Experience with Typical Antipsychotics needed!

[Arj72]

Hey folks, struggling again. Currently in the middle of a switch from my primary antidepressant from Paxil to Viibryd due to ongoing weight gain, fatigue and sexual dysfunction. I HATE MED CHANGES, but I was getting so sick and tired of those side effects and the fact that it only got me 75% of the way I wanted to be. Any way, as with many medication changes my anxiety is crazy high right now and my as needed ativan use feels like it's gonna be all the time for the time being. I feel like it's gonna be like this for some time while I adjust to the Viibryd and wean off Paxil, and I worry about getting dependant on it. Doing some research (anxiety sufferer's google the shit outta things, don't they?) I came across an old typical antipsychotic called trifluoperazine that was used for GAD in the old days, and perphenazine that was used for agitation that comes with depression. Either option would be on a short term, limited use at lower doses than needed for psychosis so I'm not worried about movement disorders. I just want relief!! Anyone have experience with either med for anxiety relief while I adjust? Thanks!

I'm hoping to get input before I see my ARNP tomorrow.

[mellifluous]

i have substantial experience with typicals, but only one of the two you cite.

i took stelazine. it worked out fine until i discontinued, so far as i recall. 

have not taken trilafon

 

did you start either? is it helping?

[OliverB]

I took perpenazine and was anti anxiety but too sedating for me (anyway sedation is a problem I get from all antipsychotics and perphenazine wasn't the worst)

[San]

Have taken haldol, thorazine, loxapine, a few more. Best was haldol, but pdoc was afraid of long term (15-20 years from now) movement disorders.

Much prefer them to atypicals.

[jt07]

I've taken perphenazine as an adjunct to antidepressants back before there were atypical antipsychotic for augmentation. I took Haldol for just a short while also at one point. I have to say that I liked the perphenazine more than the antidepressant (Elavil). It killed the anxiety and I felt good on it.

[CrazyRedhead]

I take 100mgs thorazine for anxiety and sleep...Has worked well so far, with no notable side effects.

I would say I prefer it to the atypicals I've tried for the same purposes.

[mikl_pls]

I've taken trifluoperazine (Stelazine) and it practically rehabilitated me last fall when I was too anxious to leave the house to do simple things like run errands or go to a friend's house. My pdoc prescribed me initially 1 mg twice daily along with oxazepam (Serax) 30 mg to potentiate it. Not only did it have amazing anxiolytic effects, but it had remarkable antidepressant effects, which came as a surprise from a first-generation antipsychotic. Despite that she doesn't like to prescribe these FGAs, she liked what she saw in me from this med, and when I asked for more, she increased it to three times per day. Eventually, I wound up on 2 mg three times per day (total of 6 mg) which is the max dose for anxiety.

The first time I took it, I did gain substantial weight on it, but I was slipping off of a ketogenic diet wherein I was eating ≤ 20 g carbs per day and suddenly increased my carb intake to probably above 100 g per day. The other times I've taken it, I've actually been able to lose weight while on it, which my pdoc said is uncommon. According to Stahl's Prescriber's Guide (5th ed.), it says weight gain for trifluoperazine is "unusual," and "reported but not expected."

I didn't experience any extrapyramidal side effects from it at all until the last time I took it which was this last summer (was on 6 mg/day again, but titrated up much more rapidly than the first time I took it, which may have something to do with it). The main side effect I experienced was excessive daytime sedation, which occurred only when I got to 6 mg/day, and only happened the first time I was on it, so it may have been my med combo at the time.

Other typical antipsychotics I've taken are haloperidol (Haldol), which is great for agitation and knocking the hell out of hypomania, fluphenazine (Prolixin) which didn't really seem to do much of anything (maybe my dose wasn't high enough?), and chlorpromazine (Thorazine) which I took 100 mg for sleep, and it made me sleep for 15+ hours and made me extremely depressed the next day (maybe a lower dose would've been sufficient for sleep, like 25-50 mg, maybe even 10 mg?)

[wookie]

I took 1mg of navane a day briefly.

It took me down from the anxious hell i was in.

I think it works more like an antipsychotic at higher doses.

[mellifluous]

upon re reading through this thread, i think i misunderstood and thought you were only asking about those two typicals.

 

i've taken several. i won't go through the whole list, but if you have questions about specific ones, i'm happy to share my experiences. for typicals, off the top of my head, i've taken haldol (pills and acute injections and depot), prolixin (pills and depot), navane, loxapine, stelazine, thorazine, ... if feel like i'm omitting one.....but, anyway, haldol and prolixin depot probably were best at keeping me out of hospital. the others all worked to varying degrees, except the dosage for thorazine went up super fast quickly.

atypicals, in case that ends up being of interest to you, i've taken all but clopixol and solian and the newer ones (vraylar and rexulti). most effective were risperdal, zyprexa, clozaril.

[browri]

I have BPII and a real problem with intrusive thoughts. I take loxapine 10mg. It kills the chain of anxiety at the intrusive thoughts. I feel less distracted by my constant worrying and inability to focus on the task at hand. I've taken this after Latuda, Abilify, Saphris, Fanapt. All of those felt really dulling. However, I see that you're taking clozapine and would like to point out some interesting facts.

Loxapine is actually structurally similar to clozapine and it has an extremely similar binding profile to olanzapine (Zyprexa). Zyprexa is one atypical antipsychotic along with clozapine that is least likely to cause extrapyramidal symptoms like akathisia. However, clozapine causes agranulocytosis and olanzapine causes massive increases in cholesterol, triglycerides, blood sugar, and weight. Loxapine does none of these things. In fact some people even lose weight on loxapine. And finally, loxapine can be thought of as a "crossover" antipsychotic. A big difference between the typicals and atypicals is whether they affect dopamine receptors more than serotonin and vice versa. Typicals generally affect dopamine more, and atypicals generally affect serotonin more. While loxapine is classified as a typical just because of when it was discovered, it actually affects serotonin more, much like the atypicals. It makes it really appealing. Also, this typical AP is making a resurgence as an inhaler called Adasuve which can be used in the hospital for agitated patients in place of a Haldol or Thorazine shot. It's got a strong track record and lots of promise.

[Teh Gaben]

I've taken haldol off and on for a few years now, unfortunately I don't find it to be particularly effective, but for some reason my pdoc keeps me on it anyway. Other typical I tried was clopixol, which was extremely beneficial, but it's not scheduled in the US. I was taken off that due to severe side effects though.

[mikl_pls]

5 hours ago, browri said:

I have BPII and a real problem with intrusive thoughts. I take loxapine 10mg. It kills the chain of anxiety at the intrusive thoughts. I feel less distracted by my constant worrying and inability to focus on the task at hand. I've taken this after Latuda, Abilify, Saphris, Fanapt. All of those felt really dulling. However, I see that you're taking clozapine and would like to point out some interesting facts.

Loxapine is actually structurally similar to clozapine and it has an extremely similar binding profile to olanzapine (Zyprexa). Zyprexa is one atypical antipsychotic along with clozapine that is least likely to cause extrapyramidal symptoms like akathisia. However, clozapine causes agranulocytosis and olanzapine causes massive increases in cholesterol, triglycerides, blood sugar, and weight. Loxapine does none of these things. In fact some people even lose weight on loxapine. And finally, loxapine can be thought of as a "crossover" antipsychotic. A big difference between the typicals and atypicals is whether they affect dopamine receptors more than serotonin and vice versa. Typicals generally affect dopamine more, and atypicals generally affect serotonin more. While loxapine is classified as a typical just because of when it was discovered, it actually affects serotonin more, much like the atypicals. It makes it really appealing. Also, this typical AP is making a resurgence as an inhaler called Adasuve which can be used in the hospital for agitated patients in place of a Haldol or Thorazine shot. It's got a strong track record and lots of promise.

 

I have always been fascinated with loxapine since I found out what it was and learned about its psychopharmacological profile, and have been curious about taking it. Have you found that loxapine offers any antidepressant effects what with its high 5-HT_2A:D2 ratio and its amoxapine (Asendin) metabolite?

[browri]

@mikrw33

Considering that almost all of my depression stems from some sort of anxiety. Looking at all the things I need to accomplish and feeling hopeless. Loxapine helps me to de-stress and take things one step at a time. I was taking Zyprexa. 2.5mg wasn't enough to settle my mind. 5mg was just right. Switched to loxapine because of the cholesterol and weight gain. 5mg was just not enough and 10mg is perfect. It's very light touch. I don't feel foggy. That being said, I am taking it with Aplenzin. Bupropion...stimulating...say no more. So possibly without Aplenzin, it would make me tired. However, I see you're taking Adderall, so I doubt you'll notice at all. If you're looking for an antipsychotic that doesn't make you do the Thorazine Shuffle but calms your inner chatter enough for you to stop and actually think about what you're doing...loxapine is for you. Like I said, my reaction to loxapine was almost exactly the same to Zyprexa, except without all of the side effects. That being said, I wish my doctor would have let me try Vraylar. It seems to have so much promise.

[mikl_pls]

1 hour ago, browri said:

@mikrw33

Considering that almost all of my depression stems from some sort of anxiety. Looking at all the things I need to accomplish and feeling hopeless. Loxapine helps me to de-stress and take things one step at a time. I was taking Zyprexa. 2.5mg wasn't enough to settle my mind. 5mg was just right. Switched to loxapine because of the cholesterol and weight gain. 5mg was just not enough and 10mg is perfect. It's very light touch. I don't feel foggy. That being said, I am taking it with Aplenzin. Bupropion...stimulating...say no more. So possibly without Aplenzin, it would make me tired. However, I see you're taking Adderall, so I doubt you'll notice at all. If you're looking for an antipsychotic that doesn't make you do the Thorazine Shuffle but calms your inner chatter enough for you to stop and actually think about what you're doing...loxapine is for you. Like I said, my reaction to loxapine was almost exactly the same to Zyprexa, except without all of the side effects. That being said, I wish my doctor would have let me try Vraylar. It seems to have so much promise.

 

Thanks for your response! You are on an interesting regimen, but I'm glad it seems to be effective for you! I'm even more curious about Loxitane, and I do think I will ask about it at my next pdoc appointment. I seem to have had the opposite response to Vraylar than most people what with being more depressed and the akathisia (may even be contributing to insomnia?). Someone posted in a thread of mine about insomnia that he takes Loxitane and it helps him sleep (he takes 25-50 mg though, so higher dose than you). If you ever do get to try Vraylar, I wish you good luck on it!

[browri]

@mikrw33

It is very sedating that's for sure. Although it's not like some of the newer ones that when you take it you're so asleep that you're dead to the world. At least at 10mg it just makes me groggy and I can fight it a bit if I'm not ready to go to sleep yet. There's a possibility that I'll have to go up on it. My pdoc and I decided to get rid of Lamictal. It combined with the Trileptal was making me a bit stupid, particularly in the mornings and evenings when I would take them together. At least in the morning I have Aplenzin to fight that but at night it just makes me feel useless. Yesterday was down from 200mg to 150mg and today is just 100mg. Not in a very good mood so far but it could be completely unrelated. I'm going to do 100mg for 3 days then 50mg for 2 then no more. I just really hope the other meds will help pick up the slack.