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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by AllieD on June 25, 2002, at 13:03:43
I'm taking a low (2.5 mg) dose of zyprexa to help with sleep, appetite, anxiety, etc. I can only take it at night, though, because it's so sedating, so my doctor suggested I try low doses of risperdal throughout the day (she said of seroquel, zyprexa, and risperdal, risperdal was the least likely to be sedating), plus the zyprexa at night -- because of the good sleep and appetite effects. Does anyone have any experience taking both of these at once? Does it seem like a good idea? I'm a little concerned about combining things.
Thanks,
Allie
Posted by judy1 on June 25, 2002, at 13:18:07
In reply to risperdal AND zyprexa?, posted by AllieD on June 25, 2002, at 13:03:43
Well they are both atypical AP's but work on different receptors. Your doc is correct- risperdal is very energizing (I got akathesia from it). May I ask if you are having any psychotic symptoms? If it's just anxiety (and sorry I'm not minimizing anxiety) using APs is as someone already mentioned on this site, a sledgehammer approach. If that is your main problem, then benzos work very well with little side-effects (compared to TD and EPS- which supposedly is rare in atypicals, but I sure suffered from it). Please let me know what your diagnosis is. Take care, judy
Posted by AllieD on June 25, 2002, at 13:46:19
In reply to Re: risperdal AND zyprexa?, posted by judy1 on June 25, 2002, at 13:18:07
Well, my diagnosis is something of a mess -- they think I might be bipolar II and I think the zyprexa is supposed to help with that too? I also haven't been able to tolerate ANY ADs (not because they made me manic, but because of side effects like weight loss or nervousness).
I was on high doses of ativan, and my pdoc wanted to decrease those... so I don't know. I feel like a mess; I've been diagnosed with ADD but I can't take anything for it because of anxiety.
Is risperdal riskier than zyprexa, then? I only take the 2.5 mg of zyprexa and I'd be on maybe one or two .25 mg doses of risperdal a day.
Thanks,
Allie
Posted by bobbyy on June 25, 2002, at 19:09:58
In reply to Re: risperdal AND zyprexa? » judy1, posted by AllieD on June 25, 2002, at 13:46:19
I don't take zyprexa but I do take ripserdal and love it..I am bipolar II and it really helps me to fall asleep and cuts down on obsessive thought and contains rage...and it doesn't "flatten" me...I take topamax for mood stabilizer and klonopan when I need it..and paxil as an anti depressant...but I love risperdal..so far I have had no side effects from risperdal ..at least none that i am aware of
bobbyWell, my diagnosis is something of a mess -- they think I might be bipolar II and I think the zyprexa is supposed to help with that too? I also haven't been able to tolerate ANY ADs (not because they made me manic, but because of side effects like weight loss or nervousness).
>
> I was on high doses of ativan, and my pdoc wanted to decrease those... so I don't know. I feel like a mess; I've been diagnosed with ADD but I can't take anything for it because of anxiety.
>
> Is risperdal riskier than zyprexa, then? I only take the 2.5 mg of zyprexa and I'd be on maybe one or two .25 mg doses of risperdal a day.
>
> Thanks,
> Allie
Posted by judy1 on June 25, 2002, at 20:15:23
In reply to Re: risperdal AND zyprexa? » judy1, posted by AllieD on June 25, 2002, at 13:46:19
I don't think it is riskier... just akathesia is more common in risperdal. I am dxed BP1 and am taking 10 mg of zyprexa/day now. When I took risperdal, it was in the 4-6mg/day range- significantly higher then the doses you are mentioning. I only take an AP for auditory hallucinations, if I am not have psychotic symptoms I don't take them. BTW, I've had them all- haldol, thorazine, mellaril and all the atypicals. Zyprexa is often used as a mood stabilizer in treatment resistant bipolars, but for sedation I like klonopin (which is sometimes used as a secondary mood stabilizer) Maybe your pdoc would be more accepting of klonopin over ativan. Almost every bipolar specialist feels AD's worsen cycling, so not being able to take it is probably a good thing. I really wouldn't be too concerned about side effects because your dose is extremely low. Take care, judy
Posted by AllieD on June 26, 2002, at 8:55:06
In reply to Re: risperdal AND zyprexa? » AllieD, posted by judy1 on June 25, 2002, at 20:15:23
Klonopin, unfortunately, does nothing for me. I had asked about switching to xanax or something else but instead she wants me to stick with / cut down on the ativan.
When I was in crisis, she was really nice about having me take all I needed, but now I guess it's time to scale back a bit. (Which is good, I think, just difficult.)
Thanks for your help,
Allie
Posted by katekite on June 26, 2002, at 15:24:40
In reply to Re: risperdal AND zyprexa? » judy1, posted by AllieD on June 26, 2002, at 8:55:06
Hi,
Both risperdal and xyprexa can be good in some situations: one the other for severe anxiety that is unresponsive to safer drugs, pychoses, psychotic depression, tourettes, and I'm sure a few other things too.
If your diagnosis is bipolar II however, you should try the mood stabilizers first.
I find people tell me they were often put on anti-psychotics in the hospital or in a crisis and that's why they are still on them months or years later. One of the reasons for this is because they can be so sedating and in an emergency that can be really good. After the crisis is over it can be great (a stabilizing force), ok (helping sleep and not hurting) or not good at all (impairing thinking and making life dull and hazy), depending on your chemistry.
The best use of antipsychotics for people who are not psychotic, I think, is after they are stable on one or two other things and just aren't quite all the way ok yet. Then you can play around with a touch of one or another. It didn't sound to me as if you felt really stable, though.
My advice (on a subject you didn't actually ask for advice on, LOL) is to pursue a diagnosis like those greyhounds pursue the fake bunny. (sorry don't know why that particular analogy came to mind). How can you be effectively treated if your diagnosis is up in the air? Just because a drug helps you sleep does not mean it is treating you most effectively.
Have you taken the mmpi or other similar extensive test? If BP II is a possibility you would also be wise to rule out attentional problems completely (if its a possiblity after trying the quiz at www.mindfixers.com, then its a whole different class of drugs to try). Also make sure you have had a complete physical exam with assurances that your thyroid and adrenals are working normally. For psychological testing its best to be on the minimum of drugs.
Having said all that, it probably sounds as if I'm being discouraging about the atypical antipsychotics in general, and I don't mean to be. If they feel like they are helping that's certainly good, since it's good when anything finally helps some. They are supposed to be good for anxiety for some people in very small doses, and for sleep sometimes. Someone mentioned they are like sledgehammers though, and that's true. There are other drugs with less risk of long lasting side effects, that may well treat whatever is going on with you more effectively.
Make certain you have a diagnosis that really explains who you are and what you've been going through -- that makes sense and that encompasses your moods and energies and thoughts and the way you feel physically.
Take care,
kate
Posted by AllieD on June 26, 2002, at 19:32:56
In reply to diagnosis, posted by katekite on June 26, 2002, at 15:24:40
Well, that's the thing -- I have been diagnosed with ADD (with lots of formal testing) and been through all kinds of diagnostic things -- I used to have PTSD, although I no longer do, but I still have anxiety and depression and leftover PTSD things, certainly.
I think I have such a mishmash of symptoms that I don't fit in any category -- and actually that's what my doctors tend to put down, Depressive Disorder NOS. I hate being NOS but there's no way to pin down things for everybody. I've tried millions of different drugs (ok, maybe ten different antidepressants, plus lithium and depakote) and none of them have been effective at all, except for the benzos and the atypical APs.
So I'm really frustrated and I've given up finding one thing that's wrong with me. I'm about ready to give up on all the drugs. I'm about ready to give up. It's just frustrating. Some people just don't fit into the categories.
I do think I'm fairly stable in some respects -- I just graduated college and I'm able to work on a freelance career while working part time and keeping busy in other ways. I wouldn't be able to do all that I do if I was that bad off. It's the mix of things that are wrong with me, rather than the extent of them, that make me feel unstable. Sometimes I worry that I'm borderline but that has been ruled out by more than one doctor.
Sorry for rambling --
Allie
Posted by judy1 on June 27, 2002, at 11:31:51
In reply to undiagnosable? » katekite, posted by AllieD on June 26, 2002, at 19:32:56
I think labeling has too much emphasis- remember the pharmaceutical companies put out the DSM so they can have conditions to target drugs at. So, to me, it sounds as if you have an anxiety disorder, and speaking as a person with PTSD- I don't think you ever get rid of all the symptoms- it takes a great deal of work with a therapist just to function. Lowering your ativan is in all probability causing you more anxiety symtoms. My shrink says that withdrawal from SSRI's and benzos are the primary reasons people come to see him- he is a panic disorder specialist. So, rather then say your shrink was nice to allow you to take ativan for an extended period- perhaps you still need it? Lots of people take benzos for 20+ years with little or no side effects. Xanax is the best drug for anxiety/panic and I take it prn along with klonopin. Just from the way you write, I doubt very much you have BPD- and I would seek a second opinion from somebody familiar with PTSD and anxiety disorders. Perhaps you need xanax or ativan for a longer period until you achieve coping skills through a therapist. Just some of my rambling thoughts. Take care, judy
Posted by avid abulia on June 11, 2003, at 19:44:25
In reply to diagnosis, posted by katekite on June 26, 2002, at 15:24:40
out of curiosity, what is the point of finding out a dx over finding out what just works? psychiatric diagnoses are so vague that, to draw a comparison to lung disease, it is okay to say, alright, yeah, this patient coughs... we`d better try some amoxycillin... when it won`t do a thing for someone coughing from black lung disease. this is just a question that i have always wondered about, i am not trying to be rude, but why fixate on dx?
Posted by ace on June 13, 2003, at 2:25:36
In reply to Re: diagnosis » katekite, posted by avid abulia on June 11, 2003, at 19:44:25
> out of curiosity, what is the point of finding out a dx over finding out what just works? psychiatric diagnoses are so vague that, to draw a comparison to lung disease, it is okay to say, alright, yeah, this patient coughs... we`d better try some amoxycillin... when it won`t do a thing for someone coughing from black lung disease. this is just a question that i have always wondered about, i am not trying to be rude, but why fixate on dx?
Very well put...IMO psychiatric diagnosis means very little, and making someone feel better is the most important thing.
Ace.
Posted by stjames on June 15, 2003, at 13:10:25
In reply to diagnosis, posted by katekite on June 26, 2002, at 15:24:40
My advice (on a subject you didn't actually ask for advice on, LOL) is to pursue a diagnosis like those greyhounds pursue the fake bunny. (sorry don't know why that particular analogy came to mind). How can you be effectively treated if your diagnosis is up in the air? Just because a drug helps you sleep does not mean it is treating you most effectively
I think it is a false assumption that having a better Dx get you better meds
This is the end of the thread.
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