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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by JEdwin on November 22, 2000, at 21:42:41
I have moderate symptoms of schizophrenia but medication has given me the benefit of a partial remission. I have been taking Risperdal for the last two years. At first, a moderate dose worked (3 mg/day), but after about three to six months on a given dose my symptoms always start to come back. Increasing the dose helps. Now I am on 4.5 mg/day, without the possibility of increasing, since I have akathesia (uncontrolable figiting in my legs), and at higher doses I will also start to get Tardive (have already been through that). I have a ton of questions to ask I hope you don't mind.
1) Is having to slowly increase on Risperdal "normal", like am I getting a tolerance for it, or is this a sign my condition is getting worse?
2) Is there a withdrawal period if/when I switch to a new medication (my doctor and I are considering Moban or Zyprexa). I have already tried switching once to Seroquel, but that went poorly. I'm hesitant to try switching when that could just make things worse.
Not only am I considering switching medications, but also doctors. I might ask for a reference or might go back to a previous clinic that I thought I got better advice from. Anyhow I need a plan and I thought that posting this might help me make up my mind.
Posted by ChrisK on November 23, 2000, at 6:19:02
In reply to Switching from Risperdal, posted by JEdwin on November 22, 2000, at 21:42:41
I don't have the schiz. symptoms that you have but I did have obsessive thoughts about death and suicide. While I was in a Psych Hospital the doctor started me on Risperdal but I really couldn't get over the initial "zombie" effect when I felt no emotions. After I got out my current pdoc prescribed Zyprexa. I felt a change within a week.
I don't think that I was taking the Rispedal long enough to worry about withdrawl symptoms. I'm really just trying to say that there can be a difference in the way people react to different anti-psychotics. The change to Zyprexa for me was a great change. Please consider giving it or maybe Seraquel a chance. It may make the difference.
As far as switching doctors is concerned, you need to find one that you are comfortable with. Since you are smart enough to come here and research your meds, you should be able to talk openly with your doctor about med options. I often bring my doctor posts from p-babble to discuss my own med options. He appreciates that I am concerned about my own mental health and doesn't hold it against me at all. The med program I am on now was definitely influenced by my own research on the web.
Best of luck
Chris
Posted by JohnL on November 23, 2000, at 6:31:32
In reply to Switching from Risperdal, posted by JEdwin on November 22, 2000, at 21:42:41
JEdwin,
You might want to check out the posts titled "Question for Risperdal users" starting on 11/17/2000. Dr Bob gathered some comments from other doctors concerning Risperdal that are very interesting. You may be able to play with Risperdal dose sizes, and may find lower is sometimes better than higher.I think Zyprexa or Amisulpride could be excellent choices to replace Risperdal. Your doctor can instruct you on how to switch from Risperdal to Zyprexa. Amisulpride is an excellent choice from Europe. Since it is only available from international mailorder pharmacies, and not FDA approved, I'm not sure your doctor would be able to participate. It is however a choice to keep on the back burner. Zyprexa would seem to me to be the very best choice at this time.
Though each doctor probably would handle it differently, I don't see any need for a wash out period. But whether you do a washout, or just stop one and start another, or slowly decrease one while slowly add in another, I think you should expect some weirdness in that transition zone. After two years, no matter how a switch is accomplished it will likely involve some weird feelings during the change. So be on the lookout and be prepared. Hopefully it would go smoother than expected, but still some caution and respect is warranted. Make sure your doctor is easily reachable during a transition.
I am curious. Do you primarily experience the positive symptoms or the negative symptoms of schizophrenia? Or is it a mixture of both? Is one more prominent than the other? There are two sides to schizophrenia, and I think which side you tend to experience the most could have a strong influence on which drugs should be used. For example, if you have primarily negative symptoms, then choices could be: 1)lower dose of Risperdal; 2)addition of Ritalin or Adderall to Risperdal; 3)addition of antidepressant to Risperdal; 4)Zyprexa; 5)low dose Amisulpride; 6)low dose Sulpiride. If you have primarily positive symptoms, then choices would more likely be something like: 1)increased dose of Risperdal, with another drug added to remedy the akathesia (if your doctor doesn't know what drugs do that, then yeah you probably need a new doctor); 2)Zyprexa; 3)mid-high dose Amisulpride; 4)mid-high dose Sulpiride.
What's better, optimizing Risperdal or switching completely to Zyprexa? I generally think optimizing an existing drug is best. But in your case it might be better to think about trying Zyprexa for a month or so and see how it goes. All evidence suggests it could be a superior replacement. But in a worst case scenario, you could always return to Risperdal and begin optimizing techniques. Though I could see-saw back and forth considering the pros and cons of your alternatives, Zyprexa just seems to stand out as the best choice at this time. It's primary drawback might be a bit more sedation and weight gain than Risperdal.
Hope something here is helpful.
John
Posted by JEdwin on November 24, 2000, at 4:31:05
In reply to Re: Switching from Risperdal, posted by JohnL on November 23, 2000, at 6:31:32
Thanks for your advice. Since I'm not aware of the positive symptoms of schizophrenia its hard to answer if I have any, but I defintly have a lot of the negative symptoms, including social withdrawal, disorganization, paranoia, and auditory hallucinations (mostly negative but sometimes helpful). Also, I falied to mention that I'm already taking low doses of Wellbutrin and sporadic light therapy, both of which have done wonders for my depression.
Could you please elaborate on the positive symptoms of schizophrenia, or point me to a place where I can read more about them? My doctors have never mentioned that side of things.
As for what medication to switch to, I think Zyprexa would ideally be my main choice, but my main concerns about Zyprexa are the weight gain and the cost. My doctor recommended I take Topamax with it, so I would be taking three expensive medications which would probably be too big of a hit on my budget since I mostly pay out of pocket. I'm very curious about Moban, since it doesn't have much weight gain associated with it, but it seems like it isn't prescribed that often.
> JEdwin,
> You might want to check out the posts titled "Question for Risperdal users" starting on 11/17/2000. Dr Bob gathered some comments from other doctors concerning Risperdal that are very interesting. You may be able to play with Risperdal dose sizes, and may find lower is sometimes better than higher.
>
> I think Zyprexa or Amisulpride could be excellent choices to replace Risperdal. Your doctor can instruct you on how to switch from Risperdal to Zyprexa. Amisulpride is an excellent choice from Europe. Since it is only available from international mailorder pharmacies, and not FDA approved, I'm not sure your doctor would be able to participate. It is however a choice to keep on the back burner. Zyprexa would seem to me to be the very best choice at this time.
>
> Though each doctor probably would handle it differently, I don't see any need for a wash out period. But whether you do a washout, or just stop one and start another, or slowly decrease one while slowly add in another, I think you should expect some weirdness in that transition zone. After two years, no matter how a switch is accomplished it will likely involve some weird feelings during the change. So be on the lookout and be prepared. Hopefully it would go smoother than expected, but still some caution and respect is warranted. Make sure your doctor is easily reachable during a transition.
>
> I am curious. Do you primarily experience the positive symptoms or the negative symptoms of schizophrenia? Or is it a mixture of both? Is one more prominent than the other? There are two sides to schizophrenia, and I think which side you tend to experience the most could have a strong influence on which drugs should be used. For example, if you have primarily negative symptoms, then choices could be: 1)lower dose of Risperdal; 2)addition of Ritalin or Adderall to Risperdal; 3)addition of antidepressant to Risperdal; 4)Zyprexa; 5)low dose Amisulpride; 6)low dose Sulpiride. If you have primarily positive symptoms, then choices would more likely be something like: 1)increased dose of Risperdal, with another drug added to remedy the akathesia (if your doctor doesn't know what drugs do that, then yeah you probably need a new doctor); 2)Zyprexa; 3)mid-high dose Amisulpride; 4)mid-high dose Sulpiride.
>
> What's better, optimizing Risperdal or switching completely to Zyprexa? I generally think optimizing an existing drug is best. But in your case it might be better to think about trying Zyprexa for a month or so and see how it goes. All evidence suggests it could be a superior replacement. But in a worst case scenario, you could always return to Risperdal and begin optimizing techniques. Though I could see-saw back and forth considering the pros and cons of your alternatives, Zyprexa just seems to stand out as the best choice at this time. It's primary drawback might be a bit more sedation and weight gain than Risperdal.
>
> Hope something here is helpful.
> John
Posted by JohnL on November 24, 2000, at 6:39:05
In reply to Re: Switching from Risperdal, posted by JEdwin on November 24, 2000, at 4:31:05
JEdwin,
Negative symptoms include anhedonia (lack of pleasure in normal activities), lack of drive, social withdrawal, apathy, and emotional blunting. Positive symptoms include delusions, psychosis, visual or auditory hallucinations, disorganized thinking, bizzareness, and possible agitation. You could do a net search on 'schizophrenia' to learn more about your symptoms and the various subtypes. A good place to start is http://www.mhsource.com/schizophrenia/diag.html.In his book "Dysthymia, the Spectrum of Chronic Depression", a world renowned psychiatrist/researcher makes the case that all the psychiatric disorders have considerable overlap and are not as neatly diagnosable as we would like. I agree with that because I think my subtype of depression actually fits the description of the negative side of schizophrenia closer than it does depression. Clearly though there is some overlap and a lot of gray areas between schizophrenia, depression, psychosis, and bipolar disorder.
You might want to do a search on Amisulpride and print out everything you find and take it to your doctor. I know of two European pharmacies that can mail it to your doorstep in less than a week. One needs a faxed prescription, the other doesn't. It's a wonderful antipsychotic, with a dosing pattern that can be tailored to your specific symptoms, and has far fewer side effects than other antipsychotics. A good article to read is called "Focus on Amisulpride". Just do a net search on Amisulpride and you'll find it, as well as lots of other good info for your doctor to read. Even though it's a European medicine, I was surprised to discover that the University of Maryland is studying it.
Most likely though Zyprexa will be your doctor's favorite choice. You could ask him about adding Ritalin or Adderall to your Risperdal or Zyprexa. That's because psychostimulants can clear up residual negative symptoms, decrease appetite, increase metabolism, and they are dirt cheap. Alone they can cause psychosis. But the antipsychotic will normally block that from happening.
Why is Topamax being considered?
John
Posted by Joelle on November 24, 2000, at 9:46:03
In reply to Switching from Risperdal, posted by JEdwin on November 22, 2000, at 21:42:41
I work in this field although I am NOT a psychiatrist but a dietitian...and I do suffer from depression with anxiety which is why I use this board.
I recently went to a workshop on Risperdal and they stated that the maximum dose would be 6 mg but that they did not really see any difference in effectiveness between 4mg and 6 mg. Also, Risperdal does not have the weight gain side effect that Zyprexa has.
My personal experience is that people on Risperdal did not respond as well as people on Zyprexa. That's my own observation.
If you do decide to go on Zyprexa make sure you continue to eat healthy and do not increase your portions. Zyprexa tends to increase your appetitie and give you cravings for sweets and carbohydrates (bread, pasta, etc).
Good luck to you.
Joelle
> I have moderate symptoms of schizophrenia but medication has given me the benefit of a partial remission. I have been taking Risperdal for the last two years. At first, a moderate dose worked (3 mg/day), but after about three to six months on a given dose my symptoms always start to come back. Increasing the dose helps. Now I am on 4.5 mg/day, without the possibility of increasing, since I have akathesia (uncontrolable figiting in my legs), and at higher doses I will also start to get Tardive (have already been through that). I have a ton of questions to ask I hope you don't mind.
>
> 1) Is having to slowly increase on Risperdal "normal", like am I getting a tolerance for it, or is this a sign my condition is getting worse?
>
> 2) Is there a withdrawal period if/when I switch to a new medication (my doctor and I are considering Moban or Zyprexa). I have already tried switching once to Seroquel, but that went poorly. I'm hesitant to try switching when that could just make things worse.
>
> Not only am I considering switching medications, but also doctors. I might ask for a reference or might go back to a previous clinic that I thought I got better advice from. Anyhow I need a plan and I thought that posting this might help me make up my mind.
Posted by fitgrl on November 24, 2000, at 11:31:14
In reply to Re: Switching from Risperdal, posted by JohnL on November 24, 2000, at 6:39:05
Hi,
I was wondering if anyone has ever felt a feeling like your heads inside a balloon? It's hard to explain, but I recently stopped taking paxil 20mg. It worked great for me for 2 years, but I felt it was time to give it a go without it. I started taking it because of obsessing and this "foggy head" feeling. I have never figured out what it is or why it is happening to me, but I could scream because of it. I have been off paxil now for about a week and right back is this foggy feeling just like before I started the paxil.
I feel confused. If I go in public somewhere and have to talk to someone, it's like I have to listen real closely to what they are saying to me.
I am wondering if ANYONE has experienced this? and if so, what if anything have you been able to do about it?
I can manage all the other reasons I was on paxil and be ok without it, but this fog feeling is getting the best of me. PLEASE SOMEONE!
Posted by Shell on November 25, 2000, at 0:11:12
In reply to foggy head ANYONE HAVE THIS???? PLEASE REPLY, posted by fitgrl on November 24, 2000, at 11:31:14
I really wish there was something I could tell you about what this "foggy head" syndrome is; I wish I could tell you what causes it and how to eliminate it. Unfortunately, if I knew the answer to that, I wouldn't have to deal with it myself. I have it (although I have always thought of it as my head being stuffed with cotton balls) and it doesn't seem to be relieved by antidepressants. I think if I found a medication that eliminated it for me, I would continue to take it. Being on medication long term sounds much less objectionable to me than does living with foggy head.
At least your post gives me some hope. This can be helped by medication; I will just have to keep trying.
Shell
Posted by JEdwin on November 25, 2000, at 3:08:39
In reply to Re: Switching from Risperdal, posted by JohnL on November 24, 2000, at 6:39:05
John,
My doctor said that Topomax may reduce the weight gain associated with taking Zyprexa. I've also seen that in another thread here on this board.
Thanks for explaining the difference between positive and negative. I have both "positive" and negative ranging from mild to moderate. I just thought that something that was positive would be helpful. I have already looked a little on the internet but haven't seen that distinction yet.
My very first diagnosis was ADD since I am so disorganized and sometimes agitated and I took first dexedrine and then ritalin and they are what brought out my psychotic symptoms originally, so I'm totally aware of that side of things. I am wary about taking ritalin again since I was very sensitive to it last time. Besides, my negative symptoms are a lot better with light therapy and Wellbutrin than ever.
Also, about Amisulpride, I'm not sure what my doctor would think, but it's worth a try. I'll look around and see what I can find.
> JEdwin,
> Negative symptoms include anhedonia (lack of pleasure in normal activities), lack of drive, social withdrawal, apathy, and emotional blunting. Positive symptoms include delusions, psychosis, visual or auditory hallucinations, disorganized thinking, bizzareness, and possible agitation. You could do a net search on 'schizophrenia' to learn more about your symptoms and the various subtypes. A good place to start is http://www.mhsource.com/schizophrenia/diag.html.
>
> In his book "Dysthymia, the Spectrum of Chronic Depression", a world renowned psychiatrist/researcher makes the case that all the psychiatric disorders have considerable overlap and are not as neatly diagnosable as we would like. I agree with that because I think my subtype of depression actually fits the description of the negative side of schizophrenia closer than it does depression. Clearly though there is some overlap and a lot of gray areas between schizophrenia, depression, psychosis, and bipolar disorder.
>
> You might want to do a search on Amisulpride and print out everything you find and take it to your doctor. I know of two European pharmacies that can mail it to your doorstep in less than a week. One needs a faxed prescription, the other doesn't. It's a wonderful antipsychotic, with a dosing pattern that can be tailored to your specific symptoms, and has far fewer side effects than other antipsychotics. A good article to read is called "Focus on Amisulpride". Just do a net search on Amisulpride and you'll find it, as well as lots of other good info for your doctor to read. Even though it's a European medicine, I was surprised to discover that the University of Maryland is studying it.
>
> Most likely though Zyprexa will be your doctor's favorite choice. You could ask him about adding Ritalin or Adderall to your Risperdal or Zyprexa. That's because psychostimulants can clear up residual negative symptoms, decrease appetite, increase metabolism, and they are dirt cheap. Alone they can cause psychosis. But the antipsychotic will normally block that from happening.
>
> Why is Topamax being considered?
> John
This is the end of the thread.
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