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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by fachad on December 12, 2004, at 14:29:31
My wife was prescribed Risperdal 0.25mg/day for anxiety.
To me that seemed like a bad idea - a benzo would have been much safer, but I think her pdoc is a benzophobe.
Anyway, she is now showing signs of TD, twitches of hands and arms, especially when falling asleep.
What are the options at this point? If she stops the Risperdal, she will have horrific anxiety and aggression.
Does she switch to another atypical AD or is her doc going to have to face her fears and RX for a benzo?
P.S. Beta blockers do not work, that was the first thing her pdoc tried.
Posted by Ritch on December 12, 2004, at 16:04:24
In reply to Movement Disorders from Risperal .25mg/d options?, posted by fachad on December 12, 2004, at 14:29:31
> My wife was prescribed Risperdal 0.25mg/day for anxiety.
>
> To me that seemed like a bad idea - a benzo would have been much safer, but I think her pdoc is a benzophobe.
>
> Anyway, she is now showing signs of TD, twitches of hands and arms, especially when falling asleep.
>
> What are the options at this point? If she stops the Risperdal, she will have horrific anxiety and aggression.
>
> Does she switch to another atypical AD or is her doc going to have to face her fears and RX for a benzo?
>
> P.S. Beta blockers do not work, that was the first thing her pdoc tried.
If the twitching is indeed EPS symptoms and the AP really helps a lot I would see about switching to another AP first. Seroquel would be much less likely to cause EPS than Risperdal. I found Risp. of the newer ones to be the worst. It (the seroquel) is a lot more sedative than Risperdal though-she might not like that (I didn't-couldn't take it but at night). Did her doctor have a reason to *want* to use an AP, rather than a reason to *not* want to use a benzo?
Posted by fachad on December 12, 2004, at 18:35:55
In reply to Re: Movement Disorders from Risperal .25mg/d options? » fachad, posted by Ritch on December 12, 2004, at 16:04:24
> If the twitching is indeed EPS symptoms and the AP really helps a lot I would see about switching to another AP first. Seroquel would be much less likely to cause EPS than Risperdal. I found Risp. of the newer ones to be the worst. It (the seroquel) is a lot more sedative than Risperdal though-she might not like that (I didn't-couldn't take it but at night).
OK, possibly Seroquel.
>Did her doctor have a reason to *want* to use an AP, rather than a reason to *not* want to use a benzo?
No, there was no reason to want an AP - no problems with irrational thoughts or any of the things that usually indicate that an AP is needed. I think it was purely based on the desire to treat anxiety and not RX a benzo.
Posted by ace on December 12, 2004, at 19:20:43
In reply to Movement Disorders from Risperal .25mg/d options?, posted by fachad on December 12, 2004, at 14:29:31
> My wife was prescribed Risperdal 0.25mg/day for anxiety.
>
> To me that seemed like a bad idea - a benzo would have been much safer, but I think her pdoc is a benzophobe.
>
> Anyway, she is now showing signs of TD, twitches of hands and arms, especially when falling asleep.
>
> What are the options at this point? If she stops the Risperdal, she will have horrific anxiety and aggression.
>
> Does she switch to another atypical AD or is her doc going to have to face her fears and RX for a benzo?
>
> P.S. Beta blockers do not work, that was the first thing her pdoc tried.Find another doctor who is not a benzophobe and prescribe 1-4mg Xanax a day or 10mg Valium/day or Clonazepam.....and don't go to benzophobe doctors!!!!
Ace
Posted by King Vultan on December 12, 2004, at 20:41:52
In reply to Movement Disorders from Risperal .25mg/d options?, posted by fachad on December 12, 2004, at 14:29:31
> My wife was prescribed Risperdal 0.25mg/day for anxiety.
>
> To me that seemed like a bad idea - a benzo would have been much safer, but I think her pdoc is a benzophobe.
>
> Anyway, she is now showing signs of TD, twitches of hands and arms, especially when falling asleep.
>
> What are the options at this point? If she stops the Risperdal, she will have horrific anxiety and aggression.
>
> Does she switch to another atypical AD or is her doc going to have to face her fears and RX for a benzo?
>
> P.S. Beta blockers do not work, that was the first thing her pdoc tried.
I highly doubt this is TD--I've noticed the twitching you describe while falling asleep on Nardil, as well as on a combination of desipramine and low dose Zoloft. I do not know what the exact mechanism is, but it is apparently related to either serotonin or dopamine. Assuming your wife is not taking another drug which is causing blood plasma levels of the Risperdal to increase, or that she is not a poor 2D6 metabolizer, this very low dosage of 0.25 mg/day blockades the dopamine D2 receptors associated with TD and other EPSEs to a very minimal extent. The only real pharmacologic effect normally seen at this dosage is a blockade of serotonin 2A receptors, which will tend to reduce anxiety and help sleep, while also releasing a small amount of dopamine throughout the cortex. This can have a variety of different effects, but the mechanism is rather opposite from, and not generally associated with EPSEs such as TD.Todd
Posted by JACJ on December 12, 2004, at 21:20:09
In reply to Re: Movement Disorders from Risperal .25mg/d options?, posted by King Vultan on December 12, 2004, at 20:41:52
Hi Todd,
It seems as if you know alot about AP's and movement disorders. Do you study them or just had alot of side effects from them and researched about the side effects? Are you on any? I have a bunch of questions about AP's. Can you help me answer them? I should also ask Ed.Let me know if you can help.
JACJ
Posted by King Vultan on December 13, 2004, at 12:35:11
In reply to Re: Movement Disorders/King Vultan, posted by JACJ on December 12, 2004, at 21:20:09
> Hi Todd,
> It seems as if you know alot about AP's and movement disorders. Do you study them or just had alot of side effects from them and researched about the side effects? Are you on any? I have a bunch of questions about AP's. Can you help me answer them? I should also ask Ed.
>
> Let me know if you can help.
>
> JACJ
I have some understanding of the psychopharmacologic profiles of some of the antipsychotics, as well as a basic understanding of how APs interact with the different dopamine pathways in the brain to cause side effects, but I have not actually taken an AP, and I would consider myself far more knowledgeable about antidepressants because I have much more personal experience with them. I was going to ask my pdoc at my next appointment, however, about possibly trying Risperdal at 0.25-0.50 mg/day. I have a very persuasive article that discusses the benefits of using low dose Risperdal to augment SSRIs and MAOIs (I take Parnate).Todd
This is the end of the thread.
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