Psycho-Babble Medication Thread 93523

Shown: posts 1 to 25 of 27. This is the beginning of the thread.

 

help needed with son!

Posted by e503 on February 9, 2002, at 22:08:07

I;ll try to make this as short as possible. My son, age 14, is autistic. He also is bipolar - he gets manic and rages and aggressive, very irritable and obsessive. He was stabilized for a long time on tegretol, 1 mg. risperdol (at night only - as when we gave it to him in the a.m. he gets more hyper)and 75 mg. zoloft. We gave him the zoloft 50mg. a.m. and 25 mg. p.m. for some reason. Anyways, the last few months he has been very unstable. Really manic. Keep on increasing the tegretol dosage. Levels just the other day, after 2 weeks ago increasing tegretol to total 1400 mg./day 8.4. About 2 weeks ago when we increased the tegretol, as usual, he was ok, but still kind of manic. decided to cut down on the zoloft to 50 mg./day. He is still kind of wild, and agitated. I am really worried about him, as he is talking to himself a lot and very erratic. It is not the same boy from last year. Can anyone help? I am so worried and confused. My pdoc is out of town and I just can't take it anymore! ANy ideas what ''s going on or what to do?
elise

 

Re: help needed with son! » e503

Posted by TSA West on February 9, 2002, at 22:59:09

In reply to help needed with son!, posted by e503 on February 9, 2002, at 22:08:07

He needs a long-acting antipsychotic/atypical neuroleptic like Risperdal but that won't make him more hyperactive. That is why I am recommending Seroquel.

--It can be taken all at bedtime for patient compliance.
--Titration is brief but necessary, some patients can be maintained on a small dose for long periods of time.
--No blood levels are needed.
--Its action rivals Risperidone but has more anxiolytic action due to its prominent antihistamine effect:

The American Journal of Psychiatry
Volume 157(8) August 2000 p 1341
"Quetiapine for Treatment-Resistant Mania"

JAACAP
Volume 38(5) May 1999 pp 498-499
"QUETIAPINE FOR REFRACTORY MANIA IN A CHILD"
[Letters To The Editor]

 

Re: help needed with son!

Posted by Jason911 on February 9, 2002, at 23:29:47

In reply to Re: help needed with son! » e503, posted by TSA West on February 9, 2002, at 22:59:09

He needs to be taken OFF of the Zoloft. SSRI's do not help Bipolars. It will make them more manic. Try the previous posters suggestions by TSA West as well. The Zoloft is working against you.

 

Son - autism and bipolar » e503

Posted by jane d on February 10, 2002, at 0:12:56

In reply to help needed with son!, posted by e503 on February 9, 2002, at 22:08:07

Elise,

I don't have any answers for you, just more questions. Is it possible that what your seeing now is not bipolar mania but the autism acting up? Some autistic behaviors look a little like mania and your son is at the age where many autistic children get suddenly worse. Of course hormones make all sorts of things worse at that age besides autism. How long will your pdoc be away? Can you see a back up? Are you physically in control of the situation or do you need to be asking for immediate relief?

I'm sorry I don't have more to offer.

Jane

 

Re: help needed with son! » e503

Posted by bob on February 10, 2002, at 0:46:04

In reply to help needed with son!, posted by e503 on February 9, 2002, at 22:08:07

I'd have a professional evaluate him again before you change anything. If it is mania breaking through, possibly Depakote would be more helpful. It is an excellent anti-mania treatment. So is Lithium. Like was previously mentioned though, you should try to determine if it truly is mania.

 

Re: help needed with son! » e503

Posted by Mr. Scott on February 10, 2002, at 3:33:20

In reply to help needed with son!, posted by e503 on February 9, 2002, at 22:08:07

Your doctor must have someone on call. Get their attention. Without knowing the whole story, Zoloft could be making him worse.

 

Re: Son - autism and bipolar

Posted by e503 on February 10, 2002, at 11:23:28

In reply to Son - autism and bipolar » e503, posted by jane d on February 10, 2002, at 0:12:56

I'll try to answer some questions. Autism vs. bipolar? Ben has been like this as long as I can remember. Over the years we never knew what the deal was (he is adopted). He was obsessive and got agitated, so of course, we tried the SSRI's. One thing I do remember was when we put him on anafranil. It was new and the pdoc kept on raising the dosage. Ben was jumping all over the house and was bruised and I remember thinking maybe he had leukemia (my daughter had it when she was a baby). OF course, it was the anafranil. Over the years we have tried everything. Mellaril, prozac, ritalin, dexarine, luvox, etc. A few years ago, he was on risperdol and zoloft. FOr some reason, we tried to add seroquel to the mix. Well,,,,Ben got totally wild and out of control. My pdoc was out of town and the doc on call told me to put him on tegretol. That was it. It was a miracle. So....is it bipolar or autism? I dont know, but whatever it is, he does get help from the mood stabilizers. So, anyways, he was on tegretol, 1 mg. risperdol and 75 mg. zoloft for probably abut 2 or more years. Quite stable. Life was great! In the last few months we have had to increase his tegretol. Now it is at 1400 mg. day/level was 8.4. 1 mg. risperdol and night only. (seems when i gave it to him during the day, he got more agitated, and cut back to 50 mg. zoloft. He is still cycling somewhat and i feel horrible for him. I don't know when my pdoc will be back in town. i will call tomorrow. on the bipolar kids sites it says to get him off ssri's, but i really don't know what to do.
Sorry for the ramble, but just wanted to give the details. Anyone help? PLEASE??????

 

Re: Son - autism and bipolar » e503

Posted by Mr. Scott on February 10, 2002, at 15:17:46

In reply to Re: Son - autism and bipolar, posted by e503 on February 10, 2002, at 11:23:28

> I'll try to answer some questions. Autism vs. bipolar? Ben has been like this as long as I can remember. Over the years we never knew what the deal was (he is adopted). He was obsessive and got agitated, so of course, we tried the SSRI's. One thing I do remember was when we put him on anafranil. It was new and the pdoc kept on raising the dosage. Ben was jumping all over the house and was bruised and I remember thinking maybe he had leukemia (my daughter had it when she was a baby). OF course, it was the anafranil. Over the years we have tried everything. Mellaril, prozac, ritalin, dexarine, luvox, etc. A few years ago, he was on risperdol and zoloft. FOr some reason, we tried to add seroquel to the mix. Well,,,,Ben got totally wild and out of control. My pdoc was out of town and the doc on call told me to put him on tegretol. That was it. It was a miracle. So....is it bipolar or autism? I dont know, but whatever it is, he does get help from the mood stabilizers. So, anyways, he was on tegretol, 1 mg. risperdol and 75 mg. zoloft for probably abut 2 or more years. Quite stable. Life was great! In the last few months we have had to increase his tegretol. Now it is at 1400 mg. day/level was 8.4. 1 mg. risperdol and night only. (seems when i gave it to him during the day, he got more agitated, and cut back to 50 mg. zoloft. He is still cycling somewhat and i feel horrible for him. I don't know when my pdoc will be back in town. i will call tomorrow. on the bipolar kids sites it says to get him off ssri's, but i really don't know what to do.
> Sorry for the ramble, but just wanted to give the details. Anyone help? PLEASE??????

Cut the zoloft back to 25mg and 25mg down to a total of 50mg... Or go even lower to 25mg a day and see what happens. Nothing crazy will happen. Worst comes to worse he'll be more obsessive and you'll just have to re administer the Zoloft and try a new approach.

 

Re: Son - autism and bipolar » e503

Posted by Ritch on February 10, 2002, at 16:02:49

In reply to Re: Son - autism and bipolar, posted by e503 on February 10, 2002, at 11:23:28

> I'll try to answer some questions. Autism vs. bipolar? Ben has been like this as long as I can remember. Over the years we never knew what the deal was (he is adopted). He was obsessive and got agitated, so of course, we tried the SSRI's. One thing I do remember was when we put him on anafranil. It was new and the pdoc kept on raising the dosage. Ben was jumping all over the house and was bruised and I remember thinking maybe he had leukemia (my daughter had it when she was a baby). OF course, it was the anafranil. Over the years we have tried everything. Mellaril, prozac, ritalin, dexarine, luvox, etc. A few years ago, he was on risperdol and zoloft. FOr some reason, we tried to add seroquel to the mix. Well,,,,Ben got totally wild and out of control. My pdoc was out of town and the doc on call told me to put him on tegretol. That was it. It was a miracle. So....is it bipolar or autism? I dont know, but whatever it is, he does get help from the mood stabilizers. So, anyways, he was on tegretol, 1 mg. risperdol and 75 mg. zoloft for probably abut 2 or more years. Quite stable. Life was great! In the last few months we have had to increase his tegretol. Now it is at 1400 mg. day/level was 8.4. 1 mg. risperdol and night only. (seems when i gave it to him during the day, he got more agitated, and cut back to 50 mg. zoloft. He is still cycling somewhat and i feel horrible for him. I don't know when my pdoc will be back in town. i will call tomorrow. on the bipolar kids sites it says to get him off ssri's, but i really don't know what to do.
> Sorry for the ramble, but just wanted to give the details. Anyone help? PLEASE??????


Hi, if he is generally responding to the Tegretol quite well, and you have the dose pretty much maxed out already-you could add on another anticonvulsant. Neurontin might be a good choice. It works well for partial complex seizures and helps with anxiety. It is elminated only by the kidneys, so the addition wouldn't mess up his Tegretol levels. The suggestions about reducing the Zoloft might help, too. I am bipolar and Zoloft definitely aggravated hypomania. However, if he is real obsessive and the SSRI's definitely seem to help, a flip to Celexa or Paxil might be less agitating for him (I didn't see those two in your list above).

One interesting thing in your post-you mentioned the addition of *Seroquel* made him worse? There have been reports of hypomania with the new atypical antipsychotics. Possibly the Risperdal is indirectly fueling the mania? Combined with a high dose of Zoloft, that could be possible. Also, a lot of restlessness could be Risperdal induced akathisia.

good luck, keep us posted on what happens,

Mitch

 

possible interaction carbamazepine risperidone? » e503

Posted by jane d on February 10, 2002, at 18:35:41

In reply to Re: Son - autism and bipolar, posted by e503 on February 10, 2002, at 11:23:28

Carbamazepine (Tegretol) interacts with risperidone (Risperdal). It may be that increasing the carbamazepine has effectively reduced the amount of risperidone your son is getting.

http://www.nlm.nih.gov/medlineplus/druginfo/carbamazepinesystemic202111.html

Perhaps all you will need to do is have your doctor increase the risperidone. Good luck.

Jane

 

Re: possible interaction carbamazepine risperidone?

Posted by e503 on February 10, 2002, at 20:40:33

In reply to possible interaction carbamazepine risperidone? » e503, posted by jane d on February 10, 2002, at 18:35:41

Today I gave ben 25 mg. zoloft in the a.m. and am going to give hiim 25 mg. tonight as opposed to all 50 mg. at might. Amazing,,,,he wasn't agitated much at all today!!!! What the heck is going on ? I thought zoloft only needed 1 a day dosing? He was still somewhat "active/manic", but he was definetly happier! I do have neurontin at home (ben was on it up until last year) and was thinking about adding that (mitch) or (Jane) was also thinking about the risperdol increase. Unfortunately, my doc is out of town until thursday. Also, Mitch, you are right, I am sure the risperdol during the day was causing akathasia. That's what the pdoc thouoght. So, I really hate to decrease ben's zoloft, but he is still somewhat manic. Increase risperdol or add neurontin???? I had suggested neurontin to my pdoc a few weeks ago, and he said something about ben becoming "disinhibited" on it? What is he talking about?

thanks,
elise

 

Re: possible interaction carbamazepine risperidone? » e503

Posted by Ritch on February 10, 2002, at 23:58:23

In reply to Re: possible interaction carbamazepine risperidone?, posted by e503 on February 10, 2002, at 20:40:33

> Today I gave ben 25 mg. zoloft in the a.m. and am going to give hiim 25 mg. tonight as opposed to all 50 mg. at might. Amazing,,,,he wasn't agitated much at all today!!!! What the heck is going on ? I thought zoloft only needed 1 a day dosing? He was still somewhat "active/manic", but he was definetly happier!

Zoloft seems to cause this drowsy *foggy* feeling for the first 12 hours or so, and then tends to have this *activating*, in some cases agitating effect for much longer(personal experience). I think it has something to do with the difference between sertraline (the first pass med), and desmethylsertraline (the primary active metabolite). Sertraline has a half-life of 24 hrs or so, while desmethylsertraline has a half-life of 2-3 days. The "first-pass" sertraline is what he is probably responding well to. The active metabolite (IMO), is the agitating, destabilizing part of the picture. That is why I wonder if he might do better on another SSRI like Celexa or Paxil whose metabolites have little or no activity.


I do have neurontin at home (ben was on it up until last year) and was thinking about adding that (mitch) or (Jane) was also thinking about the risperdol increase. Unfortunately, my doc is out of town until thursday. Also, Mitch, you are right, I am sure the risperdol during the day was causing akathasia. That's what the pdoc thouoght. So, I really hate to decrease ben's zoloft, but he is still somewhat manic. Increase risperdol or add neurontin???? I had suggested neurontin to my pdoc a few weeks ago, and he said something about ben becoming "disinhibited" on it? What is he talking about?
>
> thanks,
> elise


Well, if his pdoc thought that Risperdal was causing akathisia, I wouldn't increase the Risperdal for sure. Since you found that splitting the Zoloft dose seemed to help-I would continue to do that (keeping the same overall dose). The disinhibition the pdoc is referring to is something that is usually attributed to benzodiazepines. He might be afraid that it will worsen his impulsivity.

My overall impression...when you see his pdoc next-see if you can get him off the Risperdal (since it is low-dose anyhow), and perhaps switch him from Zoloft to Paxil or Celexa.

Mitch

 

Re: possible interaction carbamazepine risperidone?

Posted by e503 on February 11, 2002, at 8:25:13

In reply to Re: possible interaction carbamazepine risperidone? » e503, posted by Ritch on February 10, 2002, at 23:58:23

> > Today I gave ben 25 mg. zoloft in the a.m. and am going to give hiim 25 mg. tonight as opposed to all 50 mg. at might. Amazing,,,,he wasn't agitated much at all today!!!! What the heck is going on ? I thought zoloft only needed 1 a day dosing? He was still somewhat "active/manic", but he was definetly happier!
>
> Zoloft seems to cause this drowsy *foggy* feeling for the first 12 hours or so, and then tends to have this *activating*, in some cases agitating effect for much longer(personal experience). I think it has something to do with the difference between sertraline (the first pass med), and desmethylsertraline (the primary active metabolite). Sertraline has a half-life of 24 hrs or so, while desmethylsertraline has a half-life of 2-3 days. The "first-pass" sertraline is what he is probably responding well to. The active metabolite (IMO), is the agitating, destabilizing part of the picture. That is why I wonder if he might do better on another SSRI like Celexa or Paxil whose metabolites have little or no activity.
>
>
> I do have neurontin at home (ben was on it up until last year) and was thinking about adding that (mitch) or (Jane) was also thinking about the risperdol increase. Unfortunately, my doc is out of town until thursday. Also, Mitch, you are right, I am sure the risperdol during the day was causing akathasia. That's what the pdoc thouoght. So, I really hate to decrease ben's zoloft, but he is still somewhat manic. Increase risperdol or add neurontin???? I had suggested neurontin to my pdoc a few weeks ago, and he said something about ben becoming "disinhibited" on it? What is he talking about?
> >
> > thanks,
> > elise
>
>
> Well, if his pdoc thought that Risperdal was causing akathisia, I wouldn't increase the Risperdal for sure. Since you found that splitting the Zoloft dose seemed to help-I would continue to do that (keeping the same overall dose). The disinhibition the pdoc is referring to is something that is usually attributed to benzodiazepines. He might be afraid that it will worsen his impulsivity.
>
> My overall impression...when you see his pdoc next-see if you can get him off the Risperdal (since it is low-dose anyhow), and perhaps switch him from Zoloft to Paxil or Celexa.
>
> Mitch

Mitch-

Just curious, but, how do you know so much about this?

Regarding the risperdol,,,,,when I did lower the dose at an earlier time, it made Ben have more self-stim behavior (remember he is autistic). So, I really don't want to get rid of the risperdol. So, what do you th ink?

thanks so much for your help....you are a life saver....I couldn't figure out what the deal is with the zoloft.

elise

 

Re: possible interaction carbamazepine risperidone? » e503

Posted by Ritch on February 11, 2002, at 9:17:15

In reply to Re: possible interaction carbamazepine risperidone?, posted by e503 on February 11, 2002, at 8:25:13

> > > Today I gave ben 25 mg. zoloft in the a.m. and am going to give hiim 25 mg. tonight as opposed to all 50 mg. at might. Amazing,,,,he wasn't agitated much at all today!!!! What the heck is going on ? I thought zoloft only needed 1 a day dosing? He was still somewhat "active/manic", but he was definetly happier!
> >
> > Zoloft seems to cause this drowsy *foggy* feeling for the first 12 hours or so, and then tends to have this *activating*, in some cases agitating effect for much longer(personal experience). I think it has something to do with the difference between sertraline (the first pass med), and desmethylsertraline (the primary active metabolite). Sertraline has a half-life of 24 hrs or so, while desmethylsertraline has a half-life of 2-3 days. The "first-pass" sertraline is what he is probably responding well to. The active metabolite (IMO), is the agitating, destabilizing part of the picture. That is why I wonder if he might do better on another SSRI like Celexa or Paxil whose metabolites have little or no activity.
> >
> >
> > I do have neurontin at home (ben was on it up until last year) and was thinking about adding that (mitch) or (Jane) was also thinking about the risperdol increase. Unfortunately, my doc is out of town until thursday. Also, Mitch, you are right, I am sure the risperdol during the day was causing akathasia. That's what the pdoc thouoght. So, I really hate to decrease ben's zoloft, but he is still somewhat manic. Increase risperdol or add neurontin???? I had suggested neurontin to my pdoc a few weeks ago, and he said something about ben becoming "disinhibited" on it? What is he talking about?
> > >
> > > thanks,
> > > elise
> >
> >
> > Well, if his pdoc thought that Risperdal was causing akathisia, I wouldn't increase the Risperdal for sure. Since you found that splitting the Zoloft dose seemed to help-I would continue to do that (keeping the same overall dose). The disinhibition the pdoc is referring to is something that is usually attributed to benzodiazepines. He might be afraid that it will worsen his impulsivity.
> >
> > My overall impression...when you see his pdoc next-see if you can get him off the Risperdal (since it is low-dose anyhow), and perhaps switch him from Zoloft to Paxil or Celexa.
> >
> > Mitch
>
> Mitch-
>
> Just curious, but, how do you know so much about this?
>
> Regarding the risperdol,,,,,when I did lower the dose at an earlier time, it made Ben have more self-stim behavior (remember he is autistic). So, I really don't want to get rid of the risperdol. So, what do you th ink?
>
> thanks so much for your help....you are a life saver....I couldn't figure out what the deal is with the zoloft.
>
> elise


Elise, I have been on a couple of dozen different psychotropic meds (for about 25 years for bipolar,ADHD,panic,etc.)including the ones your son is taking. There are a *lot* of medications that *worsen* many of my symptoms, so it is somewhat easy to identify with these kind of troubles. You will just have to talk through some of this with his pdoc., especially with regard to Risperdal.

good luck to both of you,

Mitch

 

Re: possible interaction carbamazepine risperidone?

Posted by e503 on February 11, 2002, at 13:59:52

In reply to Re: possible interaction carbamazepine risperidone? » e503, posted by Ritch on February 11, 2002, at 9:17:15

mitch-

thanks so much for your help...since ben cannot verbalize to me how he feels , it is always a guessing game. WHere can i find some info about what you said about zoloft? As far as it's metabolites? thanks,
elise

 

Just another FYI

Posted by Mr. Scott on February 11, 2002, at 19:10:43

In reply to help needed with son!, posted by e503 on February 9, 2002, at 22:08:07

I've watching this thread and contributing when I can. It is also noteworthy that Zoloft dramatically increases Risperidone, perhaps increasing akathesia through further dopamine inhibition.

A change to Paxil would worsen this increase in Risperadone further. A change to Celexa would leave the Risperdal level only mildly above what it should be. Attached is a cut and paste from the P450 liver enzyme/medication tool from Harvard.

Scott

Risperidone and Paroxetine/Fluoxetine


Levels of risperidone are increased with the addition of paroxetine or fluoxetine.A case has been reported of serotonin syndrome on the risperidone and paroxetine combination.

I

n addition, cases of EPS has been reported with these combinations that may be related to both increased concentration of RSP and a pharmacodynamic effect of serotonin on dopamine receptors.


References

Ereshefsky L, et al. Antidepressant drug interactions and the cytochrome P450 system. The role of cytochrome P450 2D6.Clin Pharmacokinet. 1995;29 Suppl 1:10-8; discussion 18-9


Sproule BA, et al. Selective serotonin reuptake inhibitors and CNS drug interactions. A critical review of the evidence. Clin Pharmacokinet. 1997 Dec;33(6):454-71. Review


Hamilton S and Malone K: Serotonin syndrome during treatment with paroxetine and risperidone. J Clin Psychopharmacol 20: 103-104, 2000


Abstract


There is inhibition on all CYP pathways. (Minor pathways are disregarded.) This may heighten the impact of this interaction.


 

Re: possible interaction carbamazepine risperidone? » e503

Posted by Ritch on February 11, 2002, at 19:51:36

In reply to Re: possible interaction carbamazepine risperidone?, posted by e503 on February 11, 2002, at 13:59:52

> mitch-
>
> thanks so much for your help...since ben cannot verbalize to me how he feels , it is always a guessing game. WHere can i find some info about what you said about zoloft? As far as it's metabolites? thanks,
> elise

I got that information here-I don't know if it is still around or not-it had to do with antidepressant guidelines or something and showed antidpressants, their primary metabolites and the respective half-lives. Also, I noticed the effect that Zoloft had on me that was a little weird. I always took my dose in the morning only and I would always feel kind of tired and foggy most of the day, but then in the evening, and then especially when I got up the next morning-my sleep was abbreviated, and I was going 100mph! After I read about the metabolites here I started to put two and two together. Also, I went to the monograph for Zoloft and here is an excerpt from the Clinical Pharmacology section:

Metabolism: Sertraline undergoes extensive first pass metabolism. The principal initial pathway of metabolism for sertraline is N-demethylation. **N-desmethylsertraline has a plasma terminal elimination half-life of 62 to 104 hours**. Both in vitro biochemical and in vivo pharmacological testing have shown N-desmethylsertraline to be substantially less active than sertraline. Both sertraline and N-desmethylsertraline undergo oxidative deamination and subsequent reduction, hydroxylation, and glucuronide conjugation. In a study of radiolabeled sertraline involving two healthy male subjects, sertraline accounted for less than 5% of the plasma radioactivity. About 40-45% of the administered radioactivity was recovered in urine in 9 days. Unchanged sertraline was not detectable in the urine. For the same period, about 40-45% of the administered radioactivity was accounted for in feces, including 12-14% unchanged sertraline.

That is when I got some kind of confirmation of the idea that the primary metabolite of sertraline has denite pharmacological action (for good or ill). And the metabolite must have quite different actions from the primary med given the above information.

The last time I was taking Zoloft I tried taking it at bedtime (because it definitely was causing sleep disturbances), and it worked better taking it at bedtime instead of during the day (when I would become drowsy). So, if someone was getting benefit from the primary metabolite, taking it twice daily might be more effective.

Mitch


 

Re: possible interaction carbamazepine risperidone?

Posted by e503 on February 11, 2002, at 20:38:34

In reply to Re: possible interaction carbamazepine risperidone? » e503, posted by Ritch on February 11, 2002, at 19:51:36

Okay Mitch and Scott,

Since I am new to this pharmokinetics stuff, maybe you can just give me an idea in layman's terms, what I should suggest to my pdoc. So, if I have decreased the zoloft (from 75-50), then maybe ben is getting LESS effect from the risperdol? And maybe that's why he is doing more self-stimming? I guess I am just curious to figure out what is going on. So maybe he does need more risperidol p.m....and maybe that would help control his mania? Or does he need more risperdol AND more tegretol or another mood stabilizer? I think he really does need the zoloft or whatever, as it really seems to have helped with his anxiety when he takes it during the day. Yes, I noticed in the early evening he seems to be getting a little more revved up too - that is after taking the 25 mg. zoloft in the a.m. This COULD make sense!!!!! Okay guys, what do you think?

elise

 

Re: Just another FYI

Posted by e503 on February 11, 2002, at 20:41:31

In reply to Just another FYI, posted by Mr. Scott on February 11, 2002, at 19:10:43

But, what about this seratonin syndrome? HELP!

 

something just dawned on me...

Posted by e503 on February 11, 2002, at 22:38:28

In reply to Re: Just another FYI, posted by e503 on February 11, 2002, at 20:41:31

I just realized that we just started to give Ben all the zoloft (75 mg.) at night about 5 weeks ago. We used to give him 50 mg. in the am and 25 at night. About a week later is when all the trouble began. I never thought for a second that giving him the zoloft all at night would make any difference, but considering how much better he has been since we split the dose again starting yesterday (25 mg. and 25 mg.)I guess I was wrong. And maybe that is why he is doing more self-stimming....cuz the decrease in zoloft actually decreased the risperdol? What are your thoughts about my theory?

elise

 

Re: something just dawned on me... » e503

Posted by Ritch on February 12, 2002, at 9:55:05

In reply to something just dawned on me..., posted by e503 on February 11, 2002, at 22:38:28

> I just realized that we just started to give Ben all the zoloft (75 mg.) at night about 5 weeks ago. We used to give him 50 mg. in the am and 25 at night. About a week later is when all the trouble began. I never thought for a second that giving him the zoloft all at night would make any difference, but considering how much better he has been since we split the dose again starting yesterday (25 mg. and 25 mg.)I guess I was wrong. And maybe that is why he is doing more self-stimming....cuz the decrease in zoloft actually decreased the risperdol? What are your thoughts about my theory?
>
> elise

I don't have any ideas about the Risperdal blood levels, but splitting the dose of Zoloft definitely has helped him it appears. You could try going back to 75mg Zoloft per day (which is what he is prescribed currently-right?) Does he dose any other medication 3x daily? You might see about giving him 25mg Zoloft 3x daily and see if it gets any better. When I am taking Zoloft-the most pronounced sedative effects are always the several hours right after a dose, then later on as I have said-the "rev up". The next time you see his pdoc definitely bring all of this up.

Mitch

 

Re: something just dawned on me... » e503

Posted by Ritch on February 12, 2002, at 10:02:43

In reply to something just dawned on me..., posted by e503 on February 11, 2002, at 22:38:28

> I just realized that we just started to give Ben all the zoloft (75 mg.) at night about 5 weeks ago. We used to give him 50 mg. in the am and 25 at night. About a week later is when all the trouble began. I never thought for a second that giving him the zoloft all at night would make any difference, but considering how much better he has been since we split the dose again starting yesterday (25 mg. and 25 mg.)I guess I was wrong. And maybe that is why he is doing more self-stimming....cuz the decrease in zoloft actually decreased the risperdol? What are your thoughts about my theory?
>
> elise

Hi Elise, This is a weird twist about blood levels I just thought of.... It is entirely possible that the increased Zoloft is increasing his *Tegretol* blood levels. When I took Zoloft and Nortriptyline (a tricyclic antidepressant)-the Zoloft did increase the nortriptyline blood levels (carbamazepine is a "tricyclic" that potentially could do the same thing). That would point to a need for mood stabilizer rather than Risperdal or Zoloft. That would be an important thing to know. Definitely bring all of the "thinking out loud" in all the posts here to his pdoc. This is getting pretty complicated and he/she needs all of the information possible.

Mitch

 

Re: something just dawned on me...mitch

Posted by e503 on February 12, 2002, at 11:08:58

In reply to Re: something just dawned on me... » e503, posted by Ritch on February 12, 2002, at 10:02:43

> > I just realized that we just started to give Ben all the zoloft (75 mg.) at night about 5 weeks ago. We used to give him 50 mg. in the am and 25 at night. About a week later is when all the trouble began. I never thought for a second that giving him the zoloft all at night would make any difference, but considering how much better he has been since we split the dose again starting yesterday (25 mg. and 25 mg.)I guess I was wrong. And maybe that is why he is doing more self-stimming....cuz the decrease in zoloft actually decreased the risperdol? What are your thoughts about my theory?
> >
> > elise
>
> Hi Elise, This is a weird twist about blood levels I just thought of.... It is entirely possible that the increased Zoloft is increasing his *Tegretol* blood levels. When I took Zoloft and Nortriptyline (a tricyclic antidepressant)-the Zoloft did increase the nortriptyline blood levels (carbamazepine is a "tricyclic" that potentially could do the same thing). That would point to a need for mood stabilizer rather than Risperdal or Zoloft. That would be an important thing to know. Definitely bring all of the "thinking out loud" in all the posts here to his pdoc. This is getting pretty complicated and he/she needs all of the information possible.
>
> Mitch

mitch,

if the zoloft would increase his blood levels of tegretol, why would he need MORE mood stabilizer?

elise

 

Re: something just dawned on me...mitch » e503

Posted by Mr. Scott on February 12, 2002, at 18:46:55

In reply to Re: something just dawned on me...mitch, posted by e503 on February 12, 2002, at 11:08:58

Sertraline (Zoloft) and Carbamazepine (Tegretol)


No increase in carbamazepine levels


References

Rapeport WG, et al. Absence of a sertraline-mediated effect on the pharmacokinetics and pharmacodynamics of carbamazepine. J Clin Psychiatry. 1996;57 Suppl 1:20-3

Also, to further complicate matters...tegretol actually lowers Zoloft but has mixed effects on Zoloft's active metabolite. The picture isn't clear enough for me to interpret using my vitual liver software. At least you can be sure the Tegretol level is unaffected..

Scott

 

ben is definitely better today!

Posted by e503 on February 12, 2002, at 19:46:16

In reply to Re: something just dawned on me...mitch » e503, posted by Mr. Scott on February 12, 2002, at 18:46:55

Gave Ben 50 mg. zoloft this a.m. and will give him 25 mg. tonight. He was really much better so far today. Seemed really happy - like his old self. So I guess whatever the reason is, he needs to take zoloft 2 times a day. I remember that we started to give him the zoloft all in the p.m. cuz he was anxious during the day and we wanted to see if giving him 1/2 of his risperdol in the a.m. instead of it all in the p.m. would help and when I gave it to him in the a.m. along with the zoloft, he was manic (akathasia, i am sure). So, we went back to giving him the risperidol all at night, but continued to give him the zoloft also at night. That's when the problems began. So, I guess the next thing would be , what would you do with some anxiety during the day? his teg level was 8.4 (1400 mg./day divided into 3 doses)and 1 mg. risperdol at night and 50 mg. zoloft a.m. and 25 mg. zoloft p.m. thank goodness we were able to figure out the zoloft part!!!! What would I do with out this board???????

elise


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