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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by jimmygold70 on February 13, 2001, at 15:41:43
I’ve suffered from anxiety disorders from many years so far. My diagnoses vary: Social Phobia (Consensus), Borderline Personality Disorder without temper outbursts (Psychologist), Avoidant Personality Disorder (Psychiatrist I), Schizoid Personality Disorder (Psychologist, Psychiatrist II), Obsessive-Compulsive Personality Disorder (Psychiatrist III).
In short, all clinicians agree that I have an anxiety disorder, most agree that I fall in cluster C, and my psychologist, that seems to be the most knowledgeable of all, Also puts me in Cluster B.
I have tried all sorts of medications: SSRIs (practically each and every), MAOI (phenelzine), RIMA (moclobemide), NARI (reboxetine), SNRI (venlafaxine), Novel (nefazodone,mianserin), Benzodiazepines (clonazepam,alprazolam,alprazolam XR).
I had some, but not overwhelming success with the SSRIs, and I still take sertraline. Anything that acted on the noradrenergic system seemed a failure. Benzodiazepines were good but made me so forgetful in effective doses and ineffective in lower doses.
Then, I suddenly come to know that sulpiride, which is available here in Israel, might be of help. My psychologist also insists that he sees it as helpful in similar situations, but, unfortunately, he cannot prescribe anything…
My psychiatrist (No. III, the last one) insists that I should not take sulpiride, since it will cause me tardive dyskinesia. He has good reasons to believe that – my grandfather of my mother’s side took haloperidol in low doses for Bipolar for many years, and ended up with TD. My father took thioridazine in a low dose for a very short time for acute hypomanic episode, and had severe extrapyramidal symptoms. My psychiatrist insists that, regardless of my genetics, sulpiride is supposed to be effective but harmful in the long term, so he refused to prescribe it.
Eventually, after many efforts, I managed to put my hand on sulpiride, and it does seem to work better than anything else before. I take 50mgx2 (probably the lowest dose possible). I have taken it for a couple of days with no side effects so far.
Now, my plan is to use it for a month and see if it works. However, if I discover that it does (and so it looks so far) – I have a problem. No, it’s very easy to say “don’t take it – why take the risk ?”. But it might be the only available treatment that does work for me. In that case, I might look for two other senior psychiatrists, that would act as a “committee”, and see what they see (BTW I got the idea from the ECT approval here in Israel - you need 3 MDs to sign in order to get it…).
1. What do you think ?
2. Have you seen any similar cases ?
3. Is there really any serious concern for TD with sulpiride in low doses ?
4. Are there any early signs for TD development (i.e. tremor) on sulpiride?
5. And the most important Question (!) – In case sulpiride does work for me, can you think of another drug with similar pharmacology (olanzapine ??? anything ?!) that might help me with lower incidence of EP symptoms ?Thanks a lot !!!
Jimmy
Posted by SalArmy4me on February 14, 2001, at 4:57:12
In reply to Sulpiride, Tardive Dyskinesia and Me, posted by jimmygold70 on February 13, 2001, at 15:41:43
Before you take the sulpride or even think about ECT, you should know that you have many other options. I myself was going to do ECT, and then I found relief in a newer drug called Mirapex. Here are some more options you may not have thought of:
Nefazodone - great for sleep; no sexual dysfunction; no anticholinergics side-effects.
Lamotrigine - good side-effect profile; most antidepressant properties
Carbamazepine - less side effects than Lithium or divalproex sodium
Topiramate - the newest mood-stabilizer; it promotes weight loss
Desipramine - the least side-effects of all the Tricyclics; one of the SNRIs
High-dose Venlafaxine - at higher doses Venlafaxine affects more chemicals than SSRIs.
Buspirone - an effective antidepressant and anxiolytic at high doses.
Dopamine Agonists - Pramipexole has two studies on it (I take it).
"Power Combinations" - Remeron+Effexor; Wellbutrin+Remeron, RemeronProzac
Augmentation of anything you have tried before with Lithium, Pindolol, or Buspar (i took pindolol
Foreign medications to the US: the RIMA Moclobemide; Reboxetine; Amisulpride, etc
Atypical Neuroleptics/Antipsychotics with antidepressant properties: Risperidone, Olanzapine, Seroquel
Provigil - a stimulant that is possibly effective
Irreversable MAOIs - Phenelzine, Tranylcypromine. Extremely Effective.
MAOI-B - Selegiline
I hope that gives you _some_ hope!
Posted by jimmygold70 on February 14, 2001, at 6:38:41
In reply to Re: Sulpiride, Tardive Dyskinesia and Me, posted by SalArmy4me on February 14, 2001, at 4:57:12
> Before you take the sulpride or even think about ECT, you should know that you have many other options. I myself was going to do ECT, and then I found relief in a newer drug called Mirapex. Here are some more options you may not have thought of:
>
> Nefazodone - great for sleep; no sexual dysfunction; no anticholinergics side-effects.I tried - only had side effects from nefazodone.
> Lamotrigine - good side-effect profile; most antidepressant properties> Carbamazepine - less side effects than Lithium or divalproex sodium
>
> Topiramate - the newest mood-stabilizer; it promotes weight lossWhat good is a mood stabilizer for Social Phobia ?!
> Desipramine - the least side-effects of all the Tricyclics; one of the SNRIs
>
> High-dose Venlafaxine - at higher doses Venlafaxine affects more chemicals than SSRIs.
>
> Buspirone - an effective antidepressant and anxiolytic at high doses.Tried all of the above and had only side effects (including combinations)
> Dopamine Agonists - Pramipexole has two studies on it (I take it).For what ? Depression ? I don't have depression. Sorry.
> "Power Combinations" - Remeron+Effexor; Wellbutrin+Remeron, RemeronProzac
> Augmentation of anything you have tried before with Lithium, Pindolol, or Buspar (i took pindololYe, that's also for depression. Will not do much good for my SP. Except maybe buspirone - which proved useless in my case.
> Foreign medications to the US: the RIMA Moclobemide; Reboxetine; Amisulpride, etc
Tried the first two with no success.
> Atypical Neuroleptics/Antipsychotics with antidepressant properties: Risperidone, Olanzapine, SeroquelWell, that remains a big question.
> Provigil - a stimulant that is possibly effectiveTried it. It works, but only for vigilance...
> Irreversable MAOIs - Phenelzine, Tranylcypromine. Extremely Effective.
Tried phenelzine. Extremely side-effective. No effects on me otherwise.
> MAOI-B - SelegilineWell, never tried it.
> I hope that gives you _some_ hope!It does give me some, but not ovewrwhelming hope. Take care,
Jimmy
Posted by SLS on February 14, 2001, at 15:59:05
In reply to Re: Sulpiride, Tardive Dyskinesia and Me, posted by jimmygold70 on February 14, 2001, at 6:38:41
Hi Jimmy.
SalArmy4Me has done a wonderful job at listing some very effective treatments. There is little I can add.
Which tricyclics have you tried and what drugs have you combined with them.
Effexor + tricyclic?
Wellbutrin + tricyclicNardil and Parnate are two completely different drugs. Parnate is sort of a mixture of Nardil and selegiline - but with fewer side effects than Nardil.
You can mix Parnate with a tricyclic (desipramine or nortriptyline) with a stimulant and/or Mirapex with thyroid with lithium and Lamictal.
How's that for a cocktail? It is doable (word?).
Take inventory of what drugs you have been partially responsive to, and see whether or not you have tried combining them. You may hit something nice.
Wellbutrin + Effexor
Wellbutrin + Parnate
Wellbutrin + ZoloftGabitril
Depakote
TrileptalSpend a day going through Dr. Bob's Psychopharmacology Tips. It will renew your hope.
I wish us both good luck. It appears we need it.
Sincerely,
ScottOh, before I forget... Sulpiride and amisulpiride both carry a greater risk of producing TD than do the newer atypical neuroleptics. However, this risk is supposedly greatly reduced when they are used at the low dosages prescribed for depression and dysthymia.
This is the end of the thread.
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