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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by MuseMemento on April 10, 2016, at 11:52:58
Hi, all. I began taking 2 mg risperidone 11 days ago without titration to assist in a delusional disorder as well as OCD alongside fluvoxamine 300 mg, lamictal 200 mg, ativan 2 mg, vyvanse 80 mg. I have noticed some improvement in the areas it was intended to treat but, especially the past few days, I've had increasing difficulty in locating words, remembering the meaning of words, spelling, remembering songs and names, all words, songs and names that I've forgotten are quite familiar to me, as well. I don't see the pdoc until Friday and it's not causing a great deal of anxiety but it's severe enough that it's interfering with the few activities I engage in outside of the home. So, I'm wondering if it's worth trying a lower dosage in the meantime to see if this has less of a cognitive effect even, perhaps, at the expense of some of the intended effect. Or will this cognitive impairment pass? It's worth mentioning that the initial sedation that I experienced on the med has largely passed, so it's unlikely to be the source of the impairment. Thanks, all!
Posted by MuseMemento on April 10, 2016, at 11:56:59
In reply to Risperidone Cognitive Impairment, posted by MuseMemento on April 10, 2016, at 11:52:58
Also, I don't know if it's relevant but I also began taking metformin 1000 mg daily when I initiated the risperidone. I hope it's not the metformin as I've gained weight even on brief trials of the "weight-neutral" antipsychotics.
Posted by Lamdage22 on April 10, 2016, at 12:05:24
In reply to Re: Risperidone Cognitive Impairment, posted by MuseMemento on April 10, 2016, at 11:56:59
Metformin is a good idea. Only drawback to be absolutely safe, you should have a kidney function test every 3 months.
Posted by SLS on April 10, 2016, at 14:04:35
In reply to Risperidone Cognitive Impairment, posted by MuseMemento on April 10, 2016, at 11:52:58
> Hi, all. I began taking 2 mg risperidone 11 days ago without titration to assist in a delusional disorder as well as OCD alongside fluvoxamine 300 mg, lamictal 200 mg, ativan 2 mg, vyvanse 80 mg.
Why Lamictal?
Higer dosages of Lamictal can produce the adverse effects on cognition that you are experiencing. Normally, 200 mg/day of Lamictal does not produce profound cognitive side effects - although it can. Perhaps there is an interaction between risperidone and Lamictal*. I haven't looked into it. I would reduce the risperidone until you speak to your doctor if your present condition is intolerable. Otherwise, I would keep everything the same and let your doctor help you to make a decision.
* I looked into this and found studies that determined that there are no pharmacokinetic (blood levels) interactions between Lamictal and risperidone.
- Scott
Posted by MuseMemento on April 11, 2016, at 11:04:32
In reply to Re: Risperidone Cognitive Impairment » MuseMemento, posted by SLS on April 10, 2016, at 14:04:35
Thanks, SLS. The lamictal was in hopes that it would prove a worthwhile adjunct to fluvoxamine for both OCD and depression. I should have mentioned all of my diagnoses and not just the one pertaining to the risperidone addition. I will try to maintain this dose until Friday if I can. With a med of this type, does cognitive impairment tend to subside or should I be prepared for it to remain at this level?
Posted by porkpiehat on April 11, 2016, at 11:23:21
In reply to Re: Risperidone Cognitive Impairment » MuseMemento, posted by SLS on April 10, 2016, at 14:04:35
> Why Lamictal?
>
> Higer dosages of Lamictal can produce the adverse effects on cognition that you are experiencing. Normally, 200 mg/day of Lamictal does not produce profound cognitive side effects - although it can. Perhaps there is an interaction between risperidone and Lamictal*. I haven't looked into it. I would reduce the risperidone until you speak to your doctor if your present condition is intolerable. Otherwise, I would keep everything the same and let your doctor help you to make a decision.
>
> * I looked into this and found studies that determined that there are no pharmacokinetic (blood levels) interactions between Lamictal and risperidone.
>
>
> - ScottI can second that about the Lamictal, It definitely has significant cognitive problems for me, ESPECIALLY if mixed with anything that has serotoninergic activity. Even if there's no clearance/metabolism issues that medscape might list
>
How are you finding the risperdal otherwise?
Posted by MuseMemento on April 11, 2016, at 19:07:35
In reply to Re: Risperidone Cognitive Impairment, posted by porkpiehat on April 11, 2016, at 11:23:21
It seems okay, otherwise. I'm not sure how helpful it will be if the cognitive impairment remains but it's helped in some regards. I'm eager to see what it will ultimately be capable of in a couple of weeks.
Oh, and I was find on fluvoxamine and lamictal before the risperidone addition, and had been since September, so it's most likely the risperidone.
Posted by Christ_empowered on April 11, 2016, at 19:36:19
In reply to Re: Risperidone Cognitive Impairment » porkpiehat, posted by MuseMemento on April 11, 2016, at 19:07:35
Personally, I think its the risperidone+amphetamine combo.
Posted by MuseMemento on April 11, 2016, at 20:30:08
In reply to Re: Risperidone Cognitive Impairment, posted by Christ_empowered on April 11, 2016, at 19:36:19
Interesting. What would be the mechanism responsible? If pressed to retain only one, I don't know which one I'd choose.
Posted by Christ_empowered on April 11, 2016, at 21:31:23
In reply to Re: Risperidone Cognitive Impairment » Christ_empowered, posted by MuseMemento on April 11, 2016, at 20:30:08
I'm not a pill expert, but when I took Abilify at a lowish dose w/ Adderall, the combo was...strange. Stimulated, also tranquilized; spaced out to the max.
I did have an acquaintance who did well on seroquel w/ adderall, but...seroquel is low potency and very sedating, so that kinda makes sense (?). Risperidone is higher potency and not nearly as sedating.
I could be wrong. Some people do well on stimulants+neuroleptics, stimulants+downers, etc., I just found the stimulant+neuroleptic combination problematic.
If I were you, I'd keep the stimulant. Neuroleptics are OK if you need them, but they have some serious potential adverse effects, especially over the long haul.
Posted by MuseMemento on April 11, 2016, at 21:45:16
In reply to Re: Risperidone Cognitive Impairment, posted by Christ_empowered on April 11, 2016, at 21:31:23
Interesting and thank you so much for replying! When I first tried abilify, I couldn't get above a dose of 5 mg because I would have pretty severe facial and neck twitches. I thought I was developing acute dyskinesia. I didn't realize until trying it again 18 months later that it was the combination of abilify and methylphenidate that I'd been taking at the time that had caused the issues. I was successfully using vyvanse and abilify for a few months, tried to discontinue it for a few months, then realized I needed it and tried to add it back. I had a similar sort of reaction as I did the first time when I'd taken abilify with methylphenidate. So I started searching for other AAPs and this is my second one. Hopefully some additional clarity will arise.
This is the end of the thread.
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