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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Deneb on September 20, 2005, at 22:07:39
Hi people
A p-doc just gave me 0.5 mg risperidone to try out for 2 weeks.
The side effects listed in the monograph sound really scary. How worried should I be?
Also, what exactly does risperidone do? What is it used for exactly?
Deneb
Posted by med_empowered on September 21, 2005, at 0:23:13
In reply to Risperdal monograph and uses?, posted by Deneb on September 20, 2005, at 22:07:39
hey! Risperdal is one of the "atypical antipsychotics". The first one was Clozapine, which was used for a while in the 70s and then again in the 80s-90s in select groups of schizophrenics; it has severe side effects(but different side effects than old antipsychotics--for instance, it rarely causes movement disorders), so more tolerable antipsychotics with comparable mechanisms of action have been popping onto the market now and then since the early 90s. Anyway, Risperdal is a "high-potency" antipsychotic (this means the dose in mgs is lower and there's usually less drowsiness). It was originally developed and marketed for Schizophrenia/Schizoaffective disorders; like the older antipsychotics, it has come to be used in other psyhotic disorders (psychotic mania, drug-induced psychosis, psychotic depression, etc.). Also, like the other "atypical" antipsychotics (zyprexa, geodon, abilify, and seroquel), Risperdal is being used to help with treatment-resistant depression and anxiety, and is being used for long-term treatment of bipolar disorder. Dosing with Risperdal is a tricky business; when it first hit the market in the early 90s, doses ranged up to 8mgs. Later, it was agreed that these doses were too high; now, most doses max out at around 4-6mgs. Low-dose Risperdal (.5mgs is definitely low-dose) would be good some people with psychosis and is being used "off-label" (without official FDA approval) for helping with depression. No one knows exactly *why* low-dose antipsychotics (new and old, but especially the new ones) help some people with depression or who will most likely benefit, but in some cases the results can be very impressive (and very fast). Other times, low-dose antipsychotics can control symptoms of borderline personality disorder or agitation, anxiety associated with bipolar disorder (in these situations, the antipsychotic is often given "prn"--as needed--to maximize effectiveness and minimize side-effects). As the atypicals go, Risperdal is kind of harsh--it can cause menstrual problems in women (because of its effects on hormones such as prolactin), cognitive impairment, and it can cause EPS (extra-pyramidal signs). EPS involves symptoms such as akinesia--mask-like face, akathisia--intense inner restlesness and constant movement, shuffling gait, and tardive dyskinesia--an often permanent movement disorder characterized by uncontrolled movements, usually in the facial area. Old antipsychotics tended to cause EPS *FREQUENTLY* and the Tardive dyskinesia rates were pretty high, too--3%/year baseline, higher for women, the elderly, and those with mood-disorders (and higher still for those with 2 or more of those variables). The atypical antipsychotics cause EPS and tardive dyskinesia less often, but they still happen and there's usually still a connection between dosage and duration of treatment on the development of EPS/TD (higher dose/longer treatment=more problems). That said, any antipsychotic CAN cause EPS/TD at ANY dose...and, at least with the old antipsychotics, there were cases when TD developed after very brief (1-2months) exposure to the drugs. No one knows exactly how likely TD is with the atypicals--most likely, it varies from drug to drug (all the atypicals operate somewhat differently), and the best data available is for Zyprexa (about .5-1%/year TD rate). Risperdal's reputation would seem to indicate that its more likely to cause EPS, and tardive dyskinesia, than the other atypicals...whether this is accurate or not remains to be seen (it may have to do with patient selection and dosing), and whether this would be true even at low-doses also remains to be seen. Speaking from personal experience, I'd recommend avoiding *any* antipsychotic at *any* dose unless you are: a)actively and *floridly* psychotic or b) suffering so intensely from a treatment-resistant mood-disorder (bipolar or depression) that you'll try *anything* (keep in mind that EPS and TD rates, at least with the old antipsychotics, were considerably *higher* in those with mood-disorders than they were in those with schizophrenia). I don't know what your situation is, and I wouldn't presume to tell you what to do, but based on my own experience (I took atypicals for bipolar disorder), I would *seriously* recommend that you try to avoid the use of antipsychotics. Good luck!
Posted by Phillipa on September 21, 2005, at 17:58:26
In reply to Re: Risperdal monograph and uses?, posted by med_empowered on September 21, 2005, at 0:23:13
Deneb, I think med said it all. Fondly, Phillipa
Posted by Deneb on September 21, 2005, at 21:50:11
In reply to Risperdal monograph and uses?, posted by Deneb on September 20, 2005, at 22:07:39
I read that risperdal is a very powerful anti-psychotic! I'm scared! I took 0.25mg last night and nothing happened except for some insomnia and a small headache later on in the day and I'm not even sure if it was caused by the drug! Am I a freak for something? Is it serious?
My other pdoc didn't think I needed anti-psychotics. I think I told too much negative info to this replacement p-doc. I don't think I should have told him about the rope thing. He's not like my p-doc at all.
Posted by Phillipa on September 21, 2005, at 22:06:01
In reply to Re: Risperdal monograph and uses?, posted by Phillipa on September 21, 2005, at 17:58:26
Deneb, Don't be scared. It's used for anxiety too. Med is very informed and he doesn't leave anything out. Fondly, Phillipa
Posted by Deneb on September 22, 2005, at 6:35:03
In reply to Re: Risperdal monograph and uses? » Phillipa, posted by Phillipa on September 21, 2005, at 22:06:01
> Deneb, Don't be scared. It's used for anxiety too. Med is very informed and he doesn't leave anything out. Fondly, Phillipa
What Med_empowered said scared me, especially that part about not recommending it at any dose for any length of time unless actually psychotic.
I don't know if I am ever actually psychotic. Extremely emotional, distressed and not thinking straight yes, but psychotic? I don't really think so, maybe nearly delusional, but even that is iffy.
Anyways I decided to take another 0.25mg last night. This time I didn't experience insomnia, but I woke up to a nightmare! I almost never have nightmares. It's been many many months since I'm had a nightmare. It was scary. I had started a kitchen fire and had to call 911 and it seemed so real! I don't usually have such realistic dreams. Could this nightmare have been a side effect of the Risperdal?
Deneb
Posted by B2chica on September 22, 2005, at 9:05:47
In reply to Risperdal monograph and uses?, posted by Deneb on September 20, 2005, at 22:07:39
med said a mouthful, all i can add is that i was on it started at .5 i think and went up to 2mg. since i wasn't showing any real progress he pulled me off it.. no lasting side effects for me.
HTH
b2c.
Posted by Deneb on September 22, 2005, at 10:21:47
In reply to Re: Risperdal and nightmares, posted by Deneb on September 22, 2005, at 6:35:03
OK, maybe I'm just overly paranoid or something, but I keep thinking that Risperdal might mess with my mind or something.
A few times since yesterday and today on the bus, I thought I might have heard something that wasn't there. There was a lot of noise in the background and then suddenly there was one voice or sound that stood out. I don't know if other people heard the noise or voice as I didn't see others reacting to it.
So, is it possible that Risperdal can *cause* hallucinations? Or am I just overly anxious about things? There is a huge possibility that those sounds were heard by everyone and are not hallucinations at all.
Deneb
Posted by med_empowered on September 22, 2005, at 17:20:28
In reply to Re: Can Risperdal *give* me hallucinations?, posted by Deneb on September 22, 2005, at 10:21:47
Hey! This can happen, but its probably rare. All antipsychotics--from the old ones like Thorazine, down to the newest ones like Abilify--can *cause* psychosis (in the previously non-psychotic) or *worsen* psychosis in those who are actively psychotic. I really didn't mean to scare you, and I'm sorry about that :-( . Low-dose antipsychotics do help some people, but they are powerful drugs and both doctors and patients need to keep that in mind. Insomnia can happen with antipsychotics, especially at low-doses...although antipsychotics generally reduce overall activity, low-doses (especially combined with antidepressants) can be activating; in some cases, the combination can induce mania. When I said antipsychotics should be avoided unless you are psychotic, that was basically a statement of my approach to them based on personal experience and overall side-effect profile. Most people with anxiety can find other meds to treat their problems, as can most people with depression or bipolar disorder...I guess a better statement of my opinion would be that antipsychotics should never be 1st or 2nd line treatment for non-psycohtic disorders. Sometimes start-up side effects of antipsychotics go away; sometimes they remain, get worse, or new side effects develop over time...they're tricky drugs. My advice would probably be to look at your issues and your personal preferences before you listen to your shrink (yes, they are docs, but they aren't YOU...its important to make their treatments fit into what YOU want to do, not vice versa). So..if you don't think you need an antipsychotic, you might be better off not taking one. If you're at the end of your rope--like, if you're considering ECT for depression/bipolar-- then giving an atypical a whirl is probably a good idea. Good luck!
Posted by Deneb on September 22, 2005, at 18:18:07
In reply to Risperdal *causing* hallucinations?, posted by med_empowered on September 22, 2005, at 17:20:28
> Hey! This can happen, but its probably rare. All antipsychotics--from the old ones like Thorazine, down to the newest ones like Abilify--can *cause* psychosis (in the previously non-psychotic) or *worsen* psychosis in those who are actively psychotic.
Weird! Does anyone know the mechanism behind this?
>I guess a better statement of my opinion would be that antipsychotics should never be 1st or 2nd line treatment for non-psycohtic disorders.
What was this pdoc thinking then? My problems aren't really that big most of the time. I have a borderline personality disorder. My real p-doc saw me for like 3 years and never suggested anything besides an SSRI and therapy or me. My p-doc is on maternity leave still and I just saw her replacement. I think I told him too many negative things at once and that is why he gave me Risperdal. I think most of the time I'm OK, but sometimes I get really really upset and a bit paranoid and suicidal. I asked about antipsychotics once and my p-doc (the one on leave) told me that they were not for me.
Now that I have them, I want to take them to experiment on myself. I'm just curious about it's effects. I don't really care too much about side effects as long as they are not permanent. I just like messing around with drugs sometimes and having them around.
I'm also taking 50 mg of Celexa. I've been on that for about 7 months now. I have no idea if it does anything at all. I don't really get depressed, I mean, I do at times, but they never last long. I'm not at the end of my rope, but the rope slides back and forth really quickly!
Deneb
Posted by Chairman_MAO on September 22, 2005, at 20:33:07
In reply to Re: Can Risperdal *give* me hallucinations?, posted by Deneb on September 22, 2005, at 10:21:47
Yes it can. 5ht2 antagonists are capable of inducing hallucinations, though primarily visual LSD-like pseudohallicnations. People suffering from HPPD ("flashbacks") usually are profoundly WORSENED by antipsychotics, especially when idiot doctors think that antipsychotics fix all halluncinations. Dumb dumb dumb.
If it gives you hallucinations, switch drugs! IMHO, antipsychotics are sickeningly overprescribed. You should only be on one as a last resort; I am of the school of thought that even barbiturates like nembutal are preferable to antipsychotics. No one should have to those poisons unless they are the only things that work.
Risperidone is especially awful (prolactin elevation, etc). Try quetiapine, aripiprazole, or clozapine, in that order. If seroquel and abilify fail, you might as well bring out the gold standard, ya know?
Posted by krybrahaha78 on September 22, 2005, at 22:16:53
In reply to Re: Risperdal monograph and uses?, posted by med_empowered on September 21, 2005, at 0:23:13
my p-doc gave me risperdal once--just .5 mgs to augment my luvox...this med knocked me for a loop--i slept for 2 days straight, so i had to get off it so i could function again...
Posted by Deneb on September 22, 2005, at 22:50:45
In reply to Re: Risperdal monograph and uses?, posted by krybrahaha78 on September 22, 2005, at 22:16:53
> my p-doc gave me risperdal once--just .5 mgs to augment my luvox...this med knocked me for a loop--i slept for 2 days straight, so i had to get off it so i could function again...
Wow, just 0.5mg made you that tired?
I was a little sleepy today, but was probably because I went to bed too late yesterday and didn't get enough sleep. I was able to concentrate and pay attention in all my classes. I didn't even nod off in my morning class. :-) I was only on 0.25mg though.
I'm going to try 0.5mg tonight and see what happens. So far nothing much has happened at all.
Does anyone know how long it stays in the body for? How can one tell if one is a good or poor metabolizer?
Deneb
Posted by JenStar on September 22, 2005, at 23:17:33
In reply to Re: Risperdal monograph and uses?, posted by Deneb on September 21, 2005, at 21:50:11
hi Deneb,
many people get headaches and insomnia when starting a new med...sometimes from anxiety about the new med! I think you need to give yourself time for your body to get used to the med and to stabilize on it. If, after a few weeks, you still have issues, the drug or dosage may not be right. But hopefully the side-effects will go away.I'm so glad you're trying this. Even if it's not the right drug in the long run (and it might not be), I'm glad to hear that you're treating yourself with respect and getting help. Yeah for you! :)
Take care,
JenStar
Posted by JenStar on September 22, 2005, at 23:18:51
In reply to Re: Can Risperdal *give* me hallucinations?, posted by Deneb on September 22, 2005, at 10:21:47
I think you're being hyper-vigilant for side-effects. I do the same thing. :) To me that doesn't sound like a hallucination...so far it just sounds like you're very anxious and are afraid that you'll get bad side effects.
take care!
JenStar
Posted by Deneb on September 23, 2005, at 17:52:58
In reply to Re: Risperdal monograph and uses? » Deneb, posted by JenStar on September 22, 2005, at 23:17:33
It is so scary to read all the horrible things Risperdal can do, but I think that many drugs have the capacity to produce some horrible side effects. It is all about risk vs benefits. I think it would be much more important to have some actual probabilities.
Does anyone have the probabilities of developing certain problems through use of this drug?
Posted by Deneb on September 23, 2005, at 17:55:26
In reply to Re: Risperdal monograph and uses? » Deneb, posted by JenStar on September 22, 2005, at 23:17:33
> I'm so glad you're trying this. Even if it's not the right drug in the long run (and it might not be), I'm glad to hear that you're treating yourself with respect and getting help. Yeah for you! :)
Thanks! I'm not sure I would have gotten help if it weren't for you guys always pushing me to get help! :-P
Posted by gromit on September 23, 2005, at 20:14:51
In reply to Re: Risperdal monograph and uses?, posted by krybrahaha78 on September 22, 2005, at 22:16:53
> my p-doc gave me risperdal once--just .5 mgs to augment my luvox...this med knocked me for a loop--i slept for 2 days straight, so i had to get off it so i could function again...
I had the opposite effect, my pdoc gave me a sample pack of I think 4 .5 soltabs. They didn't make me sleepy at all, more of a warm pleasant dopamine feeling. I actually kind of enjoyed it but it was supposed to help me sleep so I got something else instead.
Rick
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