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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
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.
MTee
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
Posted by banga on January 19, 2005, at 14:40:35
In reply to Re: Risperdal Bupropion for Depression Anxiety, posted by King Vultan on January 19, 2005, at 8:19:03
Just wondering--for what symptoms are you taking/will be taking an atypical AP?
Posted by King Vultan on January 19, 2005, at 19:59:05
In reply to Re: Risperdal Bupropion for Depression Anxiety » King Vultan, posted by banga on January 19, 2005, at 14:40:35
> Just wondering--for what symptoms are you taking/will be taking an atypical AP?
The purpose is mainly to augment the Parnate for depression and perhaps help counteract some of 5-HT2A receptor related side effects (insomnia, agitation, etc.). It's thought that blockading this receptor, which all of the atypical APs do, has a number of therapeutic benefits. The cognitive problems I am having with the Risperdal at 0.375 mg/day appear to be due to dopamine D2 receptor blockade, which is very weak at this dosage, but perhaps it is just something I am overly sensitive to. However, my impression is that Risperdal is more likely to cause this sort of side effect than are the other atypicals.Todd
Posted by banga on January 19, 2005, at 21:21:00
In reply to Re: Risperdal Bupropion for Depression Anxiety » banga, posted by King Vultan on January 19, 2005, at 19:59:05
I am giving a trial of Klonopin a chance to help anxiety, but it has not been a good start. (I have MD and debilitating GAD) Taking Geodon for a few days obliterated all anxiety MUCH better, probably due to the 5HT2a blocking. According to a chart I have comparing AP's, it blocks 5HT2a to the same extent as risperdal does; and for me Geodon has less side effects. Perhaps if I kept the dosage smaller I could avoid the foggy head and akathisia that hits later on...
Posted by MTee on January 20, 2005, at 11:32:47
In reply to Re: Risperdal Bupropion for Depression Anxiety, posted by King Vultan on January 19, 2005, at 8:19:03
Thanks for your reply. I wish you the best with Geodon, which my doctor and I are also considering if the Risperdal is not effective. Not sure, but I think Risperdal may have been first resort because of lower likelihood of weight. Would love to hear how you are doing as you attain therapeutic levels.
How has the parnate served you? MAOs are my next resort after the APs.
I am not sure my doctor is aware of the amplification of which you speak. I will mention it. Notwithstanding, I am at a low dose and I dont think I am suffering any major side effects other than sleep issues, which are likely unrelated as this has been one of my ongoing issues.
Best of luck,
Todd> One 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
Posted by banga on January 20, 2005, at 13:44:06
In reply to Re: Risperdal Bupropion for Depression Anxiety, posted by MTee on January 20, 2005, at 11:32:47
Atually, Risperidone is more likely to cause weight gain than Geodon typically. On risperidone, I was EXTREMELY faigued.
Posted by MTee on January 20, 2005, at 14:10:10
In reply to Re: Geodon vs Risperdal, posted by banga on January 20, 2005, at 13:44:06
Any ideas as to whether Geodon and Bupropion will play nicely together. And how else is Geodon different when used as an adjunct for depression and anxiety? Thanks.
Posted by banga on January 20, 2005, at 14:19:17
In reply to Re: Geodon vs Risperdal, posted by MTee on January 20, 2005, at 14:10:10
I truly couldn't venture to guess how well the combo of Geodon and Wellbutrin could work. At least compared to Risperidone, Geodon for me was more activating. The unpleasant side effect I experienced at higher doses was brain fog and spaciness.
My theory is that blocking the 5ht2a site has antianxiety effects. Both Geodon and Risperdal do this.
We are all different. You may just have to try it to see if it works for you.
Posted by MTee on January 20, 2005, at 14:23:34
In reply to Re: Geodon vs Risperdal, posted by banga on January 20, 2005, at 14:19:17
Are you having less issues with gaining weight with Geodon? I just realized I have gained 5 lbs in 8 days. I'm pretty fit, so I can handle it, but I dont want to continue to gain.
> I truly couldn't venture to guess how well the combo of Geodon and Wellbutrin could work. At least compared to Risperidone, Geodon for me was more activating. The unpleasant side effect I experienced at higher doses was brain fog and spaciness.
> My theory is that blocking the 5ht2a site has antianxiety effects. Both Geodon and Risperdal do this.
> We are all different. You may just have to try it to see if it works for you.
Posted by banga on January 20, 2005, at 17:47:35
In reply to Re: Geodon vs Risperdal, posted by MTee on January 20, 2005, at 14:23:34
I have not gained any weight when I take Geodon...and if weight gain is a possible side effect of a med, I will have it!
Posted by Sebastian on January 20, 2005, at 18:29:54
In reply to Risperdal Bupropion for Depression Anxiety, posted by MTee on January 19, 2005, at 0:11:17
I took zyprexa for 7 years. I did start gaining weight, very slowly. I wanted to lose it sooner, but a girlfreind?, told me not!? So I kept gaining, I gained a total of 50 lbs. So after I dumped the girl, I went on a starvation diet, with exercise(something else I wasn't supposed to do with the girlfreind). And lost all the weight in about 3 months. And kept it off for 2 years now. The wellbutrin will help with the weight and tiredness from zyprexa. I must say zyprexa was one of the best anxiety killers I ever took. No bad mental effects, very clear mind.
I did switch to geodon lately(about a month+half ago). Geodon is great for mental clarity. But does not cut you off emotionaly like the zyprexa did. I like it better, I was I bit of a zombie on zyprexa. I still take a little though, 3.75 mg, with 120 geodon. Very good mix.
Posted by Sebastian on January 20, 2005, at 18:32:30
In reply to Re: Risperdal Bupropion for Depression Anxiety » MTee, posted by Sebastian on January 20, 2005, at 18:29:54
Oh, and I didn't like risperdal one bit. It was like acid, had me holucinating. Didn't get me moving out of the house like zyprexa, and geodon did.
Posted by MTee on January 20, 2005, at 23:50:22
In reply to Re: Risperdal Bupropion for Depression Anxiety, posted by Sebastian on January 20, 2005, at 18:32:30
After concluding that Risperdal was interrupting my sleep (overly energizing) and that I put on 5 lbs in a few weeks and hearing props from folks on this board about Geodon, I just scored some. I start at 20mg tomorrow and move up to 40mg. Doctor was surprised to hear that Risperdal was causing weight gain and constipation--something I did not realize until thinking about the weight gain and what has changed over the last several weeks. He stated that the clinical studies suggest that Risperdal is better as an adjunct, which is consistent with several abstracts I read on remedyfind.com, which explains why this was the first line of attack. Look forward to hearing what you all are taking Geodon for and dosing and any side effects. Thanks a lot for all the feedback. If things work out, I guess I owe you -- perhaps the $110 I pay for 20 minutes with the doc. ; )
Take care,
Todd
Posted by banga on January 21, 2005, at 8:28:01
In reply to Re: Risperdal versus Geodon, posted by MTee on January 20, 2005, at 23:50:22
YOu can send a money order to PO box.....LOL
If you think about it, it does save a LOT of money and time at the pdocs. This board doesn't replace the visits, but it certainly gives you a LOT of information to think about what to suggest, what recommendations to reject, etc....
Posted by Sebastian on January 21, 2005, at 11:40:56
In reply to Re: Risperdal versus Geodon, posted by MTee on January 20, 2005, at 23:50:22
Acepting persoal checks an visa cards.
I take 60 mg x2 a day geodon, best med ever, since zyprexa.
This is the end of the thread.
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