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Old 01-09-2011, 09:01 PM   #1 (permalink)
 
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Default Which med for racing thoughts?

I take fluphenazine (Prolixin) a typical antipsychotic with no side effects but afraid of long term treatment. is their anything else to help with racing thoughts?
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Old 01-09-2011, 09:42 PM   #2 (permalink)
 
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Why are you on a typical antipsychotic, if you don't mind my asking? Psychosis? I'd never even heard of that drug before and had to look it up. I also read that this drug is commonly administered intravenously. Is that the case for you?

Racing thoughts can be helped with benzos and mood stabilizers, particularly the latter in the long-term, since they are a manifestation of mania or hypomania. Definitely not SSRIs or other A/Ds, though (or amphetamines, most likely).
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Old 01-09-2011, 09:46 PM   #3 (permalink)
 
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^^^ amphetamines are great for racing thoughts its paradoxical.. stimulants focus your thoughts and let you organize them
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Old 01-09-2011, 09:54 PM   #4 (permalink)
 
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The holy grail of course, opiates.
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Old 01-10-2011, 12:07 AM   #5 (permalink)
 
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lithium will calm the bind for racing thoughts
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Old 01-10-2011, 12:38 PM   #6 (permalink)
 
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Originally Posted by californiakid18 View Post
^^^ amphetamines are great for racing thoughts its paradoxical.. stimulants focus your thoughts and let you organize them
No, they're not. Racing thoughts are a clinical term for what happens in a hypomanic, manic, or mixed state. Stimulants should not be prescribed to someone who is currently experiencing hypomanic symptoms, whether dysphoric (mixed) or euphoric. That just fuels the fire. Instead, mood stabilizers, anti-psychotics, or benzos (or opiates, as mentioned above, but good luck with that) should be prescribed.
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Old 01-10-2011, 01:20 PM   #7 (permalink)
 
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Antipsychotics should never be prescribed unless it's to calm down dangerous psychotic behaviour.
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Old 01-10-2011, 01:46 PM   #8 (permalink)
 
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Antipsychotics should never be prescribed unless it's to calm down dangerous psychotic behaviour.
That's a very broad and inaccurate statement. APs are sometimes used, quite effectively, for OCD and OCD-spectrum disorders (sometimes even "anxiety"-related symptoms like GAD, which may actually be a mixed state in some cases), particularly when nothing else works or as augmentation. Seroquel, in particular, is used for insomnia, usually under similar circumstances. APs are used for Asperger's and ASD-related stimming and other "overly" rigid behaviors and cognition.
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Old 01-10-2011, 02:00 PM   #9 (permalink)
 
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There's absolutely no excuse for prescribing such damaging drugs unless it's absolutely necessary. Most of those situations are rarely severe enough to warrant that kind of "treatment" (if you can call dumbing people down "treatment").
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Old 01-10-2011, 02:04 PM   #10 (permalink)
 
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Originally Posted by bmwfan07 View Post
That's a very broad and inaccurate statement. APs are sometimes used, quite effectively, for OCD and OCD-spectrum disorders (sometimes even "anxiety"-related symptoms like GAD, which may actually be a mixed state in some cases), particularly when nothing else works or as augmentation. Seroquel, in particular, is used for insomnia, usually under similar circumstances. APs are used for Asperger's and ASD-related stimming and other "overly" rigid behaviors and cognition.
Meh, their use for ocd and depression is retarded ****, my mum still suffers from tardive dyskinesia because of antipsychotics, she now often cries because she can barely talk on the phone, great depression relief ya rly, i posted this a while ago:

Refuse neuroleptics for 3 reasons:

1) Incosistent evidence based on small pilot study's wich hasnt been replicated in bigger study's AFAIK, as an example:
Quote:
J Clin Psychiatry. 2005 Oct;66(10):1289-97.
Olanzapine/fluoxetine combination for treatment-resistant depression: a controlled study of SSRI and nortriptyline resistance.
Shelton RC, Williamson DJ, Corya SA, Sanger TM, Van Campen LE, Case M, Briggs SD, Tollefson GD.

Department of Psychiatry, Vanderbilt University, Nashville, TN 37212, USA. richard.shelton@vanderbilt.edu
Comment in:

Evid Based Ment Health. 2006 May;9(2):42.
Abstract
BACKGROUND: This 8-week, double-blind, multicenter study was undertaken to replicate, in a larger sample of patients with treatment-resistant major depressive disorder (MDD; DSM-IV criteria), the results of a pilot study of the olanzapine/fluoxetine combination.

METHOD: The study was begun in August 1999. The primary entry criterion was a history of failure to respond to a selective serotonin reuptake inhibitor (SSRI). Patients (N = 500) who subsequently failed to respond to nortriptyline during an open-label lead-in phase were randomly assigned to 1 of 4 treatment groups: olanzapine (6-12 mg/day) plus fluoxetine (25-50 mg/day) combination, olanzapine (6-12 mg/day), fluoxetine (25-50 mg/day), or nortriptyline (25-175 mg/day). The primary outcome measure was baseline-to-endpoint mean change in score on the Montgomery-Asberg Depression Rating Scale (MADRS).

RESULTS: At the 8-week study endpoint, MADRS total scores decreased by a mean 8.7 points from baseline (28.5) with the olanzapine/fluoxetine combination, 7.0 points from baseline (28.4) with olanzapine (p = .0, 8.5 points from baseline (28.4) with fluoxetine (p = .84), and 7.5 points from baseline (28. with nortriptyline (p = .30), with no significant differences among the therapies. The olanzapine/fluoxetine combination was associated with significantly (p < or = .05) greater improvement (decrease) in MADRS scores than olanzapine at weeks 2, 4, 6, and 7; than fluoxetine at weeks 2 through 5; and than nortriptyline at weeks 1 through 4. A post hoc analysis of a subgroup of patients who had an SSRI treatment failure during their current MDD episode (N = 314) revealed that the olanzapine/fluoxetine combination group had a significantly (p = .005) greater decrease in MADRS scores than the olanzapine group at endpoint. Safety data for the olanzapine/fluoxetine combination were similar to those for its component monotherapies.

CONCLUSIONS: The olanzapine/fluoxetine combination did not differ significantly from the other therapies at endpoint, although it demonstrated a more rapid response that was sustained until the end of treatment. The results raised several methodological questions, and recommendations are made regarding the criteria for study entry and randomization.
2) Long term risks, wich includes a permanent movement disorder wich is no joke.
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Tardive dyskinesia and new antipsychotics.
Correll CU, Schenk EM.

The Zucker Hillside Hospital, North Shore Long Island Jewish Health System, Glen Oaks, NY 11004, USA. ccorrell@lij.edu
Abstract
PURPOSE OF REVIEW: To provide an update on tardive dyskinesia rates in patients treated with first-generation or second-generation antipsychotics in studies published since the last systematic review in 2004. RECENT FINDINGS: Across 12 trials (n = 28 051, age 39.7 years, 59.7% male, 70.9% white, followed for 463 925 person-years), the annualized tardive dyskinesia incidence was 3.9% for second-generation antipsychotics and 5.5% for first-generation antipsychotics. Stratified by age, annual tardive dyskinesia incidence rates were 0.35% with second-generation antipsychotics in children, 2.98% with second-generation antipsychotics versus 7.7% with first-generation antipsychotics (P < 0.0001) in adults, and 5.2% with second-generation antipsychotics versus 5.2% with first-generation antipsychotics (P = 0.865) in the elderly (based almost exclusively on one retrospective cohort study). In four adult studies (n = 2088, age 41.2 years, 71.2% male, 62.0% white), tardive dyskinesia prevalence rates were 13.1% for second-generation antipsychotics, 15.6% for antipsychotic-free patients, and 32.4% for first-generation antipsychotics (P < 0.0001). SUMMARY: Current evidence supports a lower tardive dyskinesia risk for second-generation antipsychotics than for first-generation antipsychotics. Tardive dyskinesia incidence was higher with second-generation antipsychotics than previously reported, possibly due to recent studies with relatively short mean durations and use of nonstandard tardive dyskinesia definitions.
3) Possibility of even higher risk when those drugs are being used offlablel, still need to check the full text of this one:
Quote:
Curr Drug Saf. 2010 Jul 2;5(3):263-6.
Safety considerations of the use of second generation antipsychotics in the treatment of major depression: extrapyramidal and metabolic side effects.
DeBattista C, DeBattista K.

Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA. debattista@stanford.edu
Abstract
Second generation antipsychotics (SGAs) are increasingly employed in the treatment of depression. Adjunctive aripiprizole and olanzapine/ fluoxetine combination (OFC) have been approved in the US in the treatment of depression. Quetiapine also appears to be poised for an FDA approval as an adjunctive treatment for resistant depression. Historically, first generation antipsychotics were thought to carry an enhanced risk of certain side effects in the treatment of mood disorders, including an enhanced risk of extrapyramidal symptoms (EPS). The second generation antipsychotics are also known to be associated with a variety of metabolic side effects. The use of SGA in a depressed population may pose risks that differ from use in other conditions such as bipolar disorder and schizophrenia. In this paper, the risk of extrapyramidal and metabolic side effects is reviewed in depressed patients treated with second generation antipsychotics.
This "evidence" for OCD is also based on stupid pilot study's, the long term dangerous effects do NOT justify their use for OCD or depression, altough i admit that when your having parkinson like symptons you probably dont think about ocd as much!
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Old 01-10-2011, 03:08 PM   #11 (permalink)
 
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Originally Posted by bmwfan07 View Post
Why are you on a typical antipsychotic, if you don't mind my asking?.
For racing thoughts and ocd symptoms. I also take it for hallucinations but it doesnt do anything for my delusions. ive been on fluphenazine for three years now and im worried about the potential dangers of movement disorders or diabetes.
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Old 01-10-2011, 03:44 PM   #12 (permalink)
 
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Originally Posted by Duke of Prunes View Post
There's absolutely no excuse for prescribing such damaging drugs unless it's absolutely necessary. Most of those situations are rarely severe enough to warrant that kind of "treatment" (if you can call dumbing people down "treatment").
What qualifies you to make that blanket generalization? I'm definitely not ignorant to the range of potential risks and side effects of anti-psychotics, but MOST people who take these don't these problems and are benefited by the drugs. If they weren't, they would not use or stay on them. I'm not saying they aren't overprescribed, but that doesn't prove that they shouldn't be prescribed at all.

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Originally Posted by crayzyMed View Post
Meh, their use for ocd and depression is retarded ****, my mum still suffers from tardive dyskinesia because of antipsychotics, she now often cries because she can barely talk on the phone, great depression relief ya rly, i posted this a while ago:

Refuse neuroleptics for 3 reasons:

1) Incosistent evidence based on small pilot study's wich hasnt been replicated in bigger study's AFAIK, as an example:


2) Long term risks, wich includes a permanent movement disorder wich is no joke.

3) Possibility of even higher risk when those drugs are being used offlablel, still need to check the full text of this one:


This "evidence" for OCD is also based on stupid pilot study's, the long term dangerous effects do NOT justify their use for OCD or depression, altough i admit that when your having parkinson like symptons you probably dont think about ocd as much!
I'm sorry to hear about your mom's terrible experience... that is truly awful.

That said, it doesn't mean most people have those results, and the fact is, many of the folks who are on these drugs need them. The ones that don't and are on it for any significant loss of time with issues afterward are very possibly a result of medical malpractice and should deal with it as such.

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Originally Posted by MavenMI6Agent009 View Post
For racing thoughts and ocd symptoms. I also take it for hallucinations but it doesnt do anything for my delusions. ive been on fluphenazine for three years now and im worried about the potential dangers of movement disorders or diabetes.
Are your delusions OCD-based, or are they true delusions? That is, do you get an intrusive thought like, "My parents are poisoning me," which causes a spike in anxiety and constant rumination? Or, is it being absolutely confident that they are poisoning you. There is a major difference, as sometimes runaway OCD thoughts can turn into full-fledged delusions. The presence of hallucinations suggests that it's more of the latter, but it may not be.
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Old 01-10-2011, 03:46 PM   #13 (permalink)
 
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That said, it doesn't mean most people have those results
Offcourse, but what makes that risk acceptable? The risk is still pretty high for such serieus side effects.

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, and the fact is, many of the folks who are on these drugs need them.
Ppl with depression for example need them while bigger study's dont replicate the pilot study's?


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The ones that don't and are on it for any significant loss of time with issues afterward are very possibly a result of medical malpractice and should deal with it as such
I forese a great business for meds counteracting pdocs retardation.
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Old 01-10-2011, 03:47 PM   #14 (permalink)
 
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What qualifies you to make that blanket generalization? I'm definitely not ignorant to the range of potential risks and side effects of anti-psychotics, but MOST people who take these don't these problems and are benefited by the drugs. If they weren't, they would not use or stay on them. I'm not saying they aren't overprescribed, but that doesn't prove that they shouldn't be prescribed at all.
They are most often added to SSRI's, patients cant know wich med is working and will keep taking both.
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Old 01-10-2011, 03:49 PM   #15 (permalink)
 
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A vast number of people who are having problems with antipsychotics aren't mentally fit enough to stop them and have them forced on them by carers, which is why the statistics don't really reflect the true nature of the drugs. They're only just starting to crack down on that. Before it was assumed that most of these people were just "stupid", but as soon as they take them off the antipsychotics, they "come back to life". It's mainly prevalent with old people who have dementia or other people with serious mental retardation (which is one of the most common off-label uses of antipsychotics, to control their "unpredictable" behaviour), which is why it's so overlooked.
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Old 01-10-2011, 03:51 PM   #16 (permalink)
 
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I vote for lobotomy for real mind numbing.
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Old 01-10-2011, 03:51 PM   #17 (permalink)
 
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Offcourse, but what makes that risk acceptable? The risk is still pretty high for such serieus side effects.
Sometimes, these meds are about saving someone's life, or preventing them from being absolutely miserable--or a danger to themselves or others. I'm not advocating them as first-line medications; I'm simply saying that generalizing them as bad "except for dangerous psychotic behavior," as Duke of Prunes mentioned, is not really the answer. One does not need to be psychotic to require or benefit considerably from anti-psychotics.

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Ppl with depression for example need them while bigger study's dont replicate the pilot study's?
I don't think the vast majority people with depression need them, unless their depression includes a side order of psychosis.

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I forese a great business for meds counteracting pdocs retardation.
You should become a lawyer and start a law firm doing just this. You might just make a killing. There are some firms here that specialize in this kind of stuff.
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Old 01-10-2011, 03:55 PM   #18 (permalink)
 
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Originally Posted by Duke of Prunes View Post
A vast number of people who are having problems with antipsychotics aren't mentally fit enough to stop them and have them forced on them by carers, which is why the statistics don't really reflect the true nature of the drugs. They're only just starting to crack down on that. Before it was assumed that most of these people were just "stupid", but as soon as they take them off the antipsychotics, they "come back to life". It's mainly prevalent with old people who have dementia or other people with serious mental retardation (which is one of the most common off-label uses of antipsychotics, to control their "unpredictable" behaviour), which is why it's so overlooked.
Being unfit enough to reject medications and procedures does not apply to just psychiatric issues; it can be extrapolated to medicine at large. That does not mean the practice of medicating or operating without consent needs to stop; it's necessary unequivocally in many cases. It just means that doctors need to be better educated and less hasty in making their diagnoses and determining treatment options. The fundamental problem is not, in this case, the medication itself, it's the people administering the medication. There are risks and trade-offs in almost any significant medical procedure and disease treatment, and sometimes it can be argued whether a well-intentioned, but ignorant or wrong, doctor causes more harm than he does good. This problem can be minimized with appropriate education and knowledge, but to some extent, it is a permanent conundrum.
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Old 01-10-2011, 03:57 PM   #19 (permalink)
 
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I'm simply saying that generalizing them as bad "except for dangerous psychotic behavior," as Duke of Prunes mentioned, is not really the answer.
Id say its the answer, there are far better ways to augment antidepressants, right now we have people pulling off never before seen nonesense without any lack of pharmacology, the MAOI/stimulant/NRI combo should be used BEFORE antipsychotics, only after REALLY all options are tried then they can be an option imo, they are given WAAY to fast.


Quote:
these meds are about saving someone's life, or preventing them from being absolutely miserable--or a danger to themselves or others.
Quote:
The olanzapine/fluoxetine combination did not differ significantly from the other therapies at endpoint
I vote for the good old sugar placebo.

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You should become a lawyer and start a law firm doing just this. You might just make a killing. There are some firms here that specialize in this kind of stuff.
Would be too busy putting AMT back in clinical use, sounds good tough!
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Old 01-10-2011, 03:57 PM   #20 (permalink)
 
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Nobody "benefits" from antipsychotics except for the people who have to care for the mentally ill and people with psychotic illnesses that can't be controlled by any other means. Some OCD cases I guess could benefit in the same way that schizophrenics benefit, but I'm sure there's better alternatives that don't involve simply dumbing the patient down to halt the thought patterns.

For the most part though, antipsychotics are prescribed for the benefits of carers because they make the patient stupid and docile while not really improving their mental state at all and in many cases, making them depressed and maybe even causing SA (D2 antagonism can cause SA).
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