Abilify (apripazole) is a “second generation antipsychotic” (SGN’s). It’s also really expensive (approx $500/month – no generic).

For folks who need a second-generation antipsychotic, Abilify appears to have two potential advantadges (one of which can be life-saving/life-sparing)

(1) Far less likely to cause sedation: so much less likely that just about all the patients I saw had to take it in the AM. If taken at night it would interfere with sleep.

(2) Appears not to increase blood sugar/lipids (triglycerides/cholesterol). This is the life-saving/life-sparing part. In three different Northern California public health “systems” (Catholic Healthcare West / SF County MH / Santa Clara County MH) over the last five years, I’ve seen patients with increased lipids and MARKED increase in blood glucose after starting some SGN’s.

The second SGN to come on the market in the US (Zyprexa: generic name — olanzapine) so reliably caused increased blood sugar that I call it “diabetes in a pill”: I saw oodles of adults who didn’t require medical teatment for adukt-onset diabetes (DM II) or high lipids before starting Zyprexa, but required it within a year or so after starting te drug. The process — or descent — was often documented in their charts. This didn’t surprise me: these risks were well described as early as 2001.

{Failure to document the reasons for choosing a “diabetogenic” SGN — much less document informing the patient of the risk/benefit ratios and potential alternatives — completely appalls me. Nevertheless, that appears to be to be the de facto “community standard” in the public systems I have observed outside of academic med centers. I last practiced in academic med centers before moving to Northern California.

caveat emptor}

In any event, the SGA’s (with the excepttion of apripazole and one other agent) are associated with increased serum glucose (blood sugar), increased lipids, and (what appears to be) decreased power of our natural insulin to control our blood sugar (fancy name for this is insulin resistance: our bodies ignore our own insulin).

Press reports indicate Lilly (manufacturers of Zyprexa) was aware of the drug’s effect on glucose/lipids before it was used on a widepsread basis.

Anyway, I don’t suggest folks on long-term non-apripazole SGA’s for psychosis or bipolar disorder abruptly stop their meds: that leads to almost certain relapse. Please — for those peeps — work with a doctor if you have decided to cahnge meds: don’t stop them abruptly.

OK – in which folks might antipsychotics be useful?

Well, broadly speaking, antipsychotics help with:

Thought disorders (psychotic disorders)

Bipolar disorder not responsive to lithium and/or anti-convulsants.

WRT to thought/psychotic disorders:

A very large study called the CATIE study (see Psychiatric News at psych.org) looked at SGA’s vs a “first generation” antipsychotic (perphenazine, aka Trialfon) for patients with the thought disorder (psychotic disorer) called schizophrenia.. The study did not include Ability/apripazole.

The CATIE study does seem to show that — in general — SGA’s are no better than “first generation” antipsychotics for schizophrenia. Also, the first generation don’t cause adult diabetes and increased lipids (unlike many of the SGA’s).

[deep in the weeds: the “first generation” antipsychotics include three groups:

1: “low-potency” (includes thorazine — very sedating)

2: “high-potency/lower affinity” (includes perphenazine/Trilafon — far less sedating; some risk of movement side effects {TD = chronic / akathesia - acute})

3: “high potency/higher affinity” (includes haloperidol/Haldol — far less sedating; greater risk of movement side effects {TD - chronic / akathesia - acute})]

Please note the CATIE study compared perphenazine with the SGA’s, but did not include apripazole.

PS:

(1) I have no financial interest with any drug/medical company.

(2) anyone concerned should check with their doc(s) before starting/stopping psych meds.

(3) Cognitive-behavioral and other “talking therapies”, in general, decrease severity of symptoms and hence total need for meds in thought/mood disorders.

_____

Hope this information helps. It is based on info derived from groups: individuals may find their experience varies.

Good luck!

GE trees? Yeesh…

I have faith though that we’ve had several years or various technologies in use already, and have learned a lot from that. Something like ethanol was too rushed, and many now realize it’ll harm more than help if it’s not done right, and others like this. We can be smarter now with which approaches will be most beneficial.

The two-hundred year projections Nordhaus describes use a “discount rate” for the future, and I won’t attempt to explain it, other than to point out that he uses a discount rate of 4%, which is the “conventional wisdom” of economists. The models compare the costs of a policy against the costs of the damage due to climate change.

The “Business as usual” approach is scaled to be “0.”
The Kyoto protocol is rated at +1 with US participation, “0″ without US.
The “optimal” policy is rated as +3.

The ambitious proposals have large negatives (-15, -21), meaning that the large initial costs do not yield sufficient benefits. Dyson calls the results of the ambitious proposals “disastrous”.

The “low cost backstop” proposal comes off very well (+17), but it’s specifications are vague and there are questions about its achievability. It is based on the assumption that such a low-cost technology will become available. Nordhaus speculates that this technology might include low-cost solar power, geothermal energy, climate engineering, or genetically engineered “carbon eating” trees. Yeah, right.

This has political implications, because Gore is being touted by some as Obama’s special energy czar. You can bet Republicans will glom onto the Nordhaus study as evidence that the Gore proposals just cost too much, and don’t produce much bang for the buck. On the other hand, investing in energy technology, which certainly merits considerable investment, depends on questionable technologies. I mean, come on: genetically engineered carbon-eating trees? All trees are, to some extent, “carbon eaters,” because they absorb CO2 from the air and turn it into plant material. But he’s talking about trees that do this kind of thing on a more massive scale.

Well worth reading!

Bob in HI

but – rather than destroying the party, perhaps the DLC embodied the party?

Well yes, that’s what I think happened and that’s what they wanted. That’s why I use the word “destroy,” since a DLC takeover of the Dem Party means DemocratIC principles are gone.

I wonder if we’re having a communication disconnect through the Toobz. I think bringing up the the New Deal reinforces my point, since while we’ll usually side with Dems, most of the Liberal blogosphere is is pretty independent as well. That’s why there are things like Blue America.

I think we can effect the kind of change those “outside” groups did for the New Deal today, provided we stay motivated and grow our ranks.

I’ll sign off with a quote from the always unwelcome Arthur Silbur, who has had a great streak of posts and essays lately:

In “The Fatal Illusion of Opposition,” I wrote:
In the final scene [of a common fictional scenario], we learn the truth: the victims’ defender had been working for the villain all the time. The defender had never been on the side of the victims: instead, at every critical juncture, he made sure to misdirect the victims’ efforts just enough to make certain that the villain was never seriously threatened. The defender had to do this subtly; he had to lie on every matter of moment, and he had to do so repeatedly. He did all this expertly, and the victims never suspected his actual goal. The defender is handsomely rewarded for his work, for he delivered the victims into the villain’s power, making certain that the victims would never again be a genuine threat. And the illusion is complete: even after they had lost and their lives had been destroyed forever, the victims never doubted their hero or the fact that he had fought for them so bravely.

doc, you ever heard of Abilify? I’m watching the commercial – seems to be for mood swings/bi-polar disorder…

“Side effects may include high fever, uncontrollable muscle movements, high blood sugar which can lead to death, elderly people with dementia have an increased risk of death or stroke, call your doctor if you have increased mood swings or thoughts of suicide. Other effects may include impaired motor skills, difficulty in standing and/or swallowing.”

“Ask your doctor if Abilify is right for you”.

Well – I’m sold!! where do I sign up?