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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 31. This is the beginning of the thread.
Posted by psychobot5000 on November 14, 2013, at 21:59:21
Hi all,
I've checked the archives and been disappointed both by the horror stories and by the lack of proper research that apparently goes into this nasty nasty side-effect. As for me, I fear that after more than five years of very, very low dose treatment with second generation antipsychotics (as an antidepressant), I'm developing akathisia. I've tried carefully lowering the dose and checking to make sure I'm metabolizing the med properly (and not changing my habits and absorbing too much), but the bottom line is probably that I just can' take geodon any more, which is very sad.That said, akathisia, many of you know, sounds mostly just strange on paper, but is truly horrible to experience. Has anyone had success in treating it? Careful breathing exercises seem to help some. Otherwise, propanolol helps, but a depressive shouldn't be on it (and it doesn't nearly eliminate the problem). I've also tried megadoses of B6 (1000-1500mg/day), which seemed to work great for about 24 hours, but simply no longer do so. I'm just starting acetyl-l-carnitine, but I don't know the optimal dose (or if it really work, either).
Any ideas? I'll be your guinea pig, folks--I can't stand my existence, so please tell me what might be an idea to test out, or any other useful information (the archives are just a little thin on specific remedies, especially after withdrawing the offending substance is counted).
Thanks for anyone's time, hope you're all well.Trying hard to stay functional and live in his own skin!
Psychobot
Posted by psychobot5000 on November 14, 2013, at 21:59:22
In reply to Akathisia remedies PLEASE, posted by psychobot5000 on November 11, 2013, at 22:31:07
PS - I read Dr. Bob's sensible tips, and FYI amantadine is probably not an option in my particular case. Can't tolerate that medication (huh...could memantine work...? Who knows).
Posted by psychobot5000 on November 14, 2013, at 21:59:22
In reply to Akathisia remedies PLEASE, posted by psychobot5000 on November 11, 2013, at 22:31:07
Just adding that, after more research, though amantadine is not an option, I'm adding vitamin D(3) and Ibuprofen/aspirin to my daily regimen in hopes they'll help.
PB> Hi all,
> I've checked the archives and been disappointed both by the horror stories and by the lack of proper research that apparently goes into this nasty nasty side-effect. As for me, I fear that after more than five years of very, very low dose treatment with second generation antipsychotics (as an antidepressant), I'm developing akathisia. I've tried carefully lowering the dose and checking to make sure I'm metabolizing the med properly (and not changing my habits and absorbing too much), but the bottom line is probably that I just can' take geodon any more, which is very sad.
>
> That said, akathisia, many of you know, sounds mostly just strange on paper, but is truly horrible to experience. Has anyone had success in treating it? Careful breathing exercises seem to help some. Otherwise, propanolol helps, but a depressive shouldn't be on it (and it doesn't nearly eliminate the problem). I've also tried megadoses of B6 (1000-1500mg/day), which seemed to work great for about 24 hours, but simply no longer do so. I'm just starting acetyl-l-carnitine, but I don't know the optimal dose (or if it really work, either).
>
> Any ideas? I'll be your guinea pig, folks--I can't stand my existence, so please tell me what might be an idea to test out, or any other useful information (the archives are just a little thin on specific remedies, especially after withdrawing the offending substance is counted).
> Thanks for anyone's time, hope you're all well.
>
> Trying hard to stay functional and live in his own skin!
> Psychobot
Posted by baseball55 on November 14, 2013, at 21:59:22
In reply to Re: Akathisia remedies -microupdate, posted by psychobot5000 on November 11, 2013, at 23:07:28
You might want to move this to the medication board, where you'll get more informed responses.
I developed akathesia while taking fairly high doses of perphenazine (an old anti-psychotic). The doctor at the day program I was attending suggested taking benadryl. That actually helped a lot. I also cut way back on the perphenazine which ended the problem altogether.
Posted by sigismund on November 14, 2013, at 21:59:23
In reply to Re: Akathisia remedies -microupdate, posted by baseball55 on November 12, 2013, at 19:41:59
Anticholinergics and benzos?
Posted by sigismund on November 14, 2013, at 21:59:23
In reply to Re: Akathisia remedies -microupdate, posted by sigismund on November 13, 2013, at 2:16:44
Why would ALC help?
I dunno anything about it either way.
Posted by Christ_empowered on November 14, 2013, at 22:24:37
In reply to Re: Akathisia remedies -microupdate, posted by sigismund on November 14, 2013, at 21:59:23
Try an orthomolecular program. I used to be the reigning king of neuroleptic side effects. Now, I can tolerate full dose abilify w/o problems.
Try...several grams C (time release, if you can), several grams niacinamide (2-3 divided doses), high dose b6, b-100 complex (time release, if you can), plus zinc, selenium, 800-1600IU natural form E, and melatonin (I'd guesstimate 3-10mgs) at night.
Add in meds as needed. Benzos are good, remeron can be helpful.
Posted by SLS on November 14, 2013, at 22:55:13
In reply to Akathisia remedies PLEASE, posted by psychobot5000 on November 14, 2013, at 21:59:21
cyproheptadine (Periactin)?
- Scott
Posted by g_g_g_unit on November 15, 2013, at 6:24:12
In reply to Re: Akathisia remedies PLEASE, posted by psychobot5000 on November 14, 2013, at 21:59:22
> PS - I read Dr. Bob's sensible tips, and FYI amantadine is probably not an option in my particular case. Can't tolerate that medication (huh...could memantine work...? Who knows).
I recall a post from the archives where Chairman_MAO actually recommends Memantine as a more humane treatment for neuroleptic-induced akathisia.
I found low-dose clonidine very helpful as an acute treatment, but of course it worsened my depression (a la propanolol).
Posted by SLS on November 15, 2013, at 7:13:00
In reply to Re: Akathisia remedies PLEASE » psychobot5000, posted by g_g_g_unit on November 15, 2013, at 6:24:12
> I recall a post from the archives where Chairman_MAO actually recommends Memantine as a more humane treatment for neuroleptic-induced akathisia.
That's very interesting. Good to know.
Do you have a link to one of his posts regarding this topic?
- Scott
Posted by g_g_g_unit on November 15, 2013, at 10:00:50
In reply to Re: Akathisia remedies PLEASE » g_g_g_unit, posted by SLS on November 15, 2013, at 7:13:00
I can't seem to find it. I may be imagining it, though I don't think that's the case.
Posted by ihatedrugs on November 15, 2013, at 13:05:29
In reply to Akathisia remedies PLEASE, posted by psychobot5000 on November 14, 2013, at 21:59:21
After 1 month on Abilify I developed akathisia. It did work well to stave of depression but the restlessness was a little to much to bear. Moved to Geodon for two weeks and it didn't work so now I'm back on 2 mg of Abilify and the dr added benztropine for the akathisia. Does anyone know anything about it?
ihatedrugs
Posted by phidippus on November 16, 2013, at 14:01:20
In reply to Akathisia remedies PLEASE, posted by psychobot5000 on November 14, 2013, at 21:59:21
Gogentin seemd to provide the most adequate relief from akathisia for me.
Eric
Posted by SLS on November 16, 2013, at 14:57:30
In reply to Re: Akathisia remedies PLEASE, posted by ihatedrugs on November 15, 2013, at 13:05:29
What about using Latuda (lurasidone) instead of Abilify?
- Scott
Posted by ihatedrugs on November 16, 2013, at 17:44:06
In reply to Re: Akathisia remedies PLEASE » ihatedrugs, posted by SLS on November 16, 2013, at 14:57:30
> What about using Latuda (lurasidone) instead of Abilify?
>
>
> - ScottHi Scott, what would be the benefit and how are they different. Thanks
Posted by bleauberry on November 18, 2013, at 16:14:17
In reply to Akathisia remedies PLEASE, posted by psychobot5000 on November 14, 2013, at 21:59:21
The herb Lemon Balm did a pretty good job on various different types of over stimulation including akathisia, panic, anxiety, butterflies in the stomach, nervousness, paranoid...
I have not needed it in a long time but when I used it as an emergency relief medicine it worked quite well and fast. The tincture form is far more effective than the capsules, and a lot faster, plus you can customize your dose easily, take it under the tongue for fast action, tastes good. Other herbs that go well with it in combination are Passion Flower and Valerian.
Toward the end of my 8 years on 5mg zyprexa I started getting some horrible stuff like you described. I needed those herbs to help get off zyprexa and for a while after.
Antibiotics ended up working a ton better than any of the psych meds and I believe that would be the case with many people here.
Posted by SLS on November 19, 2013, at 6:48:44
In reply to Re: Akathisia remedies PLEASE » SLS, posted by ihatedrugs on November 16, 2013, at 17:44:06
> > What about using Latuda (lurasidone) instead of Abilify?
> >
> >
> > - Scott
>
> Hi Scott, what would be the benefit and how are they different. Thanks
Latuda lacks the ability to stimulate dopamine receptors (D2/3 partial agonist), so it should be less apt to the produce akathisia. I haven't seen it for myself, but Latuda is supposed to act as an adjunct to more traditional antidepressants. Unlike Abilify, Latuda acts as an antagonist of 5-HT7 receptors, a property that is thought to be beneficial in depression. Like Abilify, Latuda has been granted the indication of being an augmenter of antidepressants.
- Scott
Posted by ihatedrugs on November 19, 2013, at 18:52:01
In reply to Re: Akathisia remedies PLEASE » ihatedrugs, posted by SLS on November 19, 2013, at 6:48:44
Posted by psychobot5000 on November 21, 2013, at 9:38:47
In reply to Re: Akathisia remedies -microupdate, posted by sigismund on November 14, 2013, at 21:59:23
> Anticholinergics and benzos?
Definitely good, solid ideas, IMO. For whatever reason, though (and I've checked, and my profile seems to fit acute akathisia rather than tardive, aside from this detail), anticholinergics (mostly Benadryl, so far, which, so far as I know, is a pretty standard anticholinergic when taken in slightly excessive doses.) seem to provide very limited relief.
The dirty secret about all this, of course, is that Benzos DO work (clonazepam and alprazolam both, in my case), but I'm not sure they're a permanent solution. The body readjusts to benzos so effectively...in my experience you definitely need dose-escalation to maintain its effect. And that's just a path into hell, let's face it--i.e. when you eventually have to come down off those benzos. But in the short term, I believe they're an excellent fudge...you just can't get dependent on large doses of them. Maybe some patients will be able to take relatively modest doses and continue to get some benefit, who knows.
Right now, I'm looking into cyproheptadine, as it seems to me a much less hardcore med than lyrics/pregabalin (those are the same, right?). Cypro is an antihistamine, true, which isn't great, but it seems to me that it's at least worth giving it's 5HT-2 modulating properties a chance to do their thing. Might even have some other ancilliary benefit...who knows. But it seems a damn sight less risky (and better understood) than something like Lyrica, which I sort of expect, as an antispasmodic, to cause various nasty side-effects in brain function, once your body gets used to it. I have an appointment with my doctor next Tuesday. We'll just see how that goes, then, I guess.
Posted by psychobot5000 on November 21, 2013, at 9:41:42
In reply to Re: Akathisia remedies -microupdate, posted by sigismund on November 14, 2013, at 21:59:23
> Why would ALC help?
>
> I dunno anything about it either way.I may have misspoken, and meant n-acetyl-cysteine, instead. A doc I spoke to about it basically said he had no idea whether it would work, but that it seemed to be a very, very harmless substance, so why not try it. I've been trying it. Just not sure I see any effects. Good catch on that--acetyl-l-carnitine...I don't think there's any reason that one would help, one way or another.
Posted by psychobot5000 on November 21, 2013, at 9:49:51
In reply to Re: Akathisia remedies -microupdate, posted by Christ_empowered on November 14, 2013, at 22:24:37
> Try an orthomolecular program. I used to be the reigning king of neuroleptic side effects. Now, I can tolerate full dose abilify w/o problems.
>
> Try...several grams C (time release, if you can), several grams niacinamide (2-3 divided doses), high dose b6, b-100 complex (time release, if you can), plus zinc, selenium, 800-1600IU natural form E, and melatonin (I'd guesstimate 3-10mgs) at night.
>
> Add in meds as needed. Benzos are good, remeron can be helpful.Hmm, Thankyou, sir, for the detailed suggestion. I'm not sure whether some of those substances are an option for a depressive: b6 is fine, though its effect seems to disappear quickly, but zinc and probably vitamin C are both depressogenic, for me, so...I think that's a pretty bad idea in my case or possibly of other severe depressives. The dose of melatonin you suggest would also definitely depress me--actually, any dose does. Believe me: I've tried that one a lot. Thanks much for your contribution. I am taking vitamin E, and I can try to add niacinamide if necessary (do you know what the rationale for the latter is??
Time release b vitamins I have no problem with--but, let's face it, benzos are problematic when used in the long term (which I'm already doing, I admit, but I feel I have to limit my dosage).
In my experience, Remeron is a bit of a wildcard--I bet it cures some folks akathisia, and makes it worse in others. That'd be a big thing to add, but thanks for suggesting!
Posted by psychobot5000 on November 21, 2013, at 9:53:15
In reply to Re: Akathisia remedies PLEASE » psychobot5000, posted by g_g_g_unit on November 15, 2013, at 6:24:12
> I recall a post from the archives where Chairman_MAO actually recommends Memantine as a more humane treatment for neuroleptic-induced akathisia.
>
> I found low-dose clonidine very helpful as an acute treatment, but of course it worsened my depression (a la propanolol).
>Yeah...that...sounds about right, to me. Clonidine could be so helpful if it didn't make getting out of bed a chore for the ages. Memantine I think is probably a good idea to try for some, but I don't think we've quite figured out how to work those NMDA receptors yet--for me, within a few days, the positive effects are gone, and I've got nothing but nasty cognitive S/E. Though it might be worth it if it cured akathisia, hell!
Posted by psychobot5000 on November 21, 2013, at 9:56:51
In reply to Re: Akathisia remedies PLEASE » psychobot5000, posted by phidippus on November 16, 2013, at 14:01:20
> Gogentin seemd to provide the most adequate relief from akathisia for me.
>
> EricThanks much, Eric. I'll look into that. I hadn't heart of it. Wait. Do you mean 'cogentin'? Isn't that the anticholinergic? I guess that could be okay...wouldn't a powerful A/c like that cause dry mouth, cognitive probs and all sorts of other nastiness, though? Still. Akathisia is hell, so if that's the temporary solution...gimme.
Posted by psychobot5000 on November 21, 2013, at 9:58:58
In reply to Re: Akathisia remedies PLEASE » ihatedrugs, posted by SLS on November 16, 2013, at 14:57:30
> What about using Latuda (lurasidone) instead of Abilify?
>
>
> - ScottHi Scott (just FYI, I use Geodon, small doses, not ability). I don't know much about Latuda, other than that its fairly new...is there any important take away about what makes it different, that you know of?
Thanks,
P-bot
Posted by psychobot5000 on November 21, 2013, at 10:04:44
In reply to Re: Akathisia remedies PLEASE, posted by bleauberry on November 18, 2013, at 16:14:17
Lemonbalm! Ha! Great idea--only bad thing is, my body is already used to me taking full doses of it every day. It seems the risks are small (temporarily lowering thyroid function), but I think it helps by being something like a GABA reuptake inhibitor, thus there's some potential synergy with, say, benzos.
Passiflora I found more problematic in the long term--I think it's a mild MAOi, and so if you take it for more than a day or two, it tends to stimulate, not just relax...
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