Expert: Ivan Goldberg, M.D. - 11/17/2009

Question
Dear Dr,
I was given Geodon 60mg for bipolar depression (with mild psychotic features). It worked very well but I had to give it up after about 1 year. This is because I developed genital pain which could have been a rare, yet possible manifestation of TD. http://www.ncbi.nlm.nih.gov/pubmed/7969969?ordinalpos=4&itool=EntrezSystem2.PEnt...
I had no other symptoms of TD and upon stopping the Geodon, the pain vanished rapidly.

My psychiatrist has now suggested Abilify. If I have developed a possible TD reaction to one atypical in the past, does that mean I am more likely (than the average person) to develop TD (in any form) on another one?  Especially Abilify? Or are the mechanisms of TD induction different for each anti-psychotic?

Thank you very much for your time.

DM

Answer
Divya . . .

I am familiar with the concept of tardive pain and have no doubts about its authenticity.

All antipsychotic medications, with one exception, are essentially similar in their ability to induce TD. The exception is clozapine which often is used to treat the symptoms of TD.

In my practice I reserve the use of antipsychotic medications for people with psychotic symptoms. When I have  patients with the triad of TD, bipolar depression, and psychosis, I usually treat them with the combination of lamotrigine and clozapine.

Best regards . . .

Ivan
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