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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 38. This is the beginning of the thread.
Posted by halcyondaze on February 5, 2007, at 14:41:53
<< http://pn.psychiatryonline.org/cgi/content/full/42/3/30?etoc >>
The atypicals are taking quite a beating lately.
It's unfortunate, because they have helped so many people and have such wide-ranging uses, but these kinds of practices are simply not okay. And, of course, this kind of thing happens with so many companies and so many different medications, but because we still live in a world where psychiatry is suspect, these are the ones grabbing the headlines and the attention of the FDA.
Posted by Phillipa on February 5, 2007, at 16:26:17
In reply to J+J and Janssen in trouble over Risperdal, posted by halcyondaze on February 5, 2007, at 14:41:53
Well does it cause diabetes like zyprexa lawsuit I didn't see this only the misuse of info. Love Phillipa
Posted by med_empowered on February 5, 2007, at 17:20:02
In reply to Re: J+J and Janssen in trouble over Risperdal » halcyondaze, posted by Phillipa on February 5, 2007, at 16:26:17
"Mad In America" had some interesting info on Risperdal...the author used Freedom Of Information Act (FOIA) to get some documents that hadn't been public before...apparently, the FDA told Jansen that alot of their claims about the med being atypical and better-tolerated weren't well supported by the data. Also, there were an unusual number of suicides, both in the Risperdal trials and in trials of some other atypical antipsychotics; sophisticated data techniques apparently made these suicides "go away". If you haven't read this book yet, please do; its thoroughly researched and quite informative.
Posted by SLS on February 6, 2007, at 5:11:16
In reply to Re: J+J and Janssen in trouble over Risperdal, posted by med_empowered on February 5, 2007, at 17:20:02
After startup side effects disappeared within a week or so, I found Risperdal to be without any psychotropic effect other than a mild antidepressant effect as an augmenter of antidepressants. On the contrary, the mind-numbing effects of the typicals remained for the entire time I was taking them.
I agree that the atypicals are now being scrutinized in a way that places them as being no better than typicals. The people doing the writing of these articles should try these drugs for themselves once in awhile.
- Scott
Posted by med_empowered on February 6, 2007, at 9:57:32
In reply to Re: J+J and Janssen in trouble over Risperdal, posted by SLS on February 6, 2007, at 5:11:16
the problem is that the improvements don't justify the costs, and they certainly don't justify the ridiculous amount of off-label prescribing. Also, typicals vs. atypicals comparisons usually fail to take into account the prescribing practices of shrinks, especially in the 70s-80s, that led to such terrible side effects. For example: in lots of Europe, Thorazine was often given at moderate doses, 300mgs/day or often less. In the United States, docs commonly gave 600,800, 1,000, or more mgs/day even in cases that were not treatment-resistant. Plus, in the 70s and 80s there was a move towards high-dose, high-potency neuroleptics, so instead of giving 300mgs Thorazine like their european counterparts, a US shrink might routintely give 20mgs Haldol. Of course there were problems--neuroleptics in general are unpleasant, and ramping up dosages of high potency neuroleptics will make the patients' lives sheer hell. So when you compare, say, 4mgs Risperdal to 20mgs Haldol (which is a pretty common tactic in studies of atypicals), you will see a huge difference--but this difference is often largely due to excessive dose of the other drug.
One study I read compared zyprexa (dosed based on clinical judgement) to fixed-dose Haldol, 5mgs, with prophylactic benztropine. The results? Overall, there were none--one a few measures zyprexa came out a little ahead, but this didn't reach statistical significance. Think about it: 5mgs of Haldol (not a small dose when you realize some patients do OK on 1-3mgs) plus benztropine did just as well as zyprexa, while costing the government (and the government foots a lot of the
bill for atypicals) less money.
What I'm hoping is that we'll start analyzing neuroleptics in general...I think these drugs help some people, but they can also create some tremendous problems, and many people with psychotic disorders can do well without them.
Posted by linkadge on February 6, 2007, at 14:32:30
In reply to Re: J+J and Janssen in trouble over Risperdal, posted by med_empowered on February 6, 2007, at 9:57:32
Risperdal just brought be down. The other atypicals at least had some more antidepressant effect (for me).
Risperidal also gave me this weird sensation like I was two half people living in the same body. It was like I was present in both my hemispheres but they were not communicating.
Really messed up, and freaky.
Linkadge
Posted by SLS on February 6, 2007, at 18:33:39
In reply to Re: J+J and Janssen in trouble over Risperdal, posted by linkadge on February 6, 2007, at 14:32:30
> Risperdal just brought be down. The other atypicals at least had some more antidepressant effect (for me).
>
> Risperidal also gave me this weird sensation like I was two half people living in the same body. It was like I was present in both my hemispheres but they were not communicating.
>
> Really messed up, and freaky.
How long were you on it? Just curious.
- Scott
Posted by Jay on February 6, 2007, at 19:15:11
In reply to Re: J+J and Janssen in trouble over Risperdal, posted by med_empowered on February 5, 2007, at 17:20:02
I think this "Risperdal Backlash' is based more on how they marketed the med, rather then any problems with the med itself. I'd also point to caution of posting such one-sided info on here, as many people may be on this drug, and it will not only scare them extremely , but could cause them to stop the drug, and cause very disastourus results.
I've heard a number of very good uses of Risperdal from everybody from pdocs to family docs. Risperdal used at a dose of 1-2 mg for a few days can stop dysphoric mania in it's tracks. Small doses of .5 mg's of Risperdal help with certain problems like SAD and Chronic Fatigue. It seems to work excellent for BP2-3. I've been on up to a 4mg a day dose of Risperdal for many years for my BP2 and GAD, with great results. I may even need to turn to the med again in the future. My *only* reasoning for stopping it was to take a more sedating atypical, as I was having some real problems dealing with a very stressful situation at my job which prevented me from sleeping good.
Yes, there may be finer points to argue over most medications, and psych meds are no exception. But, I will testify even for myself, that I as well as many millions are living proof these drugs work well in helping to give-back to a tattered life, and getting back on your feet.
IMHO,
Jay
Posted by linkadge on February 6, 2007, at 19:50:11
In reply to Re: J+J and Janssen in trouble over Risperdal » linkadge, posted by SLS on February 6, 2007, at 18:33:39
About 3 weeks @ 1mg. It also gave me the worst akathesia, worse than seroquel @75 or zyprexa @ 5mg.
Linkadge
Posted by linkadge on February 6, 2007, at 19:51:11
In reply to Risperdal has been a life-saver for me..ALL, posted by Jay on February 6, 2007, at 19:15:11
I agree, one mans curse could be another mans cure. If it works for you then just take all else with a grain of salt.
Linkadge
Posted by SLS on February 7, 2007, at 5:31:28
In reply to Re: J+J and Janssen in trouble over Risperdal, posted by linkadge on February 6, 2007, at 19:50:11
> About 3 weeks @ 1mg. It also gave me the worst akathesia, worse than seroquel @75 or zyprexa @ 5mg.
I can see that happening, of course. I would just like to point out that some neuroleptics produce anxiety as a startup side effect rather than akathisia.
I agree with Jay, and hope that these drugs do not become demonized in the same way benzodiazepines were. With what else we have available, I don't think they deserve it.
- Scott
Posted by Jay on February 7, 2007, at 10:04:57
In reply to Re: J+J and Janssen in trouble over Risperdal, posted by SLS on February 7, 2007, at 5:31:28
Yep..Scott and Link, I certainly don't think people should just take the drugs if problems show up, and that people shouldn't be afraid to be critical. Like you said Linkadge, it mostly depends on individual reactions. And Scott, I was very much thinking of the demon/fear stirred up over benzo use in this case. So, basically, I think we'd all agree, start low and go slow, and don't shrug off any side effects. Actually, in the post where I read about (an exception from above) using 2 or so mg of Risperdal at once for a few days, being somewhat useful for dysphoric mania, the author (a pdoc) said they had the same experience with a 2-3 day script of Haldol, at about 5mg. Interesting, because these two meds have some chemical connections.
Best,
Jay
Posted by Chairman_MAO on February 7, 2007, at 11:18:32
In reply to Re: J+J and Janssen in trouble over Risperdal, posted by linkadge on February 6, 2007, at 14:32:30
No one drug should be "brought down", because I believe we should have a free-market economy. It's just that the so-called "antipsychotics" should have to compete with morphine, benzodiazepines, etc. which can be just as effective in the treatment of psychosis, if not more so. And the "patient" can still think!
However, I will agree with you that risperidone is the most horrid of all of the "atypicals". Gynecomastia and other endocrine problems are far too common, viz. they happen at all! The only reason the atypicals are "safer" with regard to tardive dyskinesia AFAIK is that they bind more weakly to and/or dissocate more rapidly from D2 receptors. That's it. There's nothing magical, except perhaps with cloazpine, which is IMHO the only one of the whole class of those drugs anyone should try, as if you have to get to the aypticals, you might as well use the best one.
But far fewer people should be prescribed these things than are. Seroquel seems to be the most benign, but also mostly ineffective for treatment of schizophrenia (which, incedentally, is an obsolete and stigmatizing diagnostic category that should be abandoned).Of course, we live in an age where, despite the fact that acetaminophen/paracetamol is now known to cause liver damage at _therapeutic doses_ in _otherwise healthy individuals_, it is still considered preferable to morphine, which is non-toxic.
Posted by med_empowered on February 7, 2007, at 15:05:57
In reply to Re: J+J and Janssen in trouble over Risperdal » linkadge, posted by Chairman_MAO on February 7, 2007, at 11:18:32
I agree. Think about it: the only reason a drug company can make $$$ off of something as unpleasant as Risperdal is b/c of the RX drug system. We're giving docs waaaay too much power here.
Consumers end up with all costs--some medication costs, doctor costs, costs of side effects, so on and so forth. We should be allowed to purchase and use (or NOT purchase and refrain from using) any drug(s) we see fit. Think about ADHD...amphetamines are old, and cheap. If they were over-the-counter, consumers would probably avoid Adderall XR and what not and go for generic versions...drug costs would be reduced, and we wouldn't have to pay doctors for visits that are solely designed to give us a permission slip("prescription") to have meds that would otherwise be illegal.
In mexico, a lot of pharmacies have doctors on hand--not for controlled rx's, but for basic stuff. So if you come in with minor problems--infections, allergies, colds, whatever--the doc will do a quick consult and recommend some meds to you, and you're done. That's it. Here, you have to make an appointment, pay lots of money to the doc, and then the prescription is likely to be for some expen$ive new drug that doesn't actually benefit the consumer, but does benefit the doctor and drug companies. Its a ridiculous situation.
Posted by Sebastian on February 8, 2007, at 19:15:25
In reply to Re: J+J and Janssen in trouble over Risperdal, posted by med_empowered on February 7, 2007, at 15:05:57
I have to agree with a lot of the things you people are saying.
Risperdal, made me worse than I was. I started holucinating on it, my mucles were stiff as a board when on it, made me hungry, and I thought the TV was talking to me. had some weird thoughts on that drug.
I don't work for zyprexa or nothing, but its the most helpfull med I ever took. For most of my symptoms. I even wonder if I ever would have ended up in the hospital 3 times, if they had just given me that one first.
Ivan
Posted by munificentexegete on February 8, 2007, at 20:55:22
In reply to Re: J+J and Janssen in trouble over Risperdal, posted by med_empowered on February 6, 2007, at 9:57:32
> One study I read compared zyprexa (dosed based on clinical judgement) to fixed-dose Haldol, 5mgs, with prophylactic benztropine.
to how much zyprexa?
5mg Haldol is almost twice as much required to induce serious eps, you would have to compare it to about 30mg of zyprexa to make a valid comparison.
>they can also create some tremendous problems, and many people with psychotic disorders can do well without them.
they don't fix an imbalance and they do result in permanent damage to brain structure and indeed every organ in one's body.
Posted by Dinah on February 9, 2007, at 14:06:54
In reply to Re: J+J and Janssen in trouble over Risperdal, posted by munificentexegete on February 8, 2007, at 20:55:22
Risperdal has been a godsend for me. It is calming without making me drowsy. And it's calming in a bone deep way that benzos just can't mimic. I'm often less tearful on it, although I'm not sure whether it's because it has antidepressant qualities or if it's mainly anxiety that causes my depression.
If I use it regularly, I tend to lose touch with my emotions. And it's not great for my diabetes. So it's not without costs.
I have used between .25 mg and 1.5 mg a day, I think, with .25 mg being the norm for me when I use it. When I don't need it I don't use it, and I have no problems with withdrawal.
I find it a bit energizing, but it doesn't cause that creepy itchy jumpy feeling that anything with NE does for me.
I think results vary widely from person to person. But whatever it offers appears to be exactly what I need.
Posted by Dinah on February 9, 2007, at 14:39:19
In reply to Re: J+J and Janssen in trouble over Risperdal » munificentexegete, posted by Dinah on February 9, 2007, at 14:06:54
That was a general comment, not a reply to anyone in particular.
Posted by munificentexegete on February 9, 2007, at 15:03:42
In reply to Re: J+J and Janssen in trouble over Risperdal » munificentexegete, posted by Dinah on February 9, 2007, at 14:06:54
> Risperdal has been a godsend for me. It is calming without making me drowsy. And it's calming in a bone deep way that benzos just can't mimic. I'm often less tearful on it, although I'm not sure whether it's because it has antidepressant qualities or if it's mainly anxiety that causes my depression.
>
> If I use it regularly, I tend to lose touch with my emotions. And it's not great for my diabetes. So it's not without costs.
>
> I have used between .25 mg and 1.5 mg a day, I think, with .25 mg being the norm for me when I use it. When I don't need it I don't use it, and I have no problems with withdrawal.
>
> I find it a bit energizing, but it doesn't cause that creepy itchy jumpy feeling that anything with NE does for me.
>
> I think results vary widely from person to person. But whatever it offers appears to be exactly what I need.
>isn't the damage from risperdal cumulative, so that if tardive dyskinesia develops after say 100mg of risperdal, then it doesn't matter how low the dose is?
Posted by linkadge on February 10, 2007, at 11:44:50
In reply to Re: low dose risperdal -- Dinah, posted by munificentexegete on February 9, 2007, at 15:03:42
>they don't fix an imbalance
They do and they don't. In the case of a medication which can say, ameliorate an overactive HPA axis, improve sleeping patterns, or improve social function, one is likely to see subsequent improvements in other aspects of brain health. Some studies suggest that treatment with certain agents can prevent hippocampal volume loss associated with mood disorders.
It is hard to say that the drug doesn't get to the root cause, when nobody really knows what the root cause is.
>they do result in permanent damage to brain >structure and indeed every organ in one's body
That is simply not true. The verdict is not in on the newer antipsychotics yet. While they may cause symptomatic movement problems, there is not much conclusive evidence that they cause irreversable brain dammage, let alone dammage to every organ in the body.
There are risks involved in treatment of course, just as there are risks involved in lack of treatment.
It is fair to say that a patient should be fully informed about risks, but unfair to blow risks out of proportion.
Linkadge
Posted by munificentexegete on February 10, 2007, at 16:10:16
In reply to Re: low dose risperdal -- Dinah, posted by linkadge on February 10, 2007, at 11:44:50
>>they don't fix an imbalance
> They do and they don't.which imbalance do they fix?
>>they do result in permanent damage to brain structure and indeed every organ in one's body
> That is simply not true.
> The verdict is not in on the newer antipsychotics yet.http://www.contac.org/contaclibrary/medications22.htm
> It is fair to say that a patient should be fully informed about risks
once TD is proved, it is simply as bad as a typical AP.
Posted by cb_psy on February 11, 2007, at 5:41:25
In reply to J+J and Janssen in trouble over Risperdal, posted by halcyondaze on February 5, 2007, at 14:41:53
Ive read that it has antidepressant and anti anxiety effects at lower dosage.
"The only receptor subtype that risperidone is likely or known to saturate at these lower doses (0.5-1 mg/day) is the 5-HT2A receptor" (Schotte et al, 1996; Nyberg et al, 1999; Talvik-Lofti et al, 2000).
Posted by linkadge on February 11, 2007, at 11:42:57
In reply to Re: low dose risperdal -- Dinah, posted by munificentexegete on February 10, 2007, at 16:10:16
>which imbalance do they fix?
Like I said, antipschotic treatment can oftentimes be associated with a normalization of the HPA axis. Some researchers think that psychosis in some people is fundimentally caused by HPA axis abnormalities, hence the strong antipsychotic actions of antiglutacortacoid drugs like RU-486.
>http://www.contac.org/contaclibrary/medications22>.htmA single case of something does not proove anything. The woman was taking lithium too, which has occasionally been asociated with TD. It is impossable to say that everybody treated with atypical antipsychotics is going to develop TD, even if there have been some cases of it.
There are going to be risks involved in treatment of any disease. The decision to take a medication or not is based on the personal cost/benifit ratio.
>once TD is proved, it is simply as bad as a >typical APIts not a matter of being proven or not. You have proved that TD *can* occur. That does not proove that TD will occur in any given patient.
Just as any given side effect for any drug will not occur in all patients.
Linkadge
Posted by Dinah on February 11, 2007, at 14:36:45
In reply to Re: low dose risperdal -- Dinah, posted by linkadge on February 11, 2007, at 11:42:57
Hmmm... That makes sense. I've long thought, from things totally unrelated from emotional disorders, that my HPA axis was involved in whatever was wrong with me.
Posted by rina on February 11, 2007, at 14:44:22
In reply to Re: J+J and Janssen in trouble over Risperdal, posted by SLS on February 7, 2007, at 5:31:28
> > About 3 weeks @ 1mg. It also gave me the worst akathesia, worse than seroquel @75 or zyprexa @ 5mg.
>
> I can see that happening, of course. I would just like to point out that some neuroleptics produce anxiety as a startup side effect rather than akathisia.
>
> I agree with Jay, and hope that these drugs do not become demonized in the same way benzodiazepines were. With what else we have available, I don't think they deserve it.
>
>
> - Scott
can someone tell me what akathesia is?
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