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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 2 of 2. This is the beginning of the thread.
Posted by rogdog on October 14, 2000, at 20:54:43
thanks for the replies john, cindy, and salarmy.. my question is for anyone out there that has had experiences with neuroleptics and ocd, or knows the connection between dopamine levels and depression. I think your right on, John,when you said that seratonin basically numbs your senses, I havent had any luck with the ssri's. if you read this andrew mabey you could shed some light on this problem. if amisulpiride; at low doses, increases dopamine, then would this not make the psychosis worse at low doses? does this also work with zyprexa? and also, what are the main side effects of neuroleptic use? my doctor seems reluctant to prescribe one, for the "possible side effects". I read some where about some dermatological side effects,does anyone know what thesse might be?
Posted by JohnL on October 15, 2000, at 4:29:52
In reply to dopamine? to Andrew,John, anyone, posted by rogdog on October 14, 2000, at 20:54:43
Rogdog,
Good questions.
Since low dose Amisulpride enhances dopamine, could it worsen psychosis? Well, I've never heard of that happening. In theory it sounds like it should. But so often we notice that what happens in theory and what happens for real are two completely different outcomes. In reality, any medication can worsen psychosis. Just as we see some people actually get more depressed with antidepressants. Sometimes things just turn out all backwards for reasons we may never know for sure.I've looked everywhere for explanations of Zyprexa's mechanisms. I can't find any that are detailed enough to compare with what is known about Amisulpride. Even the PDR book is unclear. They know it blocks dopamine receptors, among other things, but no mention of presynaptic or postsynaptic. Amisulpride is more clear, it blocks presynaptic at low doses and postsynaptic at high doses. You know what puzzles me? How come there is so much detailed knowledge of a foreign antipsychotic from smaller countries, and yet such a lack of detailed knowledge of Zyprexa in the USA? I don't get it.
Primary side effects of most antipsychotics I'm aware of are sedation of varying degrees and weight gain. At the high end of the dose range there are risks of extrapyrimidal symptoms, but not usually seen at lower doses. Since I've personally sampled all kinds of meds, from mild to wild, I can honestly say there is little to fear with antipsychotics at lowish doses. They are wonderful meds for a wide variety of symptoms. And when someone discovers that they do well with one, when more common things didn't do so well, they wonder why it took so long to ever consider one. Like anything else though, everyone's mileage will vary. Your doctor's reluctance to try an AP is common. Just the word 'antipsychotic' sounds terrifying, yeah? Most of them reduce dopamine function as their primary mechanism. I think it's much more user-friendly to call them dopamine reducers instead of antipsychotics.
As far as dermatological effects, I think those are listed as possibilities with a whole bunch of drugs, including most antidepressants and anticonvulsants. Usually I think they are referring to rashes, some of which are dangerous (like Stevens-Johnson syndrome and Lamictal as one example), and others which are just nuisances. I remember when my doctor had me on 50mgZoloft and 25mgNortriptyline a couple years ago, I got these funny orange blotches on skin. Just on my arms and hands though. And the faint cigarette stain on my finger became very dark orange and quite pronounced. Weird. It all went away in days after switching meds. When they mention dermatological effects, I think they are rare, but when they happen it could be any number of weird things.
John
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