Researchers at the UK’s NICE center found that the atypical or second-generation antipsychotics do not constitute a special class. In Dr. Kendall’s view, the distinction is merely a marketing tool used by the pharma companies to justify higher prices and sell more of the newer medications.
“In selecting a medication, Dr. Kendall said we should ask our patients, “Would you rather be fat or stiff?” because the decision often comes down to whether patients can better tolerate extrapyramidal or metabolic adverse effects. An exception is clozapine, which falls into the “fat” category but remains the choice for treatment resistance”
Although the price of antipsychotic medications can vary widely, the model found no significant difference in cost effectiveness among the seven antipsychotics included in the analysis (amisulpride, aripiprazole, haloperidol, olanzapine, paliperidone, risperidone, zotepine). The driver of cost is relapse and hospitalization; drug-acquisition cost plays a minor role in the overall expense of a patient’s care. The lesson is that whatever medication a given patient is willing to take and can tolerate may improve adherence, reduce relapse, and save the immense price of inpatient treatment.
I don’t think the difference is between ‘being fat or stiff?’ It’s how each medicine affects the mind and which the patient feels more mentally comfortable on.
I will be switching meds in about a week - because of some serious side effects.
I will not be excluding some of the typicals in our conversation.
The typicals cause less metabolic issues than the atypicals - having diabetes and being overweight makes me a good candidate for taking a typical.
Thanks @SzAdmin for this important piece of info
I was “raised in the system” when the idea was to pump you so full of Haldol that you could inhale a few milligrams through the ventilation system. No atypicals around. Most pdocs I’ve encountered will confess some people only respond to typicals. That is the case with me. While I’m not on 80 mg of Haldol anymore, I still take it to this day. I will never want off of it, save for the emergence of TD or other dastardly side effects. So long as it works, I will take it. Some idiots in the anti-psychiatry field will say it’s the epitome of a chemical lobotomy. It isn’t. It’s not for everyone, but it works for me. Thank goodness it is still available. For me it is indispensable.
I think you’re right - but its probably a combination. What medication works well from a mental standpoint - but also which physical side effects are most tolerable to a person.
I’m more likely to quit taking a medicine because of mental discomfort rather than physical. And it’s not be stiff or fat - it’s get tardive dyskinesia or metabolic disorders.
For me the atypicals are hands down better than the typicals. Life on the typicals isn’t really life. If they ever try to put me on a typical med I’m going to refuse to take it. If I have to live on the streets so be it. I can’t help but wonder if that study wasn’t skewed against the atypicals with a mind towards cutting costs of treatment. As the atypicals come more into use their price will come down. I’m on Geodon and Seroquel right now, and I’m doing fine. I think both drugs have gone generic, so their price has come down.
I can’t wait for my Saphris to go generic. I have Medicaid so its paid for, but I still get anxious about losing my healthcare. It’s over $1200 a month! I’ve never tried a typical AP, I have nightmares of my time on Clozaril when I was a zombie. And that is toted as one of the best atypicals.
It took a combination of a typical and an atypical for me to reach a acceptable level. It also took a lot of other psychotropics to reach this level. My old psychiatrist said when new generations of drug come out they always promise better efficacy with less side effects. However they often find efficacy to be comparable of last gen drugs and they often generate different kind of side effects.
I think it is just a combination of persistance, durability and luck to find the med (or combination of meds) that gives you your life back
I was placed on a typical once before in my life - It was during my first psychotic break.
The drug I was on was Navane - it reduced me to a zombie, I was literally staring at the ceiling as my hobby - just laying in my bed - not being able to enjoy or do much of anything. I suffered from awful EPS - my left hand was tightly curled into a knot like position - I was basically reduced to being a robot - I was very flat and emotionless.
This was not a very good experience for me, I dont remember being on a very high dose either.
Hopefully other typicals like Haldol will not be the same way - I am kind of frightened to try a typical again to be honest - I am very med sensitive and I seem to get most of the side effects - full force.
Not too many psychiatrists prescribe the typicals any more - especially the private ones.
I mean I was given an a typical in the early 80s - 2015 is a different story - and this is a shame because drugs like Haldol and perphenazine are good drugs.
I really dont know what to do concerning my medication switch next week - I will just have to trust my psychiatrist on this one. I have eliminated certain APS just based on their side effect profile - I mean I really do not know how akathisia or anxiety as a side effect is going to help me in any way - my anxiety levels are pretty bad as it is - any drug remotely similar to Abilify, and I just wont take it. I was really deluded into thinking that I could try Abilify again the second time around and I would be fine
All the typicals were pure hell for me, especially Haldol. When I was on Haldol dec. I was just existing. For me, Abilify is hugely better than any typical. If they tried to put me on a typical again I’m not sure I could face that. I would probably choose to live on the street and be psychotic.
I see my pdoc in less than a week, and i have to switch over to another antipsychotic - I do not have a lot of options.
The thing is that I have a serious complicated form of bipolar disorder - I cycle very fast and have mixed episodes - I become delusional and hallucinate frequently, because my moods are rarely stable when I am on a low dose or the wrong med.
I do think that she will be forced to consider the typicals for me - I have decided to refuse Latuda and Saphris - these are the 2 choices she has been throwing at me for the last couple of months.
The reason why I am refusing these 2 antipsychotics is because Latuda is basically an atidepressant/antipsychotic
It is very activating and causes a lot of anxiety and akathisia - Not a good med for someone like me who experiences a lot of crippling anxiety and panic attacks - I am always on edge. Latuda is not FDA approved for Mania or mixed episodes - just for schizophrenia and bipolar depression.
The reason why I will not be trying Saphris is because it is also another antipsychotic based on an antidepressant drug - an older antidepressant not approved in the USA - Mianserin.
The bottom line is that antidepressants and antidepressant type drugs destabilize me and keep me very stimulated and anxious and hypomanic/manic.
Now I really dont know what my pdoc has in store for me - I will not try Fanapt because of the cardiac risks -
This basically leaves me with the older APs like Haldol, perphenazine, thorazine etc…
I doubt that she will approve, but I am reconsidering going back to olanzapine - Zyprexa started to be stabilizing for me at 7.5 mg - but I may ask if I can go on it at lower doses maybe minimizing the weight and diabetes issues.
Man I am so confused -
I was on the typical drug Prolixen for more than 20 years. It sedated me at work but luckily I was young and my natural vigor at that age made it possible to keep my job. But yeah, after about 10 or 15 years the side-effects did not bother me. I unloaded large trucks for 4 years at Sears when I was in my mid-thirties. and I was one of the best on our crew. I worked my ass off at that job. I remember that we got a new guy and he saw me working hard and fast and he asked my other co-worker if he had to work as fast as me. My co-worker just said, “No, it’s just that this guy has nuclear energy”. But I am not denying your experience on typicals. It’s just that there are exceptions to your expediences.
Yes like I stated before, I have only been on one typical before as maintenance - Navane.
I was also shot up with a high dose of Haldol in the Hospital, and that ■■■■ brought me down to earth from a severe mixed state in a few hours - very effective.
I may have to take another typical if need be - I am willing to try, if my doctor mentions it - but only at lower doses, maybe the Navane dose was pretty high - I really forgot, it was decades ago.
I am very curious about trying Haldol or perphenazine - My pdoc will have a lot of influence on my decision, when it comes to the typicals
i tried haldol at 100mgs for about two or three months, it did nothing for me except make me lay in bed all day…i took it up to 150mgs for a month but i simply couldn’t cope with being glued to the bed as i call it. i then switched to abilify and i’m still glued to the bed. it’s like i haven’t recovered since taking haldol at all, though i don’t know if this apathy is due to the drugs or something else entirely. guess we’ll just have to wait and see i suppose. i know i’m not exactly a whirling dervish in the housework department but i was 100% better than i am now before i started taking haldol. like i said, i don’t know if it was the haldol’s fault or something else entirely. right now i’ll stick with abilify even though it does ■■■■ all for voices…if there is no change in a few months i’ll try something else i think. i don’t really mind whether it’s typical or atypical, just so long as i don’t get fat again.
