Getting a prescription for antipsychotics with the least side effects?
January 14, 2018 9:44 AM   Subscribe

Asking for a loved one with a diagnosis of schizoaffective disorder.

The person was on risperidone, which caused a weight gain of 75 pounds. They got off of that and have lost half of the weight so far, and they were switched to a very low dose of haloperidol but even at the low dose it causes tremors and extreme sedation. Benztropine is being prescribed .5:1 to mitigate the extrapyramidal symptoms of the haloperidol but they are still occurring. Does anyone have suggestions for something better (whether a different dosage or med) that we can discuss with a doctor?
posted by Beethoven's Sith to Health & Fitness (8 answers total)
 
This is not the type of thing internet strangers can do, because internet strangers are not your (family member's) psychiatrist.

Antipsychotic medications are very difficult to 'get right' and require, oftentimes a frustrating degree of trial and error. Specific combinations given out in the internet are going to work just as well or not as combinations of medications dictated by a psychiatrist. This type of medical treatment is largely trial and error until something works. Which sucks, and your family member should have a great therapist to help work through that. The trial and error process is sometimes long and usually terrible, and super discouraging.

You might want to look into genetic testing for clues to what medications might be tolerated over others, but this science is in its infancy, and inherently unreliable. Not every psychiatrist uses these or trusts them yet (again, the technology is not mature yet and not covered by insurance in most instances). I've had a profile worked up, and it showed a couple medications as being flagged for "okay" but I ended up having drastic reactions to them.
posted by furnace.heart at 9:59 AM on January 14, 2018 [6 favorites]


Oh, my workup was for anxiety, depression and PTSD symptoms, which are typically 'easier' to treat than more complex mental health disorders. It took over s year to find a combination that worked for me, it could very well take longer for a psychiatrist to work through the appropriate medications in this case.
posted by furnace.heart at 10:03 AM on January 14, 2018


Yeah, sadly this is something that is totally dependent on the individual.

There was a medication I used to take longterm that in my had NO side effects whatsoever. One of my children (as an adult) had to take the same med (for a different condition) but she found it intolerable with many side effects. YMMV.
posted by St. Alia of the Bunnies at 10:49 AM on January 14, 2018


Like furnace.heart says, this is really not a category of medication where it makes sense to follow strangers' recommendations. (It's also, unfortunately, a category where literally everything has really shitty side effects for at least some people, and where predicting who will get those side effects is basically impossible. So it's not like there's some Good Stuff out there that your friend's doc is holding out on them.)

If you want to help by getting recommendations for your friend, I'd look for recommendations for psychiatrists in their area, not for recs for specific meds. New meds and new research are coming out pretty steadily, and having a doctor who stays up to date on stuff can make a big difference.
posted by nebulawindphone at 10:52 AM on January 14, 2018


Finding a really good psychiatrist makes a difference but it can be hard to do, especially if you are trying to stay in-network with your insurance.

The best we found was part of a residential program that focused on the whole person, not just the medication. One thing he did was to recommended some specialized genetic testing focused on tests relevant for prescribing for mental health issues. It was fairly expensive (hundreds of dollars). Most of what we learned we had already figured out but the big thing was an issue with overproduction of COMT. Putting the person on a COMT inhibitor resulted in a very clear improvement in executive functioning which in turn helped her make better choices which improved her quality of life. Apparently this is a goldilocks thing - too high is as bad as too low so you don't want to take the medication unless you have reason to believe that you need it.

The other thing that we got from the same doctor was recommendation on diet and supplements that had scientific research to show (or at least suggest) that they would be helpful.

None of this replaced the traditional medications but provided incremental help. The net results of all of the many adjustments was the she went from nine psych medications (depression, anxiety, psychosis, sleep) down to six and those were at about half the level they had been when she was admitted to the program. You can see why I am so grateful to that doctor and the larger program!
posted by metahawk at 11:57 AM on January 14, 2018


Do they need meds for the psychotic symptoms, the depressive symptoms or manic symptoms?
Here is an article that describes different meds for different symptoms.
The doctor could try adding topomax or metformin to help prevent weight gain.
Instead of antipsychotics have they tried therapy, support groups, social skills training?
posted by SyraCarol at 2:04 PM on January 14, 2018


Rexulti and Vraylar are newer antipsychotics that have fewer weight-gain side effects; I can't speak to EPS symptoms. Your friend should discuss those options with their prescribing physician.
posted by lazuli at 8:30 PM on January 14, 2018


And for a long time the assumption has been that people with psychosis just need to put up with the weight-gain and TD or EPS side-effects. The medications have been advancing and there really are better options now, in terms of unintended side effects. Good for you for advocating for your loved one.
posted by lazuli at 8:33 PM on January 14, 2018


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