Need advice with dopamine antagonists

[GABAlover]

I need the advice of someone with a higher level of knowledge than myself on dopamine antagonists. SWIM is having a rough time and wants to avoid the horrors of antipsychotic medication. SWIM is not psychotic, but is smart enough to realise that antipsychotics have become a panacea in some fields of mental health.

What type of adverse reaction could cause a patient to be unsuited to dopamine 1 and dopamine 2 antagonists, including typical and atypical antipsychotic medication?

From the limited resources I have, it seems that serious dyskinesia and increased muscle tone are far less likely with drugs that are selective for D2 receptors. That means an atypical drug could be used and SWIM would still be in trouble .

In regards to the butyrophenones, like haloperidol, how selective for D2 receptors are they?

I would greatly appreciate any informed advice.

 

[5-HT2]

Typical antipsychotics are D2 antagonists such as haloperidol, and atypical antipsychotics are mixed 5-HT2/D2 antagonists like clozapine. As far as I know, there are no antipsychotics that specifically target D1 receptors because D1 antagonism causes severe anhedonia and amotivational syndrome. However, older-generation "typical" antipsychotic D2 antagonists such as haloperidol hit all dopamine receptors to some extent at common therapeutic doses. Tardive dysknesia is a common side effect of typical antipsychotics, and is less common with atypical antipsychotics.

 

[GABAlover]

The butyrophenones like haloperidol are more specific for D2 than the phenothiazines. This did reduce the incidence of dyskinesia somewhat, but not completely.

All antipsychotics seem to produce an increase in prolactin levels. Besides a prolactin-dependant tumour, can anyone think of another significant negative effect that could be attributed to increased prolactin, thus making antipsychotics inappropriate?

 

[Mussoman_Beast]

Well as a direct consequence of excess prolactin levels lactation is the obvious side effect that comes to mind...

I don't really understand what you are looking for with this thread though...If I am being presumptuous then I'm sorry, but I get the impression you are looking for excuses to avoid using antipsychotic medication....

If this is the case then I would assume your best bet would be to use documented adverse effects as a reason rather than trying to use receptor specificity and complex pharmacology, which doesn't really seem practical unless you are trying to write a thesis or something. I have access to a reasonable number of pharmaceutical resources so if you like I could copy and paste some of the documented adverse effects of the currently available antipsychotics....

But again I'm not really sure what you are looking for, so fill me in and I'll do what I can

 

[jasoncrest]

All antipsychotics seem to produce an increase in prolactin levels. Besides a prolactin-dependant tumour, can anyone think of another significant negative effect that could be attributed to increased prolactin, thus making antipsychotics inappropriate?

The increased level of prolactin caused by antipsychotics/neuroleptics cause Galactorrhea and Gynecomastia (=growth of tits for men...)...

 

[GABAlover]

Thanks guys. Yeah, SWIM needs a good reason to avoid all antipsychotics. Gynecomastia is not going to be considered serious enough.

Maybe a falsified history of NMS would be best ? I would appreciate some of your articles, Mussoman beast

 

[Mussoman_Beast]

Who exactly do you need to convince that you need to avoid antipsychotics? The thing is that all medications which are prescribed for any condition undergo extensive risk/benefit analysis, so even if you do pull up a 500 page essay on all the possible adverse effects I doubt it will have much impact on a doctor. A doctor would not force you to take any medications which you don't want to anyway....

I don't really have articles, but access to a few databases of medicinal information...Are there any antipsychotics in particular you want to know about?

 

[GABAlover]

Thanks again for your interest in helping. Normal patient rights largely go out the window if SWIM gets an unfortunate diagnosis and is sectioned under the mental health act.

I have access to MIMS online, which is kind of like the PDR. Written for medical doctors, but certainly not at the level of a psychopharmacologist.

Drugs of interest include: risperidone, olanzapine (who's indications are becoming very broad ), quetiapine and aripiprazole