Expert: Ivan Goldberg, M.D. - 11/10/2010

Question
Dr. Goldberg-

 I have been diagnosed with Bipolar type I w/ Psychotic Features. After failed trials of anticonvulsants, I ended up taking Abilify, which is working nicely for me. I am worried about TD, though.  My doctor says Abilify is "the best thing on the market" and that TD is a rare side effect. Do you agree? Are there other drugs (besides Clozapine) that would have a lower TD risk? I was thinking about switching to Seroquel if Seroquel's TD risk is lower.  My doc advised me to take antioxidants, including vitamins E and C, to help prevent TD. Thanks for your help.

Ian  

Answer
Hi, Ian . . .

I have no doubt that some people with psychotic forms of mood disorders require treatment with antipsychotic medications. As i do nt liker to prescribe such medications I will usual;ly try people on complex "cocktails" of mood stabilizers prior to using an antipsychotic. The combination of lithium, Trileptal, Depakote and Lamictal has often worked when those drugs taken individually or in pairs were not helpful.

It is pretty clear that the newer antipsychotics such as Abilify are less likely to cause TD than older medications such as Stelazine or Trilafon.  I am not aware of any evidence that establishes that Abilify is less likely to cause TD than Seroquel. The evidence that vitamins protect against TD is not good either.

Best regards . . .

Ivan
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