Sunday, February 28, 2010

Disapointing News

There is a journal article in the February issue of the Journal of Psychiatry on rates of Tardive Dyskinesia with the Atypical Antipsychotics. And it finds that they are not much better than the older antipsychotics, as was previously thought.

I didn't read the whole article, only the summery on Medscape, so I don't know all the details. They do say at equivalent levels (presumable of D2 blockage). Perhaps the atypicals can be used at lower equivalent dosages? And did they look at Seroquel separately? There is some theoretical reason to think it might be better. I never understood why the other atypicals would be better.

We do know that the atypicals are less likely to cause short term extra-pyramidal side effects- and that was thought to indicate a decreased propensity for longer term tardive dyskinesia. But it doesn't. And, I have to say, that I had EPS side effects on Risperidal and Geodon (although not as bad as Haldol)

If this is true, we should be seeing an explosion of tardive dyskinesia among the non-schizophrenic, as the atypicals are now being used for everything from anxiety to mood disorders to insomnia. Where is it? Is it too soon for TD to have developed? Maybe these drugs haven't been on the market long enough. Or maybe this is just one study, and isn't the whole story.

The study did find that risk of TD with antipsychotic use was much more likely among the schizophrenic than the non-schizophrenic- I think previous studies had found the reverse. So I am a little confused.

But I am all the more determined to get off of my Abilify. That will still leave me with a little bit of Zyprexa. Maybe someday I'll get off it, but not soon I think. In the mean time I'll keep taking all my antioxidents and lots of vitamin E at night with my Zyprexa. I'm hoping they will prevent TD.

I wonder if this study will change prescribing patterns. I have long thought that doctors are much to quick to prescribe antipsychotics to non-psychotic people. I have met doctors who will not prescribe benzodiazapines, but they will put you on an antipsychotic for your anxiety instead- something I think is totally backwards.

It would have been nice if the atypical antipsychotics could be the new wonder drugs in psychiatry. I have not been manic since Zyprexa, it has been my wonder drug. But as time goes by, and I start to forget how bad it was to be manic, I start to wonder at what cost I take this drug.

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