Posted by ed_uk2010 on October 13, 2014, at 20:43:24
In reply to Re: Sure this problem can be resolved. » ed_uk2010, posted by mogger on October 13, 2014, at 0:39:47
Hi Joseph,
>I can't thank you enough for your thoughtful response it is so helpful.
You're welcome.
>You are spot on in that I will not reduce my clonazepam any further until I get the risperdal worked out.
Definitely, that's very important.
>I believe it could have been a double whammy adjusting to the decrease in both medications.
It could indeed. Maybe stay on 0.5mg Risperdal for a bit longer in case the response improves once you're adjusted to your lower clonazepam dose.
>I had an initial AD response to Latuda but akathisia kicked in even below sub therapeutic doses.
Latuda causes akathisia about as often as some typical APs eg. Thorazine at full neuroleptic doses. I don't think they should have been able to market it as 'atypical' because that suggests low EPS risk, at least at standard doses.
Drug regulation is odd. Some countries refused to allow amisulpiride to be classed as an atypical because it doesn't block serotonin 5-HT2 receptors. I expect this is why it was never marketed in the US. Personally, I don't think blocking 5-HT2 receptors is a good definition of atypical... neither is increased efficacy, some atypicals have no evidence of superior efficacy. Some even seen less effective. The atypicals are a diverse group, some elevate prolactin, some don't, some are very sedating, some aren't etc. The only think they have in common is that they all cause less acute EPS than standard-high dose haloperidol and usually considerably less than other typicals such as chlorpromazine (Thorazine). According to a meta-analysis, Latuda produces a similar incidence of acute EPS to Thorazine. It also causes more EPS than Risperdal, despite the high Risperdal doses used in early trials. Amisulpride, which some countries refused to call an atypical, causes fewer EPS than Latuda.
>My doctor has told me that in his experience he knows of abilify and clozapine to be the only two APs that can exacerbate OCD.
Well, that's his experience, but aggravation of OCD has certainly been reported with other APs, as has improvement. In schizophrenia, there are many reports of OCD-like illness appearing on clozapine, but there are also a lot of reports for olanzapine (Zyprexa) and a few for risperidone (Risperdal)!
In non-psychotic pts, various APs have been used as an 'add on' to SSRIs in OCD. There is more evidence here to support the usefulness of risperidone than the others. There's a bit of evidence to support aripiprazole but the studies are very small.
Clozapine or olanzapine + frequent OCD symptoms in schizophrenia.
http://www.ncbi.nlm.nih.gov/pubmed/25256097
.............................
http://www.ncbi.nlm.nih.gov/pubmed/25268790
In the above study, albeit small, scientists tried to find differences in brain functioning between schizophenics given clozapine or olanzapine, Group 1.....and those given amisulpride or aripiprazole, Group 2. As expected, more OCD-like symptoms were seen with clozapine and olanzapine, and it seems to correlate with differences in localised brain activation between the groups.
Allegedly, in four patients, aripiprazole reversed the OCD symptoms cause by clozapine....
http://www.ncbi.nlm.nih.gov/pubmed/24330737
A similar case report described a marked improvement in OCD when aripiprazole was added to the regimen of a schizophrenic pt on olanzapine.
>My sister was put on Abilify and it manifested OCD in her. Not to say that would happen to me but the nice thing is that the risperdal really cuts into my OCD thoughts.
Well, it's a bit concerning, but I wouldn't rule out Abilify of this basis, just go easy on the dose.
>I think you are right about trying a decrease in sertraline as even before adding risperdal I can think of some decreased libido
Do you think you doc might agree to try something along the lines of 125mg for a couple of months then 100mg? But should you start this now or adjust Risperdal first? It might be easier to adjust Risperdal first because the effects/side effects due to Risperdal dose changes are more rapidly assessed. And then there's the whole confusion of adjusting more than on med at once.
>I forgot to tell you that I take inositol for ocd and I remember it having an added negative effect on my libido.
Does it help and will you continue it?
>I feel relieved that my prolactin is normal so I don't have to go off risperdal immediately.
You wouldn't anyway. Drug-induced prolactin elevation is not an emergency, even if the elevation is pretty extreme.
>Are you aware of any emotional differences between the two medications? Meaning does one tend to cause anhedonia or emotional blunting more than another at similar doses?
No, not especially.
>On a side note I can easily take a .5mg tablet and a half of a .25mg tablet so it would be in between .5 and .75mg to see if that is a optimal dose.
Good idea. I forgot about the 0.25mg tablets because they don't sell them here.
>I shall hang here for another week just to take a breather and then try tackling what you have discussed.
Good. If you still feel some depression and anxiety, maybe add the half a 0.25mg risperidone to your current dose.
Best of luck. Let us know how you do.
poster:ed_uk2010
thread:1071594
URL: http://www.dr-bob.org/babble/20140914/msgs/1072212.html