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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by iowamoo on May 10, 2014, at 17:41:24
Yes I'm back and still trying to rule out different medsosoooooo any opinion between these two please let me know and thanks so much for your patience!
Posted by phidippus on May 11, 2014, at 18:57:20
In reply to invega or risperdal?, posted by iowamoo on May 10, 2014, at 17:41:24
Not much difference - Paliperidone is the active metabolite of Risperidone.
Eric
Posted by iowamoo on May 11, 2014, at 19:17:26
In reply to Re: invega or risperdal? » iowamoo, posted by phidippus on May 11, 2014, at 18:57:20
I see the psych DR.Friday instead of a psych nurse so trying to gather info I all my choices, not doing a good job though on making a decision. After this horrible mood week I'm just thinking of going back on risperdal but got scared off it because I had a lot of body stiffness and anxiety.
I'm trying B stress vitamins, vitamin D because I'm low and a omega 3 that is very high in all the things required in it. Oh yeah and valium as needed to chill out and trying ketogenic diet which is good to eat so many fats like real butter, mayo, coconut oil, but hard missing junk food, fries, chips..but gotta try anything! If I miss a meal or eat something too carby I can feel my mood swing right out the door for the whole day. My husband has the patience of a saint to put up with me or he's crazy too LoL
Posted by LouisianaSportsman on May 11, 2014, at 22:35:28
In reply to invega or risperdal?, posted by iowamoo on May 10, 2014, at 17:41:24
> Yes I'm back and still trying to rule out different medsosoooooo any opinion between these two please let me know and thanks so much for your patience!
From what I can remember when I was selecting AAPs (I have taken Abilify, and I now take Latuda), I'm not going to do any Googling for you, I know that's not the kind of answers you want anyway.
I would say that paliperidone would be the superior option only if it is not a financial burden.
Only in certain cases would Invega offer much of an advantage over Risperidone to warrant much of an extra cost.
The main advantage it offers is that it is the active metabolite of Risperdal and as such as there are no drug-drug interactions with paliperidone (low extent of enzymatic metabolism with already metabolized formulations); also,age does not factor in with the pharmokinetics of Invega if you're older I believe.
Remember that these two are not approved for the depressive phase of bipolar disorder and may very well INCREASE DEPRESSION, but may be effective for mania or treatment of bipolar disorder. There may be studies with Invega where the HAM-D (depression) score is higher at endpoint, but the mania score is lower; therefore, Invega is successful, but only technically so in my eyes. Watch out for an increase of depression with Invega or Risperdal; however, paliperidone is more likely to act as a mood stabilizer with properties similar to lithium via protein expression analysis. Regardless of this fact, I still had to rule it out for my bipolar depression, but I still think it has a merit for treating bipolar marked with particularly manic symptomology.
Invega is also lot of better in terms of glucose, cardiovascular health and metabolic side effects like hyperglycemia and lipid dysregulation than the majority of AAPs but remember your endocrine stuff is not good due to the prolactin increase and the extrapyramidal symptoms are no good but still beats Risperdal and a lot of AAPs-- but these are dose dependent as with all things are in the AAP world.
It's a great option if you're schizophrenic and I believe OROS sustained-release of it is quality (you will sh*t out and be able to see the shell of it!) (same thing in Concera, made by Alza Corporation).
If you need to things to be metabolized by your liver and you're prone to extrapyramidal side effects and need something with a better profile and have some extra money then strongly consider Invega. Don't expect it to do anything amazing for you off-label either.
Any other questions? Don't expect everything I said to be perfect because I didn't have time to research and look up things, sorry.
You'll most likely be better off with Risperdal since it will do everything you want cheaper.
Posted by tom2228 on May 12, 2014, at 13:35:25
In reply to Re: invega or risperdal?, posted by LouisianaSportsman on May 11, 2014, at 22:35:28
Invega does not cause inhibition of certain liver enzymes that risperidone does and therefore has fewer drug interactions.
Although they are going to be similar to each other as Invega (paliperidone) is the principal metabolite of risperidone, Invega does have a few pharmacodynamic differences.
One of these difference translates to data saying that risperidone can be more sedating, whereas Invega was found in a meta-analysis to be the least-sedating of the AAPs.
Posted by phidippus on May 12, 2014, at 16:43:12
In reply to Re: invega or risperdal? » phidippus, posted by iowamoo on May 11, 2014, at 19:17:26
I'd recommend you take Lamictal and Risperdal. The anxiety you experienced while on Risperdal was probably not related to it.
Eric
Posted by iowamoo on May 12, 2014, at 19:36:21
In reply to Re: invega or risperdal? » iowamoo, posted by phidippus on May 12, 2014, at 16:43:12
Which do you think would have a lower seizure risk the invega or risperdal?
Posted by iowamoo on May 12, 2014, at 21:23:42
In reply to Re: invega or risperdal?, posted by LouisianaSportsman on May 11, 2014, at 22:35:28
Wow that was a lot of great information! I've posted on here about my seizure history that is considered "seizures with provoking factor which it's strobe light effects. I quit risperdal once because of my fear of risperdal causing a seizure, I went back I after a couple months because my husband couldn't handle my bitchiness anymore and my moods were out the door. I've been diagnosed 3 out of 4 Dr.s with bipolar 2 but not to an extreme and by the 4th Dr. As"just having an anxiety disorder" BONK BONK BONK...I didn't use to be this way until about 4 years ago..I want to take what has the least seizure risk...
Posted by LouisianaSportsman on May 12, 2014, at 21:31:27
In reply to Re: invega or risperdal? » phidippus, posted by iowamoo on May 12, 2014, at 19:36:21
> Which do you think would have a lower seizure risk the invega or risperdal?
Invega
but remember it's the same thing asking:
What do you think would have a lower seizure risk the 9-Hydroxyrisperidone that I just took out of this synthetic liver or risperdal that will end up becoming primarily 9-OH-RIS anyway with maybe some 7-OH-RIS, Hydroxy Keto analogue or unchanged risperidone for good measure?
So not much of a difference.
Posted by iowamoo on May 12, 2014, at 21:45:40
In reply to Re: invega or risperdal?, posted by LouisianaSportsman on May 12, 2014, at 21:31:27
Soooooo I'm prediabetic as well lol I already know the risperdal works and works soooooo good and only at .25 I was doing so good but I was having such weird body tension that I had to stop to see if it went away and it did then got scared to go back on again. I know in the end Friday when I see the psych DR. He will have the final say so but I want to go in somewhat informed. I'm scared to take lamictal because it is for seizures and if it don't work out I risk withdrawal seizures so you see I'm ALL over the board. When I told my husband I would probably just go back on risperdal and he literally said "thank you Lord for answering my prayers"
Posted by phidippus on May 13, 2014, at 13:56:42
In reply to Re: invega or risperdal? » phidippus, posted by iowamoo on May 12, 2014, at 19:36:21
They are both going to have the same risk for seizures. But at the doses you take you really don't have to worry about it.
Especially if you take the Lamictal tooo.
Eric
Posted by ed_uk2010 on May 15, 2014, at 14:39:15
In reply to Re: invega or risperdal?, posted by iowamoo on May 12, 2014, at 21:45:40
>lol I already know the risperdal works and works soooooo good and only at 0.25
With Invega, very low dose tablets are not available. So if you were to switch to it, you would effectively need to increase your dose. I see no reason for you to switch to it.
>I was doing so good but I was having such weird body tension that I had to stop to see if it went away and it did
Tell us more about this and how it felt.
>Lamictal....withdrawal seizures
This would only be an issue if you stopped abruptly, not if you reduced the dose gradually.
Posted by phidippus on May 15, 2014, at 17:07:58
In reply to Re: invega or risperdal? » iowamoo, posted by ed_uk2010 on May 15, 2014, at 14:39:15
>I was having such weird body tension that I had to stop to see if it went away and it did
This was most likely akathisia which can bee treated with beta blockers, artane and cogentin.
Eric
Posted by iowamoo on May 16, 2014, at 6:46:39
In reply to Re: invega or risperdal? » ed_uk2010, posted by phidippus on May 15, 2014, at 17:07:58
I don't get why the first time I took this med same dose I did not get this full body tension problem. I already take as tiny dose of a beta blocker called betaxolol but at a very low dose but am willing to increase it to avoid it. The feeling is like that of pure anxiety coursing through my whole body and it makes it so bad that I cannot sit still for long because the anxiety is so intense one cannot sit still. Will it go away over time or get worse or stay the Same? I was surprised when the valium didn't help one bit.
I see the psych DR. Today to talk about either the seizure risk of risperdal or to try something else. I want the risperdal but am getting scared of it again...
Posted by phidippus on May 16, 2014, at 10:07:53
In reply to Re: invega or risperdal?, posted by iowamoo on May 16, 2014, at 6:46:39
>it makes it so bad that I cannot sit still for long because the anxiety is so intense one cannot sit still.
This is akathisia. I have experienced it many times. I prefer Cogentin to treat it - 2 mg. Propanolol is my second choice - 80 to 120 mg.
Sometimes it goes away over time, but usually it does not. It will not get worse, unless you raise the dose of the risperdal.
No need to get scared of the Risperdal - Akathisia is very treatable.
Eric
Posted by iowamoo on May 16, 2014, at 12:23:16
In reply to Re: invega or risperdal? » iowamoo, posted by phidippus on May 16, 2014, at 10:07:53
I just got back from psych DR. And we going to stick with the risperdal and if that problem comes back we will either add cogentin or try lamictal or depakote. He's not sure if I'm bipolar 2 or something called clymothymia and I know that's not how to spell it LoL but you probably know what I'm talking about..though he is leaning more towards bipolar 2 with mood disorder that's why he thinks lamictal or depakote better than risperdal...but I thought risperdal also a mood stabilizer so just back to being confused which is where I feel most comfortable anyways because it's most familiar LoL
Posted by ed_uk2010 on May 16, 2014, at 13:19:58
In reply to Re: invega or risperdal?, posted by iowamoo on May 16, 2014, at 6:46:39
> I don't get why the first time I took this med same dose I did not get this full body tension problem.
For some reason, you are extremely sensitive to Risperdal (perhaps due to the way your liver metabolises it). A very low dose (0.25mg) has had both clear beneficial effects and also what appeared to be an unpleasant side effect (akathisia).
Have you considered trying 0.125mg of Risperdal ie. half your previous dose? It might sound like nothing and for most people it probably would be but if I were you I would certainly consider trying it. You could get a prescription for a small quantity of Cogentin to take for akathisia (if it returned) but the aim should be to take a dose of Risperdal which does not cause such an unpleasant reaction.
If I were you, I'd try 0.125mg and see how you do. If the dose involves tablet cutting, it does not have to be precise, but you can buy tablet cutters very cheaply.
Posted by iowamoo on May 16, 2014, at 13:43:56
In reply to Re: invega or risperdal? » iowamoo, posted by ed_uk2010 on May 16, 2014, at 13:19:58
Oooh absolutely I will try half becsuse I always start at a quarter of the pill to start out LoL major chicken here lol in fact when I was at half the pill I felt good then too and I will try that again and see if it still works and if it does just stay there and if it stops working after a while I can just do 3/4 of the pill etc. Great idea and thank you for that reminder! I feel less stress already LoL
Posted by phidippus on May 16, 2014, at 14:05:29
In reply to Re: invega or risperdal?, posted by iowamoo on May 16, 2014, at 12:23:16
>if that problem comes back we will either add cogentin
It will come back so might as well get that script filled now.
>but I thought risperdal also a mood stabilizer
Risperdal is an atypical antipsychotic.
Depakote and Lamictal are anticonvulsants used as mood stabilizers.
Eric
Posted by iowamoo on May 16, 2014, at 17:05:19
In reply to Re: invega or risperdal? » iowamoo, posted by phidippus on May 16, 2014, at 14:05:29
Risperdal is listed under mood stabilizer for bipolar treatment and cyclothymia which is what I could have and is close to bipolar. That is what I read anyways but listed first was lithium which I tried years ago and it messed up my already messed up thyroid...It says it gets worse as you get older, how lovely. I do know the risperdal seemed to stabilizer my mood and gave me energy and made me feel more calm and interactive with other's and I didn't try to control everybody which is a very difficult and tiring job LoL
Posted by Beckett on May 17, 2014, at 1:09:04
In reply to Re: invega or risperdal?, posted by iowamoo on May 16, 2014, at 17:05:19
> Risperdal is listed under mood stabilizer for bipolar treatment and cyclothymia which is what I could have and is close to bipolar. That is what I read anyways but listed first was lithium which I tried years ago and it messed up my already messed up thyroid...It says it gets worse as you get older, how lovely. I do know the risperdal seemed to stabilizer my mood and gave me energy and made me feel more calm and interactive with other's and I didn't try to control everybody which is a very difficult and tiring job LoL
Risperdal might be needed in a higher dose to work as a true mood stabilizer. Ed UK might be more knowledgable.
Any chance anxiety is BPII related?
Your husband's observation and opinion is valuable. While I think less can be more, consider not ruling out lamictal and risperdal in tandem.
Posted by phidippus on May 17, 2014, at 17:20:15
In reply to Re: invega or risperdal?, posted by Beckett on May 17, 2014, at 1:09:04
>Risperdal might be needed in a higher dose to work as a true mood stabilizer
Risperdal is an antipsychotic at every dose. It will never be a mood stabilizer.
Eric
Posted by phidippus on May 17, 2014, at 17:24:32
In reply to Re: invega or risperdal?, posted by iowamoo on May 16, 2014, at 17:05:19
>Risperdal is listed under mood stabilizer for bipolar treatment
Where was this listed? This is incorrect. Risperdal shares none of the same moa as mood stabilizers.
Eric
Posted by ed_uk2010 on May 18, 2014, at 17:36:25
In reply to Re: invega or risperdal? » iowamoo, posted by phidippus on May 16, 2014, at 14:05:29
> >if that problem comes back we will either add cogentin
>
> It will come back so might as well get that script filled now.Not necessarily with a lower dose. Akathisia tends to be very dose-dependent with Risperdal.
Posted by ed_uk2010 on May 18, 2014, at 17:43:25
In reply to Re: invega or risperdal?, posted by iowamoo on May 16, 2014, at 17:05:19
>Risperdal is listed under mood stabilizer for bipolar treatment and cyclothymia which is what I could have and is close to bipolar. That is what I read anyways but listed first was lithium which I tried years ago and it messed up my already messed up thyroid...
What's in a name? Risperdal is officially classified as an atypical antipsychotic but it can improve various aspects of bipolar disorder so you could call it a 'mood stabiliser' in that sense. In particular, it treats manic symptoms. Anyway, the term 'mood stabiliser' isn't well defined so you may as well forget about it. What matters is whether or not it works for you and whether you have any major side effects. Various drugs often classed as 'mood stabilisers' such as lithium, Depakote and Lamictal are markedly different from one another. You are argue that Depakote and Lamictal are primarily epilepsy medications. The point is, it doesn't make a difference what you call it. Lamictal was introduced as a treatment for partial seizures in epilepsy. Risperdal was brought out as a treatment for schizophrenia. Both meds now have multiple uses and could be referred to by various different names.
Focus on what's important for you :)
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