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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 schleprock on August 10, 2012, at 12:53:33
Currently on Nortriptyline (150mg), Clonazepam (1.5 mg) and .75 mg of Risperidone as a much needed augmentor. The Risperidone (at .5 mg) was worked immediately and relieved most of my depression and anxiety after the first two weeks. Now it's effects have completely wore off, with no improvements following .25 increase over the last two days. Has anyone else had any similar experiences with initial short term efficacy of an antipsychotic? Does one typically have to wait a while for the full benefits of the drug, or is it likely that my Risperidone has more or less failed and I should try something else. I'm just surprised because it worked so well at the initial dosage level, then just stopped working overnight. I haven't had alot of experience with switching between medications since my Nortriptyline alone worked so well over a long period of time, and this breakthrough depression\anxiety I'm experiencing has occured only recently.
Posted by SLS on August 10, 2012, at 15:33:41
In reply to Long term efficacy of antipsychotics, posted by schleprock on August 10, 2012, at 12:53:33
Low-dosage risperdone produced a transient improvement of depression for me. It lasted for about about a week. I had similar experiences with Zyprexa and Geodon. The only AP that has produced a persistent improvement for me has been Abilify.
Since each of our neurobiologies are unique, I don't think it makes sense to generalize my reactions to APs to anyone else. Some people do well with Seroquel - even as monotherapy. Seroquel was not at all helpful to me. On the contrary, it produced dysphoria and irritability.
What other drugs are you considering to use as adjuncts?
What are your prominent symptoms?
- Scott
Posted by Lou Pilder on August 10, 2012, at 16:04:05
In reply to Re: Long term efficacy of antipsychotics » schleprock, posted by SLS on August 10, 2012, at 15:33:41
> Low-dosage risperdone produced a transient improvement of depression for me. It lasted for about about a week. I had similar experiences with Zyprexa and Geodon. The only AP that has produced a persistent improvement for me has been Abilify.
>
> Since each of our neurobiologies are unique, I don't think it makes sense to generalize my reactions to APs to anyone else. Some people do well with Seroquel - even as monotherapy. Seroquel was not at all helpful to me. On the contrary, it produced dysphoria and irritability.
>
> What other drugs are you considering to use as adjuncts?
>
> What are your prominent symptoms?
>
>
> - ScottScott
You wrote,[...Since each of our neurobiologies are unique, I don't think it makes sense to generalize my reactions to APs to anyone else...].
Thanks, I think that's good.
Lou
Posted by bleauberry on August 10, 2012, at 16:06:22
In reply to Re: Long term efficacy of antipsychotics » schleprock, posted by SLS on August 10, 2012, at 15:33:41
I came close to trying risperdal but never did. I tried the others. Had a decent run on zyprexa for 8 years. The others were aweful to me.
If I'm not mistaken, I think risperdal is sort of similar in a way to amisulpride or abilify in that the lower doses are generally more stimulating/antidepressant, while the higher doses are more tranquilizing. So increasing the dose might not help. Why these things poop out, I dunno. My guess is that genes have a set of instructions to follow and if something upsets their game plan they'll figure out a way around it.
I personally do not feel comfortable endorsing longterm antipsychotics. If I did, my first choice would be zyprexa, second choice abilify.
You might find interesting writings by Dr Gillman on the web. psychotropical.com I think. He endorses things that he saw actually work in his practice. One of them was nortriptyline with zoloft. Different than either of those alone.
Somewhere in the mix, whatever happens in the next few months, I would also keep the name Savella on the radar screen. On paper anyway, I can see how that one could breath new life into old nortriptyline.
Posted by schleprock on August 10, 2012, at 17:21:25
In reply to Re: Long term efficacy of antipsychotics, posted by bleauberry on August 10, 2012, at 16:06:22
Thanks for the responses. I'm taking risperidone for increased depression\anxiety that's been hitting me quite over the past few months. As far as alternatives there's seroquel, abilify, lyrica or neurontin (though the latter two my pdoc says wouldn't be as effective for the depression.
I'd consider Buspar, Savella or Zoloft, but I'm wary beacause drugs.com interactions checker insists that there are major interactions with Nortriptyline. (I'd also consider Zyprexa, but apparently there's danger from the clonazepam.)
What's funny about the risperidone is that I chose to start it gradually (at .25 mg the first four nights) and felt great, and felt very little difference once on the initially prescribed .50 mgs. I think the recent increase has made me feel worse.
@SLS and others on Abilify: is Abilify as an augment usually taken at bedtime, and does it contain any sedative effects to help with sleep.
Posted by Christ_empowered on August 10, 2012, at 17:59:47
In reply to Re: Long term efficacy of antipsychotics, posted by schleprock on August 10, 2012, at 17:21:25
I'd avoid neuroleptics long term whenever possible. I'm not saying they're the worst thing ever, but they're not exactly nice to your brain (or the rest of your body).
Personally, I'd go for lyrica and gradually ditch the risperdal.
Posted by Dinah on August 10, 2012, at 18:28:12
In reply to Re: Long term efficacy of antipsychotics, posted by schleprock on August 10, 2012, at 17:21:25
I found Risperdal to be mildly stimulating when I first started it. I think it was more a startup effect than the end goal. So it may not be so much a poop-out as a settling into its actual effects.
It might well work better for anxiety than depression, though I sometimes get a bit tearful when I've been on it a while and quit taking it regularly.
One way it may be helpful is to reduce the anxiety that accompanies a more activating antidepressant.
This is totally based on my own experience and YMMV.
Posted by phidippus on August 10, 2012, at 18:42:33
In reply to Long term efficacy of antipsychotics, posted by schleprock on August 10, 2012, at 12:53:33
Your choice of antipsychotic falls short of your needs. You rreally should be trying something with antidepressant qualities, such as Abilify, Latuda, Seroqquel or Geodon.
Eric
Posted by Phillipa on August 10, 2012, at 18:43:12
In reply to Re: Long term efficacy of antipsychotics » schleprock, posted by Dinah on August 10, 2012, at 18:28:12
What happened to benzos as they do work well and xanax in particular has some antidepressant properties. Phillipa
Posted by schleprock on August 10, 2012, at 19:17:07
In reply to Re: Long term efficacy of antipsychotics » schleprock, posted by phidippus on August 10, 2012, at 18:42:33
> Your choice of antipsychotic falls short of your needs. You rreally should be trying something with antidepressant qualities, such as Abilify, Latuda, Seroqquel or Geodon.
>
>
> EricMy pdoc steered me away from Lyrica, Neurontin, etc because AAs have antidepressent qualities. I think risperidone was chosen ultimately because it had a milder side-effect profile compared to seroquel and abilify, that they were easier to deal with in dosage, and that he'd personally seen success with it as an augmentor. Geodon and Latuda I've never heard of. I'd appreciate any knowledge of them regarding their success in augmenting antidepressents. Thanks for the response.
I'm starting to wonder whether a better strategy may be to try different meds once one fails rather than increasing the current one.
Posted by phidippus on August 11, 2012, at 18:26:31
In reply to Re: Long term efficacy of antipsychotics, posted by schleprock on August 10, 2012, at 19:17:07
>My pdoc steered me away from Lyrica, Neurontin, >etc because AAs have antidepressent qualities.
Lyrica and Neurontin are anticonvulsants used to treat epilepsy and off-label to treat anxiety. Neither have any antidepressant qualities.
Geodon is an atypicall antipsychotic which has some antidepressant qualities. One of these antidepressant qualities is that Geodon is an SNRI or seratonin norepenephrine reuptake inhibitor. Geodon is also a 5ht1a partial agonist, which helps treat depression and anxiety.
Latuda is an atypical antipsychotic wwhich also fully agonises 5ht1a receptors, making it a potent antidepressant.
Risperidone is a centrally acting atyipical antipsychotic with high affinity for dopamine receptors. It has no antidepressant qualities.
Your best choices for augmenting antidepressants are Geodon, Seroquel, Abilify and Latuda. Youu shouldn't let the side effects scare you off any medicine.
You're good increasing the dose of a medication if it doesn't seem to be working.
Eric
Posted by schleprock on August 11, 2012, at 18:36:49
In reply to Re: Long term efficacy of antipsychotics » schleprock, posted by phidippus on August 11, 2012, at 18:26:31
> >My pdoc steered me away from Lyrica, Neurontin, >etc because AAs have antidepressent qualities.
>
> Lyrica and Neurontin are anticonvulsants used to treat epilepsy and off-label to treat anxiety. Neither have any antidepressant qualities.
>
> Geodon is an atypicall antipsychotic which has some antidepressant qualities. One of these antidepressant qualities is that Geodon is an SNRI or seratonin norepenephrine reuptake inhibitor. Geodon is also a 5ht1a partial agonist, which helps treat depression and anxiety.
>
> Latuda is an atypical antipsychotic wwhich also fully agonises 5ht1a receptors, making it a potent antidepressant.
>
> Risperidone is a centrally acting atyipical antipsychotic with high affinity for dopamine receptors. It has no antidepressant qualities.
>
> Your best choices for augmenting antidepressants are Geodon, Seroquel, Abilify and Latuda. Youu shouldn't let the side effects scare you off any medicine.
>
> You're good increasing the dose of a medication if it doesn't seem to be working.
>
> Eric
>
>
>Thanks. Hypothetically, which of those meds would work best if you have a low dopamine level? From what I understand, Risperidol has a negative effect on dopamine amount.
Posted by phidippus on August 11, 2012, at 19:03:21
In reply to Re: Long term efficacy of antipsychotics, posted by schleprock on August 11, 2012, at 18:36:49
>which of those meds would work best if you have a >low dopamine level?
I doubt you have low dopamine levels. Low dopamine levels usually lead to other illness such as Parkinsons.
All atypical antipsychotics ANTAGONIZE dopamine, which means they lower dopamine levels. Except for Abilify, which is a D2 partial agonist.
Drugs which increase dopamine include Requip, Mirapex, Levadopa, Memantine and a bunch more here: http://en.wikipedia.org/wiki/Dopamine_agonist
Eric
Posted by schleprock on August 11, 2012, at 19:44:02
In reply to Re: Long term efficacy of antipsychotics » schleprock, posted by phidippus on August 11, 2012, at 19:03:21
> >which of those meds would work best if you have a >low dopamine level?
>
> I doubt you have low dopamine levels. Low dopamine levels usually lead to other illness such as Parkinsons.
>
> All atypical antipsychotics ANTAGONIZE dopamine, which means they lower dopamine levels. Except for Abilify, which is a D2 partial agonist.
>
> Drugs which increase dopamine include Requip, Mirapex, Levadopa, Memantine and a bunch more here: http://en.wikipedia.org/wiki/Dopamine_agonist
>
> EricThanks. I suppose I am, at the very least, looking for something to augment my nortriptyline that hasn't a negative effect on dopamine. Maybe.
I've seen Mirapex mentioned somewhere as being used for anxiety\depression. And apparently there's a thread somewhere around here about requip. Do you know anything about those being used as augmentors?
Posted by phidippus on August 11, 2012, at 19:54:07
In reply to Re: Long term efficacy of antipsychotics, posted by schleprock on August 11, 2012, at 19:44:02
I have used Requip in the past to augment my mood. It worked very well.
Eric
Posted by SLS on August 11, 2012, at 20:04:31
In reply to Re: Long term efficacy of antipsychotics, posted by schleprock on August 11, 2012, at 18:36:49
Just a few points:
Latuda also antagonizes 5-HT7 receptors. There is some indication that this property promotes an antidepressant effect.
As is the case with the other "atypical" neuroleptics, risperidone is a potent antagonist of 5-HT2a receptors; an action that can increase dopamine activity in the PFC. I would not discount the potential for risperidone to produce antidepressant effects, especially in combination with SRIs. It did for me, although not for very long. I was taking Parnate at the time.
If I am not mistaken, all of the DA antagonist antipsychotics increase the presynaptic synthesis and release of dopamine. Of course, the postsynaptic neuron is usually "blind" to this increase of synaptic dopamine because its receptors are being blocked by the drug.
I found that Neurontin produced some improvement in my depression. It lasted for less than a week, though. After discontinuing Neurontin, I was left in a dysphoric fog for over three weeks. I reacted to Lyrica in exactly the same way. It was very scary. I feared that I would be stuck in that state indefinitely. In the future, I will try to avoid any drug that acts to inhibit the alpha2delta subunit of the calcium channel. I am guessing that, for some people, the ability of these drugs to accelerate glutamate reuptake produces an anxiolytic effect.
- Scott
Posted by jono_in_adelaide on August 12, 2012, at 21:32:13
In reply to Re: Long term efficacy of antipsychotics, posted by SLS on August 11, 2012, at 20:04:31
I found that risperidone 1mg at night produced a profound decrease in anxiety and depression, it enhanced the effects of the antidepressants and Xanax i was taking and was of great benifit.
The only side effect was a bit of drowsiness for the first 3 days or so
Been taking it for 2 years now and its still effective
Posted by b2chica on August 15, 2012, at 15:44:35
In reply to Re: Long term efficacy of antipsychotics, posted by SLS on August 11, 2012, at 20:04:31
you mentioned that 'potentially' all the DA antagonist AP's increase presynaptic synthesis and release of dopamine.
Zyprexa is the only AP that seemed to work on me. do you know if This DA antagonist is competative antagonist and allowing for my specific DA to actually increase? if say my supply is full, just nothing binding, thus bringing about desired effect?
(i hope i have my question stated correctly. i'm still learning in my pharmacology class)
thanks Scott
b2c
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