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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by Deneb on December 20, 2010, at 22:44:06
I told pdoc about the weird stiff, jerky movements I feel when walking down the stairs and she tells me it is dystonia from the Risperdal, even though I'm taking a small dose.
I also have a bad intentional tremor sometimes. Does this mean there is something wrong with my cerebellum?
I also get regular tremors from just doing things with my hands. It is made 100 times worse by caffeine. Pdoc ordered me to stop drinking all caffeine, do progressive muscle relaxation several times a day, get 8 hours of sleep a night and do some exercise everyday, even if it is just a 15 min walk. She might replace the Risperdal with something else.
Anyways, is it possible to get dystonia on even 0.75mg Risperdal? It's such a tiny dose! Is it possible something is happening that is causing the Risperdal levels in my body to be actually higher than it is supposed to be?
Posted by Christ_empowered on December 20, 2010, at 23:32:33
In reply to Pdoc said I have dystonia, posted by Deneb on December 20, 2010, at 22:44:06
I think some anti-depressants can increase antipsychotic blood levels. Risperdal can cause movement disorders, I think it depends on dosage, length of use, and your own sensitivity.
You *are* taking a really low dose, though. I've heard that sometimes low-dose seroquel is used in treatment of movement disorder from other antipsychotics. Maybe that'd be a good option? It'd definitely help you sleep.
Posted by Phillipa on December 20, 2010, at 23:49:54
In reply to Re: Pdoc said I have dystonia, posted by Christ_empowered on December 20, 2010, at 23:32:33
Deneb you are tiny or small right so I guess it could be possible. What's you doc want to switch to. Was she worried or just wants you to try excercise and relaxation. I'm sorry this happened to you. Phillipa
Posted by emilyp on December 21, 2010, at 13:53:33
In reply to Pdoc said I have dystonia, posted by Deneb on December 20, 2010, at 22:44:06
I obviously don't know your doctor. But dystonia is a somewhat rare disease. You really need an expert to examine you and hear your story before you are diagnosed. I know a lot about this disease, as a good friend has it and he is a board member of the Dystonia Medical Research Foundation.
You should check out the foundation at http://www.dystonia-foundation.org/
I am not saying your P-doc is wrong in terms of telling you what to do. But do not jump to any conclusion until you see a specialist. Also, there are many different types of dystonia. You may have one variation of it.
Posted by bleauberry on December 21, 2010, at 17:04:11
In reply to Pdoc said I have dystonia, posted by Deneb on December 20, 2010, at 22:44:06
>
> Anyways, is it possible to get dystonia on even 0.75mg Risperdal? It's such a tiny dose! Is it possible something is happening that is causing the Risperdal levels in my body to be actually higher than it is supposed to be?
>
>The answer to all your questions is yes.
.75mg isn't all that tiny for risperdal. Tiny would be .25mg or .125. Any antipsychotic at any dose, and must about any psych med for that matter, can cause bizarre neurological problems. Actually I should probably rephrase that. It's not necessarily that they cause them, but they highlight a weakness that was already there. I mean, if we have psych symptoms to begin with, and that's why we are going to a doctor, then we already know something is messed up. Brain integrity is already in question. Drugs can sometimes make obvious what was otherwise kind of hidden.
The best strategy in my opinion is to totally avoid substances that aggravate the problem. In your case, risperdal is the aggravator. If it were me, I would stay on risperdal only if it was providing me with amazing benefits to balance out the complications. I mean, I could deal with dystonia for a few weeks, few months maybe. But think ahead a few years. You know it's only going to progress worse and worse. Is it worth it? Well, I guess if it kept me in total remission, it would be kind of a cruel trade, a cruel joke, but would ultimately be worth it just so I could live a productive life, despite the neurological jerkiness. But if risperdal wasn't doing something so good that I could celebrate about it, forget it, I'm all done with it. I'm already screwed up, I don't need some drug to screw me up even more.
It comes down to a personal risk verses benefit decision.
Posted by Deneb on December 21, 2010, at 20:47:30
In reply to Re: Pdoc said I have dystonia, posted by emilyp on December 21, 2010, at 13:53:33
Well the rigidity thing only really happens sometimes when I walk down the stairs. It's not really that big of a deal to me. It's not severe or anything. It just makes me feel like I will fall down the stairs sometimes but I never trip.
The most problematic thing for me has been my tremors. People notice them and they prevent me from doing things sometimes. Sometimes they get really bad.
I don't know if meds can cause tremors.
Posted by Deneb on December 21, 2010, at 20:51:03
In reply to Re: Pdoc said I have dystonia, posted by bleauberry on December 21, 2010, at 17:04:11
Well, pdoc thinks that if we do stop the Risperdal, she'd need to replace it with something because whenever I stop the Risperdal I became very distressed and suicidal. So yeah, it's pretty important for me.
If I had to choose between becoming distressed like that again and living with the weird symptoms I have now, hands down I'll live with the weird symptoms. There is just no comparison. Yes my distress is that bad.
Posted by violette on December 21, 2010, at 21:07:25
In reply to Re: Pdoc said I have dystonia » bleauberry, posted by Deneb on December 21, 2010, at 20:51:03
Hi Deneb,
Did you take a look at the website posted by EmilyP? There is a search feature to find a MD who specializes in dystonia, movement disorders etc. Some are psychiatrists; some specialized neurologists... Maybe you could find a doctor near you to get an assessment or consultation to help you out?
Posted by Deneb on December 21, 2010, at 21:43:37
In reply to Re: Pdoc said I have dystonia, posted by violette on December 21, 2010, at 21:07:25
Pdoc thinks my tremors are caused by a combination of an essential tremor, anxiety and meds. From what I've read there is no cure, only treatment by reducing stress, taking propranolol, sleeping enough etc., so I'm not sure what use a specialist would be to me. They'd just be giving me the same treatment as pdoc.
Posted by obsidian on December 21, 2010, at 22:58:03
In reply to Pdoc said I have dystonia, posted by Deneb on December 20, 2010, at 22:44:06
glad your pdoc is paying attention :-)
I hope it gets addressed soon,
sid
Posted by MissThang on December 24, 2010, at 8:30:59
In reply to Pdoc said I have dystonia, posted by Deneb on December 20, 2010, at 22:44:06
Is there another med in the same class as risperdol that you could take to relieve the symptoms without the tremors? If so, why not give that a try for a week or so to see if it would help you.
When I was on Abilify, I got dyskenesia but thankfully, it went away once I stopped the drug. Unfortunately, sometimes this type of neurological symptom will become permanent if you stay on the med that's causing it long enough. If it were me, I'd investigate a drug to replace the risperdol so you could get the same benefit without the drawbacks.
Posted by ed_uk2010 on December 24, 2010, at 14:00:20
In reply to Pdoc said I have dystonia, posted by Deneb on December 20, 2010, at 22:44:06
>Anyways, is it possible to get dystonia on even 0.75mg Risperdal?
It's possible, but your very potent SSRI combination might be responsible. It is not usual to take two SSRIs together at full doses.
Posted by Deneb on December 27, 2010, at 20:02:04
In reply to Re: Pdoc said I have dystonia, posted by MissThang on December 24, 2010, at 8:30:59
> Is there another med in the same class as risperdol that you could take to relieve the symptoms without the tremors? If so, why not give that a try for a week or so to see if it would help you.
I don't know. Pdoc said that if my tremors don't get better after reducing my anxiety that we could switch the Risperdal to something else. She didn't say what she'd switch it to.
Posted by Deneb on December 27, 2010, at 20:03:09
In reply to Re: Pdoc said I have dystonia » Deneb, posted by ed_uk2010 on December 24, 2010, at 14:00:20
> >Anyways, is it possible to get dystonia on even 0.75mg Risperdal?
>
> It's possible, but your very potent SSRI combination might be responsible. It is not usual to take two SSRIs together at full doses.
>Yeah, I know. I'm not too sure why I'm on two SSRI's at full dose.
Posted by Phillipa on December 27, 2010, at 21:39:18
In reply to Re: Pdoc said I have dystonia, posted by Deneb on December 27, 2010, at 20:03:09
Both prescribed by the same doc? Phillipa
Posted by jane d on December 28, 2010, at 3:54:06
In reply to Re: Pdoc said I have dystonia, posted by Deneb on December 27, 2010, at 20:03:09
> Yeah, I know. I'm not too sure why I'm on two SSRI's at full dose.
Then you really need to ask her that, don't you? I know it can be uncomfortable to ask questions of any doctor. I think it may be even harder when it's a doctor you've seen for years and never questioned before, but it's something you have to do when you don't understand something. Do you worry that she will resent it?
Posted by Deneb on December 28, 2010, at 11:40:43
In reply to Re: Pdoc said I have dystonia » Deneb, posted by Phillipa on December 27, 2010, at 21:39:18
> Both prescribed by the same doc? Phillipa
Yes.
Posted by Deneb on December 28, 2010, at 11:49:16
In reply to Talking to your doctor » Deneb, posted by jane d on December 28, 2010, at 3:54:06
> > Yeah, I know. I'm not too sure why I'm on two SSRI's at full dose.
>
> Then you really need to ask her that, don't you? I know it can be uncomfortable to ask questions of any doctor. I think it may be even harder when it's a doctor you've seen for years and never questioned before, but it's something you have to do when you don't understand something. Do you worry that she will resent it?
>No, I don't worry that she will resent it. She won't get angry if I question her. I just never seem to think of asking questions. I'm just very trusting in general and I kind of like this paternalistic arrangement we have. I'm fully aware that I can take a more active role in my care if I so choose, but I just prefer this arrangement. I'm sure she'd be fine if I suddenly wanted to be an empowered patient or something. I just like trusting her and letting her make all the decisions. I think it's working out just fine.
Posted by Phillipa on December 28, 2010, at 19:20:26
In reply to Re: Talking to your doctor » jane d, posted by Deneb on December 28, 2010, at 11:49:16
Deneb it's fine to be trusting but it's possible your pdoc made a mistake they are human as we are also. Could she have discontinued when when she prescribed the other and you might have misunderstood the directions? Just a thought. Phillipa
Posted by Deneb on December 28, 2010, at 19:58:51
In reply to Re: Talking to your doctor » Deneb, posted by Phillipa on December 28, 2010, at 19:20:26
> Deneb it's fine to be trusting but it's possible your pdoc made a mistake they are human as we are also. Could she have discontinued when when she prescribed the other and you might have misunderstood the directions? Just a thought. Phillipa
No, it is not possible. I've been taking both the Prozac and the Celexa at full doses now for years. She writes the prescription for both meds at once.
Posted by Phillipa on December 28, 2010, at 21:50:07
In reply to Re: Talking to your doctor, posted by Deneb on December 28, 2010, at 19:58:51
I find you very inquisitive and scientific based so I'd personally want to ask why she has you on two SSRI's full dose. I could see if half of each to equal one. Phillipa
Posted by Maxime on January 3, 2011, at 21:50:10
In reply to Re: Talking to your doctor » Deneb, posted by Phillipa on December 28, 2010, at 21:50:07
I have heard of people being on two SSRIs full dose before. I don't think it is that uncommon. Yes, they are both SSRIs but they target different neurotransmitters in the brain.
Posted by jane d on January 4, 2011, at 4:29:42
In reply to Re: Talking to your doctor » jane d, posted by Deneb on December 28, 2010, at 11:49:16
> No, I don't worry that she will resent it. She won't get angry if I question her. I just never seem to think of asking questions. I'm just very trusting in general and I kind of like this paternalistic arrangement we have. I'm fully aware that I can take a more active role in my care if I so choose, but I just prefer this arrangement. I'm sure she'd be fine if I suddenly wanted to be an empowered patient or something. I just like trusting her and letting her make all the decisions. I think it's working out just fine.
I'm sure it is working out. Except that you often seem to end up having questions later which you come to babble and to other web sites to get answered. And those answers you get end up being guesses at best.I don't think you need to choose between asking questions and trusting her to decide what you're going to do. A question doesn't have to be a challenge. For instance if you'd very politely asked something like "Isn't that a very high dose of SSRI's? Why am I taking so much more than other people?" I imagine she would have replied that that dose had been shown in a study to work for such and such a condition. And then, when you later came across something on the internet saying that the maximum dose is x - you'd already know why that didn't apply to you and you could just ignore it instead of worrying.
Posted by jane d on January 4, 2011, at 4:35:43
In reply to Re: Talking to your doctor, posted by Maxime on January 3, 2011, at 21:50:10
> I have heard of people being on two SSRIs full dose before. I don't think it is that uncommon. Yes, they are both SSRIs but they target different neurotransmitters in the brain.
They are more similar than they are different. So I think the concern about total cumulative dose is legitimate. The key here is probably that the maximum possible dose is actually much higher than the "full dose" commonly prescribed.
This is the end of the thread.
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