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Dr. Bob is Robert Hsiung, MD,
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Posted by ed_uk on August 6, 2005, at 14:12:55
In reply to Re: Perphenazine (Trilafon) - to zeugma » ed_uk, posted by ed_uk on August 6, 2005, at 13:53:51
Posted by ed_uk on August 6, 2005, at 14:19:54
In reply to Re: Perphenazine (Trilafon) - to zeugma » ed_uk, posted by ed_uk on August 6, 2005, at 13:53:51
Hi Scott,
You mentioned in a previous post that you'd been on chlorpromazine (Thorazine), perphenazine (Trilafon) and fluphenazine (Prolixin).
Were you prescribed these drugs to treat acute mania? What doses did you take? Were they effective? Side effects?
~ed
Posted by zeugma on August 6, 2005, at 15:58:35
In reply to Re: Perphenazine (Trilafon) - to zeugma » ed_uk, posted by ed_uk on August 6, 2005, at 13:53:51
> Hi Zeugie!
hi Ed! Been a long time, huh? A crazy stretch of months- but then, there has been no stretch of my life longer than, say, five minutes that is truly otherwise...
>
> I just found this..........
>
> 'I took a typical antipsychotic (Trilafon) many years ago. The problem as you mention was dosage: at one point I was on 48 mg a day and all I wanted to do was sleep. It probably had a 'calming' effect..........'
>
> Wow, 48mg! That's a LOT! Probably far too much! Can you tell us more about how it affected you? How were you affected by lower doses?
>I had severe Parkinsonism, for which I was on a massive dose of benztropine (no 'dumb-drug' euphoria that I remember, alas). If I am normally one stage away from comatose, then Trilafon had me in a coma. It became increasingly difficult to stay awake as the dosage was increased, and the already huge quantities of coffee that I was drinking became proportionally ineffective as the dose the was raised. I believe that my constant requests to have the 'free time' I was allowed (I was in a hospital) to be spent in bed were interpreted by the staff as antisocial behavior, and so the dose went up, 'antisocial' symptoms presumably a sign of schizophrenia.
I did not like Trilafon at any dose. But I think that maybe if the dosage had not escalated so drastically that I might have been less miserable on it. I was lethargic and 'out of it' on trilafon at any dose, but then I am 'out of it' when not on stimulants anyway.
-best,
z
Posted by ed_uk on August 6, 2005, at 16:25:30
In reply to Re: Perphenazine (Trilafon) - to zeugma » ed_uk, posted by zeugma on August 6, 2005, at 15:58:35
Hi Z!
>Been a long time, huh?
It's great to have you back! :-D
>Perphenazine dose
The usual maximum dose for schizophrenia and acute mania is 24mg/day. I've heard of people benefiting from ~2-4mg/day for severe anxiety.
>I was in a hospital...
For depression? For what reason were you prescribed perphenazine? Just out of curiousity, how old were you at the time?
Kind regards
~Ed
PS. I wrote a post to you above - about ramelteon (Rozerem).
Posted by ed_uk on August 6, 2005, at 16:29:31
In reply to Re: Perphenazine (Trilafon) - to zeugma » ed_uk, posted by zeugma on August 6, 2005, at 15:58:35
Hi again Z!
Did you suffer from akathisia on perphenazine? Did benztropine help?
~Ed
Posted by SLS on August 7, 2005, at 8:51:17
In reply to Fluphenazine (Prolixin) - to SLS (Scott), posted by ed_uk on August 6, 2005, at 14:19:54
> Hi Scott,
>
> You mentioned in a previous post that you'd been on chlorpromazine (Thorazine), perphenazine (Trilafon) and fluphenazine (Prolixin).
>
> Were you prescribed these drugs to treat acute mania?The Prolixin and the Thorazine, yes. The perphenazine was given to me much earlier in my "career" to help deal with anxiety and derealization.
> What doses did you take?
I haven't a clue.
> Were they effective?
Generally speaking, they helped with the acute mania, but not as much as Depakote or Zyprexa.
> Side effects?
Thorazine produced some EPS. I was sticking my tongue out at everybody involuntarily in the hospital. How embarrasing. It really was an assault on my dignity.
- Scott
Posted by zeugma on August 7, 2005, at 9:59:08
In reply to Re: Perphenazine (Trilafon) - to zeugma » zeugma, posted by ed_uk on August 6, 2005, at 16:25:30
>
> The usual maximum dose for schizophrenia and acute mania is 24mg/day. I've heard of people benefiting from ~2-4mg/day for severe anxiety.I was severely anxious when entering the hospital.
>
> >I was in a hospital...
>
> For depression? For what reason were you prescribed perphenazine? Just out of curiousity, how old were you at the time?
>
age: 21. Perphenazine was the second drug prescribed, after molindone. I was retropsectively diagnosed with depression, but I think the initial diagnosis was schizophrenia. I think the clinicians thought I was delusional.-z
> Kind regards
>
> ~Ed
>
> PS. I wrote a post to you above - about ramelteon (Rozerem).i'll look at the ramelteon post as soon as I feel I can digest it- I had never heard of this drug.
-z
Posted by ed_uk on August 7, 2005, at 14:33:26
In reply to Re: Fluphenazine (Prolixin) - to SLS (Scott), posted by SLS on August 7, 2005, at 8:51:17
Hi Scott,
>> What doses did you take?
>I haven't a clue.Presumably the doses of Prolixin and Trilafon were quite low if you suffered a dystonia in response to Thorazine but not Prolixin or Trilafon.......... or perhaps the dose of Thorazine was quite high? Prolixin and Trilafon cause dystonias more frequently than Thorazine - at 'equivalent' doses.
~Ed
Posted by ed_uk on August 7, 2005, at 14:36:31
In reply to Re: Perphenazine (Trilafon) - to zeugma » ed_uk, posted by zeugma on August 7, 2005, at 9:59:08
Hi Z,
How were you affected by molindone? Have you taken any other APs?
>.....i'll look at the ramelteon post as soon as I feel I can digest it- I had never heard of this drug.
That's ok - read it when you've got the time (and energy).
Kind regards
~Ed
Posted by zeugma on August 8, 2005, at 18:44:13
In reply to Re: Perphenazine (Trilafon) - to zeugma » zeugma, posted by ed_uk on August 7, 2005, at 14:36:31
> Hi Z,
>
> How were you affected by molindone? Have you taken any other APs?
>I was not in a particularly receptive mode to pharmacological interventions when I was forced to sample molindone. I had had a harrowing experience with prozac not long before and was so naive (read: pre-Internet days) that I had no idea about the different classes of psych meds. I think perphenazine is more sedating, which 'calmed me down' enough to tolerate the drug minimally.
Perphenazine's sedation probably masked the akathisia that was (as best i recall) the reason for d/x'ing molindone, and I also developed intensified akathisia on Prozac. I have akathisia anyway, though less as I've gotten older and more lethargic.
> >.....i'll look at the ramelteon post as soon as I feel I can digest it- I had never heard of this drug.
>
> That's ok - read it when you've got the time (and energy).Time, energy, and focus. That third variable that is so essential and so elusive. I wrote this post on the bus,where focus was easier to come by, and am typing from memory. Focus..
-z
>
> Kind regards
>
> ~Ed
Posted by ed_uk on August 9, 2005, at 13:26:59
In reply to Re: Perphenazine (Trilafon) - to zeugma » ed_uk, posted by zeugma on August 8, 2005, at 18:44:13
Hi Z!
>prozac
I can't remember whether you've tried any other SSRIs. Perhaps you could try citalopram for your anxiety, starting at a very low dose - say 2.5mg.
>I wrote this post on the bus
You've got a good memory!
~Ed
Posted by zeugma on August 9, 2005, at 18:54:04
In reply to Re: Perphenazine (Trilafon) - to zeugma » zeugma, posted by ed_uk on August 9, 2005, at 13:26:59
> Hi Z!
>
> >prozac
>
> I can't remember whether you've tried any other SSRIs. Perhaps you could try citalopram for your anxiety, starting at a very low dose - say 2.5mg..hi Ed,
yes, that's the plan, if it comes to that- if I need further augmentation. I mentioned a good while ago that my pdoc gave me Lexapro samples in response to my suggestion about clomipramine. He told me 2.5 mg would be the place to start with those.
It's just that I have this feeling that more meds = multiplying s/x, and that my body is near its limit of reasonable toleration, with 100 mg nortriptyline, 200 mg Provigil, 30 mg buspirone, and 1 mg clonazepam daily. I'm substituting 30 mg Ritalin LA for the Provigil for the time being, because of an interaction with an antifungal, with reasonable results (I don't have to work long hours in the summer, so I can deal with Ritalin's ridiculous half-life as an annoyance).
As a matter of fact, my pdoc had to twist my arm to take buspirone, which is nearly side-effect free. And the buspirone does 'take the edge off'.
but yes, the plan is to take lex as the next AD, if needed. But I really don't want to take more meds.
by the way, my anxiety has improved after switching from Provigil to the low dose of Ritalin. I think the modafinil was building up in my system,due to the interaction with clotrimazole, causing it to become as anxiogenic as 60 mg Ritalin, if not more so. It suggests that 200 mg Provigil is my limit for anxiogenicity. Of course, being underdosed with a stim causes a horrible anxiety of its own, owing to the fact that I am in such a wretched haze. I think I'm finding a therapeutic window for stims, which is a good thing.
oh, and I tried Zoloft when it came out- AWFUL AWFUL AWFUL. I was in a nauseated fog.
-z
Posted by ed_uk on August 10, 2005, at 14:24:52
In reply to lex- and therapeutic window for stims » ed_uk, posted by zeugma on August 9, 2005, at 18:54:04
Hi Z!
>Lexapro (escitalopram)....
Too expensive. Try generic citalopram (Celexa) first!
>....It's just that I have this feeling that more meds = multiplying s/x.......
You don't take that many meds! A woman came to the pharmacy today with 5 (full) prescription forms - 25 drugs. This isn't uncommon.
>clotrimazole...
In the UK, clotrimazole only comes as a cream and a pessary. How are you taking it? - obviously not as a pessary LOL ;-)
>oh, and I tried Zoloft when it came out- AWFUL AWFUL AWFUL. I was in a nauseated fog.
Hmm. Definately start with a very low dose if you try citalopram!
~ed
Posted by zeugma on August 10, 2005, at 17:48:38
In reply to Re: lex- and therapeutic window for stims » zeugma, posted by ed_uk on August 10, 2005, at 14:24:52
> Hi Z!
>
> >Lexapro (escitalopram)....
>
> Too expensive. Try generic citalopram (Celexa) first!Ed, how dare you make that suggestion! Don't you know that single-isomer drugs are TWICE AS GOOD as the racemate, in every case? (just kidding)
>
> >....It's just that I have this feeling that more meds = multiplying s/x.......
>
> You don't take that many meds! A woman came to the pharmacy today with 5 (full) prescription forms - 25 drugs. This isn't uncommon.
>
It's not a phobia of taking too many meds. It's that no matter what I add to nortriptyline, buspirone, and clonazepam (which added together don't give me too many side effects, but also do nothing for sleepiness and ADHD) starts to feel like 'too much' before too long, whether it's increased anxiety, appetite suppression, dry mouth, or 'vaguely toxic' feeling (Provigil).
> >clotrimazole...
>
> In the UK, clotrimazole only comes as a cream and a pessary. How are you taking it? - obviously not as a pessary LOL ;-)
>
I don't think so ;-) It comes as a 'troche' (slowly dissolving tablet).> >oh, and I tried Zoloft when it came out- AWFUL AWFUL AWFUL. I was in a nauseated fog.
>
> Hmm. Definately start with a very low dose if you try citalopram!I would (but I insist on the single isomer if it bankrupts me!). I'm sure citalopram (ahem, escitalopram) is nothing like Zoloft- consider the differences between nortriptyline and atomoxetine. But I was told by the sleep doc that SSRI's can be disruptive to sleep, which corroborates my research.
speaking of which, do you have any thoughts on Focalin, the d-isomer of methylphenidate? An XR version just came out, and this report claims it has a duration of action of 12 hours:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16026226&query_hl=4
-z
Posted by ed_uk on August 11, 2005, at 14:36:08
In reply to only single isomers for me » ed_uk, posted by zeugma on August 10, 2005, at 17:48:38
Hi Z!
>Ed, how dare you make that suggestion!
:-O
>It's that no matter what I add.........
....but surely the side effects depend on *what* you add ;-)
>........do you have any thoughts on Focalin?
I've haven't come across many people who've tried it. I've read nothing that suggests it would be superior to MPH. I suspect it's just a money making device but I could be wrong!
>An XR version just came out........
I never knew that! I just found this.....
http://www.docguide.com/news/content.nsf/news/8525697700573E188525700E00431D54
Kind regards
~ed
Posted by alohashirt on August 11, 2005, at 21:04:45
In reply to Focalin XR » zeugma, posted by ed_uk on August 11, 2005, at 14:36:08
I'm hoping to Focalin XR next month and will happily give feedback.
When I tried Focalin I found that the effects were very similar to the same dose of Ritalin, if anything it made me even grouchier than Ritalin.I wonder if the XR technology is the same technology used for Metadate? I know it isn't as sophisticated as the Concerta technology which makes me suspect that its duration will be shorter. I have always found that the time the ADHD meds are effective is between 60% and 80% of the documented time.
Unfortunately the amphetamines then keep me awake for another four hours after they stop working.
Posted by ed_uk on August 12, 2005, at 1:18:42
In reply to Re: Focalin XR, posted by alohashirt on August 11, 2005, at 21:04:45
Hi!
Please report your experience with Focalin XR :-)
~Ed
Posted by Paulbwell on August 13, 2005, at 7:14:35
In reply to Re: Focalin XR » alohashirt, posted by ed_uk on August 12, 2005, at 1:18:42
> Hi!
>
> Please report your experience with Focalin XR :-)
>
> ~EdAfter having been on stimulants SR and IR, I suspect Focalin XR is a Dope compamy stradety to extend a patent and make $$$.
Cheers
Posted by ed_uk on August 13, 2005, at 8:02:05
In reply to Re: Focalin XR, posted by Paulbwell on August 13, 2005, at 7:14:35
>I suspect Focalin XR is a Dope compamy stradety to extend a patent and make $$$.
It's all about $$$ in the pharm industry!
~Ed
Posted by zeugma on August 13, 2005, at 14:00:20
In reply to Re: Focalin XR » Paulbwell, posted by ed_uk on August 13, 2005, at 8:02:05
> >I suspect Focalin XR is a Dope compamy stradety to extend a patent and make $$$.
>
> It's all about $$$ in the pharm industry!
>
> ~Ed
So many cynics here!So you think there is enough of a disanalogy between amphetamine and methylphenidate to make isolation of the d-isomer significant in the case of amphetamine, but not MPH?
-z
Posted by ed_uk on August 13, 2005, at 18:14:54
In reply to Re: Focalin XR » ed_uk, posted by zeugma on August 13, 2005, at 14:00:20
Hi Z!
There doesn't seem to be much info about the different effects of the MPH isomers. The lack of info is not encouraging - hence the cynicism! You should try Focalin XR and see! Have you tried Concerta? I can't rememeber.
~Ed
PS. I just took a sleeping pill so I'm not sure whether I'm making sense.
Posted by zeugma on August 14, 2005, at 8:32:15
In reply to Re: Focalin XR » zeugma, posted by ed_uk on August 13, 2005, at 18:14:54
Hi Ed, hope your sleeping pill worked!
The l-isomer of MPH appears to be inactive. Dosing for Focalin appears to be similar to that of lexapro, i.e. half that of the parent molecule. You don't need me to remind you of your love for lexapro, so I suppose no more need be said.
The problem I have with Ritalin is that it is VERY difficult for me to find the right dose. At 30 mg Ritalin LA no serious loss of appetite, no chest pain, mild increase in anxiety that seems to be subsiding; but duration of effect is a problem. I make sure to have caffeine in the afternoon, and that alleviates the disorganization, fatigue, etc., somewhat, but the effect of the Ritalin is much less optimal than Provigil at an equivalent time. My guess is that optimal dosing of Ritalin would be 45 mg/day. It's impossible to get this dose with Ritalin LA however. One idea would be to take a 15 mg IR tablet in the early afternoon, which would produce an effect very different from a second 30 mg LA dose as I was doing last year. The 30 mg LA mid afternoon caused severe appetite loss and also kept me in a sustained state of anxiety that I did not develop tolerance to.
On the other hand, if Focalin really has a longer duration of action and/or fewer s/e, then the situation would be simplified and I could take 20 mg of the XR and not worry about the deleterious effects of repeated dosing.
All this is contingent on the results I get on my lab workup that my PCP gave me last week. If I am basically healthy, then I'll probably go back on Provigil as soon as possible, because its psychotropic effect is easier to deal with, assuming it isn't 'vaguely toxic' in some way to the rest of my body.
-z
Posted by ed_uk on August 14, 2005, at 9:30:35
In reply to Re: Focalin XR » ed_uk, posted by zeugma on August 14, 2005, at 8:32:15
Hi Z!
>You don't need me to remind you of your love for lexapro.....
LOL, I don't dislike it - it's just OVERPRICED and overhyped!
>It's impossible to get this dose with Ritalin LA however.
Could you use a different brand? You could try 36mg or 54mg Concerta.
>chest pain
Verapamil might help.
>On the other hand, if Focalin really has a longer duration of action and/or fewer s/e, then the situation would be simplified and I could take 20 mg of the XR and not worry about the deleterious effects of repeated dosing.
Good point. It's really imporant to have different sizes of tablet.
Warm regards
~Ed
Posted by ed_uk on August 14, 2005, at 11:29:07
In reply to Re: Focalin XR » ed_uk, posted by zeugma on August 14, 2005, at 8:32:15
Hi Z!
What you said about NRIs and circadian rhythms was extremely interesting.
~Ed
Posted by ed_uk on August 14, 2005, at 11:29:32
In reply to Re: Focalin XR » ed_uk, posted by zeugma on August 14, 2005, at 8:32:15
Hi Z!
What you said about NRIs and circadian rhythms was extremely interesting.
Have you ever tried melatonin?
~Ed
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