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Ask Dr Ivan

In the first of a regular column, we are proud to host a column by Dr Ivan Goldberg,MD, Director, N.Y. Psychopharmacologic Institute, New York, NY, in which he answers a few of the many questions that arrive in our mailbox. We are sorry, but Dr Goldberg cannot enter into individual correspondence.


I take Prozac and it's been really good at relieving my depression, but I get these cramps in my jaw - is this just tension or the Prozac? What can I do?

Prozac belongs to a group of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). Of all the SSRIs, Prozac is most likely to increase tension and anxiety. Jaw cramps are often a manifestation of such increased tension and anxiety. Paroxetine is the SSRI that is least likely to induce such tension. Paroxetine is as good an antidepressant as Prozac.


I get these cravings to eat or drink unusual things like soil, or vinegar, or bleach. These thoughts keep on coming into my mind even when I try and distract myself. Can doctors help?

Recurrent unwanted thoughts are referred to as obsessions. It sounds as if your thoughts are obsessions and may be part of what is referred to as Obsessive-Compulsive Disorder (OCD). OCD often responds to a combination of psychotherapeutic and psychopharmnacologic treatments.


I heard that chlorpromazine turns your skin grey. Does it?

When Thorazine first came out, it was found that a small number of patients who took large doses and spent long periods of time in the sun developed slate grey or purple pigmentation of those areas of the skin that were exposed to the sun. These days Thorazine is seldom prescribed, and the drugs that are used in its place are free of this side-effect.


How does lithium carbonate work? Are there any other salts which can do the same job?

The exact mechanisms by which lithium exerts is therapeutic effects are unknown. While there are other medications that have similar effects, none of them are simple salts.


My antipsychotic drugs make me restless. The doctor says it is a side effect called akathisia - is there anything that can be done about it?

Akathisia is one of the more unpleasant side-effects of the antipsychotic medications. There are a number of ways in which akathisia can be reduce or eliminated: 1/ it may be possible for you to take a lower dose of the medicine you are presently taking; 2/ you maybe switched to a different antipsychotic medication that does not produce akathisia so often; 3/ your doctor might prescribe propranolol or one of the Valium-like drugs to reduce the severity of the akathisia.


My mother is aged 80 and had a fall when she was on chlorpromazine - it did something to her blood pressure. What antipsychotics are there that are less likely to produce falls in the elderly?

Chlorpromazine is one of the antipsychotic drugs that are most likely to lower blood pressure and cause falls. Among antipsychotics that are least likely to lower blood pressure are: thiothixine, fluphenazine, and molindone.

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