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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by nellie7 on February 25, 2006, at 11:09:28
Hi,
I have been taking .5 mg risperidone and 20 mg citalopram for several weeks. The citalopram works best for depression and anxiety problems but without risperidone I feel very unreal. The problem is that I was told to take 1 mg risperidone but even on half that amount feel that it is a matter of time before I develop severe depression and serious side effects, as has been my experience with APs several years ago, so I can't take the drug for too long. It is already beginning to have a problematic effect.
Is there anything, conventional or alternative, which may have a similar effect to low-dose APs, which can be taken as a substitute and perhaps also act as an AD (discluding drugs with a "zombie" effect, such as mood stabilizers may have).
Thanks,
Nellie.
Posted by med_empowered on February 25, 2006, at 12:09:35
In reply to substitute for APs, posted by nellie7 on February 25, 2006, at 11:09:28
mood-stabilizers *generally* don't have the same "zombie" effect that even low-dose APs can have; however, there is also the question of dosing. Personally, I found Trileptal (600-900mgs/day) to be pretty good for helping out, although it didn't do much for **Intense** anxiety (it reduced my overall anxiety levels, though). It also has a mild antidepressant effect. You might want to try a benzo; they can actually help with depression, especially xanax...klonopin helps stabilize mood, and ativan can get rid of anxiety w/o affecting mood all that much.
Other than that...there's Buspar (not great, but might help), AD-AD combos (ex: "California Rocketfuel," remeron and effexor) and other mood stabilizers like Lamictal (apparently good for depression) and Lithium (low-doses might not be *too* terrible).
Good luck!
Posted by ed_uk on February 25, 2006, at 12:58:48
In reply to substitute for APs, posted by nellie7 on February 25, 2006, at 11:09:28
Hi Nellie,
Which APs have you tried apart from risperidone? What doses did you take? How did they affect you?
Ed
PS. Why not try 0.25mg risperidone?
Posted by blueberry on February 25, 2006, at 13:39:02
In reply to substitute for APs, posted by nellie7 on February 25, 2006, at 11:09:28
Nellie7, what was the risperdal prescribed for? Regardless of what it actually does to you, what did the doctor think it would do for you? What exactly does celexa not do that you need something else to help with? These questions would be helpful to maybe help other posters come up with some ideas.
Also, you mentioned another AP made you more depressed. Which one(s) was that? That might be helpful in sparking some ideas from other posters.
Posted by med_empowered on February 25, 2006, at 15:14:31
In reply to Re: substitute for APs » nellie7, posted by blueberry on February 25, 2006, at 13:39:02
some people are inclined to "neuroleptic dysphoria"--the sense of depression and dullness that comes from neuroleptics. Its apparently less common with the atypicals than with older ones, but still its a problem..personally, I can't do neuroleptics b/c of the dysphoria (crying fits, etc.)
What might help is occasional, low-dose neuroleptics...like, a zyprexa or abilify for a couple days, maybe a week, then stop. That works for some people. Or mood-stabilizers.
Surmontil might be a good option. Its a clozapine-ish TCA AD that doesn't seem to cause EPS or noticeable antipsychotic activity at usual doses.
Posted by Phillipa on February 25, 2006, at 21:23:38
In reply to Re: substitute for APs, posted by med_empowered on February 25, 2006, at 15:14:31
What about lamictal. Isn't it supposed to have a n AD effect too? Fondly, Phillipa
Posted by yxibow on February 26, 2006, at 3:13:08
In reply to substitute for APs, posted by nellie7 on February 25, 2006, at 11:09:28
> Hi,
>
> I have been taking .5 mg risperidone and 20 mg citalopram for several weeks. The citalopram works best for depression and anxiety problems but without risperidone I feel very unreal. The problem is that I was told to take 1 mg risperidone but even on half that amount feel that it is a matter of time before I develop severe depression and serious side effects, as has been my experience with APs several years ago, so I can't take the drug for too long. It is already beginning to have a problematic effect.Its curious, because my experience with some AP, namely Zyprexa, is that it has a very uplifting effect, especially in the first week. But all AP can have the effect of "blunting" of affect (mood).
While being terribly sedating, Remeron provided half of a atypical AP for me for a period of time, being a 5HT blockade antidepressant. Unfortunately one has to watch diet very carefully.
Jay
Posted by nellie7 on February 26, 2006, at 10:31:12
In reply to Re: substitute for APs, posted by med_empowered on February 25, 2006, at 12:09:35
Thanks for your ideas. A mood stabilizer may be something worth trying.
All the best,
Nellie.
Posted by nellie7 on February 26, 2006, at 10:33:51
In reply to Re: substitute for APs » nellie7, posted by ed_uk on February 25, 2006, at 12:58:48
Hi Ed,
I have tried perphenazine 4 mg and also got depressed on it.
Taking less risperidone might be a good idea.
Thanks,
Nellie.
Posted by nellie7 on February 26, 2006, at 10:38:14
In reply to Re: substitute for APs » nellie7, posted by blueberry on February 25, 2006, at 13:39:02
Hi,
I was prescribed risperidone for ocd and delusional tendencies, but I think ADs work better for that. APs make me more depressed. Taking only celexa makes me feel unreal and confused.
The AP that had the same effect on me was perphenazine. They probably all have the same effect.
Take care,
Nellie.
Posted by nellie7 on February 26, 2006, at 10:42:11
In reply to Re: substitute for APs, posted by med_empowered on February 25, 2006, at 15:14:31
I heard that taking APs on and off increases the risk of TD.
Thanks for your advice about surmontil.
Take care,
Nellie.
Posted by ed_uk on February 26, 2006, at 11:08:17
In reply to Re: substitute for APs, posted by nellie7 on February 26, 2006, at 10:33:51
Hi
Neuroleptics such as perphenazine do tend to be depressing. Have you ever tried Seroquel?
Ed
Posted by linkadge on February 26, 2006, at 16:56:07
In reply to Re: substitute for APs » nellie7, posted by ed_uk on February 26, 2006, at 11:08:17
Perhaps a different AD would not produce as much depersonalization. I found zoloft was a little more grounding than celexa.
Linkadge
Posted by med_empowered on February 26, 2006, at 19:18:40
In reply to Re: substitute for APs, posted by linkadge on February 26, 2006, at 16:56:07
i think linkadge has a point. and maybe you need something w/ less Serotonin Reuptake Inhibition..maybe Remeron? You could also add BuSpar to something..that balances stuff out for some people (although there may be BuSpar side effects to deal with).
Posted by nellie7 on February 27, 2006, at 12:55:56
In reply to substitute for APs, posted by nellie7 on February 25, 2006, at 11:09:28
Posted by Chairman_MAO on February 28, 2006, at 22:31:24
In reply to substitute for APs, posted by nellie7 on February 25, 2006, at 11:09:28
Your best bet would be methylphendiate or d-amphetamine + clonazepam (2mg/day to start). The clonazepam's dose is an educated guess based upon the dose it takes to suppress LSD flashbacks or "abort" a trip (in most cases). Psychostimulants at low doses tend to "ground" people who aren't psychotic.
You can try this with or without the SSRI, but I doubt you'd need the SSRI if you had the above two drugs (d-amphetamine is better for anxious states).
For monotherapy, I'd go with phenelzine 1mg/kg. There are at least case reports somewhere which detail the use of MAOIs for this perplexing disorder. A third-line combo would be phenelzine+[d-amphetamine]+[clonazepam]+lamotrigine.
There's tons of other stuff you can try, most of it no good. My personal opinion is that if you brought the clonazepam dose up high enough (['m talking 5-20mg/day in divided doses) and then started galantamine to keep your cognitive abilities and to counteract the sedation, your problems would be gone right there. Galantamine virtually eliminates any trace of benzodiazepine memory impairment, thought cloudiness, muscle overrelaxation, sedation, etc. There is bulgarian research I have read in the USPTO about that treatment algorithm. Normally, benzodiazpeines inhibit the release of acetylcholine; the galantamine compensates for this.
Have you ever gotten your HPTA axis checked out? Levels of hormones, etc? HPTA dysregulation is often present with that disorder.
This is the end of the thread.
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