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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by tygereyes on March 29, 2006, at 22:03:24
There is a growing body of research on the prophylactic use of atypical antipsychotics.
What is your opinion on this?
Posted by Phillipa on March 29, 2006, at 22:36:01
In reply to Atypical antipsychotics as prophylaxis?, posted by tygereyes on March 29, 2006, at 22:03:24
You mean so you don't become psychotic? Love Phillipa
Posted by yxibow on March 30, 2006, at 2:38:09
In reply to Atypical antipsychotics as prophylaxis?, posted by tygereyes on March 29, 2006, at 22:03:24
> There is a growing body of research on the prophylactic use of atypical antipsychotics.
>
> What is your opinion on this?Perhaps in patients that clearly show signs of early psychosis and schizophrenia -- I don't know that I have heard of this.
On the other hand some years ago (I'm not psychotic) I was offered olanzapine and risperdal as adjunctives from an anti-benzo psychiatrist at my university clinic (she really was quite a **).
I would say that only clinicians with a fair to large knowledge of psychopharmacology should go down this road -- while the atypicals have much less risk of nasty problems, they do have lipid and weight issues, at least some of them.
Using them just as a substitute for benzodiazepines or Neurontin or Lyrica or Paxil or any number of things to try for anxiety is in my opinion, a risky practice. Signs of psychotic depression, maybe. And I say this as a taker of Seroquel, for uses other than psychosis.
Posted by med_empowered on March 30, 2006, at 12:00:51
In reply to Re: Atypical antipsychotics as prophylaxis? » tygereyes, posted by yxibow on March 30, 2006, at 2:38:09
im not quite sure what you mean by your question. There was a study I read about where they gave non-psychotic 1st degree relatives of schizophrenics atypicals to see if it could somehow "protect" them from schizophrenia, which I think was pretty ridiculous and a waste of time and research $$$. There's apparently some renewed interest in drug-free psychosis treatment and in very low-dose, "targeted" (episodic) psychosis treatment so...in that context, I think the use of atypicals for psychosis "prevention" seems both ridiculous and unacceptably risky (not to mention unbelievably costly).
Posted by tygereyes on March 30, 2006, at 20:58:12
In reply to Re: Atypical antipsychotics as prophylaxis?, posted by med_empowered on March 30, 2006, at 12:00:51
What I meant by prophylactic antipsychotics are those who exhibit "pre-schizophrenic" symptoms. For example, one psychotic episode that might or might not be schizophrenia. Rather than tapering the AP once the episode has resolved, the person stays on the med to "prevent" (in a way) the development of schizophrenia. Kind of like the kindling effect, in reverse.
Posted by Caedmon on March 31, 2006, at 8:12:43
In reply to Re: Atypical antipsychotics as prophylaxis?, posted by tygereyes on March 30, 2006, at 20:58:12
I'm not aware of evidence showing that APs can prevent subsequent psychotic episodes. It makes sense, but I don't know.
You'd be balancing possibilities. Do I want to have a lowered odds of psychosis (assuming this can be an outcome)? Or do I want to develop metabolic syndrome X (or possibly EPS)? Kind of tricky.
Prodromal schizophrenia might respond just as well to some behavioral interventions (when not psychotic) that help with increased socialization and so on. Bipolar mania, IMHO, is appropriately treated with APs but prophylactic drugs should be lithium or anticonvulsants whenever possible. So, that kind of narrows things down.
- C
Posted by blueberry on March 31, 2006, at 17:30:55
In reply to Atypical antipsychotics as prophylaxis?, posted by tygereyes on March 29, 2006, at 22:03:24
Way too risky. As a longtime AP user, I know. I could go on for several long paragraphs telling you of the odd bizarre things APs can cause over time, not mention the aggravationi and kindling of the original condition they were meant to treat.
Two serious mixed mania episodes, more severe depression episodes than I can remember, and one depression with psychotic features episode...all while on prophylactic use of zyprexa. I guess the prophylactic thing didn't work very well. With the benefit of hindsight, the AP actually contributed and made things a lot worse in the long run, though better in the very short run.
Posted by med_empowered on April 3, 2006, at 10:18:20
In reply to Re: Atypical antipsychotics as prophylaxis?, posted by blueberry on March 31, 2006, at 17:30:55
"Antipsychotics" weren't originally known as antipsychotics; they were (and are) known as "neuroleptics," meaning that they "seize hold of" the nervous system. Their primary effect for was long seen as subduing and sedating the patient; it wasn't until the mid-60s, with the dopamine theory of schizophrenia, that docs thought maybe they had some sort of unique antipsychotic effects. The dopamine hypothesis is still hanging around, but its generally thought of as too simplistic (although it does help sell medications to the unsuspecting public).
In addition, there's apparently a theory floating around (maybe some of you will know more about this..) that many cases of schizophrenia are "really" cases of bipolar, with a heavy dose of psychosis. To that end, some docs recommend trying out mood stabilizers FIRST on younger, first break patients before busting out the neuroleptics. Also, even when patients are on neuroleptics, the mood stabilizers seem to offer benefits. Plus, in the US there's long been a practice of DXing schizophrenia when any number of other, less dire diagnoses would be more accurate (bipolar, psychotic depression, so on and so forth). European diagnostic practices apparently are more discriminating between the 2 disorders.
Finally (and I promise, this will be my final point), antipsychotics really aren't GOOD for your brain. Thankfully, the new ones don't cause TD as often as the old ones (although it does still happen). However, antipsychotics old and new can induce "dopamine supersensitivity," which puts the neuroleptic user at risk of severe psychotic breaks. Plus, in my experience, the new, wonderful antipsychotics are very much NEUROLEPTICS, no matter what the glossy drug company info packet says--they will numb your senses and dull your cognition and appreciation of life.
This is the end of the thread.
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