Posted by SalArmy4me on September 2, 2001, at 21:38:19
In reply to Wellbutrin+Respirdal=too much dopamine block?, posted by Janelle on September 2, 2001, at 19:20:27
Risperdal and the atypical neuroleptics should be an essential part of antidepressant treatment for anyone, psychotic or not. Risperdal quells anxiety and ruminating thoughts-- SSRI's often fail in this regard. Also, Risperdal has been proven to speed up the action of antidepressants, more specifically SSRI's. Don't be too concerned about the idea of too much or too little dopamine. In the long run, more people will be helped by the serotonergic aspect of Risperdal (5HT2A antagonism) than the dopaminergic mechanism.
Volume 18(1) February 1998 pp 89-91
Journal of Clinical Psychopharmacology
Adding Risperidone to Selective Serotonin Reuptake Inhibitor Improves Chronic Depression:"...These patients have in common a long course of illness, inadequate clinical response, episodes of major depression, and lack of manic/hypomanic or psychotic symptoms. Three of these patients (JG, MP, and DF) also fulfilled criteria for dysthymia (double depression).
Risperidone was targeted for the suicidal ideation and agitation that were superimposed on depression and anxiety. These symptoms, and disturbance in sleep and eating behavior, had responded poorly to an SSRI alone and with augmentation. The improvement with risperidone was rapid, and a short-duration of treatment was sufficient to control symptoms in some patients. In one patient who relapsed some months after risperidone was discontinued, a rapid response was seen again on reinstatement.
The mechanism by which risperidone augmentation acts is unclear. Adding typical antipsychotics to antidepressants can help in depression with psychotic features, possibly by modulating the dopaminergic system, [8] but these features were absent in our patients.
The symptoms that were responsive to risperidone correspond closely to those described in the "anxiety- and/or aggression-driven depression" subgroup of depressives, postulated to have serotonergic disturbance. [9] In two patients (SG, DF), the response to an SSRI was initially good but became less so with time, which suggests the development of resistance, whereas in the others, response was partial from the start. Similarly, augmentation strategies were partially effective in some cases early on but later became ineffective. There is evidence that using the differential effects of 5-HT receptor function and combining specific agents may be an effective way to enhance serotonergic transmission and improve response. [5] Risperidone may modify the serotonergic system via the 5-HT2 receptor. The involvement of this receptor in depression is supported by the finding that dysthymia may respond to ritanserin. [10] Combining SSRIs and atypical antipsychotics may be effective in treatment-resistant schizophrenia [11] and obsessive-compulsive disorder. [12] Nefazodone, which has 5-HT2A antagonist activity, is an effective antidepressant..."
poster:SalArmy4me
thread:77452
URL: http://www.dr-bob.org/babble/20010902/msgs/77469.html