Am I right to refuse to take neuroleptics?`

[Middleway]

Been on all the antidepressants, maois included. Doctor keeps raising the issue of atypicals....
I took a low dose of seraquel for 6 weeks...and in that 6 weeks put on 6kg!
More disturbingly, I actually heard voices when I took it. Doctor says bullshit and that it is anxiety but it is true. Never before had psychotic symptoms so it scared the shit outa me.
Did some searching and found something on antipsychotics causing an upregulation of dopamine receptors that could account for it.
I dunno what to do do. I am very very depressed with constant rumination. I stopped nardil because of the obscene weight gain, got past the withdrawl but now a month later everythings getting darker and darker.

Will they mess up my brain, ie neurotoxic?
Will I just end up chemically labotomised and fat as all hell?

thanks

 

[dread]

Doctor says bullshit

Change doctor. A doctor-patient relationship should be based on trust.

 

[MeDieViL]

Refuse neuroleptics for 3 reasons:

1) Incosistent evidence based on small pilot study's wich hasnt been replicated in bigger study's AFAIK, as an example:

J Clin Psychiatry. 2005 Oct;66(10):1289-97.
Olanzapine/fluoxetine combination for treatment-resistant depression: a controlled study of SSRI and nortriptyline resistance.
Shelton RC, Williamson DJ, Corya SA, Sanger TM, Van Campen LE, Case M, Briggs SD, Tollefson GD.

Department of Psychiatry, Vanderbilt University, Nashville, TN 37212, USA. [email protected]
Comment in:

Evid Based Ment Health. 2006 May;9(2):42.
Abstract
BACKGROUND: This 8-week, double-blind, multicenter study was undertaken to replicate, in a larger sample of patients with treatment-resistant major depressive disorder (MDD; DSM-IV criteria), the results of a pilot study of the olanzapine/fluoxetine combination.

METHOD: The study was begun in August 1999. The primary entry criterion was a history of failure to respond to a selective serotonin reuptake inhibitor (SSRI). Patients (N = 500) who subsequently failed to respond to nortriptyline during an open-label lead-in phase were randomly assigned to 1 of 4 treatment groups: olanzapine (6-12 mg/day) plus fluoxetine (25-50 mg/day) combination, olanzapine (6-12 mg/day), fluoxetine (25-50 mg/day), or nortriptyline (25-175 mg/day). The primary outcome measure was baseline-to-endpoint mean change in score on the Montgomery-Asberg Depression Rating Scale (MADRS).

RESULTS: At the 8-week study endpoint, MADRS total scores decreased by a mean 8.7 points from baseline (28.5) with the olanzapine/fluoxetine combination, 7.0 points from baseline (28.4) with olanzapine (p = .08), 8.5 points from baseline (28.4) with fluoxetine (p = .84), and 7.5 points from baseline (28.8) with nortriptyline (p = .30), with no significant differences among the therapies. The olanzapine/fluoxetine combination was associated with significantly (p < or = .05) greater improvement (decrease) in MADRS scores than olanzapine at weeks 2, 4, 6, and 7; than fluoxetine at weeks 2 through 5; and than nortriptyline at weeks 1 through 4. A post hoc analysis of a subgroup of patients who had an SSRI treatment failure during their current MDD episode (N = 314) revealed that the olanzapine/fluoxetine combination group had a significantly (p = .005) greater decrease in MADRS scores than the olanzapine group at endpoint. Safety data for the olanzapine/fluoxetine combination were similar to those for its component monotherapies.

CONCLUSIONS: The olanzapine/fluoxetine combination did not differ significantly from the other therapies at endpoint, although it demonstrated a more rapid response that was sustained until the end of treatment. The results raised several methodological questions, and recommendations are made regarding the criteria for study entry and randomization.

2) Long term risks, wich includes a permanent movement disorder wich is no joke.

Tardive dyskinesia and new antipsychotics.
Correll CU, Schenk EM.

The Zucker Hillside Hospital, North Shore Long Island Jewish Health System, Glen Oaks, NY 11004, USA. [email protected]
Abstract
PURPOSE OF REVIEW: To provide an update on tardive dyskinesia rates in patients treated with first-generation or second-generation antipsychotics in studies published since the last systematic review in 2004. RECENT FINDINGS: Across 12 trials (n = 28 051, age 39.7 years, 59.7% male, 70.9% white, followed for 463 925 person-years), the annualized tardive dyskinesia incidence was 3.9% for second-generation antipsychotics and 5.5% for first-generation antipsychotics. Stratified by age, annual tardive dyskinesia incidence rates were 0.35% with second-generation antipsychotics in children, 2.98% with second-generation antipsychotics versus 7.7% with first-generation antipsychotics (P < 0.0001) in adults, and 5.2% with second-generation antipsychotics versus 5.2% with first-generation antipsychotics (P = 0.865) in the elderly (based almost exclusively on one retrospective cohort study). In four adult studies (n = 2088, age 41.2 years, 71.2% male, 62.0% white), tardive dyskinesia prevalence rates were 13.1% for second-generation antipsychotics, 15.6% for antipsychotic-free patients, and 32.4% for first-generation antipsychotics (P < 0.0001). SUMMARY: Current evidence supports a lower tardive dyskinesia risk for second-generation antipsychotics than for first-generation antipsychotics. Tardive dyskinesia incidence was higher with second-generation antipsychotics than previously reported, possibly due to recent studies with relatively short mean durations and use of nonstandard tardive dyskinesia definitions.

3) Possibility of even higher risk when those drugs are being used offlablel, still need to check the full text of this one:

Curr Drug Saf. 2010 Jul 2;5(3):263-6.
Safety considerations of the use of second generation antipsychotics in the treatment of major depression: extrapyramidal and metabolic side effects.
DeBattista C, DeBattista K.

Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA. [email protected]
Abstract
Second generation antipsychotics (SGAs) are increasingly employed in the treatment of depression. Adjunctive aripiprizole and olanzapine/ fluoxetine combination (OFC) have been approved in the US in the treatment of depression. Quetiapine also appears to be poised for an FDA approval as an adjunctive treatment for resistant depression. Historically, first generation antipsychotics were thought to carry an enhanced risk of certain side effects in the treatment of mood disorders, including an enhanced risk of extrapyramidal symptoms (EPS). The second generation antipsychotics are also known to be associated with a variety of metabolic side effects. The use of SGA in a depressed population may pose risks that differ from use in other conditions such as bipolar disorder and schizophrenia. In this paper, the risk of extrapyramidal and metabolic side effects is reviewed in depressed patients treated with second generation antipsychotics.

 

[Slapdragonx]

I would also call bullshit on the psychosis from Seroquel. Neuroleptics are extremely good at getting rid of psychosis. It would be anxiety.

Weight gain is a problem. Effexor, atleast IME, has the opposite effect decreasing appetite and removing the need for water (thirst).

 

[Deleted member 170540]

I've been on 2mg risperidone a day for 5 years and in that time, I've gained 20kg of weight. I'm not very fat even now, because I only weighed 70kg before taking risperidone. If you have a serious mental health problem, I would advise that you take the antipsychotic your doctor has prescribed. When I was psychotic and wasn't on a medication, I imagined some really crazy shit, like people on television were talking to me personally, neighbors could see through walls what I was doing at home, etc. I don't think you want to get in that bad condition.

 

[pofacedhoe]

I've been on 2mg risperidone a day for 5 years and in that time, I've gained 20kg of weight. I'm not very fat even now, because I only weighed 70kg before taking risperidone. If you have a serious mental health problem, I would advise that you take the antipsychotic your doctor has prescribed. When I was psychotic and wasn't on a medication, I imagined some really crazy shit, like people on television were talking to me personally, neighbors could see through walls what I was doing at home, etc. I don't think you want to get in that bad condition.

the op is not experiencing psychosis, and as a result i would avoid antipsychotics as they can be very bad for you in the long term (neuroleptic malignant death syndrome, tarditive dyskinesia) and are only justifiable if you get psychotic episodes.

clinical depression is not really a good justification for antipsychotics.

doctors dont know everything and blindly doing everything they tell you to isn't always the best choice.

i was prescribed risperidone for bipolar disorder and my mum wouldn't pay the prescription. i'm so glad now that i never took them.

haven't had an epsiode of depression or mania since taking tramadol daily in low dose (150mg) once a day for a year. best antidepressant i EVER tried, and no doctor would ever suggest it for the condition it treated in me...

 

[GABAlover]

Definitely change doctor. Anti Psychotics can, in fairly rare cases, cause psychosis. Besides, quetiapine is not a frontline drug, it can be quite dangerous.

If you are taking any illicits or drinking too much, ditch the shit. Medication doesnt have a chance otherwise.

Good luck mate.