Antipsychotics when you're not (yet?) psychotic...

May 8, 2009 7:35 PM

Antipsychotics-filter: A conversation with a friend has me turning to the hive mind.

Feeling out of sorts for a year prompted my friend to see a psychiatrist. Her symptoms (foggy mind, problems with executive mental tasks, dull emotions, fatigue) and family history (sister has schizophrenia) led the doctor to consider that while she has no positive symptoms (hallucinations, delusions) she might be late prodromal (pre-schizophrenic) and is now considering treating her symptoms with low-dose antipsychotics. Looking around online, it appears that antipsychotics come with hefty side-effects. Our question is a 2-parter: 1: What is the rationale in treating someone before it's clear they have developed (or will develop) a psychosis? And 2: Do you have experience taking these drugs (especially for reasons less severe than schizophrenia or bipolar disorder)? Thanks so much, everybody.

posted by specialfriend to health & fitness (8 comments total)

Check your MeFiMail.
posted by twiggy32 at 7:45 PM on May 8

This wikipedia page links to some papers that give the rationale.
posted by Houstonian at 7:55 PM on May 8

Antipsychotics is kinda a vague term. Which ones have you guys been researching?
posted by mu~ha~ha~ha~har at 12:43 AM on May 9

Well, the longer that you delay treatment, whether it is medical, psychological or mixed treatment, the worse the outcome tends to be. So if you can get it treated early then the chances of it blowing up into a terrible, degenerative life-destroying disease are much lower. There seems to be a theory that if you get it very very early (i.e . earlier than would be detectable via routine clinical presentation) then the chances of something approaching a complete cure becomes much higher again.

On part 2, I've seen a one or two people with closed head injury take one of the minor antipsychotics (Stelazine iirc, this was a long time ago) but it didn't seem to be terribly helpful for them and exacerbated their other mental problems. On the other hand these were people with actual physical brain damage.
posted by singingfish at 2:19 AM on May 9

I take an anti-psychotic med off-label for depression. I take a newer one with few side effects. The only big side effect is sleepiness, so I take it at night.
posted by RussHy at 4:06 AM on May 9

I was on Seroquel for a while (for bipolar disorder II, which doesn't generally escalate to full psychosis). Antipsychotics aren't all made equally. In general, the older ones (e.g. Haldol, Thorazine) have a much, much scarier side-effect profile, including things like tardive dyskinesia. The new ones are less scary, though some of them cause problems like weight gain and increase the risk of developing diabetes.

To be honest, Seroquel kind of sucked for me. It was very sedating and consistently made me feel awful. It also caused wacky sexual side effects. On the other hand, it made perfect sense to try it and I had a supportive psychiatrist who was working with me to find appropriate medications. So, after giving it a reasonable trial period, we moved on to something else. I know other people who have had better experiences than I did.

It's definitely something your friend should bring up with her psychiatrist. Is the medication intended to help with her symptoms or purely as a way to prevent possible psychosis? And if it doesn't help with her symptoms, does that exclude the diagnosis? What's the plan if it doesn't work? How long does the psychiatrist expect her to stay on the medication if it does work?
posted by xchmp at 4:21 AM on May 9

My son's psychiatrist suggested a low dose of risperidol (probably the antipsychotic with the least side effects) when he was just delusional. He did not follow the suggestion and he became a full schizophrenic in four years.

From a support group for family members of people with mental illness I have learned that all antipsychotics have side effects: a close relation with a psychiatrist is a necessity, to monitor side effects and efficacy, since not all meds work equally on all people.

Best wishes to your friend.
posted by francesca too at 6:18 AM on May 9

Is it Abilify? Because it is being marketed as an adjunct for depression therapy. The marketing suggests it helps with those kinds of symptoms.
posted by gjc at 6:34 AM on May 9