sampling antipsychotics

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
tr

tr

inert protoplasm
Verified Member
Physician
Faculty
PhD
Joined
Nov 18, 1999
Messages
2,502
Reaction score
3,039
Has anyone here actually tried an antipsychotic?

I've had several patients ask me if I've tried this stuff I want to give them, and it always feels a bit awkward to have to say no.

I was thinking of trying a little olanzapine just to see what it feels like. I don't expect it to be pleasant.

Has anyone else tried this? If so, can you tell me how functional I would be, as a drug-naive 125-lb individual, on 2.5 mg Zyprexa? Obviously I wouldn't try to drive or anything, but is it going to make me totally somnolent for six hours?
Members don't see this ad.
 
One of the attendings around here likes to tell the story of when he was a resident back in the day, and his attending made them all sample Haldol. Then he got an acute dystonia. It went away with benadryl, but came back after the benadryl wore off. Then he had to take cogentin for 3 days, which he calls "the stupidest 3 days of my life" due to the cognitive dulling.

Same attending made them sample Thorazine, and he got orthostatic, passed out, and chipped a tooth.
 
  • Like
Reactions: 1 user
Hurricane said:
One of the attendings around here likes to tell the story of when he was a resident back in the day, and his attending made them all sample Haldol. Then he got an acute dystonia. It went away with benadryl, but came back after the benadryl wore off. Then he had to take cogentin for 3 days, which he calls "the stupidest 3 days of my life" due to the cognitive dulling.

Same attending made them sample Thorazine, and he got orthostatic, passed out, and chipped a tooth.
Click to expand...

Beautiful attending. Oh the days before the CIR :rolleyes:

I know a bunch of friends of mine have tried Seroquel. I haven't done so myself. I wouldn't think this is necessary on any level. Do IM doctors all sample vanco before they give it to patients?
 
Members don't see this ad :)
Anasazi23 said:
Beautiful attending. Oh the days before the CIR :rolleyes:

I know a bunch of friends of mine have tried Seroquel. I haven't done so myself. I wouldn't think this is necessary on any level. Do IM doctors all sample vanco before they give it to patients?
Click to expand...

I agree with you that it's not necessary, but your analogy is a tad glib. Vanco is a drug people get for a few days or weeks, with (most) non-neuro side effects. Psych (and neuro) drugs have side effects that affect cognition, emotion, motivation, attention--they affect our "self" more profoundly than any other class of drugs, as a whole.
 
I agree that it would be beneficial, although no physician I know would suggest taking such potent psychotropic drugs unless you really really needed them. My story is much more accidental. While working in a locked psych facility, we were struggling with a violent patient on the floor while a nurse was attempting to give an PRN of IM Haldol. She somehow pushed the syringe in the struggle and I got 5mg of liquid Haldol shot directly into my left eye. I slept very well that night.....
 
Chrismander said:
I agree with you that it's not necessary, but your analogy is a tad glib. Vanco is a drug people get for a few days or weeks, with (most) non-neuro side effects. Psych (and neuro) drugs have side effects that affect cognition, emotion, motivation, attention--they affect our "self" more profoundly than any other class of drugs, as a whole.
Click to expand...

So, from a philosophical standpoint, is "the self" disconnected from the fever, chills, dizziness, and muscle pain associated with vancomycin side effects? My question is only partly rhetorical, and I do understand your point. But, I would much rather take the high road, remember that we are physicians treating a disease, than to get wrapped up in psychology-esque existentialism and touchy-feeliness that in the end, does relatively little, I would argue, as beneficial for our patients.

I know after treating enough patients what side effects come from these neuroleptics. Does saying to the patient, "I know from personal experience that this causes you to feel possibly lethargic for the first few weeks, and there is the possibility of some mild emotional numbing," make any more difference than, "I've treated many patients with this medication, and I'll say that it's not uncommon to feel somewhat lethargic for the first few weeks, and some express some emotional numbing."


We don't ask any other specialty to do this. Psychiatry should be no exception.
 
"to get wrapped up in psychology-esque existentialism and touchy-feeliness that in the end, does relatively little, I would argue, as beneficial for our patients."

Ahh...the differences between the fields of psychiatry and clinical psychology...gotta love it.:laugh: No offense intended, I just thought it was funny, and a very '"Doctor-like" statement....
 
erg923 said:
"to get wrapped up in psychology-esque existentialism and touchy-feeliness that in the end, does relatively little, I would argue, as beneficial for our patients."

Ahh...the differences between the fields of psychiatry and clinical psychology...gotta love it.:laugh: I'm not in favor of trying them either....I just though it was a funny and very '"Doctor-like" statement....no offense intended.
Click to expand...

It's also kind of ironically interesting in parallel with the "Have you had psychotherapy?" thread...
 
this goes along with the crackhead asking the dr if he's ever smoked crack, otherwise he doesnt "understand" what its like.

interestingly enough, i've met a few addiction specialists who were very open about their history of drug/alcohol use. they felt it gave them "street cred" with the patients. the pt's knew they couldnt b.s. the doc, and from my superficial observation it really strengthened their dr-pt relationship. what do you all think about that?
 
PeeWee137 said:
this goes along with the crackhead asking the dr if he's ever smoked crack, otherwise he doesnt "understand" what its like.

interestingly enough, i've met a few addiction specialists who were very open about their history of drug/alcohol use. they felt it gave them "street cred" with the patients. the pt's knew they couldnt b.s. the doc, and from my superficial observation it really strengthened their dr-pt relationship. what do you all think about that?
Click to expand...

IME the addiction specialists with drug histories were far and away more effective than the ones without.

The fact remains that in the addict's head it's important that his therapist "understand where he's coming from." Dismiss it if you like, but all your training is for naught if you can't even get the addict to listen to you. For people with their own drug histories, that door is already wide open.

I agree that prescription antipsychotics are a whole different ballgame, and I wouldn't argue that it's necessary for a clinician to have tried them in order for him to use them effectively. For me it's more of a personal curiosity than anything.
 
sorry, I find some of the physicians with past addiction problems to be less effective. They seem to believe that the ways they got sober should be the ways that pts get sober. They lose the perspective that every person is an individual.
 
Update: So I tried the Zyprexa. Took 2.5 mg last night.

Don't try this at home unless you have 24 hours to kill. It's really dulling. It's now a little after noon on the next day and my head still feels foggy. I'm having a lot of word-finding difficulties and it feels like I'm typing through molasses.

No wonder patients are constantly stopping their meds. I wouldn't take something that made me feel like this all the time either. :(
 
Never tried any of the meds I prescribe patients. I was tempted.

One of my attendings told me one of his students years ago tried haldol 2mg. He also said the guy was in bed for 3 days after he tried it, with a feeling as if he was trapped in a box.
 
Hmm. If you ever get the urge to become a drooling idiot who can't move: Try Clozapine.
 
It is (of course) controversial whether the experience that a person with a mental disorder has when they take x medication is comparable to the the experience that a person without a mental disorder has when they take x medication.

Some medications are marketed with something along the lines of 'doctors believe that this medication rectifies / normalizes some imbalance'. So the thought is that when a person with an imbalance takes that medication then their experience is more like your normal experience than the experience that you would have on the medication.

I'm not sure about this... But if a short sighted person wore glasses that rectified their vision and then a person with normal vision wore those glasses then would the experiences of the people wearing glasses be comperable? Of course not.

But then we have such problems as: MY ATTENTION IMPROVES WITH STIMULANTS TOO!!!!! So... Hard to know if the disordered person has such a different experience than us if we take the meds after all...
 
Yeah, I agree with Toby. I have to wonder if the experience of taking a medication because it's indicated vs. taking one that isn't out of curiousity isn't somehow fundamentally different. I don't have ADHD and have never taken a stimulant prescribed or otherwise, and I think if I did it'd probably just make me anxious. But I don't know.
 
toby jones said:
It is (of course) controversial whether the experience that a person with a mental disorder has when they take x medication is comparable to the the experience that a person without a mental disorder has when they take x medication.

Some medications are marketed with something along the lines of 'doctors believe that this medication rectifies / normalizes some imbalance'. So the thought is that when a person with an imbalance takes that medication then their experience is more like your normal experience than the experience that you would have on the medication.

I'm not sure about this... But if a short sighted person wore glasses that rectified their vision and then a person with normal vision wore those glasses then would the experiences of the people wearing glasses be comparable? Of course not.
Click to expand...

I don't think this applies to psych meds so nicely. Since we don't have any idea of the pathophysiology behind psychiatric diseases, we're essentially shooting arrows in the dark. Antipsychotics have multiple complex agonist, partial agonist, and antagonist effects at multiple receptor types.

We know from experience that meds work to rectify certain aspects of psychosis, but they definitely don't make people with chronic psychiatric disease 'normal.' And the patients themselves not infrequently complain of sedation and 'fuzzy thinking' from the meds.

The diseases have complex and unknown causes; the meds have complex and only partially known effects; pharmacological rectification of disease symptoms is only partial; I think it's naive to postulate that psych meds 'fix the deficit' in the way that corrective lenses fix a refractive deficit of the natural lens.


sunlioness said:
Yeah, I agree with Toby. I have to wonder if the experience of taking a medication because it's indicated vs. taking one that isn't out of curiousity isn't somehow fundamentally different. I don't have ADHD and have never taken a stimulant prescribed or otherwise, and I think if I did it'd probably just make me anxious. But I don't know.
Click to expand...

I think the case for amphetamine derivatives affecting 'attention-disordered' patients differently than 'neurotypicals' is maybe a little better than the same argument for neuroleptics. I'm not super well acquainted with the research but I've heard a lot of people say that this is the case, for what that's worth. I have seen several patients who had a lot of issues with attention and lability and who said that methamphetamine 'calmed them down.'

OTOH it is also true that many non-attention-disordered college students have taken methylphenidate to improve their concentration; and that writers have been known to take amphetamines to enable them to work for extended periods of time.

http://dir.salon.com/story/mwt/feature/2005/03/21/speed_demon/index.html
http://www.amazon.com/No-Speed-Limit-Highs-Lows/dp/0312356161

So I'm not even really clear on the extent to which amphetamines have paradoxical effects on the 'truly' attention-disordered; and as I said I think the case is much shakier for antipsychotics.
 
You must log in or register to reply here.
Next unread thread

Similar threads

clement
Withdrawal and Antipsychotics
Replies
6
Views
198
Celexa
C
C
Antipsychotics & hypothermia
Replies
5
Views
508
ObsequiousAplomb
O
Tangerine123
Advice on multiple antipsychotics in an acute setting
Replies
18
Views
821
annoyedpsychiatrist
A
U
When do you switch antipsychotics in the inpatient setting?
Replies
21
Views
1K
Cath Up
Cath Up
Teufelhunden
Have to come up with a 1-hour antipsychotic lecture ASAP
Replies
9
Views
622
SmallBird
S
Top