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Dr. Bob is Robert Hsiung, MD,
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Posted by g_g_g_unit on December 3, 2013, at 23:57:28
In reply to Re: how did I induce akathisia? » g_g_g_unit, posted by ed_uk2010 on December 3, 2013, at 13:22:02
Ed, just one final question..
do you think that Prazosin could help? clonidine was actually the most effective anti-akathisia drug I've tried to date, but the sedating effects wear off in about 2 days and thereafter it becomes stimulating (messy receptor affinity, I think). there's no guanfacine available here, so I've been looking for stuff that might work similarly to clonidine.
Posted by ed_uk2010 on December 4, 2013, at 3:31:06
In reply to Re: how did I induce akathisia? » ed_uk2010, posted by g_g_g_unit on December 3, 2013, at 23:57:28
>do you think that Prazosin could help? clonidine was actually the most effective anti-akathisia drug I've tried to date, but the sedating effects wear off in about 2 days and thereafter it becomes stimulating (messy receptor affinity, I think). there's no guanfacine available here, so I've been looking for stuff that might work similarly to clonidine.
I was wondering about clonidine but didn't suggest it because you were on a beta blocker. Clonidine is a bit of an odd one. It seems to change people's emotions, flat at first followed by intensified emotions later (sometimes). That's my impression anyway, probably why both depression and euphoria are listed as side effects.
The muscle relaxant tizanidine is related to clonidine and might help. I looked for it on the Australian PBS yesterday but couldn't find it. Perhaps it's available but not covered? I suspect not though. I don't know how it works in Aus. You could ask at the pharmacy perhaps. You do have baclofen, but it's really more appropriate for severe muscle spasticity in MS and spinal disease, I don't think it would be appropriate.
I really have no idea about prazosin in your case. In psych, it seems most useful for nightmares in PTSD. It might produce some sedation perhaps? I couldn't find any articles on MedLine.
Now I did have one new idea. The drug cyproheptadine (Peractin). It's a unusual antihistamine which blocks certain serotonin receptors. It's been used in akathisia, migraine, insomnia and (formerly) for allergies. It's listed on the PBS as a restricted benefit, whatever that involves. The usual side effect is drowsiness. It's not very anticholinergic. I know several people on p-babble have taken it for various conditions, especially insomnia.
Have you improved at all over the last few days?
Posted by g_g_g_unit on December 4, 2013, at 4:10:07
In reply to Re: how did I induce akathisia? » g_g_g_unit, posted by ed_uk2010 on December 4, 2013, at 3:31:06
Lol, this is turning into a saga ..
> I was wondering about clonidine but didn't suggest it because you were on a beta blocker. Clonidine is a bit of an odd one. It seems to change people's emotions, flat at first followed by intensified emotions later (sometimes). That's my impression anyway, probably why both depression and euphoria are listed as side effects.
Yeah, clonidine definitely intensified (negative) emotion in me, and quickly became stimulating rather than sedating, even when the dose remained stable. FWIW, I'm not taking the Propranolol at the moment .. the side-effects didn't seem to be worth the modest benefits.
>
> I really have no idea about prazosin in your case. In psych, it seems most useful for nightmares in PTSD. It might produce some sedation perhaps? I couldn't find any articles on MedLine.Yeah, I can't find anything either.
>
> Now I did have one new idea. The drug cyproheptadine (Peractin). It's a unusual antihistamine which blocks certain serotonin receptors. It's been used in akathisia, migraine, insomnia and (formerly) for allergies. It's listed on the PBS as a restricted benefit, whatever that involves. The usual side effect is drowsiness. It's not very anticholinergic. I know several people on p-babble have taken it for various conditions, especially insomnia.Sadly, I tried cyproheptadine last night and can't tell if it helped or hindered, but the net effect was more on the stimulating side (which fits my general experience with cyproheptadine). However, today I had a massive relapse in symptoms -- it's happened twice now with cyproheptadine, and was wondering if it was some kind of 5HT2 rebound, given that Mirtazapine works similarly.
It might've helped the akathisia slightly, but the stimulating effect, akin to Doxylamine, was unpleasant.
>
> Have you improved at all over the last few days?
>Not really.. well, I think certain supplements I was trying were making it worse, so my anxiety has dropped off a little, which makes things easier. However, even when I'm calmer, I still can't pay attention or sit still for very long, which is frustrating.
Is akathisia something most doctors are trained to deal with? I haven't been to my own GP in months, and always feel a little uncomfortable seeing him -- I've been meaning to find someone new, but wasn't really sure if this was the kind of issue you could present on a first visit.
Posted by ed_uk2010 on December 4, 2013, at 9:05:05
In reply to Re: how did I induce akathisia? » ed_uk2010, posted by g_g_g_unit on December 4, 2013, at 4:10:07
>Is akathisia something most doctors are trained to deal with?
Not really, only psychiatrists. I would discuss it as restlessness, tension, jaw clenching and anxiety, rather than akathisia. And of course mention the recently stopped mirtazapine, which I suppose they may encourage you to restart.
On the other hand, a GP may be willing to give you a few diazepam tablets to see you through the next week. It doesn't sound like you had any clear paradoxical reaction to it before. You'll just need to mention which benzos you definitely can't take so they don't try to prescribe any of those.
Do you have a psych you can see?
Posted by g_g_g_unit on December 5, 2013, at 1:36:06
In reply to Re: how did I induce akathisia? » g_g_g_unit, posted by ed_uk2010 on December 4, 2013, at 9:05:05
>
> Do you have a psych you can see?Hi ed,
No, I don't have a psychiatrist at the moment. I ended up seeing my GP, though it was a little bizarre. I explained what was going on, and he's familiar with akathisia .. however, he commented that I didn't look very restless at the time. I explained I had taken 20mg of propanolol, otherwise I wouldn't have been able to drive there.
Then he just kept looking at me and remarking how I didn't look very restless, and I kept saying "but I took the propranolol". Maybe he thought I was drug-seeking .. I have no idea. Finally, he relented and prescribed Cogentin (0.5mg once a day).
So I'll see how that goes, but it confirmed it's probably time for a new GP.
Posted by g_g_g_unit on December 5, 2013, at 6:27:00
In reply to Re: how did I induce akathisia? » ed_uk2010, posted by g_g_g_unit on December 5, 2013, at 1:36:06
After about 2.5 hours, the Cogentin kicked in and I could distinctly feel that inner tension unwinding. It hasn't completely abated -- maybe 0.5mg is too low.. but I'll cut out everything else and see how I fare over the next couple of days.
Ed, as an anticholinergic, can Cogentin add to anxiety/overstimulation (which is distinct from akathisia)? Would it be best to take it in the a.m.?
Posted by ed_uk2010 on December 5, 2013, at 16:58:20
In reply to Re: how did I induce akathisia? » g_g_g_unit, posted by g_g_g_unit on December 5, 2013, at 6:27:00
>Ed, as an anticholinergic, can Cogentin add to anxiety/overstimulation (which is distinct from akathisia)? Would it be best to take it in the a.m.?
Great that it helped! I think you'll have to experiment to be honest. It can be stimulating for some, but can also cause an antihistamine-type drowsiness in others. Let us know how it goes.
Posted by phidippus on December 5, 2013, at 17:40:07
In reply to how did I induce akathisia?, posted by g_g_g_unit on November 29, 2013, at 9:02:52
Its the Mirtazapine.
Really, talk your doc into letting you take Tiagabine 12 mg for anxiety and insomnia. It works really well and there's plenty of literature on the net supporting it.
Eric
Posted by g_g_g_unit on December 6, 2013, at 6:55:58
In reply to Re: how did I induce akathisia? » g_g_g_unit, posted by ed_uk2010 on December 5, 2013, at 16:58:20
> Great that it helped! I think you'll have to experiment to be honest. It can be stimulating for some, but can also cause an antihistamine-type drowsiness in others. Let us know how it goes.
>Will do. Trying not to obsess about it so will report back in a few days.
Posted by g_g_g_unit on December 6, 2013, at 6:56:56
In reply to Re: how did I induce akathisia? » g_g_g_unit, posted by phidippus on December 5, 2013, at 17:40:07
> Its the Mirtazapine.
>
> Really, talk your doc into letting you take Tiagabine 12 mg for anxiety and insomnia. It works really well and there's plenty of literature on the net supporting it.
>
> EricCool, thanks, I'll make a note.
Posted by ed_uk2010 on December 6, 2013, at 13:51:07
In reply to Re: how did I induce akathisia? » ed_uk2010, posted by g_g_g_unit on December 6, 2013, at 6:55:58
>Will do. Trying not to obsess about it so will report back in a few days.
Cogentin's a long-acting med. After the first few days, it probably won't make a great deal of difference what time of day you take it. Personally, I'd stick with a fairly low dose. Best of luck!
Posted by jono_in_adelaide on December 6, 2013, at 21:57:52
In reply to Re: how did I induce akathisia? » g_g_g_unit, posted by ed_uk2010 on December 6, 2013, at 13:51:07
Try Phenergan 10mg in the morning and the afternoon, and 10-20mg half an hour before bedtime
Its OTC, not habit forming and has been in use since 1949, so they know its safe
Posted by g_g_g_unit on December 9, 2013, at 2:24:59
In reply to Re: how did I induce akathisia? » g_g_g_unit, posted by ed_uk2010 on December 6, 2013, at 13:51:07
> Cogentin's a long-acting med. After the first few days, it probably won't make a great deal of difference what time of day you take it. Personally, I'd stick with a fairly low dose. Best of luck!
Hey ed, wikipedia lists the half-life of Cogentin as 12-24 hours .. I'm a bit confused, because people most commonly seem to be dosing b.i.d.
I read it acts as a DRI at the 'nerve terminals', and have no idea what that means; but I've actually noticed some psychoactive effects that I thought might be consistent with a DRI .. namely, I've been hyperfocusing far more, my obsessive thoughts are much 'louder' and distracting, and my sleep is disturbed (I take it at 6pm and find it calming for about 3 hours, before stimulation takes over) though I'm still alert and focused during the day. I feel less 'stressed'.
The akathisia is better, and my jaw has loosened up, but it's been replaced by a different kind of anxiety/overstimulation.
Anyway, this is day 5, so I wasn't sure if blood levels have stabilized yet. Anyway, I'm seeing a new doctor at a private practice tomorrow -- more expensive, but better care, I imagine -- so hopefully they have some ideas.
Posted by g_g_g_unit on December 10, 2013, at 0:55:49
In reply to Re: how did I induce akathisia?, posted by jono_in_adelaide on December 6, 2013, at 21:57:52
> Try Phenergan 10mg in the morning and the afternoon, and 10-20mg half an hour before bedtime
>
> Its OTC, not habit forming and has been in use since 1949, so they know its safeI'm pretty sure it's a D2 antagonist, isn't it? I imagine that would make things worse.
Posted by g_g_g_unit on December 10, 2013, at 0:56:36
In reply to Re: how did I induce akathisia? » jono_in_adelaide, posted by g_g_g_unit on December 10, 2013, at 0:55:49
New doctor was nice enough, though a little confused by the situation. She suggested I stop Cogentin and gave me a script for Atenolol in case it returns.
Posted by ed_uk2010 on December 10, 2013, at 14:22:05
In reply to Re: how did I induce akathisia? » jono_in_adelaide, posted by g_g_g_unit on December 10, 2013, at 0:55:49
>I'm pretty sure it's a D2 antagonist, isn't it?
It is, yes.
Posted by ed_uk2010 on December 10, 2013, at 14:32:22
In reply to cogentin » ed_uk2010, posted by g_g_g_unit on December 9, 2013, at 2:24:59
>Hey ed, wikipedia lists the half-life of Cogentin as 12-24 hours .. I'm a bit confused, because people most commonly seem to be dosing b.i.d.
Can be taken once or twice a day, depending on response. Half lives vary between individuals so perhaps it was wrong of me to suggest that the timing of the dose won't matter after a few days.
>I read it acts as a DRI at the 'nerve terminals', and have no idea what that means; but I've actually noticed some psychoactive effects that I thought might be consistent with a DRI .. namely, I've been hyperfocusing far more, my obsessive thoughts are much 'louder' and distracting, and my sleep is disturbed (I take it at 6pm and find it calming for about 3 hours, before stimulation takes over) though I'm still alert and focused during the day. I feel less 'stressed'.
Yes, I believe it is a weak DRI. Would it be worth trying a different anticholinergic? In Aus you have benzhexol (Artane) and biperiden (Akineton). Artane has a reputation for being stimulating. Biperiden might be more suitable.
Have you tried the atenolol yet?
Posted by g_g_g_unit on December 11, 2013, at 4:04:48
In reply to Akineton » g_g_g_unit, posted by ed_uk2010 on December 10, 2013, at 14:32:22
> Can be taken once or twice a day, depending on response. Half lives vary between individuals so perhaps it was wrong of me to suggest that the timing of the dose won't matter after a few days.
Ah, maybe I'll experiment with taking it in the morning if the need arises.
>
> Yes, I believe it is a weak DRI.I wonder why Australia hasn't regulated it *eyeroll*
>Would it be worth trying a different >anticholinergic? In Aus you have benzhexol >Artane) and biperiden (Akineton). Artane has a >reputation for being stimulating. Biperiden >might be more suitable.
Thanks, I'll make a note if Biperiden! I did notice some of the symptoms returning since stopping the Cogentin last night, though not as forcefully. I'll see how it goes the next couple of days. My sleep was better last night, though.
>
> Have you tried the atenolol yet?Not yet, I was going to see what happens over the next two days.
Thanks for all your help, ed! I really do appreciate it.
Posted by ed_uk2010 on December 12, 2013, at 15:06:01
In reply to Re: Akineton » ed_uk2010, posted by g_g_g_unit on December 11, 2013, at 4:04:48
>I wonder why Australia hasn't regulated it *eyeroll*
It's too nasty!
>I did notice some of the symptoms returning since stopping the Cogentin last night, though not as forcefully. I'll see how it goes the next couple of days. My sleep was better last night, though.
I think your symptoms will be improving spontaneously now anyway. Have you tried half your previous dose of Cogentin, taken in the AM?
>Have you tried the atenolol yet?
>
> Not yet, I was going to see what happens over the next two days.It might help, but I suspect not, it penetrates into the brain only to a very limited extent. To be honest, I think you'll improve without it. As a result, you probably won't need to try biperiden either.
>Thanks for all your help, ed! I really do appreciate it.
:)
Posted by g_g_g_unit on December 13, 2013, at 1:12:33
In reply to Re: Akineton » g_g_g_unit, posted by ed_uk2010 on December 12, 2013, at 15:06:01
> I think your symptoms will be improving spontaneously now anyway. Have you tried half your previous dose of Cogentin, taken in the AM?
>No, not yet. I was considering it but thought 0.25mg would be too little to have an effect. Maybe I'll try it tomorrow.
The hardest thing is not being overcome by anger and frustration, since I can't believe I've spent 3 weeks like this. I can't even distract myself because reading or watching TV is impossible.I would guess my symptoms are at like a 5/10 now, whereas they were at a 7 when I first posted, so at least that's something.
Posted by ed_uk2010 on December 13, 2013, at 14:29:52
In reply to Re: Akineton » ed_uk2010, posted by g_g_g_unit on December 13, 2013, at 1:12:33
>I was considering it but thought 0.25mg would be too little to have an effect. Maybe I'll try it tomorrow.
I would if I were you. Cogentin is pretty potent stuff. You could try 0.25mg and repeat it later in the day if needed.
> The hardest thing is not being overcome by anger and frustration, since I can't believe I've spent 3 weeks like this.
Just keep reminding yourself, it WILL come to an end. Unfortunately, the interim period will be unpleasant, as you well know.
Posted by ed_uk2010 on December 13, 2013, at 14:35:13
In reply to Re: Akineton » ed_uk2010, posted by g_g_g_unit on December 13, 2013, at 1:12:33
>I can't even distract myself because reading or watching TV is impossible.
Can you return to your doctor soon? I still think diazepam and metoprolol could be beneficial as a temporary measure. I do not entirely understand the logical behind prescribing the very hydrophilic atenolol, which is known for its reduced effects on the central nervous system. You should try it though.
As far as distractions, have you watched any comedy clips on YouTube? Brief and funny, you don't have to concentrate much or stay still for long.
ed
Posted by g_g_g_unit on December 14, 2013, at 8:12:15
In reply to Re: Cogentin » g_g_g_unit, posted by ed_uk2010 on December 13, 2013, at 14:29:52
> I would if I were you. Cogentin is pretty potent stuff. You could try 0.25mg and repeat it later in the day if needed.Will do, ed.
Posted by g_g_g_unit on December 14, 2013, at 8:26:58
In reply to Re: Akineton » g_g_g_unit, posted by ed_uk2010 on December 13, 2013, at 14:35:13
>
> Can you return to your doctor soon? I still think diazepam and metoprolol could be beneficial as a temporary measure. I do not entirely understand the logical behind prescribing the very hydrophilic atenolol, which is known for its reduced effects on the central nervous system. You should try it though.I guess some GPs might not know which beta-blockers are specifically indicated for akathisia, and I couldn't recall if atenolol was suitable or not. I things aren't better by next Friday, and the lower dose of cogentin doesn't help, I'll make another appointment.
It was too late to start the cogentin this afternoon so I caved and bought a codeine/paracetemol mix. It helped quite significantly, of course, and eased anxiety/depression to boot, but I'm aware of course that it shouldn't be used regularly.
>
> As far as distractions, have you watched any comedy clips on YouTube? Brief and funny, you don't have to concentrate much or stay still for long.
>Yes, that's kind of what I've been doing anyway. Which comedians do you like?
Posted by ed_uk2010 on December 15, 2013, at 9:55:35
In reply to Re: Akineton » ed_uk2010, posted by g_g_g_unit on December 14, 2013, at 8:26:58
>I caved and bought a codeine/paracetemol mix. It helped quite significantly, of course, and eased anxiety/depression to boot...
Ok well take care! It's easy for people to fall into a trap and end up worse off than they were to begin with.
How are you today?
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