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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by 4wd on October 31, 2005, at 20:55:28
Okay, so I started Risperdal very low on Thursday night - .125mg. Didn't notice much on Friday, jsut a little tired. Friday night another .125mg. Okay on Saturday. Saturday night up to .25mg. Woke up very scared Sunday morning, crying a lot all morning. That afternoon felt quite apathetic, tranquil but just very detached. So that night took .125mg again. Monday morning (today) woke up extremely scared and have been very, very depressed all day and scared all day, more than usual.
Is this normal? Should I give it more time? I'm afraid if I take it again tonight and am progressively worse tomorrow it will be unbearable.
Marsha
Posted by linkadge on October 31, 2005, at 21:34:06
In reply to Risperdal ever make any one worse?, posted by 4wd on October 31, 2005, at 20:55:28
Yes, Risperdal just brought me down.
Linkadge
Posted by bipolarspectrum on October 31, 2005, at 23:23:26
In reply to Risperdal ever make any one worse?, posted by 4wd on October 31, 2005, at 20:55:28
Hey 4wd,
If I assume that your taking risperdal for bipolar.. I also must assume that your prone to mood swings... I personally dont beleive that risperdal at that dose is having a significant influece on your psyche.... I think that your experiencing a natural mood fluctuation present in bipolars.. i think u should stick with it and done hesistate to increase the dose.. just my opinion, hope u feel better regardless..
bps> Okay, so I started Risperdal very low on Thursday night - .125mg. Didn't notice much on Friday, jsut a little tired. Friday night another .125mg. Okay on Saturday. Saturday night up to .25mg. Woke up very scared Sunday morning, crying a lot all morning. That afternoon felt quite apathetic, tranquil but just very detached. So that night took .125mg again. Monday morning (today) woke up extremely scared and have been very, very depressed all day and scared all day, more than usual.
>
> Is this normal? Should I give it more time? I'm afraid if I take it again tonight and am progressively worse tomorrow it will be unbearable.
>
> Marsha
Posted by 4wd on October 31, 2005, at 23:39:24
In reply to Re: Risperdal ever make any one worse?, posted by bipolarspectrum on October 31, 2005, at 23:23:26
Hi, thanks. My diagnosis is uncertain. I am pretty stable on Celexa 10mg + Klonopin .5 -.75mg per day but I still have quite a bit of residual anxiety. It's cyclical - very high in the mornings, goes away at night. And I have had some days here and there of hopeless depression, mostly when attempting med changes. I think I'll go ahead and take the Risperdal again tonight at .25 and if the morning fear is even worse tomorrow, then I'll know for sure. If the depression is even more horrible tomorrow I'll be double sure.
Actually this happened once before when I was on Cymbalta and added Risperdal. After my third night of taking .25mg I woke up the next morning more terrified than I'd been in a while.
Sheesh, who knows. At least I have some emergency Zyprexa I can take tomorrow if it gets too bad.
Thanks,
Marsha> Hey 4wd,
> If I assume that your taking risperdal for bipolar.. I also must assume that your prone to mood swings... I personally dont beleive that risperdal at that dose is having a significant influece on your psyche.... I think that your experiencing a natural mood fluctuation present in bipolars.. i think u should stick with it and done hesistate to increase the dose.. just my opinion, hope u feel better regardless..
> bps
>
> > Okay, so I started Risperdal very low on Thursday night - .125mg. Didn't notice much on Friday, jsut a little tired. Friday night another .125mg. Okay on Saturday. Saturday night up to .25mg. Woke up very scared Sunday morning, crying a lot all morning. That afternoon felt quite apathetic, tranquil but just very detached. So that night took .125mg again. Monday morning (today) woke up extremely scared and have been very, very depressed all day and scared all day, more than usual.
> >
> > Is this normal? Should I give it more time? I'm afraid if I take it again tonight and am progressively worse tomorrow it will be unbearable.
> >
> > Marsha
>
>
Posted by SLS on November 1, 2005, at 7:23:10
In reply to Risperdal ever make any one worse?, posted by 4wd on October 31, 2005, at 20:55:28
Hi.
Risperdal produces anxiety as a startup side effect. It can also leave one feeling affectively flat (depression-like) and apathetic. Both of these are likely to be temporary. Your dosage is too low to be good for much of anything in my experience. If you trust your doctor and want to give this thing a try, I would continue to raise the dosage and not obsess about how you feel in the mornings. You need to give these startup side effects time to dissipate.
Why was Risperdal chosen in the first place? Were any other APs given consideration?
- Scott
-----------------------------------------------
> Okay, so I started Risperdal very low on Thursday night - .125mg. Didn't notice much on Friday, jsut a little tired. Friday night another .125mg. Okay on Saturday. Saturday night up to .25mg. Woke up very scared Sunday morning, crying a lot all morning. That afternoon felt quite apathetic, tranquil but just very detached. So that night took .125mg again. Monday morning (today) woke up extremely scared and have been very, very depressed all day and scared all day, more than usual.
>
> Is this normal? Should I give it more time? I'm afraid if I take it again tonight and am progressively worse tomorrow it will be unbearable.
>
> Marsha
Posted by blueberry on November 1, 2005, at 8:02:34
In reply to Risperdal ever make any one worse?, posted by 4wd on October 31, 2005, at 20:55:28
Any psychiatric med can actually make you worse. The antipsychotics can do all kinds of weird things, either good or bad.
The thing that worried me about your post was the feeling of being "scared" when you wake up. The depression and whatever else, that's one thing, but the "scared" part jumped out at me. That's not cool, especially if it didn't exist prior to starting risperdal. Micro doses or not, that is a disturbing development to me.
I would call your doctor right away and ask for something else. But that's just me.
Just a thought and just an opinion.
Posted by med_empowered on November 1, 2005, at 8:57:23
In reply to Re: Risperdal ever make any one worse?, posted by blueberry on November 1, 2005, at 8:02:34
I agree with Blueberry. Psychiatric meds can cause all kinds of side effects. Sometimes antidepressants make depression worse, sometimes antipsychotics make people psychotic, so on and so forth. So...if I were you, I'd just toss out the Risperdal and tell your doc that you didn't like it at all, and now you want something else. Why put yourself through a couple weeks of agony to see if the side effects *might* dissipate and the med *might* help you? And...why are you taking antipsychotics anyway? It seems like you'd do pretty well just upping your Klonopin (.75mgs/day is a TINY dose; 1-3mgs is more likely to help). Good luck!
Posted by Chairman_MAO on November 1, 2005, at 9:01:17
In reply to Risperdal ever make any one worse?, posted by 4wd on October 31, 2005, at 20:55:28
I took .25mg and felt the exact same way as you.
Backed up my intuition that risperidone is sick stuff that should only be taken as a last resort given all of the other options. I would rather taken cloazpine in a heartbeat despite the "risks".
Posted by SLS on November 1, 2005, at 9:39:27
In reply to Re: Risperdal ever make any one worse?, posted by blueberry on November 1, 2005, at 8:02:34
Hi Blueberry.
> I would call your doctor right away and ask for something else. But that's just me.This might be exactly the right thing to do. It is difficult to evaluate a situation and make recommendations with so little information. I would have preferred to know why Risperdal was chosen in the first place.
Although its properties are closer to the older typical neuroleptics than the other atypicals, I still find that Risperdal occupies an important place in modern psychiatry. I have experienced this drug for myself and have seen it work wonders for people with psychotic disorders for whom none of the other atypicals worked. At 3.0mg per day, Risperdal can do more for someone than 800mg of Seroquel or 30mg of Abilify.
Risperdal is not an ideal drug, but you can only work with what you have available.
- Scott
Posted by MoparFan91 on November 1, 2005, at 9:44:33
In reply to Re: Risperdal ever make any one worse? » 4wd, posted by Chairman_MAO on November 1, 2005, at 9:01:17
If you react badly to this drug or to any other AP for that matter, it indicates that you don't need them.
Basically, taking something that you don't need can mess you up. Most people should not take AP's for mood disorders, depression, or anxiety.
I react badly to about every antipsychotic except very low doses of Seroquel which works only as an anti-histamine for a sleep aid (it's a weak AP in general).
I took Zyprexa and felt super agitated out of my mind and in a Mixed State few hours after each dose and made me sleep for hours later. I took Geodon and it made me sleep for hours and made me manic as hell later. Abilify put me in Dysphoric mania, mixed states, and turned me into paranoid maniac. Risperdal, since it's older, would give me EPS. I hit jackpots on side effects, too, at higher doses.
Overall, I reacted badly because, I didn't need them.
I have BP ultradian/ultra-rapid cycling, OCD, social phobia, and possible Aspergers Syndrome.
I react best to anti-convulsants and SSRI's. I'm even able to take SSRI's by themselves but anti-convulsants and SSRI's together work best. Dopamine/Norep. drugs don't play as well with me, though. They make me too edgy.
> I took .25mg and felt the exact same way as you.
>
> Backed up my intuition that risperidone is sick stuff that should only be taken as a last resort given all of the other options. I would rather taken cloazpine in a heartbeat despite the "risks".
>
>
Posted by SLS on November 1, 2005, at 9:58:18
In reply to Re: Risperdal ever make any one worse?, posted by MoparFan91 on November 1, 2005, at 9:44:33
Which anticonvulsants have you liked best?
What are you currently taking, if you don't mind my asking?
Thanks.
- Scott
Posted by MoparFan91 on November 1, 2005, at 23:03:51
In reply to Re: Risperdal ever make any one worse? » MoparFan91, posted by SLS on November 1, 2005, at 9:58:18
I currently take Lamictal at 400mg, Topamax at 250mg, and Lexapro at 5mg.
My ultra-rapid cycling seems to have stabilized as the amplitudes of the mood swings are much reduced. Also, mood states, if they even happen, don't nearly as long now.
No more Mixed States...;-) and no more bad depressions.
My social phobia is much better, and my obsessive ruminations is dimmed down as well.My OCD is still there a bit, though, so that's why we added some Lexapro last week. I'm only on 5mg right now, and we will see how that works. Since I'm on Lamictal as well, I may not need as much Lexapro because I heard those two drugs synergize together or something.
I think the best anticonvulsant I've been on was Lamictal. After I've fully titrated up on it, I pretty much have no side effects from it. It doesn't make me sleepy or anything.
Topamax would be a second best (at least now). At first, I didn't like it as much because my other doctor ramped up on the dose too fast (titrated up by 25mg every 4 days then increased right from 100mg to 200mg). I didn't tolerate it as well due to side fx and minor cognitive problems on first trial due to fast ramp-up, though I got a lot of benefit.
On the 2nd Topamax trial, though, I like the medication better and I would consider it the 2nd best anticonvulsant. It's helped so much. The doctor I have now titrated my dose up by 25mg every week to my current dose of 250mg. I have minimal side effects. I had few cognitive problems for first few days at certain doses but they went away and mental clarity returned. I do feel a little sleepy after each dose, though.
The only other anti-convulsant I took was Depakote for many years. It helped with temper tantrums and anger impulses during adolescence and teenager years (some possbly caused by pubertal changes). Biggest downfalls were lethargy and weight gain due to appetite increases, and messing with blood sugars.
Later on, Depakote didn't help at all when my actual bipolar ultra-rapid/ultradian cycling and Mixed States began to truly manifest itself later at age 18.
I then started Lexapro by itself without a working mood stabilizer at age 19, late in 2003, and it worked fine until I stopped it cold turkey in early 2004 and went untreated for 2 months. As a result, the severe depressions and Mixed States came back.
Based on my present symptoms, Topamax is the suitable true mood stabilizer for me. When I took it with Lexapro one time, it worked fine as my only mood stabilizer.
Geodon made me manic as hell, though. SSRI's don't cause mania for me despite having ultra-rapid cycling bipolar.
In spring of 2004, I had already been taking Lexapro for a few weeks at (when I was just starting on Topamax), and Geodon was added. Five days after it was added, I became hypomanic. 2 weeks later, I went berserk. When geodon was dropped, the mania abated with Lexapro unchanged. Topamax was increased thereafter.I haven't had those hellish Mixed States, though, everytime I took Topamax at a therapeutic level.
> Which anticonvulsants have you liked best?
>
> What are you currently taking, if you don't mind my asking?
>
> Thanks.
>
>
> - Scott
Posted by SLS on November 2, 2005, at 7:31:32
In reply to Re: Risperdal ever make any one worse? » SLS, posted by MoparFan91 on November 1, 2005, at 23:03:51
Thanks for the detailed reply.
Do you think Topamax would help someone whose bipolar disorder is stuck in the depressed phase? The only time I get manic is when drugs make me that way. Even so, this has been a rare event. I don't cycle at all. So I guess my question is how much of an antidepressant effect do you think Topamax has?
Thanks again.
- Scott
Posted by 4wd on November 2, 2005, at 21:52:26
In reply to Re: Risperdal ever make any one worse? » 4wd, posted by SLS on November 1, 2005, at 7:23:10
Hi Scott,
I've stayed on the Risperdal and things are getting better. It's been about a week now. I know the dosage is low but I've always been extremely sensitive to meds - always low doses of ADs, etc.
I've tried Seroquel (couldn't tell it helped at all), Geodon, helped a little but not with depression, just helped the anxiety a little. Zyprexa was good but woke my bulimia back up (the hunger it caused). I think my pdoc chose Risperdal because it's an NE blocker and NE enhancing drugs make me more anxious.
He told me it would help with anxiety and enhance the effects of my AD (Celexa 10mg). Also taking Klonopin .5mg in the morning.
Thanks,
Marsha
> Hi.
>
> Risperdal produces anxiety as a startup side effect. It can also leave one feeling affectively flat (depression-like) and apathetic. Both of these are likely to be temporary. Your dosage is too low to be good for much of anything in my experience. If you trust your doctor and want to give this thing a try, I would continue to raise the dosage and not obsess about how you feel in the mornings. You need to give these startup side effects time to dissipate.
>
> Why was Risperdal chosen in the first place? Were any other APs given consideration?
>
>
> - Scott
>
>
> -----------------------------------------------
>
>
> > Okay, so I started Risperdal very low on Thursday night - .125mg. Didn't notice much on Friday, jsut a little tired. Friday night another .125mg. Okay on Saturday. Saturday night up to .25mg. Woke up very scared Sunday morning, crying a lot all morning. That afternoon felt quite apathetic, tranquil but just very detached. So that night took .125mg again. Monday morning (today) woke up extremely scared and have been very, very depressed all day and scared all day, more than usual.
> >
> > Is this normal? Should I give it more time? I'm afraid if I take it again tonight and am progressively worse tomorrow it will be unbearable.
> >
> > Marsha
>
>
Posted by 4wd on November 2, 2005, at 21:55:30
In reply to Re: Risperdal ever make any one worse?, posted by blueberry on November 1, 2005, at 8:02:34
> Any psychiatric med can actually make you worse. The antipsychotics can do all kinds of weird things, either good or bad.
>
> The thing that worried me about your post was the feeling of being "scared" when you wake up. The depression and whatever else, that's one thing, but the "scared" part jumped out at me. That's not cool, especially if it didn't exist prior to starting risperdal. Micro doses or not, that is a disturbing development to me.
>
> I would call your doctor right away and ask for something else. But that's just me.
>
> Just a thought and just an opinion.
Well, actually I've been waking up scared for about a year now. It was just that it seemed to get worse the first few days on Risperdal. It's back to normal levels now. Which isn't pleasant but I guess it's bearable.I guess I could try Seroquel again but my pdoc seems to think Risperdal will enhance my AD.
It seems like not many people take Risperdal. Why is that?
Thanks,
Marsha
Posted by 4wd on November 2, 2005, at 22:02:00
In reply to Re: Risperdal ever make any one worse?, posted by med_empowered on November 1, 2005, at 8:57:23
> I agree with Blueberry. Psychiatric meds can cause all kinds of side effects. Sometimes antidepressants make depression worse, sometimes antipsychotics make people psychotic, so on and so forth. So...if I were you, I'd just toss out the Risperdal and tell your doc that you didn't like it at all, and now you want something else. Why put yourself through a couple weeks of agony to see if the side effects *might* dissipate and the med *might* help you? And...why are you taking antipsychotics anyway? It seems like you'd do pretty well just upping your Klonopin (.75mgs/day is a TINY dose; 1-3mgs is more likely to help). Good luck!
Taking APs because I can't tolerate a high (even therapeutic) dose of any AD due to side effect sensitivity. The AP is supposed to enhance the AD. And my pdoc wants me to take more Klonopin but I don't want to take more. I was addicted to ATivan for about 12 years and remember all too well how horrible withdrawal was. Also if I take more than .5mg a day, I get restless legs at night, my short term memory gets bad (forgetting appointments, starting out for the gym and ending up a mile past it before I realize I missed my turn, etc.) and I get pretty severe dry mouth even at .5mg. (I am the side effect queen. I don't know whether it's more frustrating for me or my pdoc).I don't intend to stay on an AP indefinitely anyway. This is (in my pdoc's words) band aid treatment until we figure out what caused this sudden increase in anxiety and the waking up scared stuff.
Anyway, I am feeling better. I've had two good days in a row! First time in a while.
Thanks for the support.
Marsha
Posted by 4wd on November 2, 2005, at 22:04:45
In reply to Re: Risperdal ever make any one worse?, posted by SLS on November 1, 2005, at 9:39:27
> Hi Blueberry.
>
> > I would call your doctor right away and ask for something else. But that's just me.
>
> This might be exactly the right thing to do. It is difficult to evaluate a situation and make recommendations with so little information. I would have preferred to know why Risperdal was chosen in the first place.
>
> Although its properties are closer to the older typical neuroleptics than the other atypicals, I still find that Risperdal occupies an important place in modern psychiatry. I have experienced this drug for myself and have seen it work wonders for people with psychotic disorders for whom none of the other atypicals worked. At 3.0mg per day, Risperdal can do more for someone than 800mg of Seroquel or 30mg of Abilify.
>
> Risperdal is not an ideal drug, but you can only work with what you have available.
>
>
> - Scott
>Scott, what's the deal with Risperdal? Everyone seems to feel it's a kind of last resort drug. And suprised that it was prescribed. Does it have some kind of long term side effect profile that's scary? Or a tendency to cause zombie-ness or something?
Marsha
Posted by SLS on November 2, 2005, at 22:44:15
In reply to Re: Risperdal ever make any one worse?, posted by 4wd on November 2, 2005, at 22:04:45
> Scott, what's the deal with Risperdal?
Your doctor is right. It can work to augment antidepressants. You can find evidence of this on Medline.
You can also find evidence of EPS occuring with every neuroleptic (antipsychotic), whether it be typical or atypical. However, the statistical risk among drugs is different. EPS includes involuntary body movements, muscle rigidity, and akathisia. So far, you have not experienced any of these things.
The greatest fear for the use of any neuroleptic is the evolution of tardive dyskinesia (TD). TD is the occurence of involuntary muscle movements - usually orofacial and neck - that develops only after long term use of these drugs. It is not the same as the EPS that occurs at the beginning of treatment. TD can take years to develop. Unfortunately, this adverse effect is generally irreversible. Perhaps this will change in the future.
All of the newer atypical neuroleptics, including Risperdal, have a much lower incidence to EPS and TD compared to the older ones (Thorazine, Haldol, etc.) Of the newer ones, Risperdal appears to act most like the older ones in several ways. This might be why you have been given negative feedback about it. However, it is generally thought that significant risks with Risperdal occur only at dosages of 6.0mg and higher. As an augmentor of antidepressants to treat non-psychotic depression, the dosages used are generally 2.0mg and less. It does work.
Your anxiety might be a component of your depression rather than a separate disorder. When the depression is treated successfully, so might the anxiety along with it. Perhaps this can be accomplished in the future without using Risperdal. Just keep working with your doctor to try different treatments. I doubt Risperdal will be necessary long-term.
How are you handling drug trials right now? Are you trying new things? Have you ever tried an MAOI? How about Cymbalta?
- Scott
Posted by 4wd on November 3, 2005, at 22:56:24
In reply to Re: Risperdal ever make any one worse? » 4wd, posted by SLS on November 2, 2005, at 22:44:15
Hi Scott,
Thanks for your thoughtful and insightful post. I had about decided I had better quit the Risperdal right away even though I was feeling better now. I guess I wouldn't be so scared of things if I weren't already so anxious.
EPS includes involuntary body movements, muscle rigidity, and akathisia. So far, you have not experienced any of these things.
No, and at the low dose I'm taking, I don't expect I will. I have the option to increase to .5mg but as long as .25 is doing okay I think I'll give it another week or so and see how it goes before trying to raise it.
>
>
> All of the newer atypical neuroleptics, including Risperdal, have a much lower incidence to EPS and TD compared to the older ones (Thorazine, Haldol, etc.) Of the newer ones, Risperdal appears to act most like the older ones in several ways. This might be why you have been given negative feedback about it.I kept wondering why no one seemed to be on it. But the other APs haven't worked for me except for Zyprexa and since I'm less than a year into recovery from 30 years of bulimia, I can't risk messing that up.
However, it is generally thought that significant risks with Risperdal occur only at dosages of 6.0mg and higher. As an augmentor of antidepressants to treat non-psychotic depression, the dosages used are generally 2.0mg and less. It does work.
It is working. My mood is better for the last three days. I have actually had three good days in a row now. I saw my pdoc today, jubilant. He was a bit more cautious but wants me to continue the Risperdal for now. It might even be helping with anxiety a tiny bit but the early waking up from the ball of jittery nervousness rolling around in my stomach has gotten a bit worse.
>
> Your anxiety might be a component of your depression rather than a separate disorder. When the depression is treated successfully, so might the anxiety along with it.The increased anxiety did coincide with increased depression. I'm not sure which was the instigator. I had been fairly depressed on Effexor for a while but not anxious. When I switched to Cymbalta the depression didn't improve but the anxiety started getting bigger and bigger. And it has stayed with me now through another trial of Effexor, then Celexa, Lexapro and Luvox. Its' better now, though. It's just anxiety now. Last year this time it was outright terror.
Perhaps this can be accomplished in the future without using Risperdal. Just keep working with your doctor to try different treatments. I doubt Risperdal will be necessary long-term.
I don't intend to stay on it indefinitely. I'm being sent to another endocrinologist for an adrenal workup. My pdoc told me that right now we are using band aid treatment for symptoms while we try to figure out what's causing this. (The fairly sudden onset of severe anxiety a year ago).
>
> How are you handling drug trials right now? Are you trying new things? Have you ever tried an MAOI? How about Cymbalta?
>
I actually answered your post last night right after you wrote it and included a list of meds and just as I was about to finish it up, the power went out and I lost the whole thing. Let's see, I've triedSinequan
trazadone
imipramine
desipramine
Prozac
Zoloft
Buspar
Serzone
Effexor several times
Celexa
Lexapro
Paxil
nortriptyline
amytriptyline
Cymbalta
Remeron
Luvox
Ativan
Xanax
Klonopin
Seroquel
Geodon
Zyprexa
Risperdal
Atarax
Inderaland various combinations. Never tried an MAOI. It makes sense, I guess, but I had an overwhelming problem with insomnia for over 20 years and I'm very fearful of messing up my newfound ability to fall asleep easily and naturally. (never mind that I now wake up unrested after 6 hours instead)
I am excited for you about the mifepristone trial. Have you experienced any benefit at all yet from the dexamethasone trial? Everybody on the board is going to be waiting to hear how the mifepristone works for you and keeping our fingers crossed that this will be the one that does it.Thanks again, Scott.
Marsha
This is the end of the thread.
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