Drug info - Are atypicals really effective for negative symptoms of schizophrenia?

[baron samedi]

Can any SWIM with a knowledge of psychiatry give an opinion on the general worth/effectiveness of atypical anti-psychotics in relieving the negative symptoms of schizophrenia i.e apathy, lack of pleasure or interest in things, flatness of emotion etc?
Are they really as effective as many doctors think they are compared to the older types of AP's? From what SWIM has gathered there are studies to suggest that they do and studies to suggest their effects in this regard are negligible.
AnySWIM with first or second hand experience of these drugs care to share their opinion with SWIM?

[bryanbabylon]

Swim has been prescribed all the atypicals with the exception of Abilify. In his opinion they do little or nothing for negative symptoms. Swim has also been prescribed Haloperidol with the same result.

[Richard_smoker]

Originally Posted by baron samedi

Can any SWIM with a knowledge of psychiatry give an opinion on the general worth/effectiveness of atypical anti-psychotics in relieving the negative symptoms of schizophrenia??

yes. they have proven to be MUCH more effective against negative symptoms & signs than the older antipsychotics.

Originally Posted by baron samedi

Are they really as effective as many doctors think they are compared to the older types of AP's? From what SWIM has gathered there are studies to suggest that they do and studies to suggest their effects in this regard are negligible.

Put it this way. Older antipsychotics will have no effect on these symptoms. plus they've got tons of other side-effects including a permanent grimace/licking of one's lips (tardive dyskinesia).

Atypicals will, on the other hand, offer at least a fighting chance of treating the negative symptoms....as to specifics regarding percentages of effectiveness, etc., I have no idea...just that typicals will NOT work & atypicals CAN work. Now, it is also very important that you clarify exactly WHICH DRUG you're talking about! There are a handful of atypicals...the ones that treat negative symptoms are the ones that have an effect on the serotonin system (in addition to dopamine).

fyi: the most noticeable side effect from ALL atypicals is weight-gain...some docs prescribe an atypical to help with insomnia (sleepiness=side effect). here's a secret: many people (NOT ALL!) i've known whose doctor prescribed an atypical for "sleep" were also people who were either pretty-much-obviously "crazy" or the doc was suspicious of drug abuse--i.e. borderline, schitzoid, drug-seeking, etc. and from what i've heard, they do make excellent sleeping pills. case in point: seroquel.

Originally Posted by baron samedi

AnySWIM with first or second hand experience of these drugs care to share their opinion with SWIM?

sorry. see above. i'd suggest against the typicals for the side-effect profiles ALONE! but that's just me!...and yes, it is my understanding that atypicals are the only drugs that will/can treat negative symptoms with any degree of certainty.

Here's a quicky 'differences between typical and atypical antipsychotics' (off Wikepedia)...

All antipsychotic drugs tend to block D2 receptors in the dopamine pathways of the brain. This means that dopamine released in these pathways has less effect. Excess release of dopamine in the mesolimbic pathway has been linked to psychotic experiences. It is the blockade of dopamine receptors in this pathway that is thought to control psychotic experiences.

Typical antipsychotics are not selective and thus, they will also block Dopamine receptors in the mesocortical pathway, tuberoinfundibular pathway, and the nigrostriatal pathway. this leads to many of the unwanted side effects that the typical antipsychotics can produce.

Atypical antipsychotic drugs also block D2 receptors. Some also block or partially block serotonin receptors (5HT2A, C and 5HT1A receptors):ranging from risperidone*, which acts overwhelmingly on serotonin receptors, to amisulpride, which has no serotonergic activity. The additional effects on serotonin receptors may be why some of them can benefit the 'negative symptoms' of schizophrenia.

did you catch it? Looks like Risperidone is the strongest at treating negative symptoms. According to Dr. Wikepedia, you're going to need an atypical that has a strong serotonergic component.

-DICK

[baron samedi]

Well, the drug SWIM was principally talking about was olanzapine, which from what he has heard is meant to be one of the "good" ones.
SWIM's been taking it for many years, but is still unsure whether it does actually benefit any "negative" symptoms or indeed makes them worse.
To complicate matters SWIM also takes anti-depressants, so is not sure whether the "good" spells SWIM has had, are due to 1 or the other, or both together, if SWIY knows what SWIM means. He would be fairly dubious about being on olanzapine, on its own, without an AD to combat the depressive side of SWIM's problems, which makes SWIM wonder whether he should still be taking olanzapine at all for all these years.

[Richard_smoker]

yeah, that's tough to say, but i will say this... they're supposed to be BEST on serotonin system when taken TOGETHER...that is, the atypical along with the AD. they kinda do the same thing in different mechanisms... -DICK

[baron samedi]

So, basically, what SWIY is saying, is that it's not unusual to have to take both drugs together, to acheive the best results?
Off topic slightly, but SWIM also heard that GHB can be good for relieving negative symptoms. Is this true? SWIM's not really expecting his doc/shrink will ever give SWIM the chance to find this out for himself.

[Richard_smoker]

no, it's not unusual at all to take a serotonin antidepressant (eg SSRI) along with a serotonin-agonist (atypical) anti-psychotic.

there is "synergy" between the two drugs...I think it helps more with the depressive symptoms than anything else...and you get your negative schitzophrenia symptoms cured as a side-bonus.

think about it like this...the more UN-depressed you are, the more likely you will be to WANT to have social brushes with other people living around you, or in your family....you might have a greater tendency to instinctively reach-out just in passing to others, all while you go about your everday activities...see? it's not a huge surprise that serotonin system can regulate negative symptoms... negative symptoms are in large part, the lonely loner aspect of schizophrenia...the mind that keeps to itself. -DIQUE

[baron samedi]

SWIM rather fancifully mentioned GHB as an alternative treatment for negative symptoms. Are there any other "alternative" treatments that might help better with negative symptoms, other than the obvious AP/AD combination, in SWIY's opinion?

[bryanbabylon]

Kava Kava is a little effective for some of swims negative effects. Not very strong, but you do notice the difference.

[Richard_smoker]

i guess it really depends upon what negatives you're talking about. the reason i think that GHB and Kava have been mentioned is simply owing to the fact that they are successful at lowering your inhibitions. useful, i guess, if you're referring specifically to negative symptoms like being reserved or not wanting to socialize with others. if that's what the last few posters meant by resolving negative symptoms, then any GABA-stimulating drugs could be effective for the symptoms you're treating.

examples: alcohol (ethanol, beer, liquor, wine), tranquilizers (benzodiazepines--xanax, valium, etc.), central muscular relaxants (soma), and euphoriants as well (mdma, mda, opiates).

you obviously can't endorse these due to the neurotoxic, organotoxic, &/or addictive traits all these have. on the other hand, there are drugs that will make schizophrenic symptoms WORSE: stimulants like amphetamines & ritalin will worsen both negative & positive symptoms.

the only drugs mentioned that would even be obtainable from the prescriber's perspective would be benzos or other mild tranquilizers. almost certainly, opiates would not be obtained from a physician for mental symptoms.

[lostmente]

passionflower is an antipsychotic, seems to handle negative symptoms quite well

swim just started on olanzapine and venlafaxine...working quite well, although swim is very sleepy