Posted by yxibow on February 25, 2008, at 1:06:36
In reply to Scary, posted by Jamal Spelling on February 24, 2008, at 11:08:31
> This is not what I was hoping to see.
>
> ---------------------------
>
> Eur Neuropsychopharmacol. 1997 Nov;7(4):261-6.Click here to read Links
> Tolerability of low dose neuroleptics: a case control study of flupenthixol.
> Fritze J, Spreda I.
>
> Klinik für Psychiatrie und Psychotherapie I, Zentrum der Psychiatrie, Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany.
>
> There are no data available on the risk of extrapyramidal symptoms when using long-term flupenthixol in low dosage in patients suffering from anxiety and depressive disorders. In a case control study 106 patients essentially treated with the neuroleptic flupenthixol in a so-called low, non-antipsychotic dosage were compared to n=37 otherwise comparable patients who never had been treated with neuroleptics. The investigator was blind to the previous treatment conditions. Extrapyramidal symptoms were found although with a low prevalence and mild degree: 6.7% tardive dyskinesia, none in controls; pseudoparkinsonism 26%, 16% in controls. Extrapyramidal side-effects, especially tardive dyskinesia, have to be considered in the individual weighing of therapeutic benefits and risks even when prescribing flupenthixol in low dosages.
>
> PMID: 9443657 [PubMed - indexed for MEDLINE]
>
> ---------------------------If you scour pubmed for journals you'll come across small patient studies all the time. That doesn't mean it is what flupenthixol is, in your body.
The minimum effective dose of any AP is always good, and as I said in my previous posting, which you can search, the MED, minimum effective dose is always the best.
A very low dose of a typical AP probably carries a lower risk over a long time than a higher one.
But as I said, the accepted theory now is that it is about 5% per year per a maximum lifetime of about 25%. But statistics go only so far. They're very messy and are not completely linear. Genetics, brain differences, everything contributes.
For myself, I dont like taking any but even with a tic that I probably did get (and this is rare) from an atypical because I had high doses over long periods of time... the risk of things like Zyprexa and Seroquel are in the 0.1% range accepted today. Risperdal is higher, perhaps closer to the typicals in high doses and has had cases of TD, but not large cases yet.
It is true that typicals for the most part are just as effective as atypicals for schizophrenia and certain disorders, as in the CATIE study -- and for that reason NHS in the UK and other public health systems use them more. But at what price glory -- the risks are a bit higher, a lot higher at high doses and high potency, and mainly the side effects, called EPS, extrapyramidal symptoms like akathisia and pseudoparkinsonism (which go away with discontinuation basically) are less with atypicals for most people. Some people don't have much with typicals. So there's another statistical variation. I can't possibly stand Compazine (for vomiting), it made me run through the walls in an ER situation the akathisia was so high. But phenothiazines are potent typicals. On the other hand I get akathisia even with some of the stronger typicals like Geodon. Of course nothing like the prior experience.
Yes, people are scared to take the medication. I am scared to take the medication, but I guess I'm fatalistic about it at the moment -- for the short time now, I need it for my clarity. In the long run I dont know, do I risk Clozaril, or do I continue Seroquel, or what. And on top of this of course, its not all medication, there are psychological things to consider, a lot. And people really don't get enough psychological counseling in the US because the HMO system doesn't like paying for it long term. But thats my soapbox.Anyhow I hope that helped a bit about things.
-- Jay
poster:yxibow
thread:814286
URL: http://www.dr-bob.org/babble/20080221/msgs/814546.html