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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by tim100 on December 27, 2004, at 19:38:16
Has anybody had any luck with the combination of Prozac and Risperdal for OCD and Depression?
I have tried every other SSRI in the book for dealing with OCD and nothing really worked. My current Med combo is 60mg Prozac / 1mg Risperdal / 1mg ativan 4 times a day for anxiety.
How about celexa? I've heard that celexa is good in high doses for OCD but I was only on 40mg a day when I took it.
Tim
Posted by tim100 on December 27, 2004, at 19:56:54
In reply to Prozac and Risperdal for OCD and Depression, posted by tim100 on December 27, 2004, at 19:38:16
Are Antipsychotics usually prescribed for OCD and Depression? Are they used to augment an SSRI?
Tim
Posted by King Vultan on December 28, 2004, at 8:01:41
In reply to Prozac and Risperdal for OCD and Depression, posted by tim100 on December 27, 2004, at 19:38:16
> Has anybody had any luck with the combination of Prozac and Risperdal for OCD and Depression?
>
> I have tried every other SSRI in the book for dealing with OCD and nothing really worked. My current Med combo is 60mg Prozac / 1mg Risperdal / 1mg ativan 4 times a day for anxiety.
>
> How about celexa? I've heard that celexa is good in high doses for OCD but I was only on 40mg a day when I took it.
>
> Tim
Atypical antipsychotics are sometimes prescribed at low doses to augment SSRIs and other drugs that increase serotonin transmission, such as MAOIs. Treating refractory OCD seems to be one of the chief reasons to do this. I have just started taking low dosage Risperdal, currently 0.25 mg/day, to augment my Parnate. In my case, it is not so much for OCD, as it is to counteract some other negative effects I am getting from overstimulation of the 5-HT2A receptor, such as insomnia, sexual side effects, and a bit of agitation.While your dosage of Risperdal is in a range generally associated with augmenting antidepressants (0.5-1.0 mg/day), the fact that you are also taking Prozac, which is a strong 2D6 inhibitor, is likely increasing the blood plasma level of the risperidone to a significantly higher level. My guess is that it is high enough that your blood plasma levels of the Risperdal are actually well into the antipsychotic range. This is not necessarily a terrible thing, but it does suggest that further increasing the Risperdal would be futile and imprudent.
I've suffered from OCD in the past and have managed to get a pretty good handle on it with the aid of SSRI-type drugs, while also continually working on it in a cognitive sense to defeat the problem. I accomplished this pretty much on my own, but I think drugs + cognitive therapy is the best way to conquer OCD. I cannot say I've really noticed much difference in OCD efficacy between any of the drugs I've taken that increased serotonin transmission, other than that Parnate, which is also quite dopaminergic, seems to work better than the other MAOI I've tried, Nardil.
Todd
Posted by tim100 on December 28, 2004, at 11:20:22
In reply to Re: Prozac and Risperdal for OCD and Depression, posted by King Vultan on December 28, 2004, at 8:01:41
This info is very helpful to me - Thanks. Whenever I take the Risperdal I feel like i'm "out of it". Especially when I wake up in the morning - total confusion. It takes me like a good half hour to get back on track. Is this normal when taking Risperdal? Also when you were talking about sexual side effects - antipsychotics help with the sexual side effects from other meds?
Tim
> Atypical antipsychotics are sometimes prescribed at low doses to augment SSRIs and other drugs that increase serotonin transmission, such as MAOIs. Treating refractory OCD seems to be one of the chief reasons to do this. I have just started taking low dosage Risperdal, currently 0.25 mg/day, to augment my Parnate. In my case, it is not so much for OCD, as it is to counteract some other negative effects I am getting from overstimulation of the 5-HT2A receptor, such as insomnia, sexual side effects, and a bit of agitation.
>
> While your dosage of Risperdal is in a range generally associated with augmenting antidepressants (0.5-1.0 mg/day), the fact that you are also taking Prozac, which is a strong 2D6 inhibitor, is likely increasing the blood plasma level of the risperidone to a significantly higher level. My guess is that it is high enough that your blood plasma levels of the Risperdal are actually well into the antipsychotic range. This is not necessarily a terrible thing, but it does suggest that further increasing the Risperdal would be futile and imprudent.
>
> I've suffered from OCD in the past and have managed to get a pretty good handle on it with the aid of SSRI-type drugs, while also continually working on it in a cognitive sense to defeat the problem. I accomplished this pretty much on my own, but I think drugs + cognitive therapy is the best way to conquer OCD. I cannot say I've really noticed much difference in OCD efficacy between any of the drugs I've taken that increased serotonin transmission, other than that Parnate, which is also quite dopaminergic, seems to work better than the other MAOI I've tried, Nardil.
>
> Todd
Posted by King Vultan on December 28, 2004, at 12:23:44
In reply to Risperdal makes me feel out of it / confused, posted by tim100 on December 28, 2004, at 11:20:22
> This info is very helpful to me - Thanks. Whenever I take the Risperdal I feel like i'm "out of it". Especially when I wake up in the morning - total confusion. It takes me like a good half hour to get back on track. Is this normal when taking Risperdal? Also when you were talking about sexual side effects - antipsychotics help with the sexual side effects from other meds?
>
> Tim
>
Risperdal at low dosages is one of the most selective drugs available for blockading the serotonin-2A receptor, which is the one thought to be involved in SSRI-type sexual side effects. Ironically, at higher dosages, Risperdal also has an unusual (for an atypical antipsychotic) and unfortunate ability to raise prolactin levels, which can induce sexual dysfunction. At normal antipsychotic dosages, both atypical and the old style conventional antipsychotics can also have negative sexual effects due to their blockade of the dopamine D2 receptor.My current dosage of 0.25 mg/day of Risperdal is not being amplified by any of the other drugs I'm taking, and I've noticed no cognitive dysfunction, nor any negative effects to speak of. I have noticed some positive but rather subtle effects, and raising my dosage at my next appointment would appear to be the indicated course of action. This is the first antipsychotic I have taken, and I have no direct experience taking one at typical antipsychotic dosages. However, it would seem that it might be worthwhile talking to your doctor about a dosage reduction, particularly if you are not taking it for schizophrenia or bipolar disorder and are mainly suffering negative effects from it. I hope your doctor is aware of the 2D6 enzyme issue I mentioned in my other other post, as my feeling is that the Prozac is amplifying the effects of the Risperdal.
Todd
Posted by pretty_paints on December 31, 2004, at 8:34:10
In reply to Re: Risperdal makes me feel out of it / confused » tim100, posted by King Vultan on December 28, 2004, at 12:23:44
Hi Tim,
I was on Rispiridone when I was in hospital, but not for OCD. It made me feel TOTALLY out of it. No drug has ever affected me that badly. I would take it in the morning, and then I'd rush to try and get everything done in the half an hour slot I'd get before I started spacing out! I'd rush having a bath, getting dressed etc etc, and then just as the dizziness started, I could just get under my blanket and fall asleep. I couldn't do anything. I would try to put on make-up but I couldn't focus or get my arms to do what I wanted them to do! It was weird. It was EXACTLY like being drunk, you try to do detailed things, but you can't! I also was starting to get VERY sore muscles. Like when you pull a muscle or something, I'd think "what have I done to my wrist? or my legs?". They'd just be very sore and shakey. Anyway I'd lie down and just stay there all day and be woken up for meals or visitors. This was at 1mg.
The dose was increased to 2mg, and this totally spazzed out my muscles. They ached ALL the time, were sore, and they shook. Then came the worst thing of all, I couldn't sit still because my muscles would be restless and I'd have to keep twitching them or rocking them. Even when my legs calmed down, my toes would be twitched about like crazy. At the time I swore it was the most unpleasant thing I'd ever experienced. Plus, on top of that (sorry to be graphic) but I had terrible constipation, because all my muscles had totally contracted up. I remember actually thinking I was going to die from it!None of the laxatives worked or anything. AAARRGGH.
Anyway after a little while of this a nurse gave me some procyclidine, which helped the muscle aches lot. But by this point I'd had enough of the whole caboodle, so I cut down to 1mg and then stopped. PHEW. My body returned to normal, my muscles relaxed and calmed down, I was able to go to the toilet, and I just felt much better :) yay
Anyway this was just one person's experience, it's different for everyone isn't it. I found Rispiridone to be a very good drug for my thoughts though, so if you can tolerate it, it should help your OCD.
Good luck and sorry if my post hasn't been particularly relevant.
xxx
ps: I took prozac at the beginning of the year for depression and mild OCD, and I felt it was great for the ruminating thoughts. I could just "let things go". It worked better than anything else I've tried.
This is the end of the thread.
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