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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 27. This is the beginning of the thread.
Posted by lauran on March 13, 2003, at 10:46:26
I was on Abilify 7.5 mg every day for four weeks. I experienced moderate akathesia within 2 weeks of initiation of this med. I also felt the physical sensation of leaning to the left, driving to the left (here in the US we prefer drivers stay to the right)!
I stopped this med 5 days ago and reported these symptoms to my pdoc. He prescribed amantadine and within 3 doses the sensations began to subside.
Has anyone had akathesia as a reaction to a med? Did you stop the med? How long did it take for the agitation and inner restlessness to go away?
Thanks!
Posted by stjames on March 13, 2003, at 17:49:55
In reply to Abilify drug reaction?, posted by lauran on March 13, 2003, at 10:46:26
> Has anyone had akathesia as a reaction to a med?
All anti-psychotics can cause akathesia, just because they are new does not mean they will not.
Posted by SLS on March 13, 2003, at 18:28:33
In reply to Re: Abilify drug reaction?, posted by stjames on March 13, 2003, at 17:49:55
> > Has anyone had akathesia as a reaction to a med?
>
> All anti-psychotics can cause akathesia, just because they are new does not mean they will not.
Hi James.This is one time I wish you were wrong.
I have been taking Abilify 20mg for over 4 weeks. At first, I thought the impatience, restlessness, agitation and irritability were just mood side-effects like what is sometimes seen with Wellbutrin. However, these things have not abated, and I now believe them to be manifestations of mild akathisia. I have decided to reduce the dosage to 10mg. Hopefully, this will also mitigate the constipation I experience with Abilify also.
It looks like Abilify has a particularly high incidence of akathisia - more so than the other atypicals.
I hope all is well with you.
- Scott
Posted by Ritch on March 13, 2003, at 22:47:39
In reply to Re: Abilify drug reaction?, posted by SLS on March 13, 2003, at 18:28:33
> > > Has anyone had akathesia as a reaction to a med?
> >
> > All anti-psychotics can cause akathesia, just because they are new does not mean they will not.
>
>
> Hi James.
>
> This is one time I wish you were wrong.
>
> I have been taking Abilify 20mg for over 4 weeks. At first, I thought the impatience, restlessness, agitation and irritability were just mood side-effects like what is sometimes seen with Wellbutrin. However, these things have not abated, and I now believe them to be manifestations of mild akathisia. I have decided to reduce the dosage to 10mg. Hopefully, this will also mitigate the constipation I experience with Abilify also.
>
> It looks like Abilify has a particularly high incidence of akathisia - more so than the other atypicals.
>
> I hope all is well with you.
>
>
> - Scott
Scott, thanks for posting this. My pdoc gave me a 7-day 15mg sample packet of Abilify. I wasn't interested in it, but I got a big spiel about how it could replace several meds, etc. I have read about a lot of akathisia probs with this med. I'm definitely not touching it with a ten foot pole now. I remember my short Risperdal trial of .5mg at bedtime a few years ago that resulted in a dystonic reaction that took a few weeks to wither away. NO thanks. Don't want to go THERE.
Posted by lauran on March 14, 2003, at 9:43:03
In reply to Re: Abilify drug reaction? » SLS, posted by Ritch on March 13, 2003, at 22:47:39
Thanks for replying. After several doses of amantadine I've noticed physical symptoms abating. However, the inner restlessness and agitation continue to come in waves of about 2-3 hours in duration throughout the day. The worst times are when I first wake up in the morning. I attribute this to the very long half-life of this med. Hopefully this will go away soon. I've also heard that Abilify has a tendency to cause akathesia.
Posted by Ritch on March 14, 2003, at 10:23:45
In reply to Re: Abilify drug reaction?, posted by lauran on March 14, 2003, at 9:43:03
> Thanks for replying. After several doses of amantadine I've noticed physical symptoms abating. However, the inner restlessness and agitation continue to come in waves of about 2-3 hours in duration throughout the day. The worst times are when I first wake up in the morning. I attribute this to the very long half-life of this med. Hopefully this will go away soon. I've also heard that Abilify has a tendency to cause akathesia.
>
>
I was treated with 30mg/day of diazepam (+Benadryl 25mg tid) for the dystonic reaction I got from Risperdal. Also, when I get EPS reactions from AP's my anxiety level tends to skyrocket and it develops into a string of panic attacks. I think the AP's tweak with my neuroendocrine hormone balance and that winds up triggering my panic episodes. It takes a while for all of that to settle back into a more "normal" pattern again. Restlessness is not something I need as an adverse effect from a medication. I can get that from any SSRI. I got clear cut EPS even from Paxil.
Posted by stjames on March 14, 2003, at 18:13:48
In reply to Re: Abilify drug reaction?, posted by lauran on March 14, 2003, at 9:43:03
After several doses of amantadine
Amantadine just masks the side effects, they are still there.
Posted by stjames on March 14, 2003, at 18:59:35
In reply to Re: Abilify drug reaction?, posted by SLS on March 13, 2003, at 18:28:33
> > > Has anyone had akathesia as a reaction to a med?
> >
> > All anti-psychotics can cause akathesia, just because they are new does not mean they will not.
>
>
> Hi James.
>
> This is one time I wish you were wrong.Given the histroy of AP's and the fact they effect dopa, I see not point to hoping any AP
is free of movement disorders.
Posted by SLS on March 14, 2003, at 19:44:25
In reply to Re: Abilify drug reaction?, posted by stjames on March 14, 2003, at 18:59:35
> > > > Has anyone had akathesia as a reaction to a med?
> > >
> > > All anti-psychotics can cause akathesia, just because they are new does not mean they will not.
> >
> >
> > Hi James.
> >
> > This is one time I wish you were wrong.
>
> Given the histroy of AP's and the fact they effect dopa, I see not point to hoping any AP
> is free of movement disorders.
Hi James.Perhaps finding neuroleptics that are regionally specific would help. I read that Abilify did not accumulate in the striatum. This is an observation that is thought to explain the relative lack of dyskinetic and dystonic side effects. Akathisia is something different, though, and I don't know very much about its etiology.
- Scott
Posted by medlib on March 14, 2003, at 22:20:19
In reply to Re: Abilify drug reaction?, posted by SLS on March 14, 2003, at 19:44:25
Hi Scott--
Found this on an ER guide while wandering around the web trying to decide whether to risk an Abilify trial.
- drugs provoking acute akathisia include neuroleptic agents, serotonin receptor antagonists, lithium, levodopa, calcium channel blockers and phenothiazine anti-emetics eg. prochlorperazine or metoclopropamide
- the etiology of akathisia is unknown, but a good response to propanolol suggests a hyperactive adrenergic system- the treatment of acute drug-induced akathisia includes anticholinergic agents (diphenhydramine and benztropine) and propanolol +/- opioids
It goes on to say that anticholinergics aren't helpful for chronic akathisia.
Found the following on a medical mnemonics site; since so many of us are taking or considering taking APs, I thought it might be useful.
Neuroleptic side effects onset
The rule of 4's:
Dystonia: 4 hours-4 days
Akathesia: 4 days-40 days
Extrapyramidal symptoms: 4 days-4 weeks
Tardive dyskinesia: 4 months (greater than)
· Note that tardive is obviously the latest one to happen (tardive=tardy/late).
· Note that the first letters of these four classic symptoms spell "DATE", and this mnemonic is the dates when they occur.Hope that Abilify proves helpful for you.---medlib
Posted by lauran on March 14, 2003, at 22:49:22
In reply to Re: Akathisia » SLS, posted by medlib on March 14, 2003, at 22:20:19
Posted by stjames on March 16, 2003, at 3:21:40
In reply to Re: Abilify drug reaction?, posted by SLS on March 14, 2003, at 19:44:25
> Hi James.
>
> Perhaps finding neuroleptics that are regionally specific would help. I read that Abilify did not accumulate in the striatum. This is an observation that is thought to explain the relative lack of dyskinetic and dystonic side effects. Akathisia is something different, though, and I don't know very much about its etiology.
>
>
> - ScottI realize I am throwing all these conditions together, they may have different causes. Or
maybe AP's are by themselves neurotoxic. Till
we understand the dopa system better it sure seems
all psyco meds that effect dopa carry the same group of SE's, but do differ by degree.Yes I am always on the anti-AP kick. But not
for psychosis or conditions that resist other
treatments. I must not have noticed you posted this (SLS) because I have followed your posts
for years as you seek a treatment that works.
IMO you are justified in trying AP's.I think few really know what TD, EPS, ect are
like. I have seem them, my brothers friend M, who we both grew up with had a break in her 20s and is now a schito, paranoid type. During the 80's, drug holidays were thought to be a good thing.
M had massive TD, tics, extreame restlessness;
the whole ball of wax during these "holidays".
It was horrible to watch. These SE's really made
the patient look very crazy, despite the drugs intent to make the insane sane.
Posted by lauran on March 16, 2003, at 11:11:39
In reply to Re: Abilify drug reaction? » lauran, posted by Ritch on March 14, 2003, at 10:23:45
Hey Ritch. Thanks for our input. I have anxiety as well and I have to really watch for any med that exacerbates this. Once you have had a reaction like akathesia you never forget it.
Posted by lauran on March 16, 2003, at 11:17:43
In reply to Re: Abilify drug reaction?, posted by stjames on March 16, 2003, at 3:21:40
Hi stjames. I appreciated your view that too many take atypicals that do not understand the risks that go with it. I work in a profession where I often see elderly who are suffering from long term EPS/TD and the symptoms will never go away. It tears my heart out. It makes me wonder if they needed the meds in the first place. Thanks for that input.
Posted by SLS on March 16, 2003, at 11:40:39
In reply to Re: Abilify drug reaction?, posted by stjames on March 16, 2003, at 3:21:40
Hi James.
It is so hard to make decisions regarding the choosing of neuroleptic antipsychotics to treat non-psychotic disorders. I am heartened to have you understand my situation in particular. Like you, I tend to lean in the direction of conservatism. Abilify represents a good example of how unexpectedly EPS can raise its ugly head(s). I was initially suspect of this drug and somewhat afraid of it because it binds so incredibly tightly to D2 receptors. It is comparable to Haldol in this regard. It really is a mixed-up drug. However, my alternatives are few, and I deemed it worth a try.
I have noticed an association between Abilify and Geodon and the propensity of both of these drugs to produce akathisia at a rate greater than the other atypicals. Both drugs are separated from the others by their ability to bind tightly to and stimulate 5-HT1a receptors. It is quite possible that the liability of these APs to produce akathisia, anxiety, insomnia, and cognitive side effects is greater in affective disorders than in schizoid disorders in the same way that tardive dyskinesia occurs at a higher rate in bipolar disorder than schizophrenia. Perhaps neuroleptic antipsychotics are being used too cavalierly in todays's environment. They can help so much. They can hurt so much. Crystal balls are hard to come by. Hopefully, the more optimistic outlooks regarding the incidence of EPS and TD with the long-term use of the newer drugs will be justified.
- Scott
Posted by lauran on March 16, 2003, at 11:50:19
In reply to Re: Abilify drug reaction?, posted by SLS on March 16, 2003, at 11:40:39
Hi Scott. Could you briefly sum up the difference between affective and schizoid disorder? Is this question too broad? If so, I'll go to the books. Just curious though.
Thanks.
Posted by SLS on March 16, 2003, at 12:31:13
In reply to Re: Abilify drug reaction? » SLS, posted by lauran on March 16, 2003, at 11:50:19
> Hi Scott. Could you briefly sum up the difference between affective and schizoid disorder? Is this question too broad? If so, I'll go to the books. Just curious though.
>
> Thanks.
Hi.The word 'affect' refers to mood or emotion.
example: "His face betrayed his depressed affect."
The word 'affective' means of mood or mood content. Thus 'affective disorder' means mood disorder (unipolar major depression, bipolar disorder, cyclothymia, dysthymia, psychotic depression).
The word 'schizoid' refers to distortions of reality, along with disturbances of thought and language and withdrawal from social contact.
I guess the easiest way to look at it is as mood disorder versus thought disorder.
There is also a separate illness known as 'schizoffective' disorder. It has features of, and resembles both bipolar disorder and schizophrenia. Generally, both mood stabilizers and antipsychotics are required to treat it adequately.
- Scott
Posted by canwetalk on March 16, 2003, at 12:46:38
In reply to Re: Abilify drug reaction?, posted by SLS on March 16, 2003, at 11:40:39
Hi JamesI have read your recent post. My daughter has been on Abilify now for about 2 and a half months. We have seem improvement but she still has a long ways to go. My question is this, with the other anti-psychotic meds she has been on they did induce seizures. These were haldol (which is the only med that really worked for her) risperdal.
Do you know the composition of Abilify? We have noticed that it is the only med that has not induced seizures. Oh yes I forgot she was also on Zyprexa it worked beautifully but it induced seizures and her psdoc discontinued it. Abilify is the only one that is not causing seizures.
I had asked her psdoc what is with the Abilify that is not causing seizures but he did not know. This is puzzling me because I would really like to know. Any help would be appreciated.
Posted by lauran on March 16, 2003, at 13:24:09
In reply to Re: Abilify drug reaction? » lauran, posted by SLS on March 16, 2003, at 12:31:13
Posted by Ritch on March 16, 2003, at 13:46:06
In reply to Re: Abilify drug reaction? » Ritch, posted by lauran on March 16, 2003, at 11:11:39
> Hey Ritch. Thanks for our input. I have anxiety as well and I have to really watch for any med that exacerbates this. Once you have had a reaction like akathesia you never forget it.
The worst experience I ever had with AP-induced akathesia was with Haldol. OMG, I could find NO comfortable place to sit, lay, stand, anything! This was after one dose. It started within a couple of hours of taking it. I was laying on top of stoves (they weren't on!), rocking around on the floor, running, it was absolutely horrific. It was just a trapped, caged, NO ESCAPE feeling. It faded after a few hours so I could sleep. I got up the next day and felt very nervous for some reason, but the horrible restlessness was gone. I went to work and that is when the lower back dystonia kicked in. I couldn't stand up. I had to CRAWL back to my car and drive to the local doctor's office in the small town I lived in. He gave me 10mg diazepam IV and my muscles relaxed. I went home and it started again. I had to sit on the floor with my back propped against something to keep the muscles from spasm. Sat there and popped Valium all day and stayed home from work. I was OK the next day-WHEW!
Posted by lauran on March 16, 2003, at 14:45:39
In reply to Re: Abilify drug reaction? » lauran, posted by Ritch on March 16, 2003, at 13:46:06
Ritch, I can relate to your experience. I didn't equate the back pain I've had the last few weeks with the Abilify. My back is fine but a couple of weeks ago it just ached. It is slowly going away. Anyway, glad you got past the restlessness. You decribed exactly what I was feeling only mine started about two weeks after initiating the med.
Best Wishes.
Posted by stjames on March 16, 2003, at 14:54:04
In reply to Re: Abilify drug reaction?, posted by canwetalk on March 16, 2003, at 12:46:38
>
> Hi James
>
> I have read your recent post. My daughter has been on Abilify now for about 2 and a half months.Sorry, I do not know much about this issue. Perhaps SLS does.
Posted by kirk on March 17, 2003, at 6:15:26
In reply to Re: Abilify drug reaction? » SLS, posted by lauran on March 16, 2003, at 11:50:19
I just started reviewing this website and read your comments. I started looking for info on abilify because of akathisia. It started four days after I started abilify. I couldn't type a basic letter at work without a tremendous amount of will power to sit still. My doctor suggested that I change to depakote after only two weeks on abilify. I resisted the suggestion because I feel as if I've been jumping from one med to the next and just want to give it time. Dr. prescribed cogentin - it worked within 48 hours. Has anyone had the akathesia abate? If so, how long did it take?
Posted by canwetalk on March 17, 2003, at 8:12:06
In reply to Re: Akathisia » SLS, posted by medlib on March 14, 2003, at 22:20:19
Someone had suggest I direct this message to SLS hopefully SLS can help me. Just wondering what is it in the med Abilify that does not induce seizures. My daughter has been on other anti-psychotic meds and it has induced seizures.
Posted by SLS on March 17, 2003, at 8:39:04
In reply to Abilify not inducing seizures, posted by canwetalk on March 17, 2003, at 8:12:06
> Someone had suggest I direct this message to SLS hopefully SLS can help me. Just wondering what is it in the med Abilify that does not induce seizures. My daughter has been on other anti-psychotic meds and it has induced seizures.
Hi.I am sorry to disappoint you, but I don't know the answer to your question. I don't know what it is about neuroleptic antipsychotics that lowers the seizure threshold in the first place. In fact, there is still some debate as to whether they really do or not. However, clozapine is one neuroleptic that does demonstrate an increased risk of seizure in a dose-dependent fashion. Again, I do not know through what mechanisms this occurs.
Abilify differs from the other antipsychotics in that, according to a few studies, it does not act to block D2 receptors in an area of the brain called the striatum. All the others do. This area is involved in body movement. Scientists look to this as the reason why Abilify does not cause EPS movement abnormalities as often as other neuroleptics. However, it seems that Abilify does cause akathisia, a side-effect producing a sense of inner restlessness and agitation, at rates substantially higher than the other atypical antipsychotics, including Geodon.
- Scott
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