Antipsychotic drug implant

A major problem with antipsichotic & anti depressant drugs is that the users are prone to alter their doses in the absence of professional counsil. In my case, I just chose to ditch the antidepressant and learn to deal. After a few months of “uncomfortable” side effects of quitting cold-turkey I am able to get by. Granted, it takes a bit of effort as I am basically ignoring the majority of my natural impulses to do things like stay home from work and sulk in the closet and avoid my wife and kids whenever possible. But everything is more or less fine.

Should my brother someday make the same decision regarding his antipsychotics his life will change dramatically regardless of any effort he may (or may not) feel compelled to apply. He’s basically a tiger on a medicine-leash.

Which leads me to the question: since the consequences of psychotics failing to take their medicine is so terrible, has any effort been made to develop a long term implant like we have for certain female birth control drugs?

I’m envisioning a 3-part subdermal implant:
Part I: 7 month time release dose of a given antipsychotic or antidepressant
Part II: 8 month time release dose of an incapacitating/discomfort-inducing drug (Motivator)
Part III: 6 month time release dose of an antidote to Part II.

Parts II & III would be used for individuals at risk of severly disruptive behavior in the absence of the drug (violent nutjobs like my brother, for instance). The idea being that if they fail to freshen up their implant they will be “physiologically encouraged” to do so.
Part I & Part III are part of the same implant. Part II is implanted inside the body cavity and not readily accessible to the patient. Should the patient remove his antipsychotic, he will also be removing the antidote to his “motivator.”

Is this a viable drug regimen? What examples exist of a drug combination for Part II & Part III that, when taken together, produce minimal side effects? I am not interested in discussing the ethics of such a routine just yet, just wanna know if it’s possible/been done.

All I have to say is OH MY GOD! :eek: :rolleyes: :wally :confused:

Have you ever heard of ETHICAL standards in medicine? These people do have a legitimate disease you know. It is their right (although not a good idea) to go off of their medicine if they want to or even refuse all treatment.

Plus, the drugs don’t exist for II and III in combination.

Based on my own experience on these boards, I’m going to say that the biggest barrier to acceptance of the pump is public opinion, especially when you factor in mental health advocate groups.

I can’t find the thread I want because search is not cooperating. Let me just say that it provokes a huge response from some of the people who it may affect.

And Shagnasty proves my point as well as it can be proven in GQ. My experience comes from the BBQ Pit, however, so it will never grow dim or doubtful.

(It’s also interesting that 500 posts back only takes me into late January of this year.)

The reason that I brought up “ethical standards” even though you said that you wanted to avoid ethics is because doctors are bound by them legally and through review. Remember that “do no harm” thing in the oath that they take? The “motivational” drug that you dream of does cause harm. The only way that you can force treatment on a psychiatric patient who shows “a threat to themselves or to others” is to have them committed inpatient to a psychiatric ward. Once they are out, it is their right to refuse further treatment. Therefore the idea is not possible in the U.S.

Plus, as I said, the drugs don’t exist, no one will develop them for this reason, and even if they were forced on a patient, they could cause harm.

Their is one such example in the real world. Hard-core alcoholics are sometimes prescribed Antabuse. Antabuse causes a violent allegic reaction in the person if even a small amount of alcohol is ingested. However, no doctor can force the alcoholic to take it if they don’t want to even if they have had say 7 DIU’s. The courts can order random testing but they can’t make you take a drug/

Personally, I think that putting implants into people who have delusions that people are putting implants in them is a recipe for disaster.

The drugs do exist (unfortunately), they are used (unfortunately), they do cause major problems.

Prolixin and haldol both come in “depo injection” form which drug you up for weeks.

I know that their are lots of drugs that would fit the bill for II. However, I can’t think of any drugs that could work as II and III in combination at least not safely.

OK, I got back after a little bit and I actually read the OP through.

Well, let me amp up my concerns about `public acceptance.’ Let me amp them up into the gigawatt range.

Drugs that operate on the aversion-therapy principles you describe are horrible and treatments using them are even moreso. Implanting a pump with antipsychotics is one thing (hi, AHunter), but `dosing’ them with crap like that is quite another.

This is going to turn into GD pretty quick I suppose…

From a medical ethics standpoint, what is the ethical dilemma in offering to a patient who is lucid and able to understand the consequences the option of this hypothetical implant? As long as the patient is able to give informed consent what’s the problem?

None, if the patient truly desired it (if he was sure he’d still be prone to mania and positive he would try to get his “unncecessary” antipsychotic implant out of his body, I guess) but I’m having a hard time envisioning realistic scenarios where a patient would want all three parts. Anyone capable of giving informed consent to parts II and III is probably going to just want the first bit maybe with a handy “RENEW MEDS ON XX/XX” card for his dayplanner.

What makes you think someone who’s truly ill without their meds would respond to a motivator? A horribly depressed person is unlikely to be motivated by making them feel worse, a paranoid is going to have his delusions reinforced, and a garden variety violent wacko is just going to be even more pissed off. If you make the motivator drug genuinely incapacitating, then it’s worthless for someone who’s no threat to others but wants to be concretely motivated to continue their prescription, and how would they come in for a late refill aside from stumbling into the emergency room one way or another?

What would be nice would be a harmless dissolving dye pack placed someone mildly but not crippling conspicuous (inner forearm as opposed to neck) that would make itself visible after your were a overdue for a refresh of your meds and a shot of old-dye eliminator (with a fresh reminder for the other arm). For people who have trouble keeping track of time and dates for whatever reason, it’d be an unignorable reminder, and if someone really was something of a danger off meds, you could make his face turn bright Get-Me-Help-NOW purple. Not practical yet, but it’s a nice thought.

mais pourquoi??

you have, at a stroke as it were, rendered them non-delusional…

At one point, fairly recently, I was prescribed an antispychotic (neuroleptic, if you want to be polite :stuck_out_tongue: )…it made me sleep at least 18 hours a day, and eat twice normal (when normal was already more than enough). And that was IIRC a quarter of the does which a true ‘psychotic’ patient would be likely to receive.

Placing somethign like that under someone’s skin breaks both the obvious issues of mediucal ethics, as to whether there’s true control…but also, any psychiatrist who claims it’s a good idea should be shot…

I’m not speaking of the rightness or wrongness of the concept from a treatment efficacy issue, only regarding the ethics issue.

I was starting out a reply with “I’m sure I’ll get flamed for this, but…” when I realized that it was a hijack. I posted it here instead.

Inigo Montoya , thanks for the post.

Rob

RRrrrrrriiiiigghhhht. :dubious:

: Paging Dr. Montoya : :wink:

Thanks for the replies. I had planned to start a GD thread to address the ethics bit but it looks like one already got started. I’ll just climb aboard and raise hell there.

Thanks for shooting down the “Motivator” in practical terms as well as ethical (I was already pretty sure there was an ethical question about it). I like the idea of turning someone’s face a bright shade of “Get-Me-Help-NOW purple” or perhaps something a tad more subtle for those who want a simple “tap on the shoulder” as opposed to public humiliation or gut wrenching spasms ala * A Clockwork Orange*.

As for creating at least the straight forward time release implant I still think it’s a good idea. Had my own prescription been “out of mind” I’d probably not have abandoned it. But eating a pill every morning was a daily reminder of a mental failing which could not trouble me emotionally (*because * of the pill), but did so intellectually. Also a more constant release of drug seems more appropriate when the objective is to level off peaks & valleys.

Let me address it only from a practical standpoint.

Prescribing and dosing any kind of mood-altering drug is pretty much a trial and error procedure. I know a lot of people with pretty much “straightforward” depression that have had their medication changed, dosages increased and decreased, etc., until the right combination was achieved. Sometimes that takes months, or in a couple of cases I know of, several years.

Perhaps once the proper combination has been worked out, long-term dosage would be a valid option. But brain chemistry is a fragile thing, and I suspect it’s even more fragile in those with the worst symptoms.

Well, depo injections of medications to treat psychosis have been available for some time, and if they’re administered properly and monitored well they can work very effectively. I know a few people who like the depo much better because they say that it makes them more ‘level’. Whether that is a perceived difference or it’s because they’re no longer at risk of missing doses or taking them off schedule, who knows?

I’d disagree with AHunter3’s notion that it’s unfortunate that these drugs exist, but definitely think that they need to be administered with caution and monitored carefully. It’s not something you’d introduce to someone as a trial run of a medication, obviously, but if it’s a medication they have been taking and tolerating well for a few years it could be a good option for them.

As for the OP… Jesus please us. I wouldn’t touch that with someone else’s 10’ pole. That’s barbaric. I’d sooner trepanate someone.

Antabuse is infrequently prescribed, as Shagnasty mentioned. It’s not an allergic reaction, though - it’s an incomplete metabolism of the alcohol molecule, causing a buildup of acetylaldehyde in the bloodstream and consequent nausea, vomiting, and general sense of ‘why did I do this?’. I worked in detox for a few years and we had very little luck using it. Nothing will stop an alcoholic but the alcoholic (IMO).