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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by elspeth on May 1, 2001, at 15:40:00
My daughter was in treatment for anorexia for 3 years rom age 17.She resisted drug treatment but after 3 years of acute anorexia and some bulimic behaviours she was treated with fairly high dosage of prozac.In the period which followed she had a severe pschotic reaction and was in hospital for 6 months.she did not respond to treatment and had a range of drugs prescribed which were ineffective. She was then treated with risperidone and carbmazapine which gradually helped her to recover and has been on the same dosage ever since. ie 600mg carbamazapine and 4mg risperidone daily. She has been well for 2 years and has returned to studying and seems to be ok..she has of her own accord halfed the dosage of both these drugs...and after 3 months has told her gp who has supported her descision and is maintaining her on this halved dosage. Does anyone have ant advice about the pace of reduction of these drugs? or how long people should be on them?
Posted by judy1 on May 1, 2001, at 17:47:32
In reply to reducing the dosage of risperidone, posted by elspeth on May 1, 2001, at 15:40:00
My shrink and I share the same views- the risk of using a neuroleptic long term (even the atypicals like risperdal) is not justified in someone who has had one or even several brief psychotic episodes. That being said, I have stopped low doses of risperdal w/o tapering, but I am rarely on it for more than a few weeks. In your daughter's case, she may experience some withdrawal effects- anxiety, insomnia, agitation, etc. So I would find a sympathetic dr. and get a tapering schedule if she has any withdrawal symptoms that are uncomfortable. As for the tegretol- that made me so ill I was happy to go off, if I rememeber correctly I experienced more 'psych' effects, paranoia and agitation. Abruptly stopping can cause seizures. Again I recommend a shrink to monitor. Remember that withdrawal is not the same as re-emergence of the disorder and everyone should be on the same page with that. I really like the 10%/week taper- you tend to avoid discomfort that way. Just curious (having been bulimic myself in the past), did the emergence of psychosis come when the prozac was stopped? I wish your daughter well- judy
Posted by SalArmy4me on May 2, 2001, at 0:48:15
In reply to Re: reducing the dosage of risperidone » elspeth, posted by judy1 on May 1, 2001, at 17:47:32
Risperidone _is_ safe for long-term use, according to a couple studies:
1: Megna JL, Dewan M. Related Articles
A naturalistic study of risperidone maintenance treatment of outpatients with severe mental illness.
Psychiatr Serv. 1999 Aug;50(8):1084-6.
PMID: 104456612. Ghaemi SN, Sachs GS. Related Articles
Long-term risperidone treatment in bipolar disorder: 6-month follow up.
Int Clin Psychopharmacol. 1997 Nov;12(6):333-8.
PMID: 9547135 [PubMed - indexed for MEDLINE]3. Zuddas A, Di Martino A, Muglia P, Cianchetti C.
Long-term risperidone for pervasive developmental disorder: efficacy and tolerability.
J Child Adolesc Psychopharmacol. 2000 SUMMMER;10(2):79-90.
PMID: 10933118 [PubMed - indexed for MEDLINE]
Posted by judy1 on May 2, 2001, at 9:26:29
In reply to Re: reducing the dosage of risperidone » judy1, posted by SalArmy4me on May 2, 2001, at 0:48:15
Dear Sal,
I tend to discount papers written on relatively new drugs. I believe in the 10/20/30 year rule (and please someone help me if I screw this up) 10 years to start documenting adverse effects for long term users, 20 for people to start suing and 30 to withdraw the drug. I was on mellaril for many years- it took 20 years for the pharmaceutical co. to issue the cardiac effects (which I experience). I am as hopeful as anyone when a new drug comes down the pipeline, especially for us treatment resistant types- but i still prefer use of drugs like benzos (20 years?) that have known side effects. Sorry, I could rant on this and should probably move to the other site- judy
Posted by judy1 on May 2, 2001, at 9:33:42
In reply to Re: reducing the dosage of risperidone » SalArmy4me, posted by judy1 on May 2, 2001, at 9:26:29
Now I'm thinking of the ssri craze and all the side-effects that are being revealed and that are starting to make the maoi's more attractive. ok i'll stop.
Posted by elspeth on May 2, 2001, at 13:43:40
In reply to Re: reducing the dosage of risperidone » elspeth, posted by judy1 on May 1, 2001, at 17:47:32
Thankyou for reply to my query..I've never used a message board like this before!and don't know if I've typed in the right space to reply...so we'll see! Your comments about not mistaking withdrawal for re-emergence of the illness were really helpful..Its so hard to know what has been going on and my daughter doesn't have a consultant at the moment..and doesn't want one . She has been a bit hyper and uptight since she reduced the drugs and I didn't know that could just be withdrawal. I think she probably has cut down too drastically..but will just we'll see how things go now. There seem to be so many conflicting opinions. The psychosis happened when she was on a very high dose of prozac while she was being sick...and so when she quite suddenly stopped being sick due to a change in her social life, there was a much higher concentration in her body.
Its been a really hard time and I'm glad to find this site.It would have been really helpful 3 years
ago.T > My shrink and I share the same views- the risk of using a neuroleptic long term (even the atypicals like risperdal) is not justified in someone who has had one or even several brief psychotic episodes. That being said, I have stopped low doses of risperdal w/o tapering, but I am rarely on it for more than a few weeks. In your daughter's case, she may experience some withdrawal effects- anxiety, insomnia, agitation, etc. So I would find a sympathetic dr. and get a tapering schedule if she has any withdrawal symptoms that are uncomfortable. As for the tegretol- that made me so ill I was happy to go off, if I rememeber correctly I experienced more 'psych' effects, paranoia and agitation. Abruptly stopping can cause seizures. Again I recommend a shrink to monitor. Remember that withdrawal is not the same as re-emergence of the disorder and everyone should be on the same page with that. I really like the 10%/week taper- you tend to avoid discomfort that way. Just curious (having been bulimic myself in the past), did the emergence of psychosis come when the prozac was stopped? I wish your daughter well- judy
Posted by judy1 on May 2, 2001, at 18:52:57
In reply to reducing the dosage of risperidone, posted by elspeth on May 1, 2001, at 15:40:00
I'm glad you found some of my comments useful. Before I was dxed with bipolar disorder, I was given prozac and developed a psychotic manic episode. They stopped the prozac, but because it has such a long half life (and also my own denial and refusal to take any other medication) the episode took about a month to resolve. I wish your daughter had a therapist to help her through this, it's tough going through withdrawal alone. I guess the most I can say is try to be supportive until the after effects of the drugs are gone. It can take weeks to months for the brain's chemistry to normalize after being on meds for years. Take care- judy
Posted by SalArmy4me on May 6, 2001, at 0:49:07
In reply to Re: reducing the dosage of risperidone » SalArmy4me, posted by judy1 on May 2, 2001, at 9:26:29
But Risperidone is not that new (8 years of FDA approval; many years of European approval).
> Dear Sal,
> I tend to discount papers written on relatively new drugs. I believe in the 10/20/30 year rule (and please someone help me if I screw this up) 10 years to start documenting adverse effects for long term users, 20 for people to start suing and 30 to withdraw the drug. I was on mellaril for many years- it took 20 years for the pharmaceutical co. to issue the cardiac effects (which I experience). I am as hopeful as anyone when a new drug comes down the pipeline, especially for us treatment resistant types- but i still prefer use of drugs like benzos (20 years?) that have known side effects. Sorry, I could rant on this and should probably move to the other site- judy
This is the end of the thread.
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