Posted by anita on November 23, 2000, at 0:14:05
In reply to Re: Question for Risperdal users, posted by Dr. Bob on November 18, 2000, at 11:16:56
Dear Dr. Bob,
Thank you very much for posting my Risperdal question to your
psychopharm list. The responses were helpful. In case anyone would be
interested in an update, here it is (sorry so long, but I find all this
pretty interesting :-), and I hope someone can at least benefit from my
experiences):As suggested, I reduced the dose to .25mg/day from 1mg/day, and the
risperidone seemed to kick in again, although not as strongly as it
initially did. After a week or so on .5mg/day, it stopped working yet
again. I lowered it to .25mg/day a few days ago, and got some of the
beneficial effects back again. I will remain on that dose and see what
happens.Some theories: Perhaps there is a theraputic window for the
antidepressive effects of low-dose atypical antipsychotics for use in
depression. Perhaps at low doses, these meds work to _increase_ dopamine
in the mesolimbic pathway, as amisulpride does, thus functioning as an
"anti" antipsychotic. Personally, risperidone feels a lot like low-dose
amisulpride. Perhaps the low doses make one a little "manic," relatively
speaking? I wonder what the effect on 5HT2A would be at these low doses,
especially since there are conflicting studies as to whether 5HT2A
receptors are upregulated or downregulated in depression.Unfortunately, while my response to prodopaminergic meds is usually good
at first, eventually I become irritable and have to discontinue them,
even tho I am already taking a mood stabilizer (for mood swings, not
bipolar). I feel this is starting to happen with risperidone, and I may
see if raising lamotrigine or adding a beta-blocker would alleviate
that. Any other suggestions would be helpful.Again, thanks everyone for your input.
Anita
__________________________________________________________I did something Rx Qx-like and passed this on to psycho-pharm (a
list I belong to). I hope the below is helpful...Bob
--
From: Dr. James Karagianis
I used a lot of risperidone when it first came out, but found a lot
of patients pooped out on it by about 6 months. I use more olanzapine
and have found higher success rates and lower relapse rates.From: John M. Talmadge, M.D.
My experience has been that the antidepressant effects of
olanzapine (Zyprexa) are superior to those of risperidone (Risperdal).
This individual might want to try Zyprexa as an alternative to the
Risperdal.
I would offer a suggestion as well that both venlafaxine (Effexor)
and mirtazepine (Remeron) seem to do better in the apathy/lack of
motivation department than Zoloft for most of my patients.From: Deborah Pines, MD
I had a patient who needed a certain dose of Risperdal, and then
after a while it wouldn't work any more. Raising the dose helped
temporarily, but then it wouldn't work any more. This went on for
several doses. At one point ... the dose [was] lowered to the original
one. At which point he got better.
Risperdal has anti-cholinergic properties leading to sedation,
lethargy, memory loss etc. Perhaps rather than raising the dose, this
woman ought to try lowering it.
In addition, I found that Risperdal's D24 metabolism can be very
influenced by other drugs, leading to more side effects.From: Stephen J. Wieder
I have never been impressed with Risperdal functioning as an
augmenter for antidepressants in a non-bipolar/non-psychotic patient
even though I do have experience with Zyprexa working in this way. It is
therefore interesting this post suggests that it can be. I would be very
curious if others have seen Risperdal augment antidepressant response.
In response to the questioner my first suspicion would be Zoloft
poop-out as the likely cause independent of the Risperdal. I am unclear
why he is taking Lamictal. Is he bipolar?From: Jeffrey E. Kelsey, M.D., Ph.D.
I wonder if this may be a result of a drug-drug interaction between
the Zoloft (sertraline) and risperidone. Sertraline, as a weak to
moderate 2D6 inhibitor, has the potential to increase risperidone
levels. Since initial dosing was successful, and presumably at a low
serum level, this patient might now have too high a risperidone
level. Rather than raise the dose (certainly reasonable as a first
step), they may do better on a much lower dose.
poster:anita
thread:48989
URL: http://www.dr-bob.org/babble/20001115/msgs/49282.html