Wednesday, September 09, 2009

Please Pass the Haldol


The atypical antipsychotics are getting a lot of attention lately: they cost a small fortune and they are associated with an increased risk for diabetes and cardiovascular disease. Oh, and they make people gain weight. All bad things.

The older neuroleptics worked fine, they treated psychosis. And with the financial and medicals burdens that come with the new medications, there is now some thought (at least by some people) that we should be re-visiting the old, cheap, and in-some-ways safer medications: Haldol, prolixin, navane, stelazine, trilafon: those guys.

I remember when that's all we had. The medications worked well for stopping the acute symptoms of psychosis. I don't prescribe them as a first line now, because back then, it seemed to me that people hated being on those medications. It was a hard sell to get someone to take prolixin, in a way that it isn't to get someone to try Seroquel. And people constantly stopped their own medications. There were some other problems with the older medications, as well: people had Parkinsonian side effects and looked like they were medicated, they gained weight and stopped menstruating . There was the risk of dystonia, irreversible tardive dyskinesia and fatal neuroleptic malignant syndrome. Someone once told me that being on Prolixin was like have molasses poured into your brain. And there were always the stories of medical students who tried the stuff.

So this post is a question to you:
If you're a psychiatrist: do you prescribe the older medications as a first line? Why or why not?
If you're a patient: if you've taken both, what do you think?
If you haven't taken haldol or any of it's brothers, would you be willing to try it? Why or why not?

Thanks in advance for your responses!

17 comments:

Anonymous said...

not comfortable emailing you from my personal account, but check out this clip from Conan last night, poking fun at Pfizer...and recent trends in psych med prescribing in general. Awesome! http://www.tonightshowwithconanobrien.com/video/clips/the-perfect-drug-090809/1155304/

Anonymous said...

as an undiagnosed sufferer of agoraphobia with panic attacks for many years I was usually prescribed stelazine which did me no good at all and was still given steklazine when valium which would have helped was available

HappyOrganist said...

I'd love to gain weight, but those other side effects sound awful (sounds like it does more harm than good). I've never been on any of those medications - and the AD I was on (which was also known for 'weight gain') had me lose 5 lbs in a week. Not exactly the effect I was looking for (though in all fairness I wasn't taking it for the purpose of gaining weight). still, that would have been a nice side-effect..

Anonymous said...

I've been on both and am currently taking Haldol. I would never go on another atypical again--they made me gain too much weight (e.g. Zyprexa) and other side effects. I have bipolar I w/pyschosis and am enjoying the first real period of stability I've ever had. I don't have any major side effects from the Haldol and right now wouldn't change it or my other meds for anything.

Rach said...

Seroquel is my emergency/crisis drug of choice - it's fast acting, and powerful, and relatively short acting (though while I'm on it it makes me feel miserable). I also use it if my sleep is horribly disturbed.

I prefer not to Anti-psychotics if at all possible, if only because:
a) the side effects are numerous and often quite strong;
b) I do not want to put myself in a situation where I'm unable to function without it;
c) Because of a and b I need to cultivate coping/living strategies that minimize the use of medication and maximize other resources and supports in my life.

Anonymous said...

I am dxed with PTSD, DID, Bipolar, PDNOS. I am 52 and have been on psych meds and in and out of therapy since I was 14, including Haldol, Stelazine and currently Geodon. Both Haldol and Stelazine turned me into a zombie. Geodon has given me my life back. I wasn't really able to work during the years I took the other meds, but I now own a multi-million dollar consulting firm...all because of Geodon. Geodon, of course, is weight-neutral, unlike the other atypical antipsychotics. It took me months to find the right dosage, but it has been a miracle drug for me. I gained 14 pounds in ten days on Risperdal, and have lost weight on Geodon.

I swear I don't work for Pfizer.

Anonymous said...

No, I would never go on the Old School antipsychotics for fear of the Parkisons-like symptoms. A family member was on low dose Stelazine for 25 years before switching to Risperdal. She complained of the high cost and conned the doc into prescribing her some perphenazine. I have now noticed shuffling and intermittent TD symptoms. I have bipolar type I and I'd never take a first generation antipsychotic no matter what the prioe of the atypical rose to. Gimme a break.

Scream said...

I've taken most of the older ones and most of the newer ones. I had less akathesia with the newer ones but I had a lot more weight gain with some of the newer ones. I gained 30 pounds in 30 days on Zyprexa.

Both Thorazine (1984) and Risperdal (1998) made me lactate. Risperal also made me manic as hell. When I was 15 Haldol gave me akathesia and an acute dystonic reaction. They did not seem to give out the Haldol / Cogentin Cocktails back then, so I had to beg for shots of Cogentin.

Seroquel made me delusional and I still can't kick some of the delusions that started while I was on Seroquel in 1999. After two weeks of Trilafon, at the age of 14 I heard my first ever voices.

I won't take any of them now and luckily (sort of) for me I now have a movement disorder. Ironically the preferred treatment for my movement disorder is a dopamine agonist, so my pdoc does not try to force any of the dopamine blockers on me.

I'll stick with Xanax. It would take a court order to get me to take "anti-psychotics" again.

Anonymous said...

I've taken the meds and I work in a county hospital psych unit. From a personal perspective I could not function with older generation meds. The blood pressure changes, gastric upset, and general sedation also led to better controlled episodes than with nothing but a lot more variability in my moods and anxiety because of some of the side effects. Having Seroquel saved my life - I would rather have not taken anything than go back to older meds especially when combined with older mood stabilizers. With my patients I see a lot less tendency to spontaneously stop meds on the newer generation and they seem to see the changes in their moods more quickly. However for severe psychosis Risperdal is still our old standby and it has done better for our guys than Haldol and Thorazine with less overall sedation. When we think about cost since a lot of my patients are uninsured it is a godsend that they can get Risperdal generic for less than fifteen dollars and a medicine they can afford vs Abilify (290 was the best price I found) a month works there. But all the way back ... I don't see it as being a good thing

Anonymous said...

I can see the problem that psychiatrists are put in.

But at the same time I think psychiatrists are trained to develop the best set of skill and analytical techniques to make the best decisions/suggestions for their patients. (Remembering that patients are individuals)

For example:
1) Take a thorough history. NOTE any genetic predispositions for developing diabetes, cardiovascular diseases... or neuromuscular diseases.

2) Take into account financial insurance coverage or financial situation.

3)Also realize that anti-psychotics are almost like antidepressants.... in that one drug does not fit all. People will respond differently and have different side effects.

4)Remember to start and adjust dosages slowly so that any side effects don't become big problems.

5) Remember that you and the patient can always switch drugs.

6) Remember to present all the info to the patient and let them decide.

And by the way yes-- I have be on seroquel. Sort of the same way "RACH" described her use, (PRN and off label I guess). So because I haven't had high doses... I don't really think I have enough experience.

I unfortunately don't think it works fast enough and I do not like the daytime somnolence. (I think it has a long half life). But I guess there are worse out there.

So I guess since I am using these meds at a low dose and don't have to worry about cost... it is fine. But I would consider trying something else... almost in an experimental way. Ha!

Silver said...

I've taken Risperdal, Zyprexa, Seroquel, and Geodon for mood stabilization/psychosis in mania. Zyprexa is fairly good - but for sheer efficacy, Trilafon / Haldol were still the best for me. I was not on them for the long term - they were for acute states, for stabilization, and I would likely feel differently about them for the long term.
And I've prescribed them all. I am more receptive to Trilafon, Stelazine, and Haldol than some of my peers, I think, based on experience.
Prolixin-D/Haldol-D are amazing, and I still have patients who tell me they are the best drugs they have ever been on for psychosis. (I've never heard that about Risperdal Consta.)

And then, of course, there is the amazing wonderful Clozaril. Nice to see this moving up in the guidelines. Not an easy drug, but it's an amazing one when it works.

FooFoo5 said...

Wow, Dinah, how timely & pertinent. Somehow, it always works out...

Anonymous said...

I work in a mental hospital, and most of the psychotic patients are prescribed an atypical antipsychotic before anything else. Haloperidol is administered for the acute treatment of agitation. I suppose I'd warn the patient of the side effects and see if anything in their medical background was cause for concern before prescribing a conventional neuroleptic. As for me? I'd be willing to try anything!

Jesse said...
This comment has been removed by the author.
Anonymous said...

Haldol is a very dangerous nerve agent created by the intelligence discovered under adolf hitlers rule. It is a torture substance and there are many better alternatives. Haldol killed me and every dream and faith I ever had for and in life. Anyone who feels this drug is a solution is equivalent to a nazi or just stupid. Learn before you burn.

Anonymous said...

nobody claims but the USA Military to know actually the dna makeup of this drug it could be anything even food.

Msszsingle said...

I took Risperdal, Haldol, Trilafon, Clozapine, Olanzapine, Seroquel, Saphris, Geodon, Abilify and now the new Latuda, and would like to throw the whole lot in the trash. Side effects of all are horrible. I want to stop taking them now, but even a slight decrease in dose instantly throws me into a horrid relapse. Damned if you do, damned if you don't.