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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 22 to 46 of 46. Go back in thread:
Posted by Quintal on January 17, 2007, at 18:22:29
In reply to Re: I'm stopping all meds, posted by Deneb on January 17, 2007, at 17:56:44
Deneb, I worry it may destabilize you mentally to stop the Risperdal altogether and tremors are a common side effect of abrupt withdrawal anyway. A small reduction in addition of Risperdal to the Benadryl may help if it is the Risperdal that is causing this problem. I remember you posting elsewhere about excessive, involuntary blinking - that was you wasn't it? That in combination with the jerkiness and tremors is suggestive of some EPS though. Have you noticed (or has anyone else noticed) involunatry movements of your tongue or lack of facial expression?
If you've had this problem for a while then there could some other cause. For example, is your blood sugar healthy? Do the tremors improve after eating? A beta-blocker may also help with the tremors.
Q
Posted by Quintal on January 17, 2007, at 18:25:25
In reply to Re: I'm stopping all meds » Deneb, posted by Quintal on January 17, 2007, at 18:22:29
Sorry Deneb, I meant:
>A small reduction of Risperdal in addition to the Benadryl may help if it is the Risperdal that is causing this problem. I remember you posting elsewhere about excessive, involuntary blinking - that was you wasn't it?
Q
Posted by Phillipa on January 17, 2007, at 19:32:39
In reply to Re: I'm stopping all meds » Phillipa, posted by Deneb on January 17, 2007, at 18:18:16
Deneb okay I believe you. Now get yourself to an ER ASAP and call your pdoc on the way. Love Phillipa
Posted by Deneb on January 17, 2007, at 19:58:45
In reply to Re: I'm stopping all meds » Deneb, posted by Phillipa on January 17, 2007, at 19:32:39
I don't need to go to the ER. The tremors aren't that bad all the time. I've lived with them for a long time now, it's not an emergency.
Deneb*
Posted by Llurpsie_Noodle on January 17, 2007, at 20:49:48
In reply to Re: I'm stopping all meds, posted by Deneb on January 17, 2007, at 19:58:45
Hi Deneb,
I also have tremors sometimes. I get these big jerking spasms when I fall asleep, and often I notice that my handwriting is really shaky. I have excessive eye blinking sometimes too, and occasionally I will have a spasm in my jaw when I am at rest or falling asleep and I might bite my tongue a little bit. I think these effects are from seroquel, which is an atypical antipsychotic and mood-stabilizer. (It may be in a similar class to risperdal, but I'm not sure)So, here are some things that I've learned about the tremors.
1) They are better when I am well-rested.
2) They get worse if I start a new exercise program, but after a week or so, I get used to using my new muscles and so the jerks will become less frequent
3) Shaky hands are really affected by caffeine. If I drink even one cup of coffee I have the hands of my Nana.
4) Tremors are worse when we think about them too much. If you can get out and do something active (like window-shopping) or get engrossed in something else (like watching a movie) you will not be bothered as much by the tremors.
5) a small dose of klonopin helps a LOT. I'm talking about .5mg every 2 days, or even half that much.
6) If you want to do the benedryl test, (one time my pdoc asked me to, since I had this awful lump in my throat for 2 weeks, we wanted to rule out dystonia) take 50 mg and within an hour or two you should notice dramatic reduction in your symptoms.
****
You say that you've had these tremors for a while ((((Deneb)))) I'm sorry. It's not FAIR! You're so young! you shouldn't have to deal with shaky soup spoons and such. Think very carefully about the pros of taking risperdal (did I even get CLOSE?!? to the right spelling). How was your quality of life before, and how is it now? How was your clarity of thought? Your control over your emotions? Are you able to make better decisions now, or before? Are you able to concentrate better now or before?
now think carefully about the consequences of changing your medication-- I know *I* am. :(
You may feel unstable for a few days or a few weeks. You may feel withdrawal symptoms, like others have described above. You may have to get used to a brand-new drug, and develop tolerance to side-effects. You may feel sick and have to miss class some days. You may behave differently than you usually do. You may need to schedule extra therapy sessions to help keep you "on track" and prevent you from making poor decisions, while supporting you through a difficult adjustment period.
Having said that, you OWN your body. You are strong enough, and smart enough to be able to make decisions about your own body. You should also be smart enough to consult with an expert (your pdoc) about changing your internal chemistry. Ask her what your options are. Don't be afraid, it's YOUR body. You should also be frank with your T (yeah, I know, pdoc and T are one and the same), because making a med change due to severe side-effects is a big decision. It's a challenge, and you deserve support.
((((((hugs for you))))))))
{{{{{{{shaky hugs for you too}}}}}}}this evening I'm a mixture of smooth hugs and shaky hugs, 'cause I drank too much caffeine earlier. oh well. At least I'm not a surgeon, right? ;o)
-Ll
Posted by mindevolution on January 18, 2007, at 4:07:53
In reply to Re: I'm stopping all meds, posted by Deneb on January 17, 2007, at 19:58:45
> I don't need to go to the ER. The tremors aren't that bad all the time. I've lived with them for a long time now, it's not an emergency.
>
> Deneb*sounds like minor parkinsonism, essentially the antipsychotics are most likley to be causing the problem, but then again a lot of the antidepressants have akathisia as a side effect meaning they have anticholinergic effects too. if you can go without your meds then that is the lowest toxicity route, but I have no idea of your mental problems. they say that 80% of people with drug induce parkinsonism improve over the next 2 years after stopping the aps, but that also means 20% have parkinsons for life.
anyway least toxic to most: antidepressants, benadryl due to anticholinergic effect, and antipsychotics win for being the most toxic psych drug available hands down.
Posted by blueberry1 on January 18, 2007, at 5:12:48
In reply to I'm stopping all meds, posted by Deneb on January 17, 2007, at 16:24:01
Just based on side effect profiles in literature, risperdal is the one most likely causing the tremors. If it is, they should go away without risperdal, but sometimes they can linger for weeks afterwards. Sometimes they are permanent. Not to worry you though. I would stop the meds too, except I would do it slower and not cold turkey. Cold turkey is dangerous. You could crash real hard or go through a serious withdrawal that is worse than the worst flu you ever had. And tremors can actually get worse during the withdrawal.
Prozac is possible too. I actually think Celexa is the least likely. But celexa and prozac is a strange combination, so no telling what's up there.
I was on prozac for 8 years and had no tremors. But in year 9 and year 10 I did start getting tremors. They got worse as I withdrew from prozac. Now a couple months later they are gone. But it took a while.
I thought zyprexa was the cause. And it probably did play a hand. But I determined through experimentation that it was primarily the prozac that did it, and it had something to do with longterm usage.
I understand stopping meds for concerns like yours. If you do it cold turkey, be real careful, expect a bad experience (but hopefully not), and don't be afraid to reintroduce a smaller dose to then begin a slower weaning withdrawal.
Posted by Deneb on January 18, 2007, at 21:10:18
In reply to Re: I'm stopping all meds, posted by mindevolution on January 18, 2007, at 4:07:53
Parkinson's tremors are resting tremors. Mine aren't resting tremors. I don't get tremors when I'm just resting my hands. I have to be doing something.
Anyways, last night I didn't take Risperdal and I took 30 mg Celexa instead of 40 mg. I couldn't fall asleep and felt crappy during the morning and ended up skipping class. I hope I can fall asleep tonight.
I got upset today and shook really badly for a while. Stress makes the tremors worse. I just hope they aren't permanent.
Tonight I'm only going to take 20 mg Celexa.
Deneb*
Posted by Deneb on January 18, 2007, at 21:25:44
In reply to Re: I'm stopping all meds, posted by mindevolution on January 18, 2007, at 4:07:53
I'm scared. I'm scared my tremors are permanent. How long will it take? I still get them. What if it's not the meds at all? What if I have essential tremor?
I'm scared. I don't know what to do. I'll never be able to work with my hands.
Deneb*
Posted by Phillipa on January 18, 2007, at 21:37:46
In reply to Re: I'm stopping all meds, posted by Deneb on January 18, 2007, at 21:25:44
Deneb you're acting like you're a doctor and you are not . So call your pdoc now as you're getting too agitated. You didn't sleep cause you didn't take the resperidol which has a calming effect. Love Phillipa
Posted by Deneb on January 18, 2007, at 21:55:31
In reply to Re: I'm stopping all meds » Deneb, posted by Phillipa on January 18, 2007, at 21:37:46
Kind of scared now. What if I really need my meds? Am I undoing everything right now?
I just don't know.
I don't want to deal with this. I don't know what to do. Scared. Don't know what to do today. What should I do?
Deneb*
Posted by Quintal on January 18, 2007, at 21:58:24
In reply to Re: I'm stopping all meds, posted by Deneb on January 18, 2007, at 21:25:44
>What if it's not the meds at all? What if I have essential tremor?
It can be easily treated with a beta-blocker such as propranolol.
>I'm scared. I don't know what to do. I'll never be able to work with my hands.
Yes you will. This can be treated whatever the cause but it sounds like time to call the pdoc and explain your concerns. Have you asked him whetehr the Risperdal might be causing the tremors? Does he have any suggestions?
Q
Posted by Deneb on January 18, 2007, at 22:04:19
In reply to Re: I'm stopping all meds » Deneb, posted by Quintal on January 18, 2007, at 21:58:24
> >What if it's not the meds at all? What if I have essential tremor?
>
> It can be easily treated with a beta-blocker such as propranolol.
>
> >I'm scared. I don't know what to do. I'll never be able to work with my hands.
>
> Yes you will. This can be treated whatever the cause but it sounds like time to call the pdoc and explain your concerns. Have you asked him whetehr the Risperdal might be causing the tremors? Does he have any suggestions?
>
> QI've done some research on essential tremor and propranolol only helps the tremors, it doesn't eliminate them.
My pdoc doesn't think it's the Risperdal because it is such a low dose. She thinks it's the combination of meds that is causing the tremors. I haven't made a big deal out of the tremors in the past because they didn't bother me too much. I just sort of grew used to them.
I don't know what to do tonight. Should I take my meds as prescribed? What should I do? I see my pdoc on Tues.
Deneb*
Posted by Deneb on January 18, 2007, at 22:17:53
In reply to Re: I'm stopping all meds » Quintal, posted by Deneb on January 18, 2007, at 22:04:19
I think I over-reacted. I got scared. Phillipa, you're right I'm not a doctor and I have no idea what the hell I'm doing. I'm afraid of getting worse. I'm going to take my meds as prescribed tonight and talk to my pdoc about this on Tues.
Deneb*
Posted by Llurpsie_Noodle on January 18, 2007, at 22:28:42
In reply to Re: I'm stopping all meds, posted by Deneb on January 18, 2007, at 22:17:53
Hey Deneb,
did you take your meds tonight?I did. even the ones I don't like to take.
sleep well (((Deneb)))
-Lurpsed
Posted by Quintal on January 18, 2007, at 22:38:46
In reply to Re: I'm stopping all meds » Quintal, posted by Deneb on January 18, 2007, at 22:04:19
>I've done some research on essential tremor and propranolol only helps the tremors, it doesn't eliminate them.
Yes, propranolol doesn't cure the essential tremor but like many other meds it often gives relief from the worst of the symptoms.
>I don't know what to do tonight. Should I take my meds as prescribed? What should I do? I see my pdoc on Tues.
If they help you sleep then yes, I'd take them. You'll probably feel worse for lack of sleep if you don't. How about taking some Benadryl to help? Did it ease the tremors at all?
Q
Posted by Deneb on January 18, 2007, at 22:44:57
In reply to Re: I'm stopping all meds » Deneb, posted by Llurpsie_Noodle on January 18, 2007, at 22:28:42
> Hey Deneb,
> did you take your meds tonight?
>
> I did. even the ones I don't like to take.
>
> sleep well (((Deneb)))
>
> -LurpsedYes I just took them. I'm afraid that worse things than insomnia will happen. I got a little anxious today, don't know if it was because of stopping Risperdal. I hope I can sleep tonight.
Thanks for the hug. (((Llurpsie))))
Deneb*
Posted by Deneb on January 18, 2007, at 22:48:04
In reply to Re: I'm stopping all meds » Deneb, posted by Quintal on January 18, 2007, at 22:38:46
> If they help you sleep then yes, I'd take them. You'll probably feel worse for lack of sleep if you don't. How about taking some Benadryl to help? Did it ease the tremors at all?
>
> QI only took 25 mg of Benadryl. I didn't notice anything.
Deneb*
Posted by Deneb on January 19, 2007, at 14:37:22
In reply to Re: I'm stopping all meds » Quintal, posted by Deneb on January 18, 2007, at 22:48:04
I just had a chat with Dr. Scott Wylie, a psychologist with expertise on psychopharmacology and health/medical psychology issues and topics. He's on PsychCentral.
I asked him about my tremors. He agrees with my pdoc that it's not the Risperdal that's causing the tremors because it is a very low dose. He thinks it's the high doses of SSRI that are causing them. He told me that SSRIs can cause EPS. He suggested trying non SSRIs like Effexor or Remeron. I don't know what Remeron is.
I'm going to ask my pdoc about this on Tues.
Oh yeah, he also said it's a very bad idea to stop my meds cold turkey.
Deneb*
Posted by Deneb on January 19, 2007, at 14:42:13
In reply to Re: I'm stopping all meds » Quintal, posted by Deneb on January 18, 2007, at 22:48:04
Just in case I forget, he told me other things too.
He told me that Klonopin can probably help the tremors.
He told me to maybe take only one SSRI at not so high a dose and up the Risperdal.
Or to avoid SSRIs because I get EPS on them. I got twitches on Zoloft.
Deneb*
Posted by Clockwork Ange on January 19, 2007, at 16:27:31
In reply to Re: I'm stopping all meds, posted by Deneb on January 19, 2007, at 14:42:13
how's it going with changing up your meds? have you made the changes? how are you feeling now?
Posted by Deneb on January 19, 2007, at 20:23:03
In reply to Re: I'm stopping all meds, posted by Clockwork Ange on January 19, 2007, at 16:27:31
> how's it going with changing up your meds? have you made the changes? how are you feeling now?
I decided to take my meds as prescribed until I see my pdoc. My tremors didn't bother me today.
I don't know about the going down the stairs thing anymore. That might be psychological, I don't know. Maybe I concentrate too much on taking each step.
Thanks for asking about me.
Deneb*
Posted by mindevolution on January 20, 2007, at 5:59:55
In reply to Re: I'm stopping all meds » Clockwork Ange, posted by Deneb on January 19, 2007, at 20:23:03
hiya Deneb
just thought i'd mention that the antipsychotics are the most likely to cause permanent damage to your cns and cause permanent tremor due to the dopamine blockade. they are known for creating tremor much more than the ssris. are you widly psychotic, like do you see and hear things that are not there? if not you should stay well away from antipsychotics due to toxicity. they are without doubt the most serious med there is and if in doubt, do without. :) if you hate tremor, you would hate tardive dyskinesias even more, not to mention torsades de pointes, or elevated prolactin levels leading to cancer, and the list really does go on. if they bump up your dose at any time, it might be time to say goodbye if you know what i mean, so don't think they aren't dangerous just because you are on a low dose at the moment. they are drug of choice for treating criminals, the elderly and the disabled so be very, very careful with them. :) you probably already knew this anyway, just thought I'd remind you. ME
Posted by ronaldo on January 21, 2007, at 7:40:53
In reply to Re: I'm stopping all meds, posted by mindevolution on January 20, 2007, at 5:59:55
Hi Deneb
Sorry you are having such a hard time of it. I hope things improve for you shortly. In the mean time
b e c a l m a n d r e l a x
Easy enough to say I know, much harder to do.I once took risperdal 2 mg and I still have some of it left. I have just been taking a look through their information leaflet. One paragraph caught my attention:
"Sometimes trembling, pronounced muscle stiffness or spasm, slowness of movement, excess saliva or restlessness can occur but this will usually disappear if your dose of Risperdal is reduced by your doctor or if your doctor prescribes you an additional medicine."
It seems to me that maybe you should stay on all your prescribed doses of medication in order that your pdoc can witness these tremors at their full extent.
Then again I am only an ignorant amateur and you have consulted an expert in psychopharmacology who says your dose is too small to cause these tremors. As a matter of interest how much do you weigh if you don't mind me asking? 0.75 mg is a small dose but then you may have a small physique. I would still blame the Risperdal but that is because I detest anti-psychotics having gone through an aborted attempt to get off Zyprexa which resulted in horrific rebound insomnia even after I had been completely off it for 3 weeks. They do make you sleep but the cost in rebound insomnia and anxiety when you eventually come off them is far too great.
The chances are that you will not remain at 0.75 mg. You will probably end up taking 1.5 mg, possibly more. Psychiatrists have an uncanny predeliction for foisting anti-psychotics on their patients, even for off-label use. If I was you I would be tempted to give them a wide berth. But then I am embittered by my battle with Zyprexa. I am tapering off it again, this time very very slowly and gradually. If you have been on Risperdal for any length of time you should also use a very slow and gradual taper. If you have only been on it for a few months you can do it quicker but be prepared to go back to a higher dose if you experience any rebound symptoms.
As a previous poster said it is your body and you decide what goes in it. Don't let the so-called experts bully you into doing what you do not want to do.
ronaldo
Posted by Deneb on January 21, 2007, at 16:12:53
In reply to Re: I'm stopping all meds - for Deneb's attention, posted by ronaldo on January 21, 2007, at 7:40:53
Thanks for your reply. I'm not freaking out about it anymore. The tremor is back to being barely noticeable.
I experienced insomnia when I missed a dose of Risperdal too.
Deneb*
This is the end of the thread.
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