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Katie: You are correct that both stelazine and sometimes lithium are capable of causing PD like symptoms, even in people who do not have PD. In the spectrum of drugs that have these effects are all the major tranquilizers or so-called neuroleptic drugs. Some of the newer ones, such as clozapine and quetiapine seem less likely to cause the problem. So much less that, when a tranquilizer is necessary in a person with PD, they are considered to be the drugs of choice by neurologists and MDS. Clozapine can have hematologic side effects, so that most neurologists nowadays are gravitating towards quetiapine. When a person on neuroleptic drugs for psychiatric treatment develops PD symptoms, it is sometimes difficult to be sure whether the PD symptoms are entirely the effect of the drug, or the effect of the drug added to underlying PD. Often the only way to know for sure is to stop the drugs at the risk of causing worsening of the psychiatric symptoms. These drugs have a tendency to persist a long time in the brain, so that such trials often need to be done over a period of several weeks to be sure. Only your psychiatrist, in combination with your neurologist, should make those decisions, as it is a difficult problem. Sometimes the need to treat the psychiatric symptoms to keep them stable is of the same or higher priority than determining cleanly what the real underlying problem is. Some psychiatrists prefer certain specific neuroleptic drugs for the treatment of specific types of psychiatric disorders. You might consider discussing the possibility of using quetiapine instead of stelazine, although I would be surprised if your psychiatrist has not already considered that possibility. Jorge Romero, MD ----- Original Message ----- From: <[log in to unmask]> To: <[log in to unmask]> Sent: Tuesday, October 09, 2001 11:42 PM Subject: uncertain diagnosis--response to Bob B. Bob, I did ask that very question, and I have the answer, but I did not think it was pertinent to my posting. I have been diagnosed with bipolar affective disorder for many years, and I have been on lithium for at least, at least 23 years. I was taken off the lithium in June with the understanding that the PD, or PD-like, symptoms, I experience/have experienced were, or could be caused, by the lithium. I was put on depakote as an alternative to the lithium, and I am not stable psychiatricly; I am taking stelazine with the hopes it will help get me stable on the depakote. All of these drugs in the prior paragraph are contraindicated for a person with PD, and they can all cause PD-like symptoms. My latest MDS is also convinced that I do not have PD, that I had PD-like symptoms caused by the lithium, but that there are other neurological issues/ problems/ diagnoses that have to be considered once I am stable on the depakote. The muscle spasms and dystonia were supposedly from the sinemet, and the action of the first MDS this summer taking me summarily off all my medications without any titration or hospitalization. This all means I have not had an easy summer even though it may be likely that I do not have PD. And I am not going to get a clean bill of health. I may even have another neurological problems plus the PD, but they dont know at this point. I am a very active CMI (chronicly mentally ill) consumer and I am a very active PD consumer. I have asked your question, and many variants thereof repeatedly, but they, the MDSs and the psychiatrists and the neurologists and the orthopedic doctors and the endrocinologists, and etc., and etc., simply do not know the answers. Or, at this point in time, they do not know the answers. If I have PD it was probably caused by my consumption of large quantities of stelazine in my late teens and 20s for my CMI issues: I had "PD" in law school and as an undergraduate due to that medication. I am now prescribed stelazine because it is effective for my CMI issues, and I have to get stabilized on the depakote or go back on the lithium. And I have a resultant increase, and exacerbation, of PD symptoms due to taking the stelazine. I have not only asked questions, I have made my choices, and I have decided and I may well have to decide in the future to have PD, or "PD"-like symptoms, voluntarily due to the CMI issues I have. This is the background you apparently needed to put my prior posting in perspective. Katie ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn