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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Jeroen on July 17, 2009, at 18:30:28
still affraid to go on Sertindole, but i wil ask my doctor,
Posted by Phillipa on July 17, 2009, at 21:54:36
In reply to affraid to go on Sertindole - sudden death, posted by Jeroen on July 17, 2009, at 18:30:28
Jeroen where have you been? Love Phillipa
Posted by yxibow on July 18, 2009, at 0:44:50
In reply to affraid to go on Sertindole - sudden death, posted by Jeroen on July 17, 2009, at 18:30:28
> still affraid to go on Sertindole, but i wil ask my doctor,
Mellaril (thioridazine), a typical antipsychotic has a far greater chance of torsades de pointes / QTc interval change, and this was only really realized more recently. Its still being used, but with a "black box".
The risk is there for Sertindole certainly which is why it isn't here (the same can be said of Seldane, etc), but in some European countries, as even after a re-submission of Geodon for market in the US... but its very small.
Nonetheless if it concerns you and I'm sure your doctor(s) will monitor this, an EKG every so often wouldn't be a bad thing.
-- Jay
Posted by Zyprexa on July 18, 2009, at 4:34:14
In reply to affraid to go on Sertindole - sudden death, posted by Jeroen on July 17, 2009, at 18:30:28
Whats wrong with the abilify?
Posted by Jeroen on July 18, 2009, at 4:57:55
In reply to Re: affraid to go on Sertindole - sudden death » Jeroen, posted by Zyprexa on July 18, 2009, at 4:34:14
abilify is not powerfull enough for an induced psychosis
Posted by SLS on July 18, 2009, at 6:04:49
In reply to to Zyprexa, posted by Jeroen on July 18, 2009, at 4:57:55
> abilify is not powerfull enough for an induced psychosis
True. When Abilify is added to Clozapine for example, it does not reduce positive symptoms, although it does help with negative symptoms.
I can't be sure, but Abilify might even reduce the effectiveness of other antipsychotics in some circumstances. If you decide to go back to Seroquel, I'm hoping that it works better for you at a reduced dosage. Abilify acts as a partial D2 and D3 receptor agonist and has greater binding affinity than Seroquel. The Seroquel is probably not blocking as many receptors. One woman I know of had a wonderful response to Risperdal 3.0mg combined with Seroquel 200mg. When the Risperdal was substituted for with Abilify, she needed to raise the Seroquel to 800mg.
Since your doctors were willing to use polypharmacy by combining Abilify with a series of different antipsychotics, why would they be unwilling to leave Seroquel in place and try using other drugs to augment it?
- Scott
Posted by Jeroen on July 18, 2009, at 6:05:58
In reply to Abilify » Jeroen, posted by SLS on July 18, 2009, at 6:04:49
Seroquel is pooped out...
the anti depressant effect doesnt kick in anymore, i dont know why
Posted by bleauberry on July 18, 2009, at 12:16:50
In reply to affraid to go on Sertindole - sudden death, posted by Jeroen on July 17, 2009, at 18:30:28
The title is "afraid to go on...drugname".
I'm just curious, since every time I ask you questions you never really answer except maybe a few brief words that don't really say anything.
My question.
Why are you afraid of the Tricyclic antidepressants?
Do you not think they work with antipsychotics for symptoms like yours? (they do, I'm just curious what your views are)
Posted by Jeroen on July 18, 2009, at 12:26:19
In reply to Re: affraid to go on Sertindole - sudden death, posted by bleauberry on July 18, 2009, at 12:16:50
hi, its psychosis that i have , they gave me trazodone and it made things worse, no thanks
Posted by bleauberry on July 18, 2009, at 22:02:00
In reply to to bleauberry, posted by Jeroen on July 18, 2009, at 12:26:19
> hi, its psychosis that i have , they gave me trazodone and it made things worse, no thanks
Trazodone is not a tricyclic.People with treatment resistant psychosis and depression do respond to the combination of antipsychotic+TCA.
People with treatment resistant psychosis and depression do not respond to antipsychotics alone, unless that is they want it to stay treatment resistant.
Traz is not a TCA.
Posted by Zyprexa on July 18, 2009, at 23:00:24
In reply to Re: to bleauberry » Jeroen, posted by bleauberry on July 18, 2009, at 22:02:00
Bleauberry is right you should add an antidepressant. I didn't take an AD for years with my zyprexa and I was not as well as when I added an AD that acrualy worked.
Posted by bleauberry on July 19, 2009, at 17:27:54
In reply to Re: To Jeroen, posted by Zyprexa on July 18, 2009, at 23:00:24
> Bleauberry is right you should add an antidepressant. I didn't take an AD for years with my zyprexa and I was not as well as when I added an AD that acrualy worked.
I think Jereon is accidentally thinking all antidepressants are the same. I mean, if you have a bad experience with one or several of them then they are all bad, ya know what I mean? There doesn't seem to be knowledge of how different they. Sure the SSRIs are similar. But the TCAs are extremely different from SSRIs, and extremely different from each other. To say there was a bad reaction to trazodone and thus antidepressants don't work on psychotic refractory depression is nuts. I might as well just print up all the studies on pubmed with these things I talk about so the person in question can see them.
I have asked in two separate threads for a description of this "psychosis" but it never comes. Makes me wonder what's really going on.
Posted by Zyprexa on July 19, 2009, at 19:45:45
In reply to Re: To Jeroen » Zyprexa, posted by bleauberry on July 19, 2009, at 17:27:54
Yes, I'm starting to wonder what is realy going on too. Whats going on Jeroen??
Posted by Jeroen on July 19, 2009, at 19:49:53
In reply to Re: To Jeroen » Zyprexa, posted by bleauberry on July 19, 2009, at 17:27:54
nothing is going on im still an inpatient, but im affrai to take Sertindole because i might have cardiac disease
Posted by Phillipa on July 19, 2009, at 20:09:03
In reply to to all of you, posted by Jeroen on July 19, 2009, at 19:49:53
Jeroen and that's a scarey thought. Does you doc know of the fear? Love Phillipa
Posted by Jeroen on July 19, 2009, at 20:09:48
In reply to Re: to all of you » Jeroen, posted by Phillipa on July 19, 2009, at 20:09:03
yes she does
Posted by Phillipa on July 19, 2009, at 21:31:22
In reply to To Philippa, posted by Jeroen on July 19, 2009, at 20:09:48
Jeroen so your psychiatrist is a she. What does she say about the fear???? Love Phillipa
Posted by yxibow on July 20, 2009, at 2:52:29
In reply to to all of you, posted by Jeroen on July 19, 2009, at 19:49:53
> nothing is going on im still an inpatient, but im affrai to take Sertindole because i might have cardiac disease
As I noted, Mellaril is much more likely to cause QTc elongation.
Nevertheless, I also said that Sertindole was not approved in the US eventually because it does have some risk of QTc elongation greater than those in its class.
Geodon also has QTc elongation risk, but was approved here because the chance was reexamined to be less than 1/4000.
Yes, when faced with a choice of a medication it is always a choice whether the benefits will outweigh the risks.
Is there any heart disease or defects in your family ? Have you ever had a heart murmur?An EKG should be performed before starting the agent. It should also probably be used periodically (not obsessively... in terms of months perhaps) to check on how it works.
But it all comes down to this... and don't think I'm trying to be mean....
I know you've been struggling with things for a long time....but with an antipsychotic, even if in some people there is a noticeable difference in as little as a few weeks, it takes several months to really notice a difference...
I'm concerned that fears may have led to stopping medications before they had a chance to work. Yes, I know that Clozaril made you extremely lethargic and had some bad effects --- this is common in a lot of patients.
The question is... which one to keep an open mind on, at least for a month or two.
Now I'm not asking you to endure undue harm or a terrible situation, that would be Schadenfreude... but give things a reasonable chance.
-- good luck
-- tidingsJay
Posted by bleauberry on July 20, 2009, at 18:52:55
In reply to Re: to all of you » Jeroen, posted by yxibow on July 20, 2009, at 2:52:29
I totally agree with yxibow.
As I've said several times, I stand behind my insistance that an antipsychotic alone, or even a combination of them, is going to fall way short of the goal line. Spend a few dozen hours roaming through pubmed on this topic and it becomes clear that one of the best family of meds to look at for patients in Jereon's category are the TCAs+antipsychotic. Of course, the TCAs are all quite different. So as with antipsychotics, several need to be tried if a first one goes poorly.
In Jereon's case I think there are three factors of importance at play:
1) Not enough time on any particular medication or combination. Understandable though. If it is going poorly, we often have no choice but to drop out. If it is going so poorly in the early weeks to cause a drop out, either the dose management was too aggressive or the stuff was never going to work anyway. I have never ever seen anyone start off a treatment that went really bad and then it turned into a miracle. Never.
2. Medication choices have been good in the antipsychotic department, but very poor in other categories. The TCAs for example have been completely ignored. Very strange, considering those are the ones in case studies that supplied the missing link.
3. The diagnosis is questionable.
Back to the original thought by yxibow, when someone is ill for as long as Jereon has been, it will take time on a steady med combination to get there. The trick is to first find the medications that can be tolerated, and to use medications that have worked for other people with like histories. And to take a second look at the diagnosis, or even better, get a fresh second opinion from someone else.
> > nothing is going on im still an inpatient, but im affrai to take Sertindole because i might have cardiac disease
>
> As I noted, Mellaril is much more likely to cause QTc elongation.
>
> Nevertheless, I also said that Sertindole was not approved in the US eventually because it does have some risk of QTc elongation greater than those in its class.
>
> Geodon also has QTc elongation risk, but was approved here because the chance was reexamined to be less than 1/4000.
>
>
> Yes, when faced with a choice of a medication it is always a choice whether the benefits will outweigh the risks.
>
>
> Is there any heart disease or defects in your family ? Have you ever had a heart murmur?
>
> An EKG should be performed before starting the agent. It should also probably be used periodically (not obsessively... in terms of months perhaps) to check on how it works.
>
>
> But it all comes down to this... and don't think I'm trying to be mean....
>
>
> I know you've been struggling with things for a long time....
>
> but with an antipsychotic, even if in some people there is a noticeable difference in as little as a few weeks, it takes several months to really notice a difference...
>
> I'm concerned that fears may have led to stopping medications before they had a chance to work. Yes, I know that Clozaril made you extremely lethargic and had some bad effects --- this is common in a lot of patients.
>
> The question is... which one to keep an open mind on, at least for a month or two.
>
> Now I'm not asking you to endure undue harm or a terrible situation, that would be Schadenfreude... but give things a reasonable chance.
>
>
> -- good luck
>
>
> -- tidings
>
> Jay
Posted by Phillipa on July 20, 2009, at 19:55:28
In reply to Re: to all of you » yxibow, posted by bleauberry on July 20, 2009, at 18:52:55
Jeroen in your country who decides in the hospital doses and lengths of time to stay on a med? You or the doctors? I think you were diagnosed as scizophrenic weren't you? If wrong I'm sorry in advance. Love Phillipa
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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