![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by chloe on July 26, 2001, at 19:43:47
Does anyone know if Memantine, an NMDA agonist, can prevent neuroleptic TD. I was doing some research and came across such a bold statement. Is it possible? How? And is Memantine now available in the US?
TIA
Chloe
Posted by medlib on July 27, 2001, at 14:41:02
In reply to NMDA agonists to prevent TD?, posted by chloe on July 26, 2001, at 19:43:47
Hi Chloe--
Memantine is an NMDA *antagonist*. AndrewB talked about it on July 16th (Message # 70284) in relation to stimulant "poop-out." Also, Geodon and other atypical antipsychotic meds are dopamine antagonists, not agonists (so you're not really a dopamine "junkie").
BTW, you had asked me earlier about TD and EPS (sorry, I haven't been online in a few days). EPS is a whole umbrella of movement abnormalities, including akathisia, dystonia, torticollis, dyskinesia, RLS, rigidity, chorea, etc., which can affect parts or all of the body and which can occur at various times during treatment. "Tardive" just means "late onset," and refers to dyskinesia or dystonia which occurs only after 6 months or more of treatment. It is taken more seriously than other EPS symptoms because it can be irreversible, and because it becomes more likely to occur, and more severe, as the cumulative total of meds increases over time. You might be interested in this info on risk factors for EPS:
http://www.priory.com/psych/frames/risk.htm
You'll note in the last paragraph that the tongue symptoms you developed on Mellaril put you at high risk for EPS on other APs.
Some practitioners prescribe anticholinergic drugs along with APs to try to counteract or prevent EPS. Others use Symmetrel (amantadine). You can find info about that by going to Medscape Search Drugs and checking out the Pharmacology and Chemistry section for Symmetrel. I've heard of a few prescribing bromocriptine (an ergot-derived dopamine agonist) for EPS as well.
It's my impression that seratonin and dopamine receptors exist in a kind of balance, such that a big increase in one type can lead to an opposite effect on the other. (I've just ordered a S. Stahl book that will, I hope, improve my grasp of such specifics.) I do know that Celexa is a highly selective (and potent) SSRI; perhaps, a different AD that's not an SSRI, such as Serzone or Remeron or even a TCA would work better with Geodon for you.
For me, I've sent my pdoc some stuff on Mirapex (a dopamine agonist) and hope that he'll okay a trial on that. The endless hunt goes on....
Well wishes---medlib
Posted by chloe on July 27, 2001, at 17:32:58
In reply to Re: NMDA agonists to prevent TD? » chloe, posted by medlib on July 27, 2001, at 14:41:02
Medlib,
What an useful post and link. I am *sort of* relieved to know that what I am experiencing is not TD yet...But if I had been on this med from more than 6 months, would you classifiy my tongue wiggling as TD?I am really confused about what to do with my med regime, and I know my pdoc is just as frustrated.
I think she believes I am pretty well informed and she lets me do alot of the steering of what meds and dosages I take. At times this is wonderful, at other times, I feel very alone and unmanaged.
My last contact to her was about that I felt too activated and I think I am on too many energizing meds. She has not gotten back to me, though she did relay that I could try stopping the Celexa. That has proven to be a poor decision mood wise, but has helped greatly with the clenching and mouth tension (not tongue wiggle).
But I felt so edgy and short fused today, I started up on again on the tiniest dose .75 mg (half of my normal dose) of Celexa after a 36 hour moratorium. But, when I ate supper tonight, I felt it very difficult to swallow again. That had abated with the d/c of Celexa. So I confirm your statement that Celexa may not be the best choice with Geodon.But if I am having EPS should I be on Geodon for any length of time anyway? What are the chances of the EPS that has returned will become a permanent feature of me? AND is it even prudent to ask for anticholengerics to cover up these symptoms?
My biggest trouble is, that when I find a med that actually has good result for me, it tends to have intolerable side effects. I have tried countless good meds, and had to d/c for just this reason.
Serzone may be a good one to go back to now, however. I never really got any AD effect from it at the low dose I could tolerate. Just antianxiety, and better sleep, which I need desperately now. But maybe with the boost I'm getting from Trileptal and Geodon, Serzone might be just enough...Here is hoping.
BTW, do you have any info about one atypical being more "safe" than another? Specifically, is Geodon less likely to cause EPS/TD than Seroquel. Seroquel works well, too. But I tend to get the tongue thing right away, but no clenching...So I got scared and stopped it. It doesn't have the AD benefit for me at all, so it was easier to give up than Geodon.
I am not familiar with Mirapex effects. But I hope it's the "one"!
Again thank you for you informative reply. I SO appreciate you addressing my questions.
Chloe
Posted by Willow on July 27, 2001, at 22:21:45
In reply to Re: NMDA agonists to prevent TD? » chloe, posted by medlib on July 27, 2001, at 14:41:02
> For me, I've sent my pdoc some stuff on Mirapex (a dopamine agonist) and hope that he'll okay a trial on that.
Funny that you should mention Mirapex, because I have a prescription for it sitting with my others. It is to treat "periodic limb movements" which are severe during sleep and occasional when I'm awake. My hesitation has been because of the dopamine thing.
I guess a little knowledge can be dangerous. All I understand about dopamine is that it is a chemical which affects us somehow, and linked to schizophrenia somehow, which my family has a strong history of with onset at age 35.
Could you explain to me if I should have any concerns or not in a simplified version?
Willow
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.