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Dr. Bob is Robert Hsiung, MD,
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Posted by stargazer on March 17, 2007, at 22:36:14
In reply to Re: Worst side-effect you've had from a med?, posted by Maxime on March 17, 2007, at 19:46:24
Mental: Worsening depression with suicidality on Zoloft. As dose increased it got worse and worse until I refused to continue to take.
Physical: Jaw clenching and severe headaches, heart palpitations leading up to panic attack and rapid eye movements,side to side, under my closed eyelids while trying to sleep.
Posted by saturn on March 17, 2007, at 22:54:10
In reply to Re: Worst side-effect you've had from a med? » football, posted by johnnyj on March 17, 2007, at 17:48:56
Heart beating so fast and heavy that I had to go to the Emergency Room.
Posted by yxibow on March 17, 2007, at 22:55:43
In reply to Re: Worst side-effect you've had from a med?, posted by stargazer on March 17, 2007, at 22:36:14
> Mental: Worsening depression with suicidality on Zoloft. As dose increased it got worse and worse until I refused to continue to take.
>
> Physical: Jaw clenching and severe headaches, heart palpitations leading up to panic attack and rapid eye movements,side to side, under my closed eyelids while trying to sleep.
I'm sorry you had these physical effects from Zoloft. Of the SSRIs, Zoloft has a greater effect on dopamine than the others.
Posted by yxibow on March 18, 2007, at 0:02:31
In reply to Re: Worst side-effect you've had from a med?, posted by Declan on March 17, 2007, at 17:40:55
> I had a dystonic reaction from Torecan, a phenothiazine type anti-nauseant.
>
> I was fortunate enough to know what a dystonic reaction was and to have diazepam and an anticholinergic drug handy.
>
> Tearing yourself apart.Torecan is somewhat similar to Compazine.
I had a highly akathisic reaction to Compazine due to high fever and instoppable vomiting.
Benadryl stopped it, unfortunately they didn't reinject it before I left the hospital and I could barely tell the driver how to get home because it affected my mental state too.
Its a hard decision what to use to manage what can be fairly unstoppable vomiting in an ER setting, but antiemetic phenothiazines are among the harshest neuroleptic categorized substances.
There are more modern medicines available today, such as the 5HT3 blockades. They cost $25 a dose, and I'm not sure if they would stop a runaway episode of vomiting as fast as a phenothiazine or how many doses it would take.
Of course, Benadryl itself also has anti-emetic qualities.
There is Tigan, which is less harsh than Compazine and also is an anti-nausea agent. It carries considerably less movement risks. I don't know its usefulness in the same situation, as well.
Posted by yxibow on March 18, 2007, at 0:08:05
In reply to Dystonia Video, posted by Quintal on March 17, 2007, at 18:10:05
> http://video.google.com/videoplay?docid=780482311942495192&q=dystonia&hl=en
>
> Q
This is hard to watch, but dystonia as an immediate reaction to a medication is different from genetic dystonia in that it has a high likelihood of being stopped by anticholinergic, benzodiazepine, and other auxiliary agents.
Essential Tremor, or ET, is different from the tremor of Lithium, neuroleptic agents, and SSRIs, in that it too is more amenable to the aforementioned agents. But ET is also manageable with propranolol and is not a completely rare disorder and different from side effects, is genetic.
Posted by Ken Blades on March 18, 2007, at 0:22:47
In reply to Worst side-effect you've had from a med?, posted by football on March 17, 2007, at 14:29:12
I'd have to agree....akathisia.My pdoc[my first appointment with her]at the time
mistakenly diagnosed my in-office anxiety attack
with general agitation as some psychotic episode
and prescribed Haldol. It was a very small dose,
but the akathisia that resulted was awful.That feeling is living hell!
The people who invent/market these drugs
should have the opportunity to experience
this for themselves....
Posted by SistrMaggie on March 18, 2007, at 0:33:26
In reply to Worst side-effect you've had from a med?, posted by football on March 17, 2007, at 14:29:12
Hope it's okay to list more than one. 1) Depakote made my hair start falling out in CLUMPS and caused lots of weight gain even though I was working out. 2) Wellbutrin caused terrible ringing in my ears. I told a friend I was ready to take a sledgehammer to my head, but she said it was a better idea to stop taking the meds, lol 3) Effexor XR and Serzone gave me such long bouts of memory loss I've never been able to fill in those lost gaps of time.
Posted by Declan on March 18, 2007, at 3:22:25
In reply to Re: Worst side-effect you've had from a med? » Declan, posted by yxibow on March 18, 2007, at 0:02:31
Well Yxi, it was 30 years ago.
Metaclopramide is better, and lately there is better yet.
Posted by SandyWeb on March 18, 2007, at 14:48:49
In reply to Worst side-effect you've had from a med?, posted by football on March 17, 2007, at 14:29:12
Many bad experiences, but I would have to say the worst one was the psychosis caused by Paxil.
I thought my cat was talking about me, and if I had continued with the med for another week or so, I probably would have killed him because I thought he was an alien. Yikes!! (At least I knew I was weirding out, right?)
Posted by johnnyj on March 18, 2007, at 16:39:36
In reply to Worst side-effect you've had from a med?, posted by football on March 17, 2007, at 14:29:12
Can someone explain the difference and what types of meds cause this? I didn't have any idea that ssri's could do this. Can Ambien cause this too? I have had a terrible two weeks ending with seroquel making me shake and feeling like I need to run 10 miles.
thank you
johnnyj
Posted by stargazer on March 18, 2007, at 23:54:33
In reply to Re: Worst side-effect you've had from a med? » stargazer, posted by yxibow on March 17, 2007, at 22:55:43
yxibow,
really? I thought dopamine was the thing I needed and wasn't get with most of the AD's I've tried.
The only meds that have done something are are Nardil, Marplan and Celexa/Wellbutrin/Adderall combo.
What do these target and what other meds may hit the same targets.
I'm in line to retry Nardil although the formulation change in 2003 has me worried it might not work as others have claimed.
A retrial of Marplan(reformulation)in 2006 failed since Marplan was discontinued in 1994 while working very well for me. I went down hill and never had very good responses to all the SSRI's which had been released at the same time and was one reason Roche terminated its production. I later heard many successful Marplan users went on to relapse after being forced to stop it.
Any thoughts on what I should try other than Nardil? I'm now on Emsam and Provigil didn't help when added. Thanks. I'm rather desparate after so many med failures and job losses becasue of recurrent depression.
Stargazer
Posted by Ken Blades on March 19, 2007, at 1:13:55
In reply to akathisia versus anxiety, the difference?, posted by johnnyj on March 18, 2007, at 16:39:36
Evidently lots of psychopharmaceuticals can cause it and it varies from person to person-just
because you might experience it within a
particular subset of medications doesn't mean
all of them will have that effect on you.Typical antipsychotics[chlorpromazine,haloperidol],
atypical antipsychotics[risperdal,olanzapine],
SSRIs[fluoxetine,paroxetine,venlafaxine]...there
may be others that someone may list that I've
missed.Difficult to explain the difference, but
when I had experienced it the first time
I didn't know what it was. It didn't feel
identical to anxiety as I was accustomed
to, but added to it. When I sat down, I
felt like I wanted to get right back up
again. When I resisted that desire to get up,
I had to tap both feet very rapidly as if
to discharge some hellish energy. When I
was standing, I would pace around the house,
looked for things to do, rearranged things
in my room, cleaned the bathroom. I would
get things done but it was out of some drive
that wouldn't quit. The Cogentin prescribed
to counteract it didn't help. It took days
after discontinuing my medication for the
akathisia to stop. I will admit that I had
suicidal thoughts, as this sensation on top
of my preexisting anxiety was unbearable.The following is a portion of an item written by a parent whose son committed suicide:
"Akathisia can be described as a neurological phenomenon characterized by extreme internal restlessness, agitation, and emotional turmoil that is drug induced. In fact, Pfizer’s own scientist, Dr. Roger Lane explained in his medical journal article that "most researchers agree that akathisia has a strong psychological (subjective) component," describing it as "subjective distress" and "unbearable discomfort." He also stated that "the subjective components of akathisia are distinct and
overwhelming." He went on to state in another peer reviewed-medical journal article (to which he referred when he admitted that Zoloft can cause this out-of-body feeling) that "it may be less of a question of patients experiencing [SSRI]-induced suicidal ideation, than patients feeling that death is a welcome result when the acutely discomforting symptoms of akathisia are experienced on top of already distressing disorders."In a past wrongful death lawsuit against Pfizer, one of Pfizer’s own expert witnesses, Dr. John Mann, testified that "akathisia has the potential, when it is severe, of contributing to suicidality and aggression." Another drug company expert testified: "I believe that what akathisia does is it creates a state of severe anxiety which can exacerbate pre-existing proclivities, tendencies, in an individual to engage in either suicide or violence."
To top it off, we personally heard the FDA’s Dr. Robert Temple state, “There isn’t any doubt that these drug cause akathisia. That’s not in doubt.”
Why then, when the FDA and drug companies have known that these drugs can cause akathisia and for some people suffering from akathisia find “death a welcome result“ to escape its symptoms, haven’t they warned the doctors, patients, parents and the public about this potentially deadly side effect?
We learned that these types of warnings already exist in other countries for the same drugs. However, they are just marketed under different names than in the United States. In fact, the BBC did an interesting documentary on the effects of „Seroxat“ and other SSRI drugs and warned of the serious, sometimes deadly side effects. Seroxat is known in the US as Paxil. Lustral is the same thing as Zoloft manufactured by Pfizer. Watch the BBC documentary"
----------------------------------------------
> Can someone explain the difference and what types of meds cause this? I didn't have any idea that ssri's could do this. Can Ambien cause this too? I have had a terrible two weeks ending with seroquel making me shake and feeling like I need to run 10 miles.
>
> thank you
>
> johnnyj
Posted by yxibow on March 19, 2007, at 1:55:54
In reply to Yxibow,,,thoughts on other meds, posted by stargazer on March 18, 2007, at 23:54:33
> yxibow,
>
> really? I thought dopamine was the thing I needed and wasn't get with most of the AD's I've tried.
>
> The only meds that have done something are are Nardil, Marplan and Celexa/Wellbutrin/Adderall combo.
>
> What do these target and what other meds may hit the same targets.
>
> I'm in line to retry Nardil although the formulation change in 2003 has me worried it might not work as others have claimed.
>
> A retrial of Marplan(reformulation)in 2006 failed since Marplan was discontinued in 1994 while working very well for me. I went down hill and never had very good responses to all the SSRI's which had been released at the same time and was one reason Roche terminated its production. I later heard many successful Marplan users went on to relapse after being forced to stop it.
>
> Any thoughts on what I should try other than Nardil? I'm now on Emsam and Provigil didn't help when added. Thanks. I'm rather desparate after so many med failures and job losses becasue of recurrent depression.
>
> Stargazer
I wish I could help you on those other medications -- there are a number of people on here who are on Emsam or who have tried. I'm not by any means any expert on MAOIs. My vegetarian diet would implode my brain if I took one so I can't comment on any of it. But there are people here who have used a variety of MAOIs. It would be nice if RIMAs were available in the US, the diet issue would be somewhat less.
The dopamine issue with Zoloft is mild, it is a minor dopamine inhibitor like a neuroleptic but EPS is rare and TD is still rarer -- still I believe more SSRI cases occur on Zoloft. But we are talking lower than neuroleptic issues.
Celexa and most SSRIs prevent the reuptake of serotonin at various subreceptors, the chemistry of which is beyond me, I have wanted to study Stahl et alia. This is different from the blockade of serotonin which occurs on neuroleptics and Remeron, among other auxiliary agents that I know do that.
Wellbutrin generally raises the level of dopamine in the brain period, it could be called a SDNI, as noted by wikipedia it is a "selective catecholamine (dopamine and norepinephrine) reuptake inhibitor".
Adderall is d-amphetamine, similar but not exactly methamphetamine. Working differently from Wellbutrin it still blockades the same neurotransmitters but I can only imagine it is more intense. I have only used Wellbutrin for a period of time.
Posted by yxibow on March 19, 2007, at 1:59:44
In reply to Re: Worst side-effect you've had from a med? » yxibow, posted by Declan on March 18, 2007, at 3:22:25
> Well Yxi, it was 30 years ago.
>
> Metaclopramide is better, and lately there is better yet.
Time is sometimes the only thing on our side... something I wish for a better neuroleptic or a better agent for my disorder...
Yes, Reglan is somewhat better but Tigan has a lesser risk of TD. There have been cases of TD on Reglan which is probably one of the impetus for 5HT3 blockade agents for people on extended chemotherapy. Unfortunately the -tron agents such as Kytril are frightfully expensive at this point which is a shame. Depends on your provider.
Posted by yxibow on March 19, 2007, at 2:21:51
In reply to Re: akathisia versus anxiety, the difference? » johnnyj, posted by Ken Blades on March 19, 2007, at 1:13:55
Akathisia can vary from very minor agitation to kickass all out hell. That would be my experience on Compazine, which is 10 to 20 times more powerful than Thorazine. But then phenothiazines tend to have these intense effects on people.
As noted, it is very different from anxiety but mild akathisia can be confused with it, for those who are not aware of the potential side effect bearing its name.
It is a movement disorder, not an anxiety condition. It is internal agitated movement. At its strongest strength the feeling is that no matter if there is a concrete wall in front of you , you want to smash through it. Other feelings can be writhing on the floor waiting for it to stop. (personal experience)
It is usually moderated by anticholinergics such as Cogentin, Artane, and Benadryl (IV in hospitals).Other things can be thrown at it with varying success including propranolol, possibly clonidine (?), varying amounts of benzodiazepines such as Valium.
The wisdom of covering up very strong akathisia lies in the true necessity of the drug for the patient and the hopefully extensive experience of the psychopharmacologist about the agent being used. Generally it is (obviously) more humane to use agents (neuroleptics, etc) that cause less EPS if possible.
Posted by johnnyj on March 19, 2007, at 8:45:02
In reply to Re: akathisia versus anxiety, the difference? » Ken Blades, posted by yxibow on March 19, 2007, at 2:21:51
Wow, that is exactly the feeling I have gotten with paxil and luvox. Serqouel is causing the same thing. I could not sit still. I just wanted to go run 10 miles or something. I was a complete mess. It makes one want to die. It is truley the feeling that one is going compeletely mad. I am worse than the few short weeks ago before I decided to try meds again.
The only bright spot is that it appears remeron can help this and I have been on it in the past. The pdoc wants to try a small dose of it. I did not know what was going on untiil I called the doc yesterday morning. My legs are still jumpy this morning. I just want to tap or bounce my legs. It is better than yesterday because I couldn't just stop the seroquel, I think my doc thought a smaller dose would work. The weird thing is last night I took a 25 mg dose of seroquel and felt tired/relaxed and jumpy all at the same time. WEIRD! By morning the relaxed effect was going away leaving me only with the jitterydizzy/tapping feeling. I need off this today!
Posted by naughtypuppy on March 19, 2007, at 10:01:11
In reply to Re: akathisia versus anxiety, Ken Blades? » yxibow, posted by johnnyj on March 19, 2007, at 8:45:02
I would best describe akathisia as a restless feeling so bad that you wanted to crawl out of your own skin. I have experienced it with a combination of AD's and Diphenhydramine. The worst though, was in the early 70's when it was trendy to put some one with anxiety on antipycotics such as haloperidol. Amazing that the psyciatric community keeps repeating the same things over and over again. I believe that Albert Einstein said somthing to the effect of "Insanity: doing the same thing over and over again and expecting different results".
Posted by Quintal on March 19, 2007, at 10:42:14
In reply to Re: akathisia versus anxiety, Ken Blades? » yxibow, posted by johnnyj on March 19, 2007, at 8:45:02
I was just thinking that Remeron was the only other drug that I'd experienced a similar reaction to what I felt on Abilify. It seemed to give me restless legs at night when I was trying to sleep. It's actually listed as a side effect of Remeron on the Wiki profile. Did you not have that problem when you were taking it?
Posted by yxibow on March 19, 2007, at 15:33:57
In reply to Re: akathisia versus anxiety, Ken Blades?, posted by naughtypuppy on March 19, 2007, at 10:01:11
> I would best describe akathisia as a restless feeling so bad that you wanted to crawl out of your own skin. I have experienced it with a combination of AD's and Diphenhydramine. The worst though, was in the early 70's when it was trendy to put some one with anxiety on antipycotics such as haloperidol. Amazing that the psyciatric community keeps repeating the same things over and over again. I believe that Albert Einstein said somthing to the effect of "Insanity: doing the same thing over and over again and expecting different results".
>
Well, EPS remains the bane of neuroleptics for disorders that in many cases unfortunately must be treated with them, namely schizophrenia where the patient or others are in danger of harm.Don't think the scientific community has tried to get away from it.
Atypicals were first surmised to not have this issue, unfortunately they do. However, the first atypical, Clozaril, had nearly none but has other potentially -bad- side effects. It still remains a "gold" standard for treatment resistant schizophrenia though as even if it does not produce much EPS, it is a strong antipsychotic.
Its hard to believe that one would get akathisia from diphenhydramine since IV Benadryl remains one fairly quick fix for in-hospital treatment of akathisia with agents that are either neuroleptics or are but are generally not used for psychosis (Compazine), but I guess there are idiosyncratic reactions in anybody.
Posted by johnnyj on March 19, 2007, at 17:12:50
In reply to Re: akathisia versus anxiety, Ken Blades? » johnnyj, posted by Quintal on March 19, 2007, at 10:42:14
The only thing I recall was sometimes when I would be falling asleep I would startle awake. I had this too on Lunesta and when I would awake on it too.
What dose where you on. I was on 15-mg so manybe it doesn't cause it at lower doses?
Actually, I liked it at 3.75 mg the best. I am trying that tonight. I can't take the seroquel anymore. I am sort of afraid that maybe there are not meds to help me and that sucks.
Posted by johnnyj on March 19, 2007, at 17:44:28
In reply to Re: akathisia versus anxiety, Ken Blades? » Quintal, posted by johnnyj on March 19, 2007, at 17:12:50
Is it cortisol? I guess I am trying to figure out a way to counteract it, if that is possible. I would like to slow my body down with good stuff like vitamins?
Thanks
johnnyj
Posted by yxibow on March 20, 2007, at 0:06:13
In reply to physiologicaly what is occuring in akathisia?, posted by johnnyj on March 19, 2007, at 17:44:28
> Is it cortisol? I guess I am trying to figure out a way to counteract it, if that is possible. I would like to slow my body down with good stuff like vitamins?
>
> Thanks
>
> johnnyjIts EPS. Extrapyramidal symptoms, or if you want to put it in plain terms, side effects.
Neuroleptics, and to some rarer extent, TCAs and SSRIs, block various dopamine receptors.
They occupy various subreceptors, the main one being focused upon here is D2. Neuroleptics can occupy the D2 pathway up to 100%, but they vary wildly in the intensity to which they both occupy to that extent and how much they let go and start again. Stronger neuroleptics such as the typical haloperidol occupy and take a long time to let go, whereas weaker atypical neuroleptics such as Seroquel, occupy the receptors but let go much easier, grab on again, and let go, etc.
What happens in EPS, which is akathisia, pseudoparkinsonism, and other symptoms outside of the intended effect is that neurotransmitters in the nigrostriatal pathway are effected -- this pathway is responsible for movement, rather than the mesolimbic pathway, which is the intended target, responsible for various mood effects.So D2 blockade basically overruns and enters that pathway, and akathisia results. It gets more complicated, but that is a simple description of it.
courtesy wikipedia, which has an external link to explaining pathways, which happens to be on a university drug addiction explanation page, but it does illustrate these pathways :
http://learn.genetics.utah.edu/units/addiction/reward/pathways.cfm
As for counteracting it, there really isn't any other way other than reducing the amount of the drug in question, switching agents, using none of the above, or taking auxiliary agents with a neuroleptic, TCA or SSRI, primarily anticholinergics such as Artane and Cogentin, or propranolol for pseudoparkinsonism, or benzodiazepines for all of the above to some degree.Some people swear by Vitamin E as a neurotoxin blockade, I variably take it, but there is no proof that it actually does anything. A normal capsule is an usually an okay dose, beyond 400 IU, you're getting into the range of experimental studies and possible hemorrhage issues that would far negate its use.
Posted by vwoolf on March 20, 2007, at 14:14:23
In reply to Worst side-effect you've had from a med?, posted by football on March 17, 2007, at 14:29:12
Seizures. First petit-mal attacks for a few days, and then a full-on grand-mal seizure. I was on Tofranil at the time. Never had another seizure before or since.
Posted by Cynthia_Greene on March 21, 2007, at 18:21:46
In reply to Re: Worst side-effect you've had from a med?, posted by vwoolf on March 20, 2007, at 14:14:23
Does withdrawal count as a "side effect"? I took Xanax pretty much to sleep at nightfor a short while every night then stopped and felt like I was going crazy. I lost 5 pounds in only a few days even though I was trying to eat the same, and just had the worst panic type feelings for no reason.
I've since learned that it's safer to use it as needed or not at all. And I'm going back to Valium for anxiety during the day because its safer and less addictive.
Posted by cloudnine on March 23, 2007, at 8:45:01
In reply to Re: Worst side-effect you've had from a med?, posted by Cynthia_Greene on March 21, 2007, at 18:21:46
Akathesia from Fluphenazine.Later from Trifluoperazine.Had to discontinue immediatley.Never tried any APs except Amisulpride and Sulpride which do not produce this terrifying effect.
2. Sibutramine produced premature venticular arrythmia,which I treated for months,but comes up from time to time (permenant damage Never again this life threatining expensive ineffective pro depressive medication!!!!
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Dr. Bob is Robert Hsiung, MD,
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