Antipsychotics / Really Old School and New Stylee Mood Stabilizers

They’re not just for schizophrenia anymore! The antipsychotics are effective medications for bipolar disorder, panic/anxiety disorder and when the atypicals are mixed with antidepressants they work well for all sorts of depression, especially bipolar depression. For all we know the standard / typical antipsychotics may work in combination with antidepressants, I just haven’t found any studies or anecdotal evidence to back that up. But they must have, as Etrafon / Triavil is the original (amitriptyline hydrochloride & perphenazine) Symbyax! Combining a TCA (Elavil) with a standard antipsychotic (Trilafon). So the practice has been around for more than 20 years.
Antipsychotics come in two flavors, the newer atypical and older typical, or standard forms. They work in the brain in different ways. The newer atypicals tend to have fewer side effects and are generally less sedating, although Seroquel (quetiapine) will give any of the typicals a run for their money when it comes to knocking you out.
If it’s bad enough where you need to take an antipsychotic, there’s usually no question that you need to be taking meds. Plus you need to be seeing a therapist or a counselor. If you’re nuts, you need to see a therapist, and that’s that. The meds are just not enough. If you’re taking these meds for a sleep disorder or any other off-label uses, you should see a counselor to get a better idea of how you need to live your life with whatever disorder you have, because your doctor sure as hell isn’t going to tell you everything you need to know. And regardless of the affliction, you need to belong to a support group to learn what it’s really all about to have whatever you have. For more information on, and reasons why you should be seeing a pro and belong to a support group, take a look at my page on support groups.

They also carry with them a few things that prevent people from using them.

First there’s the stigma. There seems to be a hierarchy of craziness, and while it’s bad enough to be labeled as mentally ill with depression or panic/anxiety it’s a hundred times worse to be bipolar and a million times worse to be schizophrenic. Would everyone please get the fuck over it already? Illness is illness, we are not possessed by demons and nobody is going to catch our cooties, as these are not contagious illnesses. Genetically transferable to children, perhaps. Unpleasant to be around, definitely. But not contagious. OK, we can certainly drive our friends and relatives crazy with our behaviors, but it’s not a long-term crazy like we have. Anyone with one mental illness most certainly shouldn’t be looking down on someone else with another mental illness for being crazier than thou. Stigmatization ends at home. Yet plenty of people in the heavily stigmatized bipolar spectrum are resistant to taking antipsychotics because they’re not, you know, psychotic.

Next there’s the cost. While the older typicals aren’t that expensive, the newer atypicals are some of the most expensive drugs in the psychiatric pharmacopoeia. If you’re paying for these drugs out of pocket it’s possible that a Zyprexa (olanzapine) or Risperdal (risperidone) prescription could exceed your mortgage.
Finally there are a couple of rare, but potentially nasty side effects you can get with all antipsychotics. They far more likely with the typicals than atypicals, to the point of their being only hypothetical in humans with the atypicals, but no one has been taking an atypical long enough to know for sure. The first is Extrapyramidal Symptoms, or EPS, including Tardive Dyskinesia, or the worst facial tics ever. Everything you wanted to know about TD: http://web.nami.org/helpline/tardys.htm. Once you get the symptoms of EPS, including TD with a typical antipsychotic you’re often shit out of luck. With the atypicals it is still possible once you begin to experience the symptoms you can have options. These include taking an anti-Parkinson’s medication, reducing the dosage from the point where the symptoms arose, or stopping the med altogether. The odds are good that the symptoms will abate and that EPS or TD won’t be a problem. My EPS went away at a reduced dosage of Risperdal (risperidone). I also had TD with Risperdal (risperidone) that forced me to stop taking that med. What sucked was having to stop taking an effective medication. The TD went away. Now EPS, including TD crops up in people fairly fairly often with atypical antipsychotics, the hypothetical part I allude to above is it being permanent. There is, to my knowledge, one, count it, one case of someone outside of the high-risk group (i.e. over 65 and taking high dosages for a long time) having permanent TD from Risperdal (risperidone), and that’s the only one I’m aware of. I’m not sure if everyone was on the ball about lowering dosages and everything. You also have the option of trying another atypical antipsychotic, or not if the thought of TD is too scary. There is one antipsychotic on the market, Clozaril (clozapine), that is the exception to the EPS and TD rule. It does not cause EPS or TD and is even being evaluated as a cure for TD. Clozaril (clozapine) has its own problems, though. The only data we can find on permanent cases of TD with atypicals are among those most likely to get it in any event, the elderly. So if you’re over 65, you may want to think twice about any flavor of antipsychotic.

The other rare side effect is a potentially deadly one, Neuroleptic Malignant Syndrome. While TD is more likely to hit old ladies, NMS is more likely to hit young men. The risk of NMS increases when mixing the older typicals with lithium. Early symptoms include fever, rigidity and increased heartbeat. Unlike TD, NMS requires a lot of intervention in addition to cessation of the medication.

Until I get around to writing something up on the standard / typical antipsychotics, here is a handy Antipsychotic Comparison Chart. Courtesy of Brent Jensen of Queen’s University School of Medicine, Kingston Ontario. It does compare typical and atypical meds. Of course it applies only for meds available in Canada, eh. But it’s better than nothing.

I’ve divided the antipsychotics into the atypical and standard/typical classes. The standards are generally used these days for schizophrenia, if someone doesn’t respond to atypicals, or if you’re getting Medicaid and are stuck with the option of a generic antipsychotic.

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