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As of right now, what is the best Anti-Psychotic for not causing Akathisia?


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Because of my extremely negative reactions to almost all the AP injections down the list, my probation officer and my psych are allowing me to switch to an oral medication for my last month on probation before I graduate. They know it's not even a risk if I didn't take it (which I'm going to) because it usually takes me many months to a year for me to become symptomatic and have a relapse. I'm not one of those type of people who relapse in less than a week or even a month. So this Tuesday, I have an appointment with my psych to discuss my options with the oral medications.

According to my psych and what I know, I'm very responsive to low doses of anti-psychotics, almost becoming completely rational in a few hours of taking Zyprexa 2.5mg or Abilify 2mg. However, I'm also very sensitive at the same time and experience severe amounts of Akathisia that last all day from the moment I wake up to when I go to sleep. I could pace back and forth all day if there were no interruptions. I feel like I want to jump through a ceiling or run through a glass door to alleviate the constant need to be moving. We have tried everything from Cogentin, Artane, Propanolol, Clonazepam, Benadryl, and now Gabapentin 600mg 3x per day and all it's doing is helping with my anxiety and stabilizing my mood but not relieving the Akathisia. The counteractive drugs simply don't work for me. Never did. They're to weak compared to the agent that's causing the Akathisia.

I saw a commercial over the summer that claims that Fanapt has a lower Akathisia risk than other atypical anti-psychotics but I'm not entirely sure. It seems that Fanapt has to be taken twice a day and is recommended at at least 6mg after the 1mg starting dose. I want something that can remain low. I've also read that Seroquel, at the higher doses, like 400mg to 800mg can treat schizophrenia with less of the Parkinson like side effects. I've discussed this with my psych and he says he wants to keep Seroquel as a last resort because of its low efficacy. He may not be realizing that I don't have the average type of schizoaffective disorder (if that exists). He's fearing that my claims of the extremely low-dose oral meds while I was in jail is not a true account.

So. conclusively, what is the best option for a schizoaffective patient who's highest priority is ridding the Akathisia while still taking the medication consistently? I don't care about the 100% efficacy or having some symptoms. I just want the ******** akathisia gone. I also have other side effects from this crap they've been sticking in my arm for the last 15 months such as Weight Gain, Gynecomastia (just won a huge lawsuit against Janssen Pharmaceuticals for Invega), Sedation, Fatigue, Depression, Anxiety, Panic Attacks, Anhedonia, Throat Swelling, Involuntary Eye Movements, and Suicidal Ideation. Just to name a good amount of them. Please help me as my appointment takes place later this week and I want more knowledge going into it. Thanks  

Edited by tsteele
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I believe quetiapine and clozapine are the least likely to cause it, followed by olanzapine.  Unfortunately those are also the ones that cause the most sedation and weight gain. 

Edited by tryp
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As you mentioned, Fanapt has a very low incidence of akathisia. As in, they found that the difference in the rate of akathisia on the medication versus on the placebo was not clinically significant (source). I've gotten akathisia on pretty much everything except that, Saphris, and Seroquel. 

The half-life of Fanapt is long enough that my pdoc had no issue in letting me take it all at night.

The reason I stopped it is that it wasn't very effective at treating my psychosis.

Edited by Swamp56
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13 hours ago, Swamp56 said:

As you mentioned, Fanapt has a very low incidence of akathisia. As in, they found that the difference in the rate of akathisia on the medication versus on the placebo was not clinically significant (source). I've gotten akathisia on pretty much everything except that, Saphris, and Seroquel. 

The half-life of Fanapt is long enough that my pdoc had no issue in letting me take it all at night.

The reason I stopped it is that it wasn't very effective at treating my psychosis.

I would prefer to take the Fanapt at night only and not in the morning. The thing is, can I remain on a dosage that's 5mg or lower rather than the 6-12mg? I appear to be the opposite of you as my psychosis is highly sensitive to the medications. Almost everything treats it accordingly and it has to be a low dose for it to be remotely tolerable. What dosage was the Fanapt you were given?

Edited by tsteele
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Went to my appointment today and my psych is really getting on my nerves now. He's still using the whole probation thing against me and decided against starting me on Fanapt or Seroquel. He absolutely despises Seroquel for some reason. He's not even really acknowledging that my medication needs to be dosed extremely low for the best effect in terms of side effects. Like I said in my earlier posts, he's a clinic psych and he's incredibly by the book and refers to manuals and charts to decide on what he prescribes.

So he prescribed me Latuda 40mg (wouldn't even consider 20mg) knowing that the akathisia rate is much higher on that than Fanapt or Seroquel combined. His reasoning is that he likes to begin all patients coming off of injections on Latuda as it's his favorite drug for treating psychosis. I've seen posts on here from others complaining about the massive akathisia they get on doses as low as 40mg. And why couldn't he have allowed me to take 20mg knowing my response history and susceptibility to akathisia. He claimed that the 20mg would be to much like a "light sprinkling" and would therefore be too low. I see plenty of others on here with that dosage.

I just made it clear that this little trial he's doing will end once my probation term does and I will at that point demand he prescribe me Fanapt or Seroquel or I'll be leaving the clinic earlier than I once thought for a private psych.

Edited by tsteele
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Like you, I have gotten akathisia on all atypicals and thus tolerate them poorly (e.g. max out on Zyprexa at 1.25 mg). 

When one is pacing like a caged animal, swinging one's legs in chairs, and writhing in agony lying in bed nightly, it becomes a serious quality of life issue.  Frankly, it really gets my goat that your pdoc is not hearing your concerns and understanding the torture that is akathisia.

A new pdoc recently convinced me to retry 10 mg of Latuda on an empty stomach (so it would, in effect, be more like 5 mg), and I was reminded that crippling symptoms are almost preferable to bone-burning-ant-crawling akathisia. 

Going into the med trial with full optimism is your best bet, but experience tells me to suggest a sensible PRN and back-up strategy coordinated with your pdoc.

Good luck.

 

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3 hours ago, lifequake said:

Like you, I have gotten akathisia on all atypicals and thus tolerate them poorly (e.g. max out on Zyprexa at 1.25 mg). 

When one is pacing like a caged animal, swinging one's legs in chairs, and writhing in agony lying in bed nightly, it becomes a serious quality of life issue.  Frankly, it really gets my goat that your pdoc is not hearing your concerns and understanding the torture that is akathisia.

A new pdoc recently convinced me to retry 10 mg of Latuda on an empty stomach (so it would, in effect, be more like 5 mg), and I was reminded that crippling symptoms are almost preferable to bone-burning-ant-crawling akathisia. 

Going into the med trial with full optimism is your best bet, but experience tells me to suggest a sensible PRN and back-up strategy coordinated with your pdoc.

Good luck.

 

Thank You very much for that post. You're literally the first person who is speaking my language after 6 1/2 intermittent ******** years of agonizing akathisia.

I didn't even know what the **** the irritating inner feeling was the first time it hit me when I was first hospitalized for psychosis at 22 (and at that time I wasn't even really that psychotic, just my parents freaking out about things I was saying). I've done my research throughout the years as to what the **** this inexplicable **** actually is. I actually learned the name "akathisia" while I was in jail from the facilities psychiatrist. Prior to that I couldn't differentiate it from Restless Leg Syndrome and thought they were the same.

I literally want to print your post out and shove it down the throat of not only my inconsiderate psychiatrist but also my old-school, antiquated, primary GP (Get This: he's retiring next year because he can't figure out how to write electronic scripts!) who is the strongest advocate of all these so-called miracle drugs. "We have to come up with better medicines, the ones we have now are not the best, but they're all we have right now", he says while adamantly pointing out that tolerating the side effects caused by the medications is the only answer and that anything is better than the psychosis itself. Easy for him to say sitting there relaxing in his plush leather chair, never had even taken anything remotely like an anti-psychotic medication, researched it thoroughly or prescribed any of it himself, or most importantly experience the pulsating, blood rushing feeling straight through your ********* legs of akathisia. "He's just following modern procedure as a GP and being like a secondary psychiatrist", says my psych. I can tell you that my GP is anything but modern except when he's doing that.

And you're absolutely right about my psychiatrist. He's not the meanest psych in the realm of psychiatry but he's certainly someone who's afraid of taking risks and getting a lawsuit when it could be to the benefit of his patient and he's most likely not going to be sued for anything. The whole clinic he works for praises Latuda. That's why he prescribed it today. My GP on the other hand is like an Abilify commercial from 2011. "It might be uncomfortable at times but you just need to suck it up and realize that you're living." Akathisia is not living . It's sub-human quality of life where you can't even maintain a normal sitting position and burn out thousands of dollars of area rugs in your 2nd-floor apartment.

Edited by SheltieUnderdog
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