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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Jack Smith on July 10, 2003, at 17:41:26
Just an idea I am toying with. Really unsure about doing it but what are people's experiences with either med simply as an AD augmentor.
I am having a partial response to effexor (been at 300 for about a month after about two months moving up). Looking into a whole bunch of options. I have depression with a strong anxiety component.
Thanks to anyone,
JACK
Posted by ace on July 10, 2003, at 23:42:39
In reply to Opinions: Risperdal v. Zyprexa as AD augmentor??, posted by Jack Smith on July 10, 2003, at 17:41:26
> Just an idea I am toying with. Really unsure about doing it but what are people's experiences with either med simply as an AD augmentor.
>
> I am having a partial response to effexor (been at 300 for about a month after about two months moving up). Looking into a whole bunch of options. I have depression with a strong anxiety component.
>
> Thanks to anyone,
>
> JACK
Hi Jack,
I'd absolutley without doubt choose Zyprexa. A lot of people say that Risperidone has few s/effects- I am a big disbeliever of this. On 2mg I had extreme akathisia. I have heard of plenty of reports of EPS from Risperidone and maybe 1 or 2 from Zyprexa, and Risperidone has been out longer.Diabetes from Zyprexa is not definite- I am sceptical after reading a great paper on the subject. Weight gain is often but not definite. Zyprexa has shown efficacy for depression in many clinical trials- after much searching I havent seen any for Risperidone, only OCD.
Good luck Jack!
Ace.
Posted by juanantoniod on July 11, 2003, at 15:35:50
In reply to Opinions: Risperdal v. Zyprexa as AD augmentor??, posted by Jack Smith on July 10, 2003, at 17:41:26
I hope these are helpful. They are from the recent American Psychiatrists Association meeting.
Antipsychotic Augmentation in Treatment-Resistant Depression[4]
There has been recent interest in the use of atypical antipsychotics as augmenting agents in the treatment of depression. This study reported on the preliminary results from the large, international, multicenter ARISe-RD trial. Patients included in this trial had all failed previous treatments with antidepressants, as well as a prospective 4- to 6-week course of citalopram. Patients not responding to citalopram received open-label risperidone augmentation (0.25-2 mg/day). This study presented data from 41 enrolled subjects, of whom 80% did not respond to the citalopram. Subjects receiving risperidone augmentation (n= 33) had significant improvement in HRSD and Montgomery-Asberg Depression Rating Scale (MADRS) total scores with mean percentage reductions of 49.9% on the HRSD and 47% on the MADRS (P < .001). Significant improvement was noted by day 4 of augmentation. The authors concluded that the preliminary data suggest that augmentation with low-dose risperidone provides a rapid, robust improvement of depressive symptoms in treatment-resistant patients without evidence of movement disorders liability.
Major Depression and Long-term Olanzapine/Fluoxetine Use[10]
This is the final data presentation from a long-term study investigating the use of an olanzapine/fluoxetine combination in the treatment of major depressive disorder (MDD) in a group of patients with or without treatment-resistant depression (TRD). The open-label study followed 560 patients treated for 76 weeks. The primary outcome measure was the MADRS. MADRS mean total scores decreased 6 points from baseline (31.6; n = 552) at a half week of treatment, 11 points at 1 week, 18 points at 8 weeks, and 22 points at 76 weeks. Response and remission rates for the total sample were high (62% and 56%, respectively), and the relapse rate was low (15%). Response, remission, and relapse rates for TRD patients (n = 145) were 53%, 44%, and 25%, respectively. Adverse events included somnolence, weight gain, dry mouth, increased appetite, and headache. At end point, there were no clinically meaningful changes in vital signs, laboratory values, or electrocardiography, and no significant increases on measures of extrapyramidal symptoms. Overall this study suggests that olanzapine/fluoxetine can product rapid, robust, and long-term improvements in depressive symptoms in patients with MDD. The combination was also effective in TRD patients, and the side-effect profile of the combination appears to be similar to that of its component monotherapies.
They indicate that both are helpful. I'm on Resperidol because my pdoc won't give me Zyprexa because of the blood sugar complications (I already have Type 1 diabetes), and the weight gain.
Antonio
> Just an idea I am toying with. Really unsure about doing it but what are people's experiences with either med simply as an AD augmentor.
>
> I am having a partial response to effexor (been at 300 for about a month after about two months moving up). Looking into a whole bunch of options. I have depression with a strong anxiety component.
>
> Thanks to anyone,
>
> JACK
Posted by Jack Smith on July 11, 2003, at 15:52:07
In reply to Re: Opinions: Risperdal v. Zyprexa as AD augmentor??, posted by juanantoniod on July 11, 2003, at 15:35:50
> I hope these are helpful.
Yes, they were quite helpful.
> They indicate that both are helpful. I'm on Resperidol
What are you taking with it and how is it working?
JACK
Posted by Maximus on July 12, 2003, at 14:37:36
In reply to Opinions: Risperdal v. Zyprexa as AD augmentor??, posted by Jack Smith on July 10, 2003, at 17:41:26
> I am having a partial response to effexor (been at 300 for about a month after about two months moving up). Looking into a whole bunch of options. I have depression with a strong anxiety component.
Hi Jack,
Nice to see you again. Do not take APs, not yet at least. Ok you get a partial response from Effexor XR 300 mg and you have a lot of anxiety. There is a more logical algorithm. Did you try these augmentations?
1- Effexor + Lithium or buspirone (for 5HT1A reuptake)
2- Effexor + SSRI
3- Effexor + Remeron (good for anxiety and melancholia)http://www.medscape.com/viewarticle/406472
http://www.projectsinknowledge.com/Init/P/depres/pcppdf/switching.pdfGood luck Jack!
Max
Posted by tepiaca on July 12, 2003, at 15:44:33
In reply to Opinions: Risperdal v. Zyprexa as AD augmentor??, posted by Jack Smith on July 10, 2003, at 17:41:26
In my own experience , risperdal did nothing to help my depression .
Zyprexa was the first ,medicine that give me some relief , and also help a little with social anxiety.
anyway I was suffering a low pychosis .
I also believe that you should not take AP ,before trying other drugs firts
hope this help
Tep
Posted by Janelle on July 12, 2003, at 18:33:33
In reply to Re: Do not take APs... » Jack Smith, posted by Maximus on July 12, 2003, at 14:37:36
Posted by Juanantoniod on July 12, 2003, at 22:37:41
In reply to Re: Opinions: Risperdal v. Zyprexa as AD augmentor » juanantoniod, posted by Jack Smith on July 11, 2003, at 15:52:07
Hi, Jack.
I'm taking Risperidol .5mg twice daily. I have been on it for about 2 weeks and haven't really seen a difference, but it is a low dose, according to my pdoc, so maybe when I see him, he will increase it.
Take care,
Antonio
> > I hope these are helpful.
>
> Yes, they were quite helpful.
>
> > They indicate that both are helpful. I'm on Resperidol
>
> What are you taking with it and how is it working?
>
> JACK
Posted by Maximus on July 13, 2003, at 0:41:00
In reply to WHY do NOT take AP's?? (nm) » Maximus, posted by Janelle on July 12, 2003, at 18:33:33
- Because there are so much better alternatives out there being a lot more safe.
- Because APs are suboptimals for the depression. They often worsen the depressive symptoms.
- Because of their dreaded side effects:TARDIVE DYSKINESIA and INVOLUNTARY MOVEMENTS without counting diabete and massive weight gain.
- Because there aren't simply not appropriate; reference to their mode of actions.
To put it simple, APs are greats for what they have been created; they are real sledge hammer for:- For the schizophrenia.
- For psychosis, of course
- For the treatment of acute mania (recently)
- And as last resort, augmentation strategies in the treatment of depression IF and only IF everything else have failed.Well this is of course my opinion and i share it with you because i feel that everybody here deserve to be well treated.
Max.
Posted by Janelle on July 13, 2003, at 14:35:54
In reply to Re: WHY do NOT take AP's?? » Janelle, posted by Maximus on July 13, 2003, at 0:41:00
This is the end of the thread.
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