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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by tom_p on April 27, 2006, at 13:29:09
Has anyone had success using Risperdal as an augmenting med for unipolar depression?
I am currently on 40mg of Lexapro (trying higher dose for OCD stuff) and 45mg of Remeron and about 2mg of Klonopin. Through the years, I've been on many different meds and different combos and I am still not doing too well. My Pdoc added Seroquel to the mix last August, and I just got off of it last month because it wasn't helping with the depression. Actually I think the Seroquel made the depression worse and I worry that the Risperdal would do the same.
My GP said to stay away from the atypicals and so did a second Pdoc I saw before.
I'd actually like to try the new Emsam patch, but getting off my current meds and being med free for a week or so scares me. I've been on various SSRIs for 16 years now and I wonder how my body and brain would react without an SSRI. I've also got anxiety and OCD issues and it sounds like Emsam might not be the best med for those problems.
Any comments would be appreciated. Tom.
Posted by tom_p on April 27, 2006, at 15:16:05
In reply to Add Risperdal or switch to Emsam for unipolar MDD?, posted by tom_p on April 27, 2006, at 13:29:09
As evidenced by this post, my cognitive abilities haven't been that great, which I forgot to mention previously. I'm a professional and my short term memory and other cognitive difficulties have impaired my performance. The Seroquel made the above worse and I'm guessing the Risperdal might too.
I also didn't include the fact that I've never tried a MAOI.
One reason I'd like to try Emsam, is that perhaps it would improve my cognitive abilities.
I'm also having problems with aggitation and crankiness that might be attributed to the Lexapro and Remeron. I talked to my pdoc about this and he didn't really say anything - which was frustrating. I gave him a PI sheet for Emsam and he is open to the idea of trying it.
Posted by blueberry on April 27, 2006, at 16:08:28
In reply to Add Risperdal or switch to Emsam for unipolar MDD?, posted by tom_p on April 27, 2006, at 13:29:09
Considering how long you've been on ssri's, I think a massive switch would be very hard. Coming off high dose lexapro would be hard, especially with anxiety issues involved.
Seroquel made me very depressed, so you aren't alone on that one.
I generally shy away from the atypicals, but I was on low dose zyprexa for 5 years. My GP and my pscyhiatrist use them to augment antidepressants. I think the big concerns with the atypicals are diabetes/glucose/insulin problems, and movement disorders. With low doses, careful diets, and periodic monitoring, these risks can be controlled.
Risperdal is used to augment antidepressants. From what I have heard, it is better in very low doses, as that is where it causes a release of dopamine. Medium or higher doses do more blocking of dopamine. It might be that the lexapro and klono are squashing out dopamine, so a little dopamine release might be good. Risperdal does have the worst sexual side effects of them all though, as it raises prolactin levels significantly. Zyprexa would be a better option in that regard.
You could try lowering the lexapro dose and see what happens.
You could lower the lexapro dose and add in 20mg of cymbalta to get some norepinephrine/dopamine action going.
If you could do it without anxiety, a stimulant might be an option for dopamine/norepinephrine action.
Dumping the whole program to try ensam sounds scary to me.
Posted by Phillipa on April 27, 2006, at 20:12:03
In reply to Re: Add Risperdal or switch to Emsam for unipolar MDD?, posted by blueberry on April 27, 2006, at 16:08:28
The good news is that it is okay to take a benzo with ENSAN. Love Phillipa ps you will have the brain zaps with stopping the SSRI's but if ENSAM is really affecting people the way they say it is they go for it. I'm sure you doc will help you transition if he/she thinks it's the right med for you. Love Phillipa
Posted by Emily Elizabeth on April 27, 2006, at 22:43:37
In reply to Add Risperdal or switch to Emsam for unipolar MDD?, posted by tom_p on April 27, 2006, at 13:29:09
Sounds like we are neighbors in depressive hell! Here is my med combo:
40 lexapro
125 desipramine
300, 600, 300 neurontin
15-20 dexedrine
750 lithium
2.5-5 ambienMy pdoc and I have been tossing around the idea of adding an atypical AP, but I think that we are going to hold off for now. The one we were talking abt was Abilify--have you thought abt that one? It is supposed to have less s/e's than other AP's.
Have you tried lithium? Some people have probs w/ s/e's, bit I don't. It probably has been the most helpful thing in my mix. It is one of the longest studied and statistically supported augmenters. Some people also find lamictal helpful, but it didn't help me. It is supposed to be pretty good on s/e's.
I personally, am too afraid to go off of everything to try an MAOI right now. Right now it looks like I'm going to switch to effexor (instead of the lexapro and desipramine).
It's "good" to hear that someone else is experiencing similar stuff. Please write w/ any ?'s if you have them.
Best,
EE
Posted by med_empowered on April 27, 2006, at 22:44:45
In reply to Re: Add Risperdal or switch to Emsam for unipolar MDD?, posted by Phillipa on April 27, 2006, at 20:12:03
hey! OK, personally, I'd avoid all antipsychotics, new or old...they can cause dysphoria/depression, make anxiety worse, etc. Plus...I'm kind of concerned about people using them for OCD. With Zyprexa, for instance, the serotonin antagonism has actually caused OCD in some people or made it worse, so thats a little disconcerting.
Maybe you could add a stimulant? For me, the amphetamines (Dexedrine, Adderall) didn't impact anxiety much; if anything, it helped me handle the anxiety a little better. Bumping the Klonopin and/or adding BuSpar is another option. Instead of an MAOI, maybe you could try Anafranil? Its kind of hardcore, but it seems to help a lot of people. Luvox might also be a good option.
Posted by Caedmon on April 28, 2006, at 0:36:51
In reply to Re: Add Risperdal or switch to Emsam for unipolar MDD? » tom_p, posted by Emily Elizabeth on April 27, 2006, at 22:43:37
I might try Risperdal first, and Emsam if that fails. The nice thing about it is that you can usually evaluate how it will end up affecting you within a week, and if you don't like the initial side effects, you can stop quickly (unlike SSRIs where you have to wait them out because they "might go away"). But I would use a LOW dose, less than 1 mg (I would say .25 or .5 are good doses for many people).
Risperdal helps me tremendously, easily one of my favorite drugs. Because it has an antidepressant effect, I used it when bridging over to Parnate to kind of 'smooth out' the transition.
- C
Posted by bigcat on April 28, 2006, at 15:33:16
In reply to Re: Add Risperdal or switch to Emsam for unipolar, posted by med_empowered on April 27, 2006, at 22:44:45
>Instead of an MAOI, maybe you could try Anafranil? Its kind of hardcore, but it seems to help a lot of people. Luvox might also be a good option.
Hey Med Empowered: Sorry to slip in a sidenote question, but I've been flirting with the idea of trying Anafrinil again (giving it a full 6-8 week trial this time). Could you elaborate on Anafrinil being "hardcore"? In terms of side effects or what? I'd appreciate any kind of scouting report you may have on this med. I'm thinking either Anafrinil or Effexor+Remeron next. (I have severe depression/anxiety and effexor was effective for a few weeks before becoming essentially neutral). Dexedrine and Nardil were the only other meds to bring me any relief. many thanks.
-matt-
Posted by tom_p on May 1, 2006, at 20:43:32
In reply to Re: Add Risperdal or switch to Emsam for unipolar MDD?, posted by blueberry on April 27, 2006, at 16:08:28
Thanks blueberry for your information. Interesting to hear that Seroquel made you more depressed as well. Yeah, dumping my whole program scares me and my pdoc because it would be hard to impossible to do med combos with Emsam. Even this weekend I took half my usual dose of Remeron and my tummy didn't like it.
My GP also mentioned Cymbalta, but I didn't have the best of luck with Effexor, so I'm hesitant to try it.
I've tried Concerta before, but I didn't get any emotional boost and it increased my anxiety. Might try Adderall as my pdoc is open to the stimulants.
Posted by tom_p on May 1, 2006, at 21:02:43
In reply to Re: Add Risperdal or switch to Emsam for unipolar MDD? » tom_p, posted by Emily Elizabeth on April 27, 2006, at 22:43:37
Thanks for your reply. Good to hear someone else is on a high dose of Lexapro. I'm actually doing better on the higher dose, so dumping everything to try Emsam might not be prudent.
My pdoc isn't a big fan of Abilify and I'm concerned about its chance of making my anxiety worse.
No, I haven't tried lithium, but I've definitely thought about it. I worry about the side effects - that's great you don't have any. I worry about getting the hand tremor side effect as I need a steady hand at work. Do you have any tremor problems?
I took Lamictal for about year without success like you.
I know what you mean about being afraid to go off everything just to try an MAOI. The potential of getting really depressed again is scary. I didn't have much success with Effexor, but hopefully you will find it helpful.
Posted by tom_p on May 1, 2006, at 21:16:40
In reply to Re: Add Risperdal or switch to Emsam for unipolar, posted by Caedmon on April 28, 2006, at 0:36:51
I'm really starting to have second thoughts about trying Emsam. My pdoc is a fan of Risperdal, so I may give it a go if I start slipping further. Like you, my pdoc says one should know within a week if its going to be helpful. A low dose is what my pdoc has in mind.
That's interesting that Risperdal is one of your favorite meds. It sounds like when it works, people really like it.
Posted by Emily Elizabeth on May 2, 2006, at 8:51:21
In reply to Re: Add Risperdal or switch to Emsam for unipolar MDD? » tom_p, posted by Emily Elizabeth on April 27, 2006, at 22:43:37
I have an occassional hand tremor w/ Li, although it was much less w/ the 600mg (compared to my current 750). It is like a little twitch that is only a prob when I'm holding a pill or something. It would be a prob if I were a surgeon, but it wouldn't be a prob if I had a job where a steady hand was required, but mistakes were fixable. Make sense? I don't know what category your job falls in to.
Best,
EE
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