Posted by yxibow on January 13, 2007, at 15:12:04
In reply to Re: ABILIFY + EPS, posted by alanjacobs on January 13, 2007, at 5:19:26
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> The effects I experienced were the slight protrusion of my tongue and some uncontrollable frowning and facial movements. Mostly the frowning though.This early on suggest EPS but I understand your concern.
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> So when you say the "General Scale of Strength of A typical" you are showing that Abilify is in the middle of the pack but below Zyprexa and Seroquel?Roughly... for most people. Of course, as they say, your miles may vary. I was showing in order of descending strength, I should have made that clear, Zyprexa and Seroquel while they have cholesterol side effects are less "potent".
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> I understand the low percentage of actually getting TD, still worries me though.Worries me too as well but treatment can't continue with constant worry so maybe a less potent one is of more value -- but if you are doing well on it, maybe that outweighs it. That is for better or worse "informed consent."
> My PDoc told me that 20 years ago similar medicines would have been prescribed with congentin at the same time.
This is true, and they still are, although there is Artane and Akineton and if your in other countries a few more. They all came from about the same era. They're anti-parkinsonian as well and still used.
> TD really scares the crap out of me because I don’t think I could live with it, maybe just how I am feeling now.I know -- as I say, it still does for me -- its a tradeoff. If it really does, there are other treatments for BP... I am assuming BP I, but I can't be sure. Lithium, Depakote come to mind and Depakote has some of the least side effects in general.
> Some Background on me
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> Was diagnosed bipolar 4 years ago. Had some real lousy treatment at U of Penn, which included 3 P Docs leaving me during a 10 month period of time. I got so upset with them I stopped going and took myself off my meds which had helped very little.:( That doesn't create a good atmosphere for psychiatry.
> Through U of Penn I was on lamictall and celexa first, then some seroquel in small dosage (25mg) for sleep. I still felt like crap and the seroquel gave me the worst hangover in the morning. So I went off the seroquel and the celexa and moved to Effexxor, still nothing at all. At this point I stopped not because the drugs but because Of the Docs kept changing on me and I felt the general care there was sub par. That was maybe 16 months ago.
I don't know enough about SRIs on Bipolar... Seroquel is fairly strong in the antihistamine department, I know, I take it. It takes a while to get used to it but you still are lethargic.
You were probably I assume most feeling the side effects of Seroquel and not Lamictal.
> During the time with no therapy and no meds I of course got worst and worse.
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> In November I decided to find someone on my own. Found a therapist over the net and went for a visit. I like her a lot and think she really listens understands and is helping me. The P Doc I began to see was someone she had recommended to me. I like him a lot. The first visit I met with him and his nurse-practioner for a total of 2 hours. I told them my history and the medicines I had been on that had not worked.It sounds at least like you have a good set of doctors you trust and believe in. That is the most important. There is no point in wasting time and money on therapy when it doesn't come to value. I had a good psychologist in college but the psychiatrist who ran that part of the student health center like it was her fiefdom was a royal b**
> His first thoughts were Prozac and Abilify. I took this regiment for two weeks and I started feeling really good. Probably the best I have felt in 5-6 years. Then the problems start. I was frowning one Friday night a little, was not sure what it was from.
Probably initial strong EPS is my guess. Oral fasciculations.
Took my abilify and went hunting the next day. While hunting I noticed it was getting worse and worse and that my tongue felt swollen and was pushing to exit my mouth a bit. This really bothered me to say the least.Yes, I have had slight tongue movements here and there but not protrusions. Nonetheless you are on a slightly stronger medication so it doesn't surprise me earlier on that it could be stronger.
When I got home I looked up side effects of Abilify and the one it closely resembled was Tardive. But I had also red tardive usually appears much later after long periods of taking these type of drugs. I called the doctor who I luckily had an appointment with a few days later. I told him I stopped taking the abilify. He was fine with that. When I went for my visit and explained what was going on he said Ill give you some cogentin and that should reduce the symptoms right away and we will just stay on the Prozac and see how you do. Well the cogentin worked great 2-3 days later I was back to normal except for my mood which had gone down the tube once again.
This is the first indication that it is not TD. TD almost probably 100% for reasons we still don't fully understand does not respond well at all -- in fact badly opposite, to anticholinergics. If it was TD, your symptoms would have been magnified by the Cogentin, not reduced.
SO I met with him Tuesday of this week. He said since we had such good mood results with Abilify we should try it again this time also with ongoing cogentin.
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> Jay you seem very knowledgeable, Whets your background if I may. Your reply was probably the most informative I have ever received on here.
My background is 19 years of mental health issues, mostly in the OCD/depression region. My mother's sister did... well anyhow is no longer here, due to BP-II. My mother herself has foibles of sorts, a cluster of phobias about elevators, etc. but has never treated herself. She could never go back to the Grand Canyon again, sadly -- the beauty of standing at the rim and looking far across, but I understand, she would suffer from vertigo. I guess I have the elevator/claustrophobia thing a little bit too.
I did also work for a psychiatrist group once administratively and computer support.
But mostly it is years of my own experience with mental/psychobiological illness and medications and what I've responded too -- which I can sometimes identify with people and sometimes not. So I don't foray into responses when I can't really offer the best suggestions, but I know how I've responded to medications. And its also important to remember that its only how you've responded and others can be completely different.
But you are probably right that you will respond similarly to other neuroleptics, just less strongly so if they are less potent (usually.) You can always try Geodon, its a tossup between the two. Zyprexa especially and Seroquel to an extent you should blood monitor lipid (cholesterol) and weight and diabetes potential levels because that is their achilles heel to otherwise more gentle atypical antipsychotics.
> Please ask me more if I did not answer you fully.I think you've explained some of the history about the bipolar in fair degree, I see the reason for trying a neuroleptic after a history of other medications. Nonetheless you might ask about lithium and Depakote if you haven't tried them.
> Ps. He also gave me some lunesta to try Seems to work pretty well so far.
That sounds good... Lunesta is a bit less strong than Ambien but if you are a responder than that is good. Some people will have sort of a metallic taste when going to bed (some swear it still remains after) but since you don't seem to be having that, don't worry about it. Over time, it is possible to become habituated to it, it is conceivable, so you may have to back off of your dose and start again, although it is supposed to be less so with Lunesta. Also, you may discover that your insomnia will go away alone without Lunesta as treatment continues and you become more used to your other medications.
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> Thanks
>No worries -- keep us posted on how Abilify treats you, and your doctor as well and your concerns about getting possibly a baseline AIMS exam so he can compare it in the future with a 6 month one if you decide to stick it out that far. A lot of doctors don't give AIMS exams because they don't know the protocol or don't see the need but it is good practice to keep tabs on any movement disorders. It is just a simple less than 5 minute subjective test of muscles and reflexes and the like to monitor a patient's response to a neuroleptic agent.
Hope that answers some of your questions and continue to post here as much as you like -- I'm sure people with first hand experience of BP I or II can answer more detail on the actual disorder itself.-- Jay
poster:yxibow
thread:721839
URL: http://www.dr-bob.org/babble/20070113/msgs/722002.html