Posted by King Vultan on January 19, 2005, at 8:19:03
In reply to Risperdal Bupropion for Depression Anxiety, posted by MTee on January 19, 2005, at 0:11:17
> Hi there. I'm a 35 yr old male, and I suffer from major depression and anxiety, and I also suffer from attentional issues (either hyper vigilant or out in left field). I am generally medication resistant.
>
> I am currently taking 150 mg Bupropion and .5 mg Risperdal (which will soon be increased to 1 mg), the latter of which I started a week ago as a mood stabilizer. The hope is that the Risperdal will quell anxiety and increase AD effects of Bupropion, and, in turn, attentional issues will abate. If this doesn't work, I will next turn to Zyprex, and, if that doesn't work, I will (last) resort to MAO inhibitors.
>
> I am interested to hear from anyone that has tried a similar combination and the results, including side effects. I haven't noticed much in the way of side effects thus far except for periodic tiredness in the afternoon, which could be partly attributable to my recent discontinuation of Seroquel, which I took for sleep.
>
> I am also interested in hearing from folks regarding Zyprexa and, particularly whether you did not gain significant weight. I am physically fit and do not want to gain significant weight, as I did when I took Mirtazipine.
>
> Thanks a lot. Peace to you all.
> MTeeOne problem I see with your combo is that Wellbutrin is a CYP-450 2D6 inhibitor and will amplify the effects of the Risperdal beyond what one would generally expect at any particular dosage. Risperdal is not a particularly dangerous drug, but it does have more adverse effects at higher dosages than do the other atypicals. The situation is actually much more complicated than that, and I hesitate to really get into it in any detail, but basically, using Wellbutrin with Risperdal will also tend to change the ratio between Risperdal and its main active metabolite (9-OH-risperidone). IMO, this may actually be a good thing, but your doctor needs to be on the ball and aware of all these factors, and the dosage really should be kept on the low side, at least at the beginning.
I take Parnate and am currently augmenting it with Risperdal at 0.375 mg/day. In my case, there is probably no enzyme interaction between the two drugs, or at least none of any significance, and I guess I am coming to the conclusion that my pdoc was correct in his original thought that Geodon/ziprasidone would be a better choice for someone like me. I had asked about trying an atypical AP mainly because I had found a paper that talked up Risperdal, which does have some very good properties, at least in theory, but I am coming to realize that this is one of those cases where I know just enough to be dangerous, and I am fortunate to be working with a good doctor who humors me to some extent but who also prevents me from getting into too much trouble. I seem to be experiencing some negative effects even at this dosage, mainly subtle cognitive issues, such as increased absentmindedness, slight confusion, and decreased attention to detail. I had planned on going up to 0.5 mg/day but am now probably more likely to go back to 0.25 mg/day, which I felt was an extremely beneficial dosage without a lot of negatives. I likely will be discussing Geodon with him at my next appointment.
Todd
poster:King Vultan
thread:444059
URL: http://www.dr-bob.org/babble/20050119/msgs/444131.html