![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by karlmarx on July 4, 2002, at 14:41:17
I recently completed a short (~1 month) trial of Risperdal, which was terminated for reasons unrelated to the drug itself. Risperdal was the second to the last stop in what has been a long and fruitless search for a replacement for my initially successful three year course of therapy with Prozac.
I was taking a dose of .5 milligrams per day, and was very pleased at the reduction in obsessive thinking and depression which it afforded me, but beginning with the first few days of use I noticed a slight tightness in a very small area of my back on one side. I understood that this was a side effect of the drug, and it was not unpleasant, and in fact barely noticeable, so I ignored it.
About a week after stopping the drug I noticed a slight twitching in the facial muscles beneath one of my eyebrows. This, again, was barely perceptible, and not noticeable to an observer. But it persisted for almost a month, occurring perhaps two or three times an hour.
Over the next three or four weeks it diminished and essentially dissappeared, however now, almost three months after discontinuing Risperdal, I still have the sensation, for want of a better term, of the muscle in my back. It is not painful, incapacitating, or really much of anything. It is just there.
I am currently taking valproate for my Bipolar II mixed states condition, and for those of you who have not had the joy, while it works fairly well it has one side effect which does not appear on the label: It makes you stupid. At least it does me.
When taking the 1000 mg needed to control my symptoms if I write something and then read it the next day it usually sounds like the work of a moron. Then there are the problems it induces with finding words. I find myself reduced to using precise terms like the whatchmcallit, that thing over there, and other highly descriptive phrases for common household objects, and when I attempt to discuss anything related to the technical government field I work in, I am sure I confirm every stereotype private sector government contractors have about government employees being idiots.
So I am interested in going back to the Risperdal. But now I am bothered by this whole issue of dyskinesia/dystonia tardive or otherwise. My current psychiatrist is not much help in getting answering questions about this, so I am hoping someone here can help out until I am able to replace her.
First I am wondering if these two symptoms I described are any cause for concern in initiating another trial with Risperdal. The eyebrow thing seems to fit the definition of tardive dyskinesia since it emerged after the cessation of treatment, but since it went away and was fairly insignificant to begin with, I am not particularly concerned about it. More troubling, in that it seems persistent, is the back muscle sensation.
Again, it is just barely noticeable, but it is there. My concern is that the combination of these two symptoms could indicate:
1) a tendency towards tardive symptoms, so that I might take the drug for months or years and not know that other dyskinesias/dystonias were developing until I stopped it, or until they emerged.
2) that these dyskinesias/dystonias might be more noticeable and less benign that those I experienced in the past.
2)that these might be irreversible, i.e. the potential of irreversiblity being indicated by the back muscle symptom.
I have read that the incidence of TD with Rispedal is very low, essentially at the same level as spontaneous TD *among schizophrenics* treated with Risperdal, but I have also read somewhere that antipsychotics (the older ones I think) are more likely to induce TD in bipolar than in schizophrenics.
Should I be concerned about the possility of irreversible TD emerging eventually if I resume taking Risperdal?
in solidarity,
Karl
Posted by Ritch on July 4, 2002, at 23:55:59
In reply to The Problem With Risperdal-, posted by karlmarx on July 4, 2002, at 14:41:17
> I recently completed a short (~1 month) trial of Risperdal, which was terminated for reasons unrelated to the drug itself. Risperdal was the second to the last stop in what has been a long and fruitless search for a replacement for my initially successful three year course of therapy with Prozac.
>
> I was taking a dose of .5 milligrams per day, and was very pleased at the reduction in obsessive thinking and depression which it afforded me, but beginning with the first few days of use I noticed a slight tightness in a very small area of my back on one side. I understood that this was a side effect of the drug, and it was not unpleasant, and in fact barely noticeable, so I ignored it.
>
> About a week after stopping the drug I noticed a slight twitching in the facial muscles beneath one of my eyebrows. This, again, was barely perceptible, and not noticeable to an observer. But it persisted for almost a month, occurring perhaps two or three times an hour.
>
> Over the next three or four weeks it diminished and essentially dissappeared, however now, almost three months after discontinuing Risperdal, I still have the sensation, for want of a better term, of the muscle in my back. It is not painful, incapacitating, or really much of anything. It is just there.
>
> I am currently taking valproate for my Bipolar II mixed states condition, and for those of you who have not had the joy, while it works fairly well it has one side effect which does not appear on the label: It makes you stupid. At least it does me.
>
> When taking the 1000 mg needed to control my symptoms if I write something and then read it the next day it usually sounds like the work of a moron. Then there are the problems it induces with finding words. I find myself reduced to using precise terms like the whatchmcallit, that thing over there, and other highly descriptive phrases for common household objects, and when I attempt to discuss anything related to the technical government field I work in, I am sure I confirm every stereotype private sector government contractors have about government employees being idiots.
>
> So I am interested in going back to the Risperdal. But now I am bothered by this whole issue of dyskinesia/dystonia tardive or otherwise. My current psychiatrist is not much help in getting answering questions about this, so I am hoping someone here can help out until I am able to replace her.
>
> First I am wondering if these two symptoms I described are any cause for concern in initiating another trial with Risperdal. The eyebrow thing seems to fit the definition of tardive dyskinesia since it emerged after the cessation of treatment, but since it went away and was fairly insignificant to begin with, I am not particularly concerned about it. More troubling, in that it seems persistent, is the back muscle sensation.
>
> Again, it is just barely noticeable, but it is there. My concern is that the combination of these two symptoms could indicate:
>
> 1) a tendency towards tardive symptoms, so that I might take the drug for months or years and not know that other dyskinesias/dystonias were developing until I stopped it, or until they emerged.
>
> 2) that these dyskinesias/dystonias might be more noticeable and less benign that those I experienced in the past.
>
> 2)that these might be irreversible, i.e. the potential of irreversiblity being indicated by the back muscle symptom.
>
> I have read that the incidence of TD with Rispedal is very low, essentially at the same level as spontaneous TD *among schizophrenics* treated with Risperdal, but I have also read somewhere that antipsychotics (the older ones I think) are more likely to induce TD in bipolar than in schizophrenics.
>
> Should I be concerned about the possility of irreversible TD emerging eventually if I resume taking Risperdal?
>
> in solidarity,
>
> Karl
Karl,I wouldn't revisit the Risperdal. I also got some good responses from atypical AP's and also got EPS symptoms that seem to take longer to recover from each subsequent trial of each newer dopamine antagonist. I would suggest lowered dose of Depakote instead combined with a low-dose serotonergic antidepressant like Prozac. What if you could take just 500mg of Depakote with a much smaller dose of Prozac?
Mitch
Posted by Schuyler on July 5, 2002, at 5:19:14
In reply to The Problem With Risperdal-, posted by karlmarx on July 4, 2002, at 14:41:17
Sorry I haven't any answers, since I've just started on Risperdal, but I am very interested in the responses you get, so I am posting to get email notices of follow-up posts.
Schuyler
Posted by crepuscular on July 5, 2002, at 14:21:02
In reply to The Problem With Risperdal-, posted by karlmarx on July 4, 2002, at 14:41:17
i just went through a similar situation with seroquel for bipolar disporder. for me, i got twitching in my lower lip after about 4 months of therapy, then my neck basically froze up, with tightness in the mid-back that was *unreal*.
sadly, i really liked seroquel. it has been the msot effective mood stabilzer & sleep regulating med i've ever taken. i did ex[periements with coming off seroquel and boom, the TD/EPS symptoms went away. went back on seroquel, symptoms return.
so it sucks, because after years of trying all sorts of drugs & combos, i had something that worked. but it was too good to be true.sounds to me like you're having a similar experience. i'm hoping aripiprazole comes on the market soon and doesn't have these side effects.
i don't do well on lithium or the anti-convulsants for some reason, i feel smothered by them, my brain "fights" them somehow. i feel stupid, am stupid, teetering on depression-stupid. seroquel did not have this effect. but i think the TD thing is bad news and rates appear to be higher for bp/bp2 folks than pure schizos.am going down the omegabrite route for the summer. have klonopin & old seroquel tabs if i really need to sleep. in summer i can go on 3-4 hours of sleep/night for months straight - which is bad bad bad. when fall hits, the melancholia is crushing. i party too much, spend money. blech.
oh sleep, the great unobtainable. sometimes i think my mood disorders are really secondary to a sleep disorder.
best of luck Karl. don't know if i helped, but at least there are others w/same problem.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.