Re: Re: Clozapine effective for controlling dyskinesias in people with Parkinson's

[Guest guest]

monikawoolsey wrote:

> ne,

>

> Are you aware that this drug also poses a very high risk for

> diabetes/diabetic ketoacidosis/hypertriglyceridemia/weight gain, and

> even potentially binge eating disorder? It's up there with

> olanzapine. If this med is used it is recommended that blood glucose

> function be monitored from the onset of use.

>

, I hear you, and am NOT a fan of additional drugs for anyone,

particularly those with PD. They are often suffering from the effects of

polypharmacy as it is.

The disorders you name are very real and of great concern; but even

these may be secondary to uncontrollable dyskinesia for those with

Parkinson's disease. In extreme cases, people with dyskinesia have

literally starved because the constant movement both burned calories,

and also prevented them from manipulating eating utensils. It's not an

easy call, but I think there are times when its use is warranted.

Best,

ne

--

ne Holden, MS, RD

" Ask the Parkinson Dietitian " http://www.parkinson.org/

" Eat well, stay well with Parkinson's disease "

" Parkinson's disease: Guidelines for Medical Nutrition Therapy "

http://www.nutritionucanlivewith.com/

[Guest guest]

monikawoolsey wrote:

> I wonder if there might not be another atypical antipsychotic with

> similar therapeutic effects and fewer risks? In cases like the one I

> described above, ED psychiatrists are starting to lean toward Abilify

> (aripiprazole) as it can reduce the psychotic thinking and normalize

> eating through the back door. Weight gain is achieved without such

> metabolic risk. Maybe such a drug would have pertinence in

> Parkinson's.

The tough part is, that there is little research money available for PD,

compared to, say, diabetes, heart disease, cancer, etc. There are

around 1 million people with PD compared to many millions with the above

diseases, relatively few PD specialists, and relatively little research,

though it's a lot better than it used to be. It's also difficult to get

a sizable number of PD patients together for a meaningful study. It's

quite likely that there are useful drugs out there, that no one knows

about, because no one has ever done a study.

Having said that, however, Abilify is being used increasingly, and I

hope to have more information in future.

Regarding weight gain, this definitely can be a problem in PD; but

unplanned weight loss is common and at least as hard to manage,

dyskinesia being just one of many concerns.

Best,

ne

--

ne Holden, MS, RD

" Ask the Parkinson Dietitian " http://www.parkinson.org/

" Eat well, stay well with Parkinson's disease "

" Parkinson's disease: Guidelines for Medical Nutrition Therapy "

http://www.nutritionucanlivewith.com/

[Guest guest]

Pardon for my butting in, but - in every plan of care and decision made, the cost (risk) v. benefit must be considered. Monika, ne, you've both expressed that clearly. Rather than scare away patients, these considerations should be evaluated by all the healthcare providers prior to disclosing/discussing with the patients/clients.

Digna Cassens, MHA, RDhttp://groups.msn.com/RDForum

Re: Re: Clozapine effective for controlling dyskinesias in people with Parkinson's

monikawoolsey wrote:> ne,> > Are you aware that this drug also poses a very high risk for> diabetes/diabetic ketoacidosis/hypertriglyceridemia/weight gain, and > even potentially binge eating disorder? It's up there with > olanzapine. If this med is used it is recommended that blood glucose > function be monitored from the onset of use.> , I hear you, and am NOT a fan of additional drugs for anyone, particularly those with PD. They are often suffering from the effects of polypharmacy as it is.The disorders you name are very real and of great concern; but even these may be secondary to uncontrollable dyskinesia for those with Parkinson's disease. In extreme cases, people with dyskinesia have literally starved because the constant movement both burned calories, and also prevented them from manipulating eating utensils. It's not an easy call, but I think there are times when its use is warranted.Best,ne-- ne Holden, MS, RD"Ask the Parkinson Dietitian" http://www.parkinson.org/"Eat well, stay well with Parkinson's disease""Parkinson's disease: Guidelines for Medical Nutrition Therapy"http://www.nutritionucanlivewith.com/

[Guest guest]

monikawoolsey wrote:

> ne,

>

> This whole area fascinates me. Schenck, sleep scientist with

> an interest in night eating, uses a lot of Parkinson's meds with his

> sleep disorder clients. After reading about the sleep problems that

> these drugs cause in Parkinson's I understand why he does.

>

> Also, knowing how dopamine relates to both sleep and eating, it makes

> total sense that you can't just separate the two and try to treat

> one. recently told me he thinks I could fill an entire

> newsletter on just sleep and eating...so I have taken him up on the

> suggestion and we are working on such an issue.

>

> Sounds like we could look at Parkinson's as well some day! The more

> connections (and off label uses for these meds) we can find the more

> likely it is that someone will want to spend money researching your

> favorite people. :-)

that, Monika!!

Best,

ne

--

ne Holden, MS, RD

" Ask the Parkinson Dietitian " http://www.parkinson.org/

" Eat well, stay well with Parkinson's disease "

" Parkinson's disease: Guidelines for Medical Nutrition Therapy "

http://www.nutritionucanlivewith.com/

[Guest guest]

nne Koritz wrote:

> hi- upon reading all your concerns with the useage of drugs by our

> doctors- i invite all of you to read Death by Prescription and then

> start giving it to the docs to read, that you work with. I don't think

> anyone realizes the implications of using only drugs to treat a

> patient. Patients are human beings with needs that drugs cannot always

> " cure " . Have any of you looked into the use of omega fatty acids for

> depression. I have a patient that has been able to decrease his dosage

> of depression meds since starting taking omega fatty acids.

Re omega-3 and depression, yes, in fact I have written an article on PD

and depression, including use of fish and fish oils. Thanks for bringing

it up!

Best, ne

--

ne Holden, MS, RD

" Ask the Parkinson Dietitian " http://www.parkinson.org/

" Eat well, stay well with Parkinson's disease "

" Parkinson's disease: Guidelines for Medical Nutrition Therapy "

http://www.nutritionucanlivewith.com/