![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by chess on December 13, 2006, at 10:25:07
Can someone explain to me why a neuroleptic like Risperdal would be useful for GAD? Neuroleptics BLOCK the effects of serotonin and dopamine, but my doctor said that neuroleptics actually stimulate the release of serotonin and that its action on dopamine is what works for anxiety.
Posted by med_empowered on December 13, 2006, at 11:08:34
In reply to Risperdal for GAD?, posted by chess on December 13, 2006, at 10:25:07
your shrink is full of s**t. some people get better on neuroleptics--they blunt everything, so if being apathetic works for you, then you'll love neuroleptics. No atypical neuroleptics are approved for GAD or social phobia or any sort of anxiety. I believe Stelazine, an old one, is approved for non-psychotic anxiety but...very few docs use it anymore, because its so risky.
Some studies have actually shown an *increase* in anxiety of antipsychotics, which makes sense...when you use neuroleptics, you block dopamine, which creates a state of Parkinsonism (you may not get physical signs, but Parkinson's is also a psychiatric condition, marked by apathy and fatigue, etc., so I'd wager all doses of neuroleptics make one somewhat Parkinsonian..and lots of people with Parkinson's have intense anxiety). Personally speaking, neuroleptics made my anxiety 10 times worse. It was pure, unmitigated hell, and that's not including the akathisia, which is another fun side effect shrinks tend to not tell their patients about. Ask your doc about that, and the risks of TD and neuroelptic malignancy syndrome (that one's potentially fatal, by the way).
RXing a neuroleptic for GAD is totally irresponsible and puts the patient at risk. There are benzos and antidepressants and buspar to use; one could even brand out and go for hydroxyzine, propranolol, anticonvulsants, "alternative" therapies, opiates....but neuroleptics? Ridiculous. Especially Risperdal--as the atypials go, Risperdal is the *least* atypical (its closer to, say, Haldol than it is to clozapine) and possibly the most likely to cause god-awful side effects, including tardive dyskinesia. The FDA hasn't even approved it for long-term use in bipolar (only management of acute mania), much less GAD or other relatively minor problems.
Do what you want, but I think a neuroleptic for GAD is a very, very bad call, and I think your shrink should be ashamed of suggesting it without presenting all the risks and pointing out the (inconvenient) fact that there isn't all that much quality data to support using Risperdal for this indication.
Posted by chess on December 13, 2006, at 16:31:48
In reply to Re: Risperdal for GAD?, posted by med_empowered on December 13, 2006, at 11:08:34
how do you explain this then:
The antidepressant Wellbutrin causes anxiety and even panic sometimes because it increases the activity of dopamine by being a dopamine reuptake inhibitor. Therefore a med that reduces dopamine activity (atypicals) can work as an anti-anxiety agent.btw, my doc offered seroqeul also, saying he would prefer to start with that one or zyprexa but zyprexa can cause weight gain. i should have made my post "Seroquel for GAD?"
your shrink is full of s**t. some people get better on neuroleptics--they blunt everything, so if being apathetic works for you, then you'll love neuroleptics. No atypical neuroleptics are approved for GAD or social phobia or any sort of anxiety. I believe Stelazine, an old one, is approved for non-psychotic anxiety but...very few docs use it anymore, because its so risky.
>
> Some studies have actually shown an *increase* in anxiety of antipsychotics, which makes sense...when you use neuroleptics, you block dopamine, which creates a state of Parkinsonism (you may not get physical signs, but Parkinson's is also a psychiatric condition, marked by apathy and fatigue, etc., so I'd wager all doses of neuroleptics make one somewhat Parkinsonian..and lots of people with Parkinson's have intense anxiety). Personally speaking, neuroleptics made my anxiety 10 times worse. It was pure, unmitigated hell, and that's not including the akathisia, which is another fun side effect shrinks tend to not tell their patients about. Ask your doc about that, and the risks of TD and neuroelptic malignancy syndrome (that one's potentially fatal, by the way).
>
> RXing a neuroleptic for GAD is totally irresponsible and puts the patient at risk. There are benzos and antidepressants and buspar to use; one could even brand out and go for hydroxyzine, propranolol, anticonvulsants, "alternative" therapies, opiates....but neuroleptics? Ridiculous. Especially Risperdal--as the atypials go, Risperdal is the *least* atypical (its closer to, say, Haldol than it is to clozapine) and possibly the most likely to cause god-awful side effects, including tardive dyskinesia. The FDA hasn't even approved it for long-term use in bipolar (only management of acute mania), much less GAD or other relatively minor problems.
>
> Do what you want, but I think a neuroleptic for GAD is a very, very bad call, and I think your shrink should be ashamed of suggesting it without presenting all the risks and pointing out the (inconvenient) fact that there isn't all that much quality data to support using Risperdal for this indication.
Posted by med_empowered on December 13, 2006, at 17:16:29
In reply to Re: Risperdal for GAD? » med_empowered, posted by chess on December 13, 2006, at 16:31:48
dude...atypicals are designed for schizophrenia. Maybe bipolar. Possibly severe depression. Anxiety? Not so much.
A lot of the older drugs also have effects on serotonin. Mellaril does, loxapine does, moban definitely does....thorazine even has weak dopamine re-uptake inhibition action and some weak serotonin antagonism. These features really aren't anything new, although they are more promient and more heavily promoted in the atypicals.
If you really think the risks of a neuroleptic are justified for you, then do it. I'm just saying--there are lots and lots and lots of other options out there that don't involve antagonism of dopamine and don't involve the risks of dopamine blockade.
Also...the atypicals can cause EPS, especially Risperdal; it can induce full-fledged Parkinsonism at higher doses, just like Haldol and other old school high potency meds. It may help you, but it really isn't that huge of an innovation--one reason it came out so great in studies was b/c investigators used 20mgs+ Haldol (which is about 1,000mgs thorazine, I believe--a pretty massive dose pretty much guaranteed to cause EPS).
you are less likely to have serious problems with new meds than old meds, but what i"m saying is that the risks are still there, and they are still pretty hardcore, and for something as minor as GAD, there are any number of much safer, much more pleasant, much less expensive alternatives one could try before resorting to dopamine blockers.
Posted by blueberry1 on December 13, 2006, at 18:15:32
In reply to Risperdal for GAD?, posted by chess on December 13, 2006, at 10:25:07
I've used low dose zyprexa for a long time (10 years?). I used low dose seroquel a few times. I used low dose amisulpride for a month. I can only speak from my own experience. Antipsychotics can work wonders on GAD and almost immediately. But, the risks are way too high. They've already been mentioned by med_empowered. They are very real and serious. As for risperdal, if you want serious sexual dysfunction, you'll likely get it fairly fast.
If I had ever been told how difficult it is to get off of antipsychotics, I never would have started. If I had ever been told they would screw with my movements (tremors, twitches), screw with my energy (very low), screw with my emotions (dull), and screw with all kinds of bodily mechanisms, well, the benefits were not worth the risks.
Finding a benzo that agrees with you sounds a lot better to me. And if not that, other posters have mentioned other alternatives. There are also natural routes to go...many calming herbs to use in combination with rhodiola rosea or st johns wort. 5hpt. Tyrosine with 5htp. There are so many choices besides the high risk antipsychotics.
The only antipsychotic in the entire world I could safely mention is low dose amisulpride. It blocks only certain dopamine receptors and causes more dopamine to be fired. How that leads to improvement of GAD I have no idea, because it doesn't make sense on paper. But it works wonderfully for that. And because it doesn't screw with other dopamine receptors, serotonin receptors, histimine receptors, and bodily mechanisms, it is much safer. Unfortunately it is not an FDA drug and can only be ordered from overseas.
Risperdal. No. My vote anyway. Maybe look for a new doctor too.
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.