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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 Jeroen on July 7, 2008, at 15:33:25
Clozapine not working now what?????
psychosis worse too
Options are, Sulpiride, Impromen
Posted by Phillipa on July 7, 2008, at 16:00:34
In reply to Clozapine not working now what?????, posted by Jeroen on July 7, 2008, at 15:33:25
Jeroen still in hospital and those are you doc's recommended choices for you? Love Phillipa
Posted by Jeroen on July 7, 2008, at 17:18:01
In reply to Re: Clozapine not working now what????? » Jeroen, posted by Phillipa on July 7, 2008, at 16:00:34
no idea now, NEED HELP ON NEXT DRUG TO TAKE
clozapine is a terrible drug for me
Posted by yxibow on July 7, 2008, at 18:44:01
In reply to Clozapine not working now what?????, posted by Jeroen on July 7, 2008, at 15:33:25
> Clozapine not working now what?????
>
> psychosis worse too
>
>
> Options are, Sulpiride, Impromen
>
>
I would go with the sulpirides -- Impromen (bromperidol) is a very potent antipsychotic and you have possible/proven TD.
Now the sulpirides are argued not to be atypicals, but they do have the properties of them -- they're not available in the US but they are in Europe, so maybe that is a better choice.
But I think that one of the problems with all of the APs that you have tried, and I could be mistaken -- I'm not your doctor(s), is that you may not have reached the MED (minimum effective dose).
Without that, you're not getting the benefits of things like Clozaril, even for all its massive side effects that I know you have been suffering through.
I do wish you well and I hope that you get to a dose that regulates things for you and makes you happier, so that you can socialize and feel better about yourself. The psychological components of schizophreniform disorders are just as important.
-- best wishes Jeroen-- Jay
Posted by bleauberry on July 7, 2008, at 19:48:57
In reply to Clozapine not working now what?????, posted by Jeroen on July 7, 2008, at 15:33:25
Of the two options you mentioned, definitely amisulpride, then sulpiride.
But, I wouldn't be honest if I didn't say I think your options are a lot greater than antipsychotics. I don't know why you are being stuck in such a limited arena. If excess dopamine activity was involved in your symptoms, the APs up to this point would have done a lot more than they did. It aint dopamine man, and that's just my humble unscientific opinion, not knowing you or your doctors or anything. All I know is pure logic...when a bunch of antipsychotics don't do the job, then it is something else that is wrong. Profound resistant symptoms can be caused by such silly things as a faulty magnesium circuitry, requiring healthy doses of magnesium glycinate; or an excess accumulation of copper (talk about psychosis) requiring high doses of zinc+B6 to clear it out.
Sorry, don't mean to sound any particular way, it's just very frustrating to see someone stuck in such a small confined area of treatment when there are OTHER causes of your symptoms. If someonoe thinks antipsychotics are the only things that can treat psychosis or schizo-like symptoms, they are dead wrong.
> Clozapine not working now what?????
>
> psychosis worse too
>
>
> Options are, Sulpiride, Impromen
>
>
Posted by yxibow on July 8, 2008, at 0:15:08
In reply to Re: Clozapine not working now what????? » Jeroen, posted by bleauberry on July 7, 2008, at 19:48:57
> Of the two options you mentioned, definitely amisulpride, then sulpiride.
>
> But, I wouldn't be honest if I didn't say I think your options are a lot greater than antipsychotics. I don't know why you are being stuck in such a limited arena. If excess dopamine activity was involved in your symptoms, the APs up to this point would have done a lot more than they did. It aint dopamine man, and that's just my humble unscientific opinion, not knowing you or your doctors or anything. All I know is pure logic...when a bunch of antipsychotics don't do the job, then it is something else that is wrong. Profound resistant symptoms can be caused by such silly things as a faulty magnesium circuitry, requiring healthy doses of magnesium glycinate; or an excess accumulation of copper (talk about psychosis) requiring high doses of zinc+B6 to clear it out.
>
> Sorry, don't mean to sound any particular way, it's just very frustrating to see someone stuck in such a small confined area of treatment when there are OTHER causes of your symptoms. If someonoe thinks antipsychotics are the only things that can treat psychosis or schizo-like symptoms, they are dead wrong.They aren't the only thing that can treat psychosis. Before we had chlorpromazine (Largactil) people either were locked up with insulin injections or if there was humane treatment there were discussion groups in hospitals that managed to get some higher functioning people with schizophreniform disorders to function better.
I know you believe a lot in alternative therapy, and that's fine -- but vitamins are not going to stop schizophrenia, a disorder that has befounded medicine for more than 50 years, and neither copper nor aluminum nor magnesium are exactly heavy metals. They are ubiquitous on our planet, especially aluminum, a part of clay (kaolin) and soil. Copper is somewhat less ubiquitous than aluminum and in fact we are stripping the planet of it, but thats neither here nor there.Yes, I have heard of the reference to copper in the brains of people with schizophrenia, but at this point that is the same cause and effect argument as aluminum and Alzheimers. You can't escape aluminum on this planet as it is one of the most present elements.
Lead is allowed up to 7% in brass faucets in the US for water systems, an alloy of copper and zinc and has been for many years. I don't think anyone has dropped dead of water faucets.
It is some of the compounds of copper that are toxic, such as copper sulfate, a heavily used industrial compound. Not the metal itself. So don't cook in green rusted copper pots and don't put Miracle Gro in your koi ponds.
It is clear that dopamine has some function in it -- there are many other areas unexplored, sigma receptors, other serotonin receptors, etc.
If after exhaustive searches for a diagnosis for some years, I mean, Jeroen is free willed to do what he wants unless there really is a "psychotic episode" (which really can sound pejorative and not exactly a diagnostic name) and find other doctors for other therapy.
I feel for you, Jeroen -- but as I have said, I don't think doses are high enough to make enough of a difference so that you can appreciate it. And again, I will say mea culpa if your doctors have done this already.
I'm not for shoving APs down anybody but if there is an evidence based psychiatric diagnosis, then some use of it (MED) should make some difference. In the end, as all things, medication isn't everything. There is restructuring and reintegrating into the community and therapy which I hope is part of your plan from your doctors.-- best wishes
Jay
Posted by Quintal on July 8, 2008, at 4:04:50
In reply to Re: Clozapine not working now what????? » Jeroen, posted by bleauberry on July 7, 2008, at 19:48:57
I wonder if rimonabant has antipsychotic activity? There could be an overproduction of endo-cannabinoids, or heightened sensitivity of receptors in some psychosis sufferers. I found melatonin to have a mild antipsychotic effect, probably in the same range as 200mg amisulpride (not great, but a noticable improvement).
As with any serious illness, a person has to be willing to work with the treatment and actually want and strive to get better. I've seen people repeatedly sabotage their chances of success, and so long as that continues recovery isn't a likely outcome.
According to my social worker, most people with psychotic disorders have co-comittant personality disorders (mostly antisocial and borderline) which complicate treatment. Psychotherapy and behavioural interventions are necessary for these people because medication alone doesn't usually change the ingrained patterns of interacting with the world and other people that are at the core of PDs.
Q
Posted by BPPsychFellow on July 8, 2008, at 15:08:28
In reply to Re: Clozapine not working now what?????, posted by Quintal on July 8, 2008, at 4:04:50
Jeroen,
I'm sorry to hear that you've not improved like you had hoped you would. I'm relatively new to the boards so I haven't gotten to "know" you yet. Maybe some of the other posters can fill me in on details.
Is the dx schizophrenia? When psychosis and paranoia are present there is often significant lack of insight. When this is the case I think it best to trust the wisdom of the treatment team (doctor, psychologist, nurses) in the selection of medication. In other words, don't stress about which med to "ask for" next. I hope you trust your doctor enough to follow his suggestions.
As others have mentioned here: please be sure you have given the Clozapine a good LONG trial. In very ill people I do this: wait until they are at a therapeutic dose THEN wait 6 or 8 weeks before giving up on the drug.
If I see even a small bit of improvement with clozapine I keep it on-board and add another antipsychotic to it. Every person is different and this is simply my opinion. Your treatment choices are up to your doctor and you.
Regards, BPPsychFellow
Posted by bleauberry on July 9, 2008, at 18:41:33
In reply to Re: Clozapine not working now what????? » bleauberry, posted by yxibow on July 8, 2008, at 0:15:08
"The hoofprints definitely belong to a horse. Or do they? Did it cross anyone's mind it might be a zebra?"
I respectfully disagree strongly with pretty much everything here. It would be long and boring to most readers, and off topic for this thread. Just realize my input is not based on my own opinion, feelings, ideas, or unfounded internet sites. I prefer the growing body of scientific evidence, an already large body of anecdotal evidence, and real institutions that successfully treat people like Jereon with targeted approaches. We can leave it at that. If interested in more, start another thread and we'll talk about it.
Back on topic for the thread, I just want to reiterate that if practically all antipsychotics are not doing the job, or actually make things worse, well, duh, hello? Time to expand the thought processes? Time to reassess the diagnosis? Time to think outside the box maybe? It sure looks like psychosis, but that darned zebra.
I don't know what else Jereon has tried? Do we know Klonopin won't work? Do we know Memantine won't work? Do we know Magnesium Glycinate won't work? Do we know an anti-craziness herb won't work? Have we tested for intracellular copper? Have we checked a hair sample for mineral content, heavy metal content, lithium content, and the stories their comparative patterns tell? I doubt we know any of these things. I mention the above things because they are examples of things that have worked when psychiatry failed. All we know for sure is that the best of the best in the antipyschotic world have not worked. I don't know how many times we have to throw spaghetti at the wall until we realize it isn't sticking.
In the meantime, I give a thumbs up for a trial of Sulpiride. I personally think Amisulpride has a better chance, but they are similar enough, so who knows.
>
> I know you believe a lot in alternative therapy, and that's fine -- but vitamins are not going to stop schizophrenia, a disorder that has befounded medicine for more than 50 years, and neither copper nor aluminum nor magnesium are exactly heavy metals. They are ubiquitous on our planet, especially aluminum, a part of clay (kaolin) and soil. Copper is somewhat less ubiquitous than aluminum and in fact we are stripping the planet of it, but thats neither here nor there.
>
> Yes, I have heard of the reference to copper in the brains of people with schizophrenia, but at this point that is the same cause and effect argument as aluminum and Alzheimers. You can't escape aluminum on this planet as it is one of the most present elements.
>
> Lead is allowed up to 7% in brass faucets in the US for water systems, an alloy of copper and zinc and has been for many years. I don't think anyone has dropped dead of water faucets.
>
>
> It is some of the compounds of copper that are toxic, such as copper sulfate, a heavily used industrial compound. Not the metal itself. So don't cook in green rusted copper pots and don't put Miracle Gro in your koi ponds.
>
>
> It is clear that dopamine has some function in it -- there are many other areas unexplored, sigma receptors, other serotonin receptors, etc.
>
>
> If after exhaustive searches for a diagnosis for some years, I mean, Jeroen is free willed to do what he wants unless there really is a "psychotic episode" (which really can sound pejorative and not exactly a diagnostic name) and find other doctors for other therapy.
>
>
> I feel for you, Jeroen -- but as I have said, I don't think doses are high enough to make enough of a difference so that you can appreciate it. And again, I will say mea culpa if your doctors have done this already.
>
>
> I'm not for shoving APs down anybody but if there is an evidence based psychiatric diagnosis, then some use of it (MED) should make some difference. In the end, as all things, medication isn't everything. There is restructuring and reintegrating into the community and therapy which I hope is part of your plan from your doctors.
>
> -- best wishes
>
> Jay
>
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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