Simba Cub Posted January 29, 2020 Share Posted January 29, 2020 The most often cited med is Olanzapine, although Quetiapine is the closest relative to Clozapine and Aripiprazole in many ways is the new boy on the street... Quote Link to comment Share on other sites More sharing options...
Arj72 Posted January 29, 2020 Share Posted January 29, 2020 8 minutes ago, Simba Cub said: The most often cited med is Olanzapine, although Quetiapine is the closest relative to Clozapine and Aripiprazole in many ways is the new boy on the street... Would you consider typical APs? Haldol, maybe? Otherwise, for AAP's, I'd say you're right on Olanzapine with regard to wide spectrum usage. Helps me with anxiety, depression, hypomania, agitation/anger, etc. Just makes me too fat to use more than sparingly. Quote Link to comment Share on other sites More sharing options...
CeremonyNewOrder Posted January 29, 2020 Share Posted January 29, 2020 From what I've tried, risperidal and haldol. Haldol is the only AP I've tried (and hopefully will be the last) so don't know about the others. Quote Link to comment Share on other sites More sharing options...
Iceberg Posted January 29, 2020 Share Posted January 29, 2020 Depends on desired effect. The best ones for agitation and sedation aren’t necessarily best for psychosis and the other way around Quote Link to comment Share on other sites More sharing options...
mikl_pls Posted January 29, 2020 Share Posted January 29, 2020 (edited) From a combination of my experience and looking at affinity for 5-HT2A and D2 receptors... For antipsychotic action: aripiprazole (Abilify), Saphris (asenapine), Rexulti (brexpiprazole), Vraylar (cariprazine), Latuda (lurasidone) (up to 160 mg), olanzapine (Zyprexa), paliperidone (Invega), high dose quetiapine (Seroquel/XR) (750-800 mg), risperidone (Risperdal), and high- to supratherapeutic-dose ziprasidone (Geodon) (60-80 mg 2x/day up to 160 mg 2x/day) (provided that adequate calories are consumed with each dose). Pretty much any of the typicals will be good for antipsychotic/agitation. With quetiapine (Seroquel), you really have to get to the higher doses/max dose to get the antipsychotic effect (600 mg at minimum, should really be 750-800 mg for IR and 800 mg for XR). For acute agitation: Saphris (asenapine), oral and intramuscular olanzapine (Zyprexa), low- to moderate-dose quetiapine (Seroquel) (probably 25-200 mg), risperidone (Risperdal), and intramuscular ziprasidone (Geodon) For antidepressant effects: aripiprazole (Abilify), Saphris (asenapine) (possibly), low- to moderate-dose Rexulti (brexpiprazole) (0.5-2 mg) (for most people), low-dose Vraylar (cariprazine) (1.5-3 mg), Latuda (lurasidone) (up to 120 mg), olanzapine (Zyprexa), (paliperidone? (Invega)), mid- to mid-high dose quetiapine (Seroquel/XR) (300-600 mg), risperidone (Risperdal) (dose? probably low...), low- to moderate-dose ziprasidone (Geodon) (20-40 mg 2x/day) Anxiety, I'm not sure about because I've never taken many antipsychotics for anxiety, but I will say that trifluoperazine (Stelazine) has been a life saver for me and anxiety, especially when paired with a benzo. Low- to moderate-dosed quetiapine (Seroquel) (25-200 mg) is supposed to be good for anxiety too, and as @Arj72 said, olanzapine (Zyprexa). To my understanding, drugs of last resort are Fanapt (iloperidone) (not sure why...) and, of course, clozapine (Clozaril). Those are the antipsychotics available in the US. There may be some antipsychotics available where you live that I don't know about. I believe amisulpride is available where you live, as is sulpiride. They're sort of multi-modal like quetiapine insofar as low doses are good for depression and higher doses for psychosis. Also, flupenthixol is also another one that may be available where you live, and is multi-modal in this same fashion. Edited January 29, 2020 by mikl_pls Quote Link to comment Share on other sites More sharing options...
Iceberg Posted January 29, 2020 Share Posted January 29, 2020 1 hour ago, mikl_pls said: From a combination of my experience and looking at affinity for 5-HT2A and D2 receptors... For antipsychotic action: aripiprazole (Abilify), Saphris (asenapine), Rexulti (brexpiprazole), Vraylar (cariprazine), Latuda (lurasidone) (up to 160 mg), olanzapine (Zyprexa), paliperidone (Invega), high dose quetiapine (Seroquel/XR) (750-800 mg), risperidone (Risperdal), and high- to supratherapeutic-dose ziprasidone (Geodon) (60-80 mg 2x/day up to 160 mg 2x/day) (provided that adequate calories are consumed with each dose). Pretty much any of the typicals will be good for antipsychotic/agitation. With quetiapine (Seroquel), you really have to get to the higher doses/max dose to get the antipsychotic effect (600 mg at minimum, should really be 750-800 mg for IR and 800 mg for XR). For acute agitation: Saphris (asenapine), oral and intramuscular olanzapine (Zyprexa), low- to moderate-dose quetiapine (Seroquel) (probably 25-200 mg), risperidone (Risperdal), and intramuscular ziprasidone (Geodon) For antidepressant effects: aripiprazole (Abilify), Saphris (asenapine) (possibly), low- to moderate-dose Rexulti (brexpiprazole) (0.5-2 mg) (for most people), low-dose Vraylar (cariprazine) (1.5-3 mg), Latuda (lurasidone) (up to 120 mg), olanzapine (Zyprexa), (paliperidone? (Invega)), mid- to mid-high dose quetiapine (Seroquel/XR) (300-600 mg), risperidone (Risperdal) (dose? probably low...), low- to moderate-dose ziprasidone (Geodon) (20-40 mg 2x/day) Anxiety, I'm not sure about because I've never taken many antipsychotics for anxiety, but I will say that trifluoperazine (Stelazine) has been a life saver for me and anxiety, especially when paired with a benzo. Low- to moderate-dosed quetiapine (Seroquel) (25-200 mg) is supposed to be good for anxiety too, and as @Arj72 said, olanzapine (Zyprexa). To my understanding, drugs of last resort are Fanapt (iloperidone) (not sure why...) and, of course, clozapine (Clozaril). Those are the antipsychotics available in the US. There may be some antipsychotics available where you live that I don't know about. I believe amisulpride is available where you live, as is sulpiride. They're sort of multi-modal like quetiapine insofar as low doses are good for depression and higher doses for psychosis. Also, flupenthixol is also another one that may be available where you live, and is multi-modal in this same fashion. If we’re including typicals - I might add haldol and probably Thorazine for the acute agitation category as well. The haldol IM is super common for emergency hospital use, and I know that some inpatient wards (including a children’s ward oddly) that give Thorazine as a sedative instead of benzos when people are freaked out manic Quote Link to comment Share on other sites More sharing options...
argh Posted January 29, 2020 Share Posted January 29, 2020 (edited) . Edited September 16, 2020 by argh Quote Link to comment Share on other sites More sharing options...
psychwardjesus Posted February 12, 2020 Share Posted February 12, 2020 On 1/29/2020 at 1:05 AM, Iceberg said: If we’re including typicals - I might add haldol and probably Thorazine for the acute agitation category as well. The haldol IM is super common for emergency hospital use, and I know that some inpatient wards (including a children’s ward oddly) that give Thorazine as a sedative instead of benzos when people are freaked out manic I'd say Thorazine is a very sedating antipsychotic, but not a good or potent one when compared to others, both typical and atypical. Generally speaking, an antipsychotic's potency — not to be confused with efficacy — is at least in part determined by its D2 and D3 receptor-binding affinity. So, for typicals, ones like Haldol, Stelazine, and Prolixin would qualify. In conjuction with dopamine receptor binding affinity, it's all relative to Thorazine. In other words, scientists measured how much of a particular drug vs how much thorazine would it take to occupy x% of receptors. So potency really only correlates with a higher risk of extrapyramidal side effects, not how good it is at alleviating whatever you have going on. Atypical antipsychotics are even harder to measure as some don't bind very tightly to D2/D3 or hit many other receptors than just dopamine. And if you look at the "best" antipsychotic we have, clozapine, it has a pretty weak affinity for D2 as compared to other meds, but it can do a lot for people where all others have failed Quote Link to comment Share on other sites More sharing options...
saintalto Posted February 12, 2020 Share Posted February 12, 2020 (edited) I found Seroquel, which I was on the maximum dose when I was on it, to be weaker at fighting psychosis than olanzapine. That was my experience. Edited February 12, 2020 by saintalto Quote Link to comment Share on other sites More sharing options...
Iceberg Posted February 12, 2020 Share Posted February 12, 2020 Well I guess we need to define “beefy”... to me that is more about knock out power than potency. If we’re talking strictly potency, than I wouldn’t have said Thorazine Quote Link to comment Share on other sites More sharing options...
clinic Posted February 17, 2020 Share Posted February 17, 2020 (edited) If you want to know which is the most effective and which is the most least, here's a chart from a study. [1] Most effective is clozapine, and least is Iloperidone[1] [1] http://www.kcl.ac.uk/ioppn/news/events/2013/september/Leucht-2013-15-antipsychotics-meta-analyses.pdf Edited February 17, 2020 by clinic Quote Link to comment Share on other sites More sharing options...
Iceberg Posted February 17, 2020 Share Posted February 17, 2020 58 minutes ago, clinic said: If you want to know which is the most effective and which is the most least, here's a chart from a study. [1] Most effective is clozapine, and least is Iloperidone[1] [1] http://www.kcl.ac.uk/ioppn/news/events/2013/september/Leucht-2013-15-antipsychotics-meta-analyses.pdf Treating what though? What symptoms were being measured? Quote Link to comment Share on other sites More sharing options...
saintalto Posted February 17, 2020 Share Posted February 17, 2020 Keep in mind everyone has a different experience and reacts to drugs differently. I took clozapine and didn’t find it very effective, but I stabilized completely on Latuda which is considered a much weaker drug. It’s been my miracle drug, regardless of it being considered less effective than clozapine. Quote Link to comment Share on other sites More sharing options...
clinic Posted February 18, 2020 Share Posted February 18, 2020 (edited) 15 hours ago, Iceberg said: Treating what though? What symptoms were being measured? Sorry the link is dead. https://www.ncbi.nlm.nih.gov/pubmed/23810019 Well the study title says its about schizophrenia in general. But i think it measures positive symptoms mainly. Edited February 18, 2020 by clinic Quote Link to comment Share on other sites More sharing options...
Simba Cub Posted February 22, 2020 Author Share Posted February 22, 2020 I've done some digging. Olanazapine was designed to be the new Clozapine, minus the side effects and blood tests. It turned out to be powerful, but not quite as "beefy" as Clozapine. Interestingly, despite this, Quetiapine remains the closest drug to Clozapine biologically. Quote Link to comment Share on other sites More sharing options...
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