Poll Time- If it comes to taking an antipsychotic, which one would you prefer?

[TheWowEffect]

Please feel free to add the reasons for the choice.

P.S.- Mainly for psychosis. Feel free to discuss other uses as well like DS did in his post.

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[TheWowEffect]

I am going with Risperidone(Risperdal) for now. I would consider Aripiprazole(Abilify) as an alternative if my illness is less severe or paliperidone(Invega) if it is proven that it has less side effects than Risperdal.

 

[manwhoisthursdy]

Clozapine!!

Just kidding.

I went with aripiprazole ... but this was a very hard question to answer. I never thought about putting myself in patient's shoes this way, and I have to admit that I chose abilify even though I suspect it has the crappiest efficacy ... I assumed in the question that my illness was very mild.

If my illness were more severe, I'd have to pick one of the scarier choices.

Your question really made me think about putting ourselves in the patient's shoes when we give him a drug that could give him a fatal arrhythmia, or make him fat and diabetic, or give him a scary movement disorder, or kill his white count, etc.

 

[PeeWee137]

i picked seroquel. when i did my inpt rotation everyone seemed to be on it.

my friend's doc prescribed it to him as a "sleeping pill". does that sound crazy to anyone? he's never been diagnosed with any kind of psychotic or manic episode. he just cant sleep. granted he takes like a quarter of a pill, but wtf?

 

[billypilgrim37]

my friend's doc prescribed it to him as a "sleeping pill".

oh, you mean "really expensive benadryl"?

 

[OldPsychDoc]

Depends on how truly psychotic I am...If it's severe & frightening, make it risperidone. Otherwise, I'm feeling sorry for ziprasidone in this poll, so I'll volunteer for that, assuming my EKG is normal...

(This isn't going to get turned in to an ad is it? --you know, "3 out of 7 prescribers surveyed would take Abilify for their own antipsychotic needs".)

---------------------------------
"Pacifex--a doctor gave it to you".

 

[TheWowEffect]

Depends on how truly psychotic I am...If it's severe & frightening, make it risperidone. Otherwise, I'm feeling sorry for ziprasidone in this poll, so I'll volunteer for that, assuming my EKG is normal...

(This isn't going to get turned in to an ad is it? --you know, "3 out of 7 prescribers surveyed would take Abilify for their own antipsychotic needs".)

---------------------------------
"Pacifex--a doctor gave it to you".

Lol...no I just saw it on another forum and thought it would be interesting to discuss here.

May be I should have given the option of multiple choices. Don't think I can edit the poll options now.

 

[PeeWee137]

oh, you mean "really expensive benadryl"?

i'd much rather be hooked on benadryl than screw around with my dopamine, thank you very much!

 

[Anasazi23]

Antidepressant effect, resolution of psychotic symptoms, AND good for my cholesterol? I'll take it!

Geodon FTW.

 

[billypilgrim37]

i'd much rather be hooked on benadryl than screw around with my dopamine, thank you very much!

Fortunately, at the "help you sleep" dose, there's like .1% D2 binding...

 

[Doc Samson]

Fortunately, at the "help you sleep" dose, there's like .1% D2 binding...

At pretty much any dose there's .1% D2 binding. It's all about conformational change in the receptor.

In terms of the poll, are we talking treatment of psychosis? delirium? anxiety? My choice varies for each.

Psychosis: Risperdal up to 4 mg/day, then I'd give Abilify a shot (and hope I don't assault anyone while I'm agitated for the first few days).

Delirium: IV Haldol and lots of it

Anxiety: Frequent teeny-tiny doses of Seroquel

 

[PeeWee137]

Fortunately, at the "help you sleep" dose, there's like .1% D2 binding...

i didnt know that, sweet.
time for some vitamin S!

 

[manwhoisthursdy]

i picked seroquel. when i did my inpt rotation everyone seemed to be on it.

my friend's doc prescribed it to him as a "sleeping pill". does that sound crazy to anyone? he's never been diagnosed with any kind of psychotic or manic episode. he just cant sleep. granted he takes like a quarter of a pill, but wtf?

I've heard drug reps for Seroquel mention that it's the "most-prescribed" antipsychotic ... with the implication that it's prescribed more than other atypicals for psychosis because it's "better." Bullcrap ... it's the most-prescribed because so many non-psychiatrists use as a sleeping pill.

I've seen more people on Seroquel on my family and internal med rotations than on psychiatry ... on the sleep dose.

 

[whopper]

Whatever works best with the least amount of side effects.
As Doc Samson said, I'd want to know more about the sx before choosing a med.

ve heard drug reps for Seroquel mention that it's the "most-prescribed" antipsychotic ... with the implication that it's prescribed more than other atypicals for psychosis because it's "better." Bullcrap ... it's the most-prescribed because so many non-psychiatrists use as a sleeping pill.

Exactly. Someone at the IPS convention did a study where patients were given $10 benadryl instead of $300 Seroquel for sleep.

Seroquel's sleep benefits are due to its antihistamine effects. Benadryl is an antihistamine. I have occasionally heard someone mention on the board why they still prefer seroquel, but its much more expensive. Does it justify that cost?

In south Jersey, several people are on seroquel simply for the antihistamine effect--which should in time be susceptible to sleep tolerance anyway. I sometimes get consults because the patient is on seroquel, and they say its only for sleep, yet their PCP upped it to the 600-800 range because the sleep tolerance would set in. I guess the PCP didn't know the anithistamine effect is supposed to top off at 200mg.

I'm suspecting that drug dinners are involved as to why so many PCPs are giving it out (at least in my area). We also got several PCPs overdiagnosing bipolar (anecdotal observation). I'm suspecting it may be to due ICD codes allowing for higher reimbursement, than a dx of a personality DO-and viola--you can now give them seroquel.

 

[TheWowEffect]

Whatever works best with the least amount of side effects.
As Doc Samson said, I'd want to know more about the sx before choosing a med.

The question is not what you would prescribe for the patients but rather what you would choose for yourself(if you were psychotic), given that we as physicians know everything that is known(presumably) about these drugs.

 

[nancysinatra]

I picked clozapine, because of all the free monitoring tests I'll get weekly at least for the first month. I love getting free medical tests without someone questioning why, oh why, do I need them. Also, if I'm going to take an antipsychotic, I figure, why not just go for it? No fooling around with seroquel for me. I considered Haldol too--it would sure make an impression if I just casually pulled the bottle out every now and then--especially in class. But clozapine looked lonely so I picked that.

 

[Hurricane]

Risperdal Consta, delivered to my door every couple weeks by my friendly ACT team

 

[OldPsychDoc]

Risperdal Consta, delivered to my door every couple weeks by my friendly ACT team

Nah...you're just going to lock the doors and refuse to let them in because they've been secretly replaced by the Clone Police...

 

[Therapist4Chnge]

But clozapine looked lonely so I picked that.

There are a handful of reasons why it is lonely....... Up to 5 BB warnings I think?

-t

 

[deleted77919]

I had to give my vote for olanzapine, sure it has the metabolic side effects, but it deserves at least one vote for being the best tolerated in the CATIE trial.

 

[toby jones]

Placebo thanks. Guess that means I don't get to vote ;-)

 

[TheWowEffect]

Placebo thanks. Guess that means I don't get to vote ;-)

No, you don't because we, psychiatrists, don't treat believe in treating psychosis with placebos.

This leads me to an important question. What do people think are the most consistent and important symptoms in schizophrenia- positive/negative/cognitive? Literature and latest research shows that it is the cognitive problems which are mainly responsible for functional impairment. Positive and negative symptoms don't matter that much in the long term picture. Schizophrenia researchers have started looking at the illness in a different way now. So, expect lot of medications and treatment approaches foscussing on cognition, and not on positive or negative sxs in next few years.

 

[toby jones]

> No, you don't because we, psychiatrists, don't treat believe in treating psychosis with placebos.

Hmm. Well... Okay... But I don't think that disbelief in the efficacy of placebo undermines the effectiveness of placebo

> Literature and latest research shows that it is the cognitive problems which are mainly responsible for functional impairment.

How do they define 'cognitive problem' (compared with negative symptoms, say)?

 

[TheWowEffect]

>
How do they define 'cognitive problem' (compared with negative symptoms, say)?

You need to do some more reading. And read some real stuff and not the scientology literature.

 

[MBK2003]

I have to say, the prospect of being able to stuff my face twice a day and blame it on my need to take my medication with food really sealed the deal for Ziprasidone.

But Hurricane's remark about the ACT team delivery of my Risperdal Consta made it a close race.

 

[worriedwell]

I chose risperdal without having read the thread. It was almost a no brainer among atypicals when comparing efficacy vs side effects plus option of consta. I am frankly shocked and appalled that abilify is on top of this poll. It must say something for the power of pharm reps. The question was for psychosis right?

Unbelievable.

Some good points on geodon but too unreliable of absorption and having to take it twice daily is a bummer.

 

[worriedwell]

> No, you don't because we, psychiatrists, don't treat believe in treating psychosis with placebos.

Hmm. Well... Okay... But I don't think that disbelief in the efficacy of placebo undermines the effectiveness of placebo

> Literature and latest research shows that it is the cognitive problems which are mainly responsible for functional impairment.

How do they define 'cognitive problem' (compared with negative symptoms, say)?

There is a promising phase 3 trial for schizophrenia that I believe acts on glutamate receptors.

And actually, in one old study I saw there was a 20% response for placebo in schizophrenia vs 60% on first generation antipsychotic...the sample was on a group of inpatients for 6 weeks however I believe so not sure if the environment is what accounted for the placebo response or what. But either way, very consistent and vastly superior results for dopamine blockers compared to placebo in positive symptoms of schizophrenia.

 

[TheWowEffect]

I chose risperdal without having read the thread. It was almost a no brainer among atypicals when comparing efficacy vs side effects plus option of consta. I am frankly shocked and appalled that abilify is on top of this poll. It must say something for the power of pharm reps. The question was for psychosis right?

Unbelievable.

Some good points on geodon but too unreliable of absorption and having to take it twice daily is a bummer.

I am surprised with the results too. No self-respecting psychiatrist would expect Abilify to on top in a poll for psychosis meds. Surprisingly, people who have chosen Abilify haven't posted any reasons for their choice. One or two people chose Risperdal in their posts but did not vote.

Come on people! Let's have more votes and discussion....

 

[OldPsychDoc]

I am surprised with the results too. No self-respecting psychiatrist would expect Abilify to on top in a poll for psychosis meds. Surprisingly, people who have chosen Abilify haven't posted any reasons for their choice. One or two people chose Risperdal in their posts but did not vote.

Come on people! Let's have more votes and discussion....

Hey, the original question was "If it comes to taking an antipsychotic, which one would YOU prefer?" To me, the votes for Abilify indicate a desire to ingest only the most innocuous! Nothing was asked about effectiveness...

As for a serious "What would you do...?" question--I told my wife that if I were ever psychotically depressed, to just skip the meds and go straight for the voltage. If I forget something along the way it probably wasn't worth remembering anyway!

 

[Chimed]

As for a serious "What would you do...?" question--I told my wife that if I were ever psychotically depressed, to just skip the meds and go straight for the voltage. If I forget something along the way it probably wasn't worth remembering anyway!

!

(BTW, does the Vuclan Mind Meld help retrieve memories?)

 

[deleted77919]

No self-respecting psychiatrist would expect Abilify to on top in a poll for psychosis meds.

Well, since this is a public poll you can take a look at who voted for what and examine trends in med-student vs resident vs attending attitudes (or at least self reported status as a student, resident, attending, etc).

 

[TheWowEffect]

Hey, the original question was "If it comes to taking an antipsychotic, which one would YOU prefer?" To me, the votes for Abilify indicate a desire to ingest only the most innocuous! Nothing was asked about effectiveness...

I guess my assumption was about the perceived effectiveness...just goes on to show that we are no different than our patients or may be worse because most patients will listen to the physician's suggestion...hopefully!!!

 

[OldPsychDoc]

!

(BTW, does the Vulcan Mind Meld help retrieve memories?)

I don't know, but you're giving me a great idea for a clinical trial!

 

[OldPsychDoc]

I guess my assumption was about the perceived effectiveness...just goes on to show that we are no different than our patients or may be worse because most patients will listen to the physician's suggestion...hopefully!!!

Well if it's just about effectiveness, then dang the side effects and give me Clozaril!

 

[Anasazi23]

This reminds me of a poll that was done years ago that was brought up to us in med school during a heme-onc class. Something about how 80%ish of heme-onc doctors would refuse their own treatment if they were to get a particular type of cancer that would require radation + chemo.

 

[PsyKardinal]

I am all about the local friendly ACT team delivering my consta to me.

Jeff

 

[TheWowEffect]

Well if it's just about effectiveness, then dang the side effects and give me Clozaril!

May be considering life-threatening v/s non-life-threatening side effects would be a better idea, but then arguement could be- Oh! I'll be getting regular blood work...so what's the big deal..!!!

Although there are so many individual differences depending on the patient, in my experience Risperdal works great without too many bad side effects. I like the arguement about Geodon too because I think it is "under-used" due to the "over-feared" QT side effect. I expected more votes for Zyprexa- I guess the metablic side effects are really scary, but then people are also voting for Seroquel.

We need more votes to increase the power of the survey. So far, the N=31.

 

[PeeWee137]

for what its worth i think abilify has the nicest sounding and least scary name. it makes me think of sunshine and flowers. if i was psychotic, i think hearing clozaril and zyprexa would freak me out, they just sound angry and mean. i think i have something against the letter Z.

 

[Hurricane]

Nah...you're just going to lock the doors and refuse to let them in because they've been secretly replaced by the Clone Police...

Oh, I'd let them in as long as I had my trusty tin-foil hat to shield myself from their mind penetrating death rays.

for what its worth i think abilify has the nicest sounding and least scary name. it makes me think of sunshine and flowers. if i was psychotic, i think hearing clozaril and zyprexa would freak me out, they just sound angry and mean. i think i have something against the letter Z.

That's because this poll was brought to you by the letter A. Damn sales reps!!

 

[Anasazi23]

for what its worth i think abilify has the nicest sounding and least scary name. it makes me think of sunshine and flowers. if i was psychotic, i think hearing clozaril and zyprexa would freak me out, they just sound angry and mean. i think i have something against the letter Z.

Does anyone do those paid physician surveys where you have to rate all the potential names for a drug, then listen to them pronounced over real audio ? They have these extensive lists for a psych drug that's going to market, and they have the physician rate a number of names (around 25) on a number of factors, such as ease of pronounciation, what it reminds you of, similar sounding drugs, and if it reminds you of another medical term, condition, or disease. In addition, there's a section where they explain to you how a drug name can't be misleading...for example, "cureitall," or something like that. Easy way to make $25.

I have a patient who is very preoccupied with medication names, and has been treated for a very pronounced axis I/II intertwining since she was young. She's been on many, many medications, but never Abilify. When I brought this up to her, and mentioned the name, she lauged out loud and stated how "nice" it sounded. Reminded her of the word "ability." She lauged again when I said there was a drug named, "enablex," and "ascendin."

 

[Hurricane]

Does anyone do those paid physician surveys where you have to rate all the potential names for a drug, then listen to them pronounced over real audio ? They have these extensive lists for a psych drug that's going to market, and they have the physician rate a number of names (around 25) on a number of factors, such as ease of pronounciation, what it reminds you of, similar sounding drugs, and if it reminds you of another medical term, condition, or disease. In addition, there's a section where they explain to you how a drug name can't be misleading...for example, "cureitall," or something like that. Easy way to make $25.

Sounds intriguing. How do I sign up?

When Viagra came out, I remember reading that the name combined "vitality" and "Niagra" as in the Falls, because it suggests strength and romance. hee.

But back to the psych drugs... I always thought Geodon was out of left field. Sounds like a tiny car. And when I was first trying to learn them all in med school, I always got it mixed up with Zyprexa, because ziprasidone sounds like it ought to be Zyprexa.

 

[whopper]

I read somewhere that quite a bit of money was spent to pay an advertising firm on picking the name "PROZAC". Not an antipsychotic but it does show that names can sell (read FREAKONOMICS).

Geodon. Sounds like it has some type of Earth relationship. Oh well.

 

[OldPsychDoc]

Sounds intriguing. How do I sign up?

When Viagra came out, I remember reading that the name combined "vitality" and "Niagra" as in the Falls, because it suggests strength and romance. hee.

But back to the psych drugs... I always thought Geodon was out of left field. Sounds like a tiny car. And when I was first trying to learn them all in med school, I always got it mixed up with Zyprexa, because ziprasidone sounds like it ought to be Zyprexa.

Ziprasidone was originally set to be something starting with a 'Z', as I recall. Pfizer had even rolled out the name in pre-release marketing--wish I could remember it. But at about the same time Zyvox was released, Zelnorm went on and off the market, and the marketing "experts" came up with "Geodon".
I remember thinking "WTF?? It sounds like some kind of DINOSAUR!"

 

[Faebinder]

In all honesty, we are all voting without having the disease (well maybe not all of us). If you have a bad experience with the disease and your currently voted for antipsychotic just doesnt do it... I am sure the preference limit will change. Geodon would start to look good.


Having said that, I am one of the ones who voted for Abilify (although respiradone is tempting but more likely to gain weight? Lactation? Sexual dysfunction more likely? mmmm.. Can I still try Abilify? ).

 

[chaos]

Prozac is a very pleasing word to say. Prozac. Prozac.

Abilify has got to be the smarmiest trade name I have heard. I would refuse to take it for just that reason.

Probably the most unpleasant common 2nd generation antipsychotic side-effect is akathesia. Psychiatrists tend to underestimate it since it can't be visibly measured and isn't an actual health concern, but it is pretty much like being incessantly tortured. For that reason, I'd deliberately choose something sedating, like Seroquel. I might sleep all day and get nothing accomplished, but at least I won't feel like pacing around and occasionally crashing into things and/or stepping in front of traffic just to stop what feels like the constant, simultaneous activation of every nerve-ending in the body.

It will be interesting to see the side-effect profiles of the new NMDA agonists, once they make it to large-scale trials...seems like they would have a lot of 'activating' side-effects as opposed to sedating. I don't think that's necessarily a good thing. I believe the theory is that nmda hypofunction, primarily in the frontal lobe, leads to the mesolimbic/mesocortical negative feedback dysfunction in the DA system, so supposedly targeting glutamate is is a step up in cutting symptoms off at the source. However, since drug will obviously not be site-specific, I don't see how globally messing around with glutamate levels is preferable to screwing with dopamine levels.

 

[Anasazi23]

Ziprasidone was originally set to be something starting with a 'Z', as I recall. Pfizer had even rolled out the name in pre-release marketing--wish I could remember it. But at about the same time Zyvox was released, Zelnorm went on and off the market, and the marketing "experts" came up with "Geodon".
I remember thinking "WTF?? It sounds like some kind of DINOSAUR!"

A drug rep told me once during a long discussion about how in their "classes," they mention how research has determined that there are "powerful" and "impact" letters...particularly when it comes to drug names. The letter "Z" has the most impact and power, hence the overrepresented amount of drugs with "Z" names, either generic or trade.

Off the top of my head....think about what heavy hitting market drugs these are:

Zetia
Zosyn
Zanaflex
Zyvox
Zantac
Zarontin
Zyrtec
Zemplar
Zofran
Zestril
Zevalin
Zidovudine
Ziprasidone
Zithromax
Zolmitriptan
Zoloft
Zomig
Zonegran
Zolpidem
Zyban
Zyprexa
Zydis

 

[toby jones]

I don't read 'scientology' literature, I read 'anti-psychiatry' literature that has been written by psychiatrists. It is much to the detriment of the anti-psychiatry critique that the scientologists have become involved. I don't think that the anti-psychiatry claims that 'there is no such thing as mental disorder' should be taken seriously. I think that rather than an eliminativist view of mental disorder the anti-psychiatrists have an alternative view of the nature of mental disorder. In particular, they maintain that social causal mechanisms are where we get the best explanations. This is in contrast to 'the reductionist line) whereby either neurological or genetic (or both kinds of) causal mechanisms are where we get the best explanations.

I think the idea is to figure out the relative contributions of social, cognitive, neurological, and genetic causal mechanisms. In particular, to figure out how models that appeal to one kind of causal mechanism relate to models that appeal to a different kind of causal mechanisms.

I'm happy if people suggest particular reading to me, and I'm more than happy when people are able to summarise why my view is inadequate (or why I need to think about other stuff) and point me towards a reference. If you can't even do that, however, then, well... Whatever...

You need to do some more reading. And read some real stuff and not the scientology literature.

 

[toby jones]

> in one old study I saw there was a 20% response for placebo in schizophrenia vs 60% on first generation antipsychotic...

we would like the finding for that study to have been replicated at least once to show that it wasn't an abberant finding

so 40% difference in outcomes between placebo and first generation anti-psychotic.

now... what if we add increased social supports to the control (placebo) group? can we get 40% difference in outcomes by adding a supportive environment to the mix?

> the sample was on a group of inpatients for 6 weeks

so the negative side-effects (long term ones) weren't factored into this analysis (e.g., the percentage of people who developed TD symptoms longer term). not sure how we weigh those against immediate efficacy...

> not sure if the environment is what accounted for the placebo response or what.

? the control and experimental group should have been matched for environment or it wouldn't have been a fair trial - the results would have been confounded. it should have also been a double blind trial such that the patients and clinicians didn't know whether their patients were taking the active or placebo medication. there should also have been a comperable amount of clinician contact between the two groups...

> But either way, very consistent and vastly superior results for dopamine blockers compared to placebo in positive symptoms of schizophrenia.

ah. but have studies been done comparing dopamine blockers to social supports? because... that is the kind of experiment that the WHO study suggests (where two thirds of people with dx of schizophrenia recovered in developing countries whereas only one third of people with dx of schizophrenia recovered in developed countries)

 

[worriedwell]

> in one old study I saw there was a 20% response for placebo in schizophrenia vs 60% on first generation antipsychotic...

we would like the finding for that study to have been replicated at least once to show that it wasn't an abberant finding

so 40% difference in outcomes between placebo and first generation anti-psychotic.

now... what if we add increased social supports to the control (placebo) group? can we get 40% difference in outcomes by adding a supportive environment to the mix?

> the sample was on a group of inpatients for 6 weeks

so the negative side-effects (long term ones) weren't factored into this analysis (e.g., the percentage of people who developed TD symptoms longer term). not sure how we weigh those against immediate efficacy...

> not sure if the environment is what accounted for the placebo response or what.

? the control and experimental group should have been matched for environment or it wouldn't have been a fair trial - the results would have been confounded. it should have also been a double blind trial such that the patients and clinicians didn't know whether their patients were taking the active or placebo medication. there should also have been a comperable amount of clinician contact between the two groups...

> But either way, very consistent and vastly superior results for dopamine blockers compared to placebo in positive symptoms of schizophrenia.

ah. but have studies been done comparing dopamine blockers to social supports? because... that is the kind of experiment that the WHO study suggests (where two thirds of people with dx of schizophrenia recovered in developing countries whereas only one third of people with dx of schizophrenia recovered in developed countries)

I consider the inpatient millieu to be "increased social support" and the difference in groups to be a result of adding drug to that increased intensive social support. Also, TD occurs as a natural age related process of schizophrenia. Its not totally clear whether second generation antipsychotics reduce TD rates but it is apparrent that they don't cause as much acute EPS...its also unclear exactly in what capacity antipsychotics accelerate/incite the onset of TD. Because we have never just sat around a watched a group of chronic patients with schizophrenia for years and years and measured their rate of TD. It is indeed possible that they have a similar rate to those treated with antipsychotics (although I think this is a fringe opinion and I doubt this). It also should be noted that antipsychotics have historically been prescribed at doses way higher than needed for optimal dopamine blockade. This probably accounts for a large part of the difference between second generation antipsychotics and first in terms of eps and TD.

Go ahead and try that study comparing dopamine blockers to social supports (whatever that means to you) and get back to me on how it goes. While you are at it, look up the term "expressed emotion" and tell me how that affects patients with schizophrenia.

 

[toby jones]

> I consider the inpatient millieu to be "increased social support" and the difference in groups to be a result of adding drug to that increased intensive social support.

Ah. You didn't tell me that the idea was to compare people who were hospitalised and medicated with people who... Weren't either hospitalised or medicated? Was that the idea? I hope they were matched for severity at least. If this is a correct description of the study then you do realise that the positive effects of the people who were hospitalized could be due to social supports rather than medication. They have confounded two variables together so you can't tell which is responsible for the improvement. Hard to say without a reference to the study (and a bit puzzled why you cited it if it isn't supposed to be showing medication vs increased social support).

It concerns me that people are so quick to prescribe anti-psychotic medications when we don't really know what the long term side effects are going to be and where there seems to be something of a 10-15-20 year pattern. Takes about 10 years for doctors to publish case studies and / or for the word to spread that some medication might have not so nice side-effects after all. Takes about 15 years for there to be a systematic investigation into those side effects. Takes about 20 years for the prescribing practices to be curbed. By then the medication is out of patient of course and the companies have gone onto defending alternatives. (Anyone remember what the old generation anti-p rates of TD were estimated to be by the drug companies? How about rates of sexual dysfunction on SSRI'S?)

> Go ahead and try that study comparing dopamine blockers to social supports...

What concerns me is that someone who alledgedly wants to 'help' doesn't seem to give a **** about finding out about the best way to help. Wouldn't you like to know if you can help someone by providing a brief respite without exposing them to potentially harmful medications?

No?

That concerns me.