Posted by med_empowered on September 21, 2005, at 0:23:13
In reply to Risperdal monograph and uses?, posted by Deneb on September 20, 2005, at 22:07:39
hey! Risperdal is one of the "atypical antipsychotics". The first one was Clozapine, which was used for a while in the 70s and then again in the 80s-90s in select groups of schizophrenics; it has severe side effects(but different side effects than old antipsychotics--for instance, it rarely causes movement disorders), so more tolerable antipsychotics with comparable mechanisms of action have been popping onto the market now and then since the early 90s. Anyway, Risperdal is a "high-potency" antipsychotic (this means the dose in mgs is lower and there's usually less drowsiness). It was originally developed and marketed for Schizophrenia/Schizoaffective disorders; like the older antipsychotics, it has come to be used in other psyhotic disorders (psychotic mania, drug-induced psychosis, psychotic depression, etc.). Also, like the other "atypical" antipsychotics (zyprexa, geodon, abilify, and seroquel), Risperdal is being used to help with treatment-resistant depression and anxiety, and is being used for long-term treatment of bipolar disorder. Dosing with Risperdal is a tricky business; when it first hit the market in the early 90s, doses ranged up to 8mgs. Later, it was agreed that these doses were too high; now, most doses max out at around 4-6mgs. Low-dose Risperdal (.5mgs is definitely low-dose) would be good some people with psychosis and is being used "off-label" (without official FDA approval) for helping with depression. No one knows exactly *why* low-dose antipsychotics (new and old, but especially the new ones) help some people with depression or who will most likely benefit, but in some cases the results can be very impressive (and very fast). Other times, low-dose antipsychotics can control symptoms of borderline personality disorder or agitation, anxiety associated with bipolar disorder (in these situations, the antipsychotic is often given "prn"--as needed--to maximize effectiveness and minimize side-effects). As the atypicals go, Risperdal is kind of harsh--it can cause menstrual problems in women (because of its effects on hormones such as prolactin), cognitive impairment, and it can cause EPS (extra-pyramidal signs). EPS involves symptoms such as akinesia--mask-like face, akathisia--intense inner restlesness and constant movement, shuffling gait, and tardive dyskinesia--an often permanent movement disorder characterized by uncontrolled movements, usually in the facial area. Old antipsychotics tended to cause EPS *FREQUENTLY* and the Tardive dyskinesia rates were pretty high, too--3%/year baseline, higher for women, the elderly, and those with mood-disorders (and higher still for those with 2 or more of those variables). The atypical antipsychotics cause EPS and tardive dyskinesia less often, but they still happen and there's usually still a connection between dosage and duration of treatment on the development of EPS/TD (higher dose/longer treatment=more problems). That said, any antipsychotic CAN cause EPS/TD at ANY dose...and, at least with the old antipsychotics, there were cases when TD developed after very brief (1-2months) exposure to the drugs. No one knows exactly how likely TD is with the atypicals--most likely, it varies from drug to drug (all the atypicals operate somewhat differently), and the best data available is for Zyprexa (about .5-1%/year TD rate). Risperdal's reputation would seem to indicate that its more likely to cause EPS, and tardive dyskinesia, than the other atypicals...whether this is accurate or not remains to be seen (it may have to do with patient selection and dosing), and whether this would be true even at low-doses also remains to be seen. Speaking from personal experience, I'd recommend avoiding *any* antipsychotic at *any* dose unless you are: a)actively and *floridly* psychotic or b) suffering so intensely from a treatment-resistant mood-disorder (bipolar or depression) that you'll try *anything* (keep in mind that EPS and TD rates, at least with the old antipsychotics, were considerably *higher* in those with mood-disorders than they were in those with schizophrenia). I don't know what your situation is, and I wouldn't presume to tell you what to do, but based on my own experience (I took atypicals for bipolar disorder), I would *seriously* recommend that you try to avoid the use of antipsychotics. Good luck!
poster:med_empowered
thread:557521
URL: http://www.dr-bob.org/babble/20050914/msgs/557547.html