncomfortable with them, and like any medication there is a bit of a 'risk' with them, but I think in particular, these meds appear just as safe as any new antidepressant. I have been quite impressed at their ability to tackle the agitation that brings on activated responses to antidepressants. I've been on many benzos before too, and they are another great safe medication, but the overall long-term goal of eliminating horrid agitating anxiety seems better served by augmentation with an atypical antipsychotic. I honestly think they are a much better long-term solution than the very-rarely-affective 'Buspar'. (And you can always have a good dose of benzo's as a back-up.)
The only thing I find bothersome is the weight gain, but I really would like to see how consistent this is in the 'very' long-term. It seems people gain most within the first 6 months to a year use. After awhile it seems that weight does even itself out a bit more. I also think these atypical antipsychotics are great for 'mixed states', with all of their mixed and agitated anxiety, and recall Zyprexa proving to actually be faster and better acting for these than Lithium. (There are many important things to be researched beyond this, but I recall the results for this study where quite in favour of Zyprex's efficacy.)
As for their specific mechanisms, I have heard many things about the atypicals, but I believe a few things might explain them fairly well. One is the antagonism of serotonin and dopamine. The other is linked to this, and it may have to do with the overall regulation of dopamine. (That most current antidepressants don't do in much the same way. I know some have weak effects, and others have an indirect effect, like the SRI's.)
Don't be afraid to talk to your doctor about them.
Jay
poster:jay
thread:125017
URL: http://www.dr-bob.org/babble/20021019/msgs/125150.html