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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 12 to 36 of 36. Go back in thread:
Posted by Ritch on February 20, 2002, at 23:51:53
In reply to Re: Anti-depressants and dystonia/dyskenesia, posted by OldSchool on February 20, 2002, at 18:33:14
> SSRIs like Paxil should not generally cause movement disorders like dystonia. HOWEVER, it is becoming known more and more that the SSRIs have a dampening effect on dopamine which in susceptible individuals could lead to development or exacerbation of problems like you are talking about. Dystonia is more of a problem with anti-psychotics, but serotonergic antidepressants do rarely cause movement problems.
>
> Here is an article about SSRIs and induction of movement disorders:<snip>
Serotonin (5-HT)-containing raphe nuclei extend diffuse interconnections to the DA-rich substantia nigra (Dray, 1981). Neurophysiologic and electric stimulation studies demonstrated that the 5-HT released by the raphe nuclei inhibit striatal neurons, an effect which is reversed by 5-HT antagonists (Davies and Tongroach, 1978). Thus, it is plausible that inhibitors of neuronal 5-HT reuptake, by increasing the availability of 5-HT, might be expected to produce an effect similar to that of DA-blocking agents (Figure). In fact, high doses of fluoxetine (Prozac) have been shown to inhibit DA synthesis in the forebrain, hippocampus and portions of the basal ganglia, specifically the caudate-putamen (Baldessarini and Marsh, 1990). Hence, it can be expected that movement disturbances might arise from SSRI use.
Thanks a whole bunch for that article! It is truly a nightmare that SSri's help my anxiety so well, but give me ever-increasing problems with dystonia and akathisia. I can't take any AP's anyore.I find the terms "neurological insult" and "compromised nigrostriatal functioning" to be a lot closer to home than I would like. It makes me feel very concerned about the possiblity of getting old and what it would be like if I ever get there. Obviously, the question arises-should I also need to stop SSRi use for long-term health in addition to already stopping DA-antagonists as well? If I *need* SSRi's for anxiety/impulsivity problems, will I need to switch-and if I switch-what will I switch to in replacement(that has the efficacy)??
Mitch
Posted by skills on February 21, 2002, at 7:29:48
In reply to Re: Anti-depressants and dystonia/dyskenesia » borderliner21, posted by Mr. Scott on February 18, 2002, at 23:03:45
Mr.Scott is right Trazodone worked for me with SSRI's. Another thing which helped was a 5-10mg dose of procyclidine three times a day.
skills.
Posted by OldSchool on February 21, 2002, at 9:50:27
In reply to Re: Anti-depressants and dystonia/dyskenesia, posted by borderliner21 on February 20, 2002, at 23:13:41
> thanks for the information. I found it useful.
> My dystonia from paxil has gotten a lot better and when taking zyprexa i noticed an improvement also...weird huh
Not really its not weird at all if youve read about this stuff. Its well known that taking anti-psychotics can "mask over" drug induced movement disorders. In fact back in the old days, one of the main ways psychiatrists dealt with neuroleptic induced TD was to increase the dosage of the anti-psychotic. This creates a masking over effect of the TD, the patient physically feels better and stops complaining and everyone is happy. However when the neuroleptic is reduced or removed the movement disorder returns with a vengeance.In fact this is sort of what happened to me this past fall when I developed a bad case of EPS while on low dose Seroquel. I first noticed on the Seroquel that my throat began getting very tight and sore, particularly later in the day when the Seroquel began to wear off. I found that after I took my nightly dose of Seroquel, I loosened up a lot, throat pain and tightness dissipated. Then, as soon as I stopped taking the Seroquel the EPS hit full force. Muscle twitches, muscle tightness and a contraction feeling, tongue numbing, weakness on my right side. It was actually worse OFF the Seroquel than on. I hope you see my point.
Please do not believe these various people who will tell you that atypical anti-psychotics can improve movement disorders. Some on this message board will tell you atypicals can "fix" movement disorders...thats BS and is anything but the truth. There is no anti-psychotic anywhere that will do you any good if you have drug induced movement disorders. You might feel better while on the atypical anti-psychotics, but in the long run you are just doing more damage to yourself.
Drugs useful to combat neuroleptic induced dystonia includes anti-cholinergics (OTC benadryl, Cogentin), Klonopin...it has muscle relaxant properties, dopaminergic drugs...and also, ahem...ECT. ECT is very effective for neuroleptic induced movement disorders. ECT has strong "off label" uses for parkinsons and neuroleptic induced movement disorders. I was reading recently that schizophrenics who have ECT have much lower rates of TD than schizophrenics who dont have ECT.
Old School
Posted by borderliner21 on February 21, 2002, at 17:00:59
In reply to Re: Anti-depressants and dystonia/dyskenesia, posted by OldSchool on February 21, 2002, at 9:50:27
I have a question... Does lithium cause any movement disorders or will it exabberate my dystonia or dyskenesia?
Posted by OldSchool on February 21, 2002, at 18:05:51
In reply to Re: Anti-depressants and dystonia/dyskenesia, posted by borderliner21 on February 21, 2002, at 17:00:59
> I have a question... Does lithium cause any movement disorders or will it exabberate my dystonia or dyskenesia?
I know lithium can cause tremor in some people. However, Ive never read or heard anything about lithium causing EPS like symptoms similar to neuroleptics. That would be a question for your doctor. I know I took lithium to augment my antidepressant once and never noticed any muscle stiffening type side effects like Ive always gotten with atypical anti-psychotics.
I always considered lithium to be a pretty safe drug.
Old School
Posted by Angel-2 on March 6, 2002, at 0:41:30
In reply to Re: Anti-depressants and dystonia/dyskenesia, posted by OldSchool on February 21, 2002, at 18:05:51
Hi. I really don't want to scare you but my mother -who was manic depressive from age 30 to age 60- has been treated on lithium for 1/2 her life. About the movement disorders: besides from the tremor, she did "well" for the first 10-15 years but eventually developed acute akathisia (she HAD to keep on pacing all the time) and diskynesia (mostly strange mouth mov.). Obviously we don't know but I think the EPS can come from ANY meds -it depends on every person and his/her meds storyline.
Good luck,
A-2
Posted by Angel-2 on March 6, 2002, at 0:54:26
In reply to Re: Anti-depressants and dystonia/dyskenesia, posted by borderliner21 on February 18, 2002, at 23:53:52
Hi. IMHO and also judging from my 12 years experience -I tried a LOT of tricyclics and then new meds as SSRI-, they ALL eventually give you EPS. I just came out of my last Prozac episode (3 years at 20 mg/day). I had dystonia 3 years ago (but didn't know it) and it got so much worst in the last year that I had to go off cold turkey (and nope, it's not THAT easy to go off Prozac after years of use and other tryings). I feel like I just came out of a nightmare -it's not really over yet since I have so much sleeping problems- and here it is: as if the dystonia condition was not enough, I now have to deal with an annoying tinnitus. Now THAT might make me go crazy. *** Does anyone know if the ear ringing will ever go away? The dystonia (ocular rest myoclonus, blepharospasm, facial tics, cluster headaches, photophobia) is a misery. But the tinnitus (ear ringing), I think I just can't take it.
Good luck.
A-2
Posted by sue doe on March 6, 2002, at 17:53:59
In reply to Anti-depressants and dystonia/dyskenesia, posted by borderliner21 on February 16, 2002, at 11:25:51
Why do ssri's cause dystonia in some people?(I was predisposed to it).
I am not well informed, but I read a lot. I have seen dystonia mentioned in genetic studies of Tourette's Syndrome. there seem to be genetic connections between many of the mental illnesses, alcoholism, obesity and dystonia. Is the dystonia just another ramification of our proneness to mental illness. In my family three siblings are bi-polar, one is schizophrenic, one committed suicide at age 19, and one has serious problems with dystonia. Our children are beginning to show mental illness symptoms also. My pet theory is that these illnesses are all in the same, they just reveal themselves in different ways.
Does anyone think I may have a good point here?
Sue doe (nym)
Posted by JohnX2 on March 7, 2002, at 3:06:40
In reply to Re: Anti-depressants and dystonia/dyskenesia, posted by sue doe on March 6, 2002, at 17:53:59
Hi Sue,I've looked a bit into a similar phenomina called tardive dyskinesia
and it seems as though the latest concensus is that most of these disorders
occur as a part of a progressive neurodegenerative process. In the case
of schizophernia clearly there is a genetic link. Its my understanding
that people can carry the schizophernia gene but not activate the disease,
I don't know if these people taking SSRIs are predisposed to
dystonia, dyskinesia etc. Down to the nitty gritty it has to do
with glutamate (excitatory) transmission and how serotonin medicines goof with
this.The neurodegenerative process seems to be understood and I even have seen
good strategies to treat it beyond those commerically available (I have dug
up patent disclosures, hints into the future). One curiousity I saw was "trick" published
by a physician to treat dystonia with an anti-alcoholism medication
in Europe called Acamprosate. In just happens to protect the neurons in the
brain pathways that get decomposed from excessive stimulation caused from
these neurodegenerative disorders. Ironically when I saw this medicine I thought it might also be useful
for bipolar disorder as it had neuromodulatory action at multiple sights, and alas
I see clinical trials are popping up for bipolar. There's ?a? connection (grabbing at straws)...
someone like CAM will buzz in and spoil my elaborate hope.Sorry to hear such an ugly story. :(
I loved your poems today by the way.
-John
> Why do ssri's cause dystonia in some people?(I was predisposed to it).
>
> I am not well informed, but I read a lot. I have seen dystonia mentioned in genetic studies of Tourette's Syndrome. there seem to be genetic connections between many of the mental illnesses, alcoholism, obesity and dystonia. Is the dystonia just another ramification of our proneness to mental illness. In my family three siblings are bi-polar, one is schizophrenic, one committed suicide at age 19, and one has serious problems with dystonia. Our children are beginning to show mental illness symptoms also. My pet theory is that these illnesses are all in the same, they just reveal themselves in different ways.
> Does anyone think I may have a good point here?
> Sue doe (nym)
Posted by sue doe on March 7, 2002, at 6:53:53
In reply to Re: Anti-depressants and dystonia/dyskenesia » sue doe, posted by JohnX2 on March 7, 2002, at 3:06:40
Progressive neurodegenerative process??? Maybe I should just sit in my rocking chair and hum. Except I would probably break it with all the weight I have put on.
I have a teen age son who has been using marijuana. Perhaps he's trying to self-medicate. Of course, I don't like it. My husband drives truck. I want to send him off with him. Stress has always been a culprit when my problems have flared up. I've been jailed and hospitalized! What more can THEY do? Maybe if I don't get out from under the stress, that sczisophrenic gene will push forward its ugly face. I'll be hearing voices again! Nonetheless, I am who I am and I have the right to be me. I think I'll go sit in a closet.Please forgive me if I'm too cynical. Sometimes I feel like all is loss. But thanks for complimenting the poetry. Maybe I better write another poem. I think it will be about a dripping faucet, dripping away the last of my brain turned to rain. (That rhymes, you know!)
Thus begins day five. Drug free!! Hee! hee! hee! Crazy me!!! Sue Doe (Nym)
Posted by JohnX2 on March 7, 2002, at 19:00:03
In reply to Re: Progressive neurodegenerative process??? » JohnX2, posted by sue doe on March 7, 2002, at 6:53:53
I like who you are!I was talking to an interesting friend last night about all my
other "boring" friend with "normal" lifes, default marriages, kids,
9-5 jobs, etc. Trying to follow all the trends. Copy what other
people establish. Any i think to my self "when I sit on my death bed,
do I want to look back on my life and feel accomplished that I did my
best to be like everyone else?". NO! Frankly, I've remarked that my
treatment is going better and I'm having fewer of these little
"hypomanic" episodes. But I'm also not having these interesting racing
thoughts were I sometimes "think outside the box" and have something
that makes me a unique person. That's who I AM.Cherish who YOU ARE. I LIKE IT.
MY BEST,
JOHN> Progressive neurodegenerative process??? Maybe I should just sit in my rocking chair and hum. Except I would probably break it with all the weight I have put on.
> I have a teen age son who has been using marijuana. Perhaps he's trying to self-medicate. Of course, I don't like it. My husband drives truck. I want to send him off with him. Stress has always been a culprit when my problems have flared up. I've been jailed and hospitalized! What more can THEY do? Maybe if I don't get out from under the stress, that sczisophrenic gene will push forward its ugly face. I'll be hearing voices again! Nonetheless, I am who I am and I have the right to be me. I think I'll go sit in a closet.
>
> Please forgive me if I'm too cynical. Sometimes I feel like all is loss. But thanks for complimenting the poetry. Maybe I better write another poem. I think it will be about a dripping faucet, dripping away the last of my brain turned to rain. (That rhymes, you know!)
>
> Thus begins day five. Drug free!! Hee! hee! hee! Crazy me!!! Sue Doe (Nym)
Posted by sue doe on March 7, 2002, at 21:37:40
In reply to Re: Progressive neurodegenerative process???, posted by JohnX2 on March 7, 2002, at 19:00:03
Thanks John. That's the idea. I want to learn who I am once I escape this medicated life. It was frightening to consider a degenerative brain disease! I did write a poem about it, by the way. It was pretty morbid. but I'm feeling better this evening.
Brain Drips
Brain drips,
Drips away.
Soggy-bread brain.
Squeeze it, let it leak.Pills to fix it.
Pills to melt it.
Which came first?
Has Dr. dealt it?Try another drug to see if
This one was not right for me.
Just like fashion,
Trying on.
Another drug, a different song.We seek to find a normalcy.
Who is normal? It’s not me.
Normal is a farce, you see.I had a friend once who had recovered from cancer once after horrible sessions of chemo. When she was diagnosed again, she simply decided, no more chemo. She didn't think it was worth it. I guess we need to count the costs. If being dumbed down by medicines is the best way of dealing with my disease, I would rather live less days, only fuller days. Thanks for letting me be me.
Thus ends day five. The worst thing today was that I ate a box of doughnuts, at least most of it. I need to stop this eating. My son has been quite cruel to me. This follows a pattern of always loosing the men in my life. I loose love, then I eat. I understand why my father's leaving hurt me. And I understand why my husband's desertion hurt me (he's back now). but I never believed my son could hurt me too. This always leads to eating, self abuse. I need to rise above it. Day six, I hope to succeed!!
Sue Doe (Nym)
Posted by Zo on March 9, 2002, at 18:43:46
In reply to Re: Progressive neurodegenerative process???, posted by JohnX2 on March 7, 2002, at 19:00:03
Is it just because my TLE is "flowing" today, and everything seems more highly fraught with meaning. . .
. .. or is that one of the best, warmest, most affirming posts anyone ever made?!
. .. and how lucky, sue doe, to have something like that written to you!
Zo
Posted by sue doe on March 10, 2002, at 14:11:45
In reply to Re: Staggered » JohnX2, posted by Zo on March 9, 2002, at 18:43:46
> Is it just because my TLE is "flowing" today, and everything seems more highly fraught with meaning. . .
>
> . .. or is that one of the best, warmest, most affirming posts anyone ever made?!
>
> . .. and how lucky, sue doe, to have something like that written to you!Yes, Zo. I, too, was very touched. And inspired to continue being me. What is TLE? I'm not too well versed on my abbreviations. I finally figured out what an AD was! And thanks, again JohnX2, you are truly wonderful to be so kind and understanding.
Sue Doe (Doing great, mostly, on day eight without any AD's!) I'm so glad for such good people on this site!
Posted by Zo on March 12, 2002, at 2:17:32
In reply to Yes, I'm honored and thanks again johnX2, posted by sue doe on March 10, 2002, at 14:11:45
Temporal Lobe seizures. . And Sue! Thanks for that post about my writing! When my website goes up, end of April, there'll be stuff there to read.
Zo
Posted by sue doe on March 13, 2002, at 11:41:11
In reply to Re: Yes, I'm honored and thanks again johnX2 » sue doe, posted by Zo on March 12, 2002, at 2:17:32
When my website goes up, end of April, there'll be stuff there to read.
>
> Zo
Zo: I am glad to hear about your launching a site. I can't wait to see it. Please announce it on psycho-babble when you open! See you there.
Sue Doe Nym
P.S. I'm on day eleven of med free, still waiting to find the true me!
Posted by groundsquirrel on November 18, 2002, at 19:45:13
In reply to Anti-depressants and dystonia/dyskenesia, posted by borderliner21 on February 16, 2002, at 11:25:51
Do you have continuing dystonia from the paxil, or was it just a one-time thing? If one time, how long did it last?
Thanks!
Posted by oracle on November 19, 2002, at 0:47:51
In reply to Re: Anti-depressants and dystonia/dyskenesia, posted by groundsquirrel on November 18, 2002, at 19:45:13
> Do you have continuing dystonia from the paxil, or was it just a one-time thing? If one time, how long did it last?
>
> Thanks!the last post on this thread was 3/11 so do not expect an answer to your question.
Posted by syringachalet on November 21, 2002, at 8:37:12
In reply to Re: Anti-depressants and dystonia/dyskenesia » borderliner21, posted by JohnX2 on February 16, 2002, at 12:53:10
Hello borderline,
I was interested that you were having dystonic events while on the SSRI Paxil.
My question was were you taking any other psychotrophic medications prescribed for you by your Paxil prescribing MD or did you have the Paxil prescribed for you by another MD who was not aware of the your on-going Paxil meidcation regime?
ALso did your precribing MD do a Tardive Dyskenisa evaluation prior to adminstering your first does of Paxil? The standard AIMS (autonomic involuntary movement scale) has long been the bench mark in assessing potential TD risks.
If you were on any psychoactive medications,
esp tricyclics like Elavil or sedative-hyponotics like Ambien, those too could have cause these idiopatihic dystonic events.
I once had been placed on a anti-psychotic injectible back in the early 1990s, I had
what is called a occular-gyro crisis...
now that was one very scary event...esp. when these seldom occur and almost never in females.Having to find the balance between the disease and the cure.....
Posted by Ritch on November 22, 2002, at 9:32:00
In reply to Re: Anti-depressants and dystonia/dyskenesia, posted by syringachalet on November 21, 2002, at 8:37:12
> Hello borderline,
> I was interested that you were having dystonic events while on the SSRI Paxil.
> My question was were you taking any other psychotrophic medications prescribed for you by your Paxil prescribing MD or did you have the Paxil prescribed for you by another MD who was not aware of the your on-going Paxil meidcation regime?
> ALso did your precribing MD do a Tardive Dyskenisa evaluation prior to adminstering your first does of Paxil? The standard AIMS (autonomic involuntary movement scale) has long been the bench mark in assessing potential TD risks.
> If you were on any psychoactive medications,
> esp tricyclics like Elavil or sedative-hyponotics like Ambien, those too could have cause these idiopatihic dystonic events.
> I once had been placed on a anti-psychotic injectible back in the early 1990s, I had
> what is called a occular-gyro crisis...
> now that was one very scary event...esp. when these seldom occur and almost never in females.
>
> Having to find the balance between the disease and the cure.....
Hi, John hasn't posted for quite a while. I had EPS symptoms from Paxil the first day I tried it. I continued to take it for several days, but stopped it. My pdoc told me to stop it and pitch it. I am sensitive to EPS. The National Health Service in Britain (in their AD guidelines), doesn't recommend starting AD treatment with Paxil (Seroxat there), but recommend fluoxetine or sertraline instead because of Paxil induced EPS problems.
Posted by McPac on November 26, 2002, at 15:01:38
In reply to Re: Anti-depressants and dystonia/dyskenesia » syringachalet, posted by Ritch on November 22, 2002, at 9:32:00
Anyone?
Posted by Ritch on November 26, 2002, at 20:17:12
In reply to What is EPS?????????, posted by McPac on November 26, 2002, at 15:01:38
> Anyone?
Hi, there aren't many decent links that describe it but I thought this one was rather straightforward:
http://www.theberries.ns.ca/Archives/XPEffects.html
If you have never *experienced* EPS then it is obviously difficult to explain without resorting to technical jargon. If you *have* experienced it then it may require little explanation :) ! Unless, of course, you are wanting to understand the *mechanism* in the brain/motor circuits that presents the symptoms. I just know what can cause it, what has caused it for me, and what it feels like. We just finished reading a book over in the book club "Awakenings" and it goes into quite a bit of detail about Parkinsonian symptoms. This is about drug-induced "pseudo-Parkinsonism", however. The EPS symptoms I got from Paxil were a sense of choking (laryngeal spasm), and involuntary tongue movements and stiffness which interfered somewhat with my speech (nowhere like Stelazine, however). I didn't spend much time with that medication.
Posted by SLS on November 26, 2002, at 21:43:44
In reply to Re: Anti-depressants and dystonia/dyskenesia » syringachalet, posted by Ritch on November 22, 2002, at 9:32:00
Amoxapine (Asendin) is a tricyclic that is well known to produce EPS at a frequency significantly higher than any other antidepressant. Still, it is a godsend for some people.
- Scott
Posted by ItsHowdyDudyTime on November 27, 2002, at 20:18:34
In reply to What is EPS?????????, posted by McPac on November 26, 2002, at 15:01:38
EPS is a neurological problem known as a movement disorder. Usually it stems from use of anti-psychotic (neuroleptic) drugs. Basically, it feels like a mild form of parkinsons and is sometimes referred to as "pseudu-parkinsons" in various psychiatric literature. Symptoms can include things like tightened stiff and sore muscles, muscle twitches or tremors, tongue numbnes, tightness in the throat or back of head area, monotone facial expressions that to a psychiatrist looks like a "flat effect." Also, in serious cases of EPS, it oftentimes hits you harder on one side. It hit me on my right side (dominant side) harder than my left side. For example my right grip and right arm and leg was stiffer and weaker than my left side.
EPS is not a psychiatric illness, its a Neurological condition caused by psychiatric medications. Treatment usually involves stopping the anti-psychotic medication and taking anti-cholinergic drugs such as OTC benadryl, Cogentin or Artane and sometimes dopamine agonists like Amantadine. ECT is also very effective as combatting EPS and nipping it in the bud early on.
Usually EPS goes away on its own shortly after cessation of anti-psychotic medication. But sometimes it hangs around a long time and this is where it can really anger a patient and worry psychiatrists.
The newer anti-psychotics dubbed "atypical anti-psychotics" cause EPS at lower rates than the original typical anti-psychotics. But they still can cause EPS. Additionally, those afflicted with mood or anxiety disorders develop EPS easier and faster than schizophrenics. So this means that neuroleptic drugs must be used very conservatively and for short periods in those who are primarily mood or anxiety affected and not floridly psychotic.
I hope this answers your questions about EPS.
Howdy Doody
Posted by McPac on November 28, 2002, at 1:42:45
In reply to What is EPS?McPac, posted by ItsHowdyDudyTime on November 27, 2002, at 20:18:34
I have 'odd' movements...they are not 'twitches' or involuntary 'jumps' of bodyparts....I know I'm doing it but still can't seem to stop...so hard to explain....whatever it is, it blows.
This is the end of the thread.
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