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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by alienatari on February 4, 2007, at 4:56:09
Hey all. Anyone recommend a typical antipsychotic or on a typical antipsychotic apart from Thorazine (been on it before) and Haloperidol (on it now). Been on all the atypicals except clozapine and im not taking clozapine so please dont suggest for me to do that. I'm just looking for somthing to help with my paranoia/psychosis .etc. Haloperidol works great (not for the paranoia though but for the halucinations and most of my delusions) but I cant stand the side effects.
Please dont suggest non antipsychotic drugs. My Pdoc is very much into using only drugs that have been proven to work for that particular problem (he works in research). He is a good doctor and I trust him but he wants me to stay on haloperidol and i cant stand it anymore.
Please if anyone could offer any advice as I want some releif. I appreciate the advice that has been given before but there is no way my pdoc is ever going to rx me methadone or morphine for psychosis (would that even help?)
I should note that I am on valium too and been on other benzo's, quite a lot of them. And they dont help. Even large doses of valium doesnt touch my paranoia/anxeity type thing that I have.
Xanax made me psychotic to the point of hospitalisation. Lexotan seropax and Ativan have been better but my pdoc wont let me use these long term, only the valium.
Oh well.Another note. Ive been on every antidepressant in Australia except Nardil and have been on all the Mood Stabalizers there are available in Australia and I'm currently on Lithium and Clomipramine.
Take care
Chris.
Posted by Phillipa on February 4, 2007, at 11:54:00
In reply to typical antipsychotics, posted by alienatari on February 4, 2007, at 4:56:09
Alien hope someone can help you. Love Phillipa
Posted by alienatari on February 4, 2007, at 16:52:28
In reply to Re: typical antipsychotics » alienatari, posted by Phillipa on February 4, 2007, at 11:54:00
Thanks *hugs*
> Alien hope someone can help you. Love Phillipa
Posted by Phillipa on February 4, 2007, at 19:09:19
In reply to Re: typical antipsychotics, posted by alienatari on February 4, 2007, at 16:52:28
Alien hi sweetie online now. Love Phillipa
Posted by med_empowered on February 4, 2007, at 19:37:56
In reply to Re: typical antipsychotics » alienatari, posted by Phillipa on February 4, 2007, at 19:09:19
I think you should avoid the haldol+lithium combo...this combo has caused serious problems in some patients. Can you switch shrinks? The risk w/ combining lithium and antipsychotic, especially haldol, is *not to be ignored*.
Anyway...I dont know what dose of valium you're on but..can you up it? Loxapine and moban would be my first pics for typical antipsychotics; after that, perphenazine and after that Mellaril, if your heart is OK. You might even want to try amoxapine..its like loxapine+an AD all in one.
Do see about another doctor.
Posted by alienatari on February 4, 2007, at 21:59:01
In reply to Re: typical antipsychotics, posted by med_empowered on February 4, 2007, at 19:37:56
I know of the risk, he has told me of the risk and Ive read alot about the problems with combining haloperidol with lithium. LIke I was saying before, my Pdoc is well experienced and is in Research. I trust him. I dont want to change him he is not a bad psychatrist.
I cant try amoxapine because If i do that i have to stop clomipramine and I have severe OCD I dont want that to make things worse as I am on a high dose of clomip (200mg).
Anyway maybe Clozapine is the only thing left for me. *shrugs*
> I think you should avoid the haldol+lithium combo...this combo has caused serious problems in some patients. Can you switch shrinks? The risk w/ combining lithium and antipsychotic, especially haldol, is *not to be ignored*.
>
> Anyway...I dont know what dose of valium you're on but..can you up it? Loxapine and moban would be my first pics for typical antipsychotics; after that, perphenazine and after that Mellaril, if your heart is OK. You might even want to try amoxapine..its like loxapine+an AD all in one.
>
> Do see about another doctor.
Posted by xbunny on February 5, 2007, at 6:22:12
In reply to Re: typical antipsychotics, posted by alienatari on February 4, 2007, at 21:59:01
> I know of the risk, he has told me of the risk and Ive read alot about the problems with combining haloperidol with lithium. LIke I was saying before, my Pdoc is well experienced and is in Research. I trust him. I dont want to change him he is not a bad psychatrist.
>
> I cant try amoxapine because If i do that i have to stop clomipramine and I have severe OCD I dont want that to make things worse as I am on a high dose of clomip (200mg).
>
> Anyway maybe Clozapine is the only thing left for me. *shrugs*
>There are many typical antipsychotics, I would say try roughly one from each major group and one of each subgroup of phenothiazine since that is the largest major group. Since you have already tried haldol (a high potency, low sedation, high eps, non phenothiazine), I would try a low potency phenothiazine next. Despite the connotation of the chemical cosh etc I reckon chlorpromazine (thorazine, largactil) is a reasonable first phenothiazine as it is fairly midrange with regards to the side effects of the group as an entirety (I reckon at least), since you say you have already taken chlorpromazine you might examine why you didnt persist with it. If chlorpromazine seemed promising but some side effect was too bothersome (ie EPS or sedation) then you could try another phenothiazine from a group which exchanges that side effect (ie melleril if the EPS was too much, or perphenazine if the sedation was too much). Remember EPS can sometimes be managed with anticholinergics and sedation often becomes tolerable eventually so a promising drug is often worth perserving with. I found the drug stelazine surprisingly tolerable I cant remember where it fits in the grouping if I recall it might be a reasonable alternative to perphenazine if you go in that direction.
You say you are also on chlomipramine for OCD. Are you sure that is helping it? I also have OCD like symptoms and took chlomipramine for nearly year, in retrospect I found it didnt really help. I also found that changing antipsychotics improved the OCD symptoms no end. Zyprexa particularly worsens these symptoms in me and I got a noticeable reduction when I transfered to a different drug, that said I found all antipsychotics increased these symptoms and after quitting them entirely the symptom was considerably reduced. I am not suggesting you do that however I am saying that my experience is that antipsychotics can aggravate OCD. Similarly you say you have "anxiety/paranoia" and valium doesnt touch it and that haldol only touches other positive symptoms but not the anxiety/paranoia. I would try to differentiate if it all possible between the anxiety and paranoia. It is my experience that antipsychotics can aggravate anxiety, again my experience but this effect is not just limited to the low sedation, high potency drugs like haldol or flupenthixol (which it tends to be documented for), but for all the antipsychotics I have tried.
You say your dr is in research, surely he would be amply qualified to recommend you a potential typical antipsychotic.
You also say you have tried all the atypicals, have you tried Amisulpride? Its a very novel drug and I think worth trying.
For me the antidepressant mirtrazapine was a good drug for its anxiety reduction and mood enhancement and combined with an antipsychotic well, its very sedating and the weight gain can be severe (especially when combined with an antipsychotic). My CPN used to say that pretty much all of her clients who took an antidepressant with an antipsychotic regarded mirtrazapine as thier favourite choice (of course she might have just been saying that!). All others (including chlomipramine) increased my psychotics symptoms.
Hope this is of some benefit.Bunny
Posted by med_empowered on February 5, 2007, at 9:53:00
In reply to Re: typical antipsychotics » alienatari, posted by xbunny on February 5, 2007, at 6:22:12
Maybe...loxapine? moban? Perphenazine, appropriately dosed, is about as tolerable as zyprexa according to the CATIE studies. Adding BuSpar to an antipsychotic may help with EPS.
Posted by alienatari on February 6, 2007, at 3:54:37
In reply to Re: typical antipsychotics » alienatari, posted by xbunny on February 5, 2007, at 6:22:12
Thanks heaps for that post. Ive tried amisulpride before and it gave me terrible akathisia. I will tell you what my Pdoc says when i see him next.
Take care
Chris
This is the end of the thread.
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