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Advice » mogger

Posted by ed_uk2010 on October 1, 2014, at 15:22:41

In reply to Risperdal helping but loss of libido, posted by mogger on September 28, 2014, at 23:38:35

> Hi there,
>
> I have added Risperdal to my cocktail and it has made a substantial difference to both my depression and killed my anxiety/ocd. I am encouraged by marked improvement however my libido has plummeted. I am at .75mg a day of Risperdal which I think is a low dose and I don't think I could go any lower without the depression/anxiety returning so I am in a major predicament. I have tried meds for 21 years and this seems to be the best med other than lamictal I have tried so I don't want to go off it. Has anyone ever heard that Invega has lessened side effects i.e. perhaps less sexual dysfunction or am I screwed? I don't want to come off Risperdal so the only thing I can think of is to try decreasing my 150mgs of sertraline? Many thanks for your thoughts and experiences,
>
> Joseph

Hi Joseph,

Very pleased to hear that Risperdal is helping your symptoms.... and no, you are not screwed.

The mechanism by which risperidone causes sexual dysfunction is quite well understood. Even at low doses, it can produce quite a marked elevation of prolactin levels. Prolactin is a hormone which is vital in women during breastfeeding because it allows milk to be produced. In men, its function is less clear but it is always present in the blood at a low level. Given your sexual problems, you should ask your doctor to do a blood test for prolactin.

Certain antipsychotics, notably risperidone, paliperidone (Invega) and amisulpride (Solian) can produce large increases in the blood levels of prolactin. In women, the increase is often even worse. Invega causes just as much sexual dysfunction as Risperdal so is not an option.

Anyway, the increase in prolactin produces a decrease in libido and sexual dysfunction. Part of the reason for this may be that high prolactin causes a drop in testosterone levels.

So.... how to deal with it. There are several options.

Some antipsychotics produce very little change in prolactin levels eg. quetiapine (Seroquel). Olanzapine (Zyprexa) often causes a marginal increase, much less than Risperdal. Aripiprazole (Abilify) is totally unique because it actually reduces prolactin levels. If you respond well to any of the above you could switch. If not, there is the option of adding a tiny dose of Abilify. When added to Risperdal, Abilify can reverse the increased prolactin and restore sexual function. Because aripiprazole acts as a partial agonist (stimulant) of the dopamine receptors in the pituitary gland, it prevents prolactin from being released. This can improve sexual function. Assuming your prolactin levels come back as high and you don't respond as well to other antipsychotics as Risperdal, I suggest adding 2mg of Abilify and then increasing to 5mg after a week or two. Your prolactin levels should then drop over the next few weeks, testosterone levels should increase and you should notice an improvement in both libido and sexual function.

Hope this helps. Do let me know if you have any further questions.

 

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