In theory antipsychotic drugs (APs - also called neuroleptics, major tranquilizers, and the ever-so-charming “chemical straitjackets”) should the easiest of the crazy meds to take. They can be rapidly titrated (increase the dosage) if needed, their side effects are consistent, you can take them as required (PRN), if you stop taking one and try it again years later1 it usually works just as well as it did the first time. If you have to stop taking one immediately the worst problem you can expect is usually rebound symptoms - where whatever you were taking the drug for comes back, but is a lot worse - but eventually tones down to however bad it was before you started taking the med.
First there’s the stigma. There seems to be a hierarchy of craziness, and while it’s bad enough to be labeled as mentally ill with depression or panic/anxiety it’s a hundred times worse to be bipolar and a million times worse to be schizophrenic. Would everyone please get the fuck over it already? Illness is illness, we are not possessed by demons and nobody is going to catch our cooties, as these are not contagious illnesses. Genetically transferable to children, perhaps. Unpleasant to be around, definitely. But not contagious. OK, we can certainly drive our friends and relatives crazy with our behaviors, but it’s not a long-term crazy like we have. Anyone with one mental illness most certainly shouldn’t be looking down on someone else with another mental illness for being crazier than thou. Stigmatization ends at home. Yet plenty of people in the heavily stigmatized bipolar spectrum are resistant to taking antipsychotics because they’re not, you know, psychotic. Except, technically, we are. Or were. For a long-ass time manic-depression was classified as a form of psychosis, and that is the era where thinking that people with psychosis-spectrum conditions are somehow even less human than the rest of us with other flavors of brain cooties belongs.
Next there’s the cost. While the older First-Generation APs (AKA typical or standard APs) aren’t that expensive, the newer Second- & Third-Generation APs (AKA atypical APs) are some of the most expensive drugs in the psychiatric pharmacopoeia. Fortunately several of them are now available as generics, including Zyprexa (olanzapine) and Risperdal (risperidone). If you’re paying out of pocket for brand drugs still too new for a generic version to be available, it’s possible that a prescription for something like Saphris could exceed your mortgage.
What is a big deal is to avoid alcohol with antipsychotics. Turns out it’s not as big of a deal as I thought it was. It’s stupid to drink heavily while taking antipsychotics, like I did when I was first on Risperdal, as I still think some occasional heavy drinking contributed to my nervous breakdown on or about my birthday in February of 2002. Yet it’s smart to take antipsychotics if you drink heavily all the time. What? APs can keep you from frying your brain due to excessive drinking. Your liver might explode sooner, but at least you might have it together enough to be living in an SRO instead of a cardboard box when you get to that point.
Mixing alcohol and benzodiazepines can be fatal. Mixing alcohol and anticonvulsants is weird. Mixing alcohol and most modern antidepressants is generally not a big deal.
However, mixing alcohol and any crazy med is always going to be unpredictable. Here is an example of what a couple of glasses of wine and a low dosage of Seroquel (quetiapine) can do to someone in distress and looking for support on an Internet support group. Normally this person can type proficiently:
siorry jmy popst lioikds l;ielk i am druikn
i dont driglk
i am toooo tired ot tyo;pw
i dolnt droinkkkkk
mky yese asre all mlessed ujp form anothner drugnnnnnnnand i haove a sevfer
healtdcalcl]] myua got toe er donot nfelel l ewelll at allllllllll
strfated birth donltroel pil;ls as fewa daYs ago
tye agian tomoerowow
Then, twenty minutes later:
theklank s brina
i have nbmb halnds and at heatdacah e
form new pillllllllllls well lsee dr tabout that domtoorrow
what isss keoppera?
caleed nursre aboutj mmmmy porblem wriantnng and wiath the bumv b’handedss
wils se dorctor tomeorw
headabke very bnead anow to gbed now
gonit wondw worry pplaese
One great thing about antipsychotics is that you can take them as required (or PRN in medical shorthand). Feeling just a bit too anxious or manic? Try some Risperdal (risperidone) or Zyprexa (olanzapine) instead of increasing your normal amount of benzos or mood stabilizers / anticonvulsants. Once you feel stable, you can just stop taking the extra antipsychotics. Let me stress the extra part. If an antipsychotic is your primary medication and you’re feeling just great you have to keep taking your maintenance dosage, whatever that may be. Now you can discuss with your doctor about taking a lower dosage and seeing how that works out. These meds are very flexible when it comes to dosages. Go up, go down, in the long run it turns out to be OK as they are far less picky than the anticonvulsants.
Even though I was skeptical at first and thought the real reason for pushing antipsychotics for bipolar and anxiety was money, I’m starting to come around to them. On the bipolar side of things several act as true mood stabilizers for some people, helping with both mania and depression. They are perfect for the non-compliant, which defines the schizophrenic and bipolar, as some have long half-lives and they work just fine if you stop taking them and start up again. The combination of atypical antipsychotics and antidepressants is being shown to be the best thing since sex to combat bipolar depression and refractory unipolar depression.
The withdrawal has been likened to taking small amounts of psychedelic drugs. Whether that is a good or bad thing is up to individual experience. Others get rebound symptoms for a day or two, sometimes longer and that’s about it. Of course, that’s for issues where it’s OK to stop taking meds at some point, like panic/ anxiety disorders. The big problem is that the bipolar and the schizophrenic are the worst about stopping their meds because they think they’re cured when their symptoms stop. Wrong answer! Your symptoms stop because the meds are working. As of the early 21st century there are no cures for these disorders, just management of symptoms. The good news is you can just start right back up on the atypicals and get back to where you were in controlling your symptoms.
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1 With a fresh prescription that is. After 3-4 years practically all crazy meds begin to break down and lose effectiveness, some a lot faster than others.
Tips on Taking or Discontinuing Antipsychotic Drugs (APs) by Jerod Poore is copyright © 2011
Page created by: Jerod Poore. Date created: 12 July 2011 Last edited by: JerodPoore on 2014–05–22
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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.
2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.
3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas? I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion of anonymity. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.
Author: Jerod Poore Date Modified: 2014–09–01 Date Published: 2011–07–12