![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by anita on November 17, 2000, at 18:49:20
Hi,
I'm taking low-dose risperidone (along with an AD) for depression. I started at .5mg/day and it worked wonderfully for 12 days, then stopped working entirely. Five days later, I lowered the dose to .25mg/day and it started working again a day or two later.
Has anyone ever heard of this happening? I cannot find any references to risperidone poop-out. If risperidone has ever done something like this with anyone, I'd love to hear from you.
thanks,
anita
Posted by Dr. Bob on November 18, 2000, at 11:16:56
In reply to Question for Risperdal users, posted by anita on November 17, 2000, at 18:49:20
> Has anyone ever heard of this happening?
I did something Rx Qx-like and passed this on to psycho-pharm (a list I belong to). I hope the below is helpful...
Bob
--
From: Dr. James Karagianis
I used a lot of risperidone when it first came out, but found a lot of patients pooped out on it by about 6 months. I use more olanzapine and have found higher success rates and lower relapse rates.
(funding from all makers of atypical antipsychotics in Canada)
From: John M. Talmadge, M.D.My experience has been that the antidepressant effects of olanzapine (Zyprexa) are superior to those of risperidone (Risperdal). This individual might want to try Zyprexa as an alternative to the Risperdal.
I would offer a suggestion as well that both venlafaxine (Effexor) and mirtazepine (Remeron) seem to do better in the apathy/lack of motivation department than Zoloft for most of my patients.
("goodies" from Lilly, Janssen, Astra-Zeneca, Wyeth-Ayerst, Organon, Pfizer)
From: Deborah Pines, MDI had a patient who needed a certain dose of Risperdal, and then after a while it wouldn't work any more. Raising the dose helped temporarily, but then it wouldn't work any more. This went on for several doses. At one point ... the dose [was] lowered to the original one. At which point he got better.
Risperdal has anti-cholinergic properties leading to sedation, lethargy, memory loss etc. Perhaps rather than raising the dose, this woman ought to try lowering it.
In addition, I found that Risperdal's D24 metabolism can be very influenced by other drugs, leading to more side effects.
From: Stephen J. WiederI have never been impressed with Risperdal functioning as an augmenter for antidepressants in a non-bipolar/non-psychotic patient even though I do have experience with Zyprexa working in this way. It is therefore interesting this post suggests that it can be. I would be very curious if others have seen Risperdal augment antidepressant response. In response to the questioner my first suspicion would be Zoloft poop-out as the likely cause independent of the Risperdal. I am unclear why he is taking Lamictal. Is he bipolar?
(associations with Forest, Pfizer, Wyeth-Ayerst, Shire-Richwood)
From: Jeffrey E. Kelsey, M.D., Ph.D.I wonder if this may be a result of a drug-drug interaction between the Zoloft (sertraline) and risperidone. Sertraline, as a weak to moderate 2D6 inhibitor, has the potential to increase risperidone levels. Since initial dosing was successful, and presumably at a low serum level, this patient might now have too high a risperidone level. Rather than raise the dose (certainly reasonable as a first step), they may do better on a much lower dose.
Posted by R.Anne on November 22, 2000, at 23:18:02
In reply to Question for Risperdal users, posted by anita on November 17, 2000, at 18:49:20
My prescription of risperdal says between 1 and 4 tablets a day (they are .25). I told my doctor how I do better on one dose sometimes and another at other times. Now I am on .25 and okay but I used to be on .75 and up to 1 mg. I personally like risperdal but also wonder, at times, if zyprexa and one that begins with a "s" are better. I haven't asked my doctor because I haven't thought it's a problem at this point. I just take what I need between .25 and 1. I really like the feeling of risperdal! I wonder if I'm psychologically addicted to it. I went off it for 3 weeks and kept getting too low and I thought I should start back on it. I kept thinking I needed the risperdal again. I especially like the option of the very low doses, too. I don't know if I'll try any of the other stuff....
Posted by anita on November 23, 2000, at 0:14:05
In reply to Re: Question for Risperdal users, posted by Dr. Bob on November 18, 2000, at 11:16:56
Dear Dr. Bob,
Thank you very much for posting my Risperdal question to your
psychopharm list. The responses were helpful. In case anyone would be
interested in an update, here it is (sorry so long, but I find all this
pretty interesting :-), and I hope someone can at least benefit from my
experiences):As suggested, I reduced the dose to .25mg/day from 1mg/day, and the
risperidone seemed to kick in again, although not as strongly as it
initially did. After a week or so on .5mg/day, it stopped working yet
again. I lowered it to .25mg/day a few days ago, and got some of the
beneficial effects back again. I will remain on that dose and see what
happens.Some theories: Perhaps there is a theraputic window for the
antidepressive effects of low-dose atypical antipsychotics for use in
depression. Perhaps at low doses, these meds work to _increase_ dopamine
in the mesolimbic pathway, as amisulpride does, thus functioning as an
"anti" antipsychotic. Personally, risperidone feels a lot like low-dose
amisulpride. Perhaps the low doses make one a little "manic," relatively
speaking? I wonder what the effect on 5HT2A would be at these low doses,
especially since there are conflicting studies as to whether 5HT2A
receptors are upregulated or downregulated in depression.Unfortunately, while my response to prodopaminergic meds is usually good
at first, eventually I become irritable and have to discontinue them,
even tho I am already taking a mood stabilizer (for mood swings, not
bipolar). I feel this is starting to happen with risperidone, and I may
see if raising lamotrigine or adding a beta-blocker would alleviate
that. Any other suggestions would be helpful.Again, thanks everyone for your input.
Anita
__________________________________________________________I did something Rx Qx-like and passed this on to psycho-pharm (a
list I belong to). I hope the below is helpful...Bob
--
From: Dr. James Karagianis
I used a lot of risperidone when it first came out, but found a lot
of patients pooped out on it by about 6 months. I use more olanzapine
and have found higher success rates and lower relapse rates.From: John M. Talmadge, M.D.
My experience has been that the antidepressant effects of
olanzapine (Zyprexa) are superior to those of risperidone (Risperdal).
This individual might want to try Zyprexa as an alternative to the
Risperdal.
I would offer a suggestion as well that both venlafaxine (Effexor)
and mirtazepine (Remeron) seem to do better in the apathy/lack of
motivation department than Zoloft for most of my patients.From: Deborah Pines, MD
I had a patient who needed a certain dose of Risperdal, and then
after a while it wouldn't work any more. Raising the dose helped
temporarily, but then it wouldn't work any more. This went on for
several doses. At one point ... the dose [was] lowered to the original
one. At which point he got better.
Risperdal has anti-cholinergic properties leading to sedation,
lethargy, memory loss etc. Perhaps rather than raising the dose, this
woman ought to try lowering it.
In addition, I found that Risperdal's D24 metabolism can be very
influenced by other drugs, leading to more side effects.From: Stephen J. Wieder
I have never been impressed with Risperdal functioning as an
augmenter for antidepressants in a non-bipolar/non-psychotic patient
even though I do have experience with Zyprexa working in this way. It is
therefore interesting this post suggests that it can be. I would be very
curious if others have seen Risperdal augment antidepressant response.
In response to the questioner my first suspicion would be Zoloft
poop-out as the likely cause independent of the Risperdal. I am unclear
why he is taking Lamictal. Is he bipolar?From: Jeffrey E. Kelsey, M.D., Ph.D.
I wonder if this may be a result of a drug-drug interaction between
the Zoloft (sertraline) and risperidone. Sertraline, as a weak to
moderate 2D6 inhibitor, has the potential to increase risperidone
levels. Since initial dosing was successful, and presumably at a low
serum level, this patient might now have too high a risperidone
level. Rather than raise the dose (certainly reasonable as a first
step), they may do better on a much lower dose.
Posted by SLS on November 23, 2000, at 7:06:55
In reply to Re: Question for Risperdal users, posted by R.Anne on November 22, 2000, at 23:18:02
> My prescription of risperdal says between 1 and 4 tablets a day (they are .25). I told my doctor how I do better on one dose sometimes and another at other times. Now I am on .25 and okay but I used to be on .75 and up to 1 mg. I personally like risperdal but also wonder, at times, if zyprexa and one that begins with a "s" are better. I haven't asked my doctor because I haven't thought it's a problem at this point. I just take what I need between .25 and 1. I really like the feeling of risperdal! I wonder if I'm psychologically addicted to it. I went off it for 3 weeks and kept getting too low and I thought I should start back on it. I kept thinking I needed the risperdal again. I especially like the option of the very low doses, too. I don't know if I'll try any of the other stuff....
Hi R.AnneIn what ways does Risperdal help you? Does it act as an antidepressant?
Thanks in advance for any reply.
Please don't feel you are addicted, psychologically or physically, to any medication that provides you with such relief from your suffering. If I were to find something that worked well, I would feel psychologically "addicted" to it too. I would be afraid to miss even a single dose because I know that my brain relies on it to function in a healthy manner. True "addiction" involves cravings, compulsion, and being habit-forming. I doubt any of these apply to you. I don't think you should allow the word "addicted" rule your decision making process.#1 - Stay well.
Sincerely,
Scott
----------------------------------------------------------------From Webster's dictionary:
ad·dict (-dkt)
v. tr. ad·dict·ed, ad·dict·ing, ad·dicts.1. To devote or give (oneself) habitually or compulsively: She was addicted to rock music.
2. To cause to become compulsively and physiologically dependent on a habit-forming substance: He was addicted to cocaine.
n. (dkt)----------------------------------------------------------------
Posted by R.Anne on November 24, 2000, at 2:08:01
In reply to Re: Question for Risperdal users » R.Anne, posted by SLS on November 23, 2000, at 7:06:55
> > My prescription of risperdal says between 1 and 4 tablets a day (they are .25). I told my doctor how I do better on one dose sometimes and another at other times. Now I am on .25 and okay but I used to be on .75 and up to 1 mg. I personally like risperdal but also wonder, at times, if zyprexa and one that begins with a "s" are better. I haven't asked my doctor because I haven't thought it's a problem at this point. I just take what I need between .25 and 1. I really like the feeling of risperdal! I wonder if I'm psychologically addicted to it. I went off it for 3 weeks and kept getting too low and I thought I should start back on it. I kept thinking I needed the risperdal again. I especially like the option of the very low doses, too. I don't know if I'll try any of the other stuff....
>
>
> Hi R.Anne
>
> In what ways does Risperdal help you? Does it act as an antidepressant?
>
> Thanks in advance for any reply.
>
>
> Please don't feel you are addicted, psychologically or physically, to any medication that provides you with such relief from your suffering. If I were to find something that worked well, I would feel psychologically "addicted" to it too. I would be afraid to miss even a single dose because I know that my brain relies on it to function in a healthy manner. True "addiction" involves cravings, compulsion, and being habit-forming. I doubt any of these apply to you. I don't think you should allow the word "addicted" rule your decision making process.
>
> #1 - Stay well.
>
>
> Sincerely,
> Scott
>
>
> ----------------------------------------------------------------
>
> From Webster's dictionary:
>
>
> ad·dict (-dkt)
> v. tr. ad·dict·ed, ad·dict·ing, ad·dicts.
>
> 1. To devote or give (oneself) habitually or compulsively: She was addicted to rock music.
>
> 2. To cause to become compulsively and physiologically dependent on a habit-forming substance: He was addicted to cocaine.
> n. (dkt)
>
> ----------------------------------------------------------------*******
Hi there Scott,
Thanks for your interest. Risperdal helps me with the excessive obsessing and worrying component of depression along with hypervigilence that had led me to some pretty extreme and very uncomfortable feelings. The reason I thought about being psychologically addicted is because I feel I need it if I don't take it-maybe that just means I feel a lot better with it. I try to take the least amount of meds. as possible because I want to keep my liver as healthy as possible. I have prior damage already so....But they say the meds I take are pretty safe ones but still I am cautious anyways.Thanks for your info.! Hope you have a nice weekend! r.anne
Posted by CraigF on November 28, 2000, at 9:27:44
In reply to Re: Question for Risperdal users-for SLS, posted by R.Anne on November 24, 2000, at 2:08:01
I'd like to get some thought on this topic as well...
I added Risp. at a low dose (.5 and then 1.0 mg) when I was taking Serzone ... to boost the AD effects and to cut back on my obsessive paranoia, let some of the "fun" me to shine through.
It worked so well for a while. I had a sense of self confidence that made me feel I didn't have to perform for others or please others or hang on their perceptions of me. I was able to take the advice "you're not put here to amuse other people. they are worried about their own problems" to heart for the first time and use it theraputically throughout the day. Paranoia decreased as well.
Aside from some weight gain and appetite problems, I started to become easily agitating, I had physical side effects such as nuasea, numb lips, anxiety, sweating.
I kept cutting back on the dose, which worked fine initially, but the symptoms would catch up and I started to have VERY strange cognitive, emotional feeling that nearly drove me over the edge.
I've since been on Celexa to stop me from losing it altogether. I feel great and productive, but I'm also getting fat and losing self control (spending, illegal drugs, eating) with virtually no sex drive.
Thinking back, I wonder if Risperidone w/out the Serzone could work, or maybe Zypreza, seroquel, or Amulsipiride/Sulpiride would be effective alone. Does my reaction to Risp. indicate an overall intolerance to Atypical APs? I simply cannot experience that hell again.
Any thoughts?
PS: I had to stop taking Wellbutrin on the Serzone also because of Irritability and lack of concentration (a dopamine problem, maybe)
Posted by AndrewB on November 29, 2000, at 2:49:40
In reply to Riperdal questions....anyone?, posted by CraigF on November 28, 2000, at 9:27:44
I think your reaction to risperdal gives promise that another antipsychotic may be very beneficial to you. I prefer the antipsychotics that are more specific in their action on the limbic system D2/D3 autoreceptors, namely amisulpride and sulpiride. Being more directed in their action, they are known to cause relatively less in the way of troublesome side effects. For an info. piece on amisulpride email me at andrewB@seanet.com.
Best wishes,
AndrewB
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.