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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 Janelle on September 2, 2001, at 19:20:27
After reading a comment in a thread somewhere above, I need to ask the "pros" out there if it is possible that my friend who's being treated for severe depression and irrational, catastrophic thinking with Wellbutrin and Respirdal (not sure of spelling!) could be getting *too much* dopamine blockage?
I ask because side effects that were mentioned as being associated with Respirdal included restlessness, shuffling, and being unable to sit still. My friend has ALL of these. Could the combo of Wellbutrin and Respirdal be *too* intense? Thanks to anyone with any comments, info.
Posted by SalArmy4me on September 2, 2001, at 21:38:19
In reply to Wellbutrin+Respirdal=too much dopamine block?, posted by Janelle on September 2, 2001, at 19:20:27
Risperdal and the atypical neuroleptics should be an essential part of antidepressant treatment for anyone, psychotic or not. Risperdal quells anxiety and ruminating thoughts-- SSRI's often fail in this regard. Also, Risperdal has been proven to speed up the action of antidepressants, more specifically SSRI's. Don't be too concerned about the idea of too much or too little dopamine. In the long run, more people will be helped by the serotonergic aspect of Risperdal (5HT2A antagonism) than the dopaminergic mechanism.
Volume 18(1) February 1998 pp 89-91
Journal of Clinical Psychopharmacology
Adding Risperidone to Selective Serotonin Reuptake Inhibitor Improves Chronic Depression:"...These patients have in common a long course of illness, inadequate clinical response, episodes of major depression, and lack of manic/hypomanic or psychotic symptoms. Three of these patients (JG, MP, and DF) also fulfilled criteria for dysthymia (double depression).
Risperidone was targeted for the suicidal ideation and agitation that were superimposed on depression and anxiety. These symptoms, and disturbance in sleep and eating behavior, had responded poorly to an SSRI alone and with augmentation. The improvement with risperidone was rapid, and a short-duration of treatment was sufficient to control symptoms in some patients. In one patient who relapsed some months after risperidone was discontinued, a rapid response was seen again on reinstatement.
The mechanism by which risperidone augmentation acts is unclear. Adding typical antipsychotics to antidepressants can help in depression with psychotic features, possibly by modulating the dopaminergic system, [8] but these features were absent in our patients.
The symptoms that were responsive to risperidone correspond closely to those described in the "anxiety- and/or aggression-driven depression" subgroup of depressives, postulated to have serotonergic disturbance. [9] In two patients (SG, DF), the response to an SSRI was initially good but became less so with time, which suggests the development of resistance, whereas in the others, response was partial from the start. Similarly, augmentation strategies were partially effective in some cases early on but later became ineffective. There is evidence that using the differential effects of 5-HT receptor function and combining specific agents may be an effective way to enhance serotonergic transmission and improve response. [5] Risperidone may modify the serotonergic system via the 5-HT2 receptor. The involvement of this receptor in depression is supported by the finding that dysthymia may respond to ritanserin. [10] Combining SSRIs and atypical antipsychotics may be effective in treatment-resistant schizophrenia [11] and obsessive-compulsive disorder. [12] Nefazodone, which has 5-HT2A antagonist activity, is an effective antidepressant..."
Posted by Janelle on September 2, 2001, at 22:32:15
In reply to Re: Wellbutrin+Respirdal=too much dopamine block? » Janelle, posted by SalArmy4me on September 2, 2001, at 21:38:19
Posted by Mitch on September 2, 2001, at 23:40:52
In reply to Wellbutrin+Respirdal=too much dopamine block?, posted by Janelle on September 2, 2001, at 19:20:27
> After reading a comment in a thread somewhere above, I need to ask the "pros" out there if it is possible that my friend who's being treated for severe depression and irrational, catastrophic thinking with Wellbutrin and Respirdal (not sure of spelling!) could be getting *too much* dopamine blockage?
>
> I ask because side effects that were mentioned as being associated with Respirdal included restlessness, shuffling, and being unable to sit still. My friend has ALL of these. Could the combo of Wellbutrin and Respirdal be *too* intense? Thanks to anyone with any comments, info.It is important to note whether the agitation was present *before* the meds started and how your friend responded to the meds *after*. If your friend presented with profound agitation I would question the judgement of starting them off with something as activating as Wellbutrin. Given that scenario, why not just Risperdal by itself? Why complicate things with a med (Wellbutrin) that could aggravate psychosis??
Posted by Janelle on September 3, 2001, at 15:17:35
In reply to Re: Wellbutrin+Respirdal=too much dopamine block? » Janelle, posted by Mitch on September 2, 2001, at 23:40:52
I can tell you that that the agitation was present *before* the meds started but seems to have gotten WORSE since my friend has been on Wellbutrin (though IR is "better" than SR).
The main reason she was started on Wellbutrin at all was because when she had a bad bout of depression a number of years ago, Wellbutrin brought her out of it beautifully. However, I'm wondering about its efficacy now since what worked in the past may NOT work again in subsequent *episodes*.
Thanks very much for your comments.
-Janelle
Posted by Mitch on September 3, 2001, at 15:27:05
In reply to MITCH - thanks ... more:, posted by Janelle on September 3, 2001, at 15:17:35
> I can tell you that that the agitation was present *before* the meds started but seems to have gotten WORSE since my friend has been on Wellbutrin (though IR is "better" than SR).
>
> The main reason she was started on Wellbutrin at all was because when she had a bad bout of depression a number of years ago, Wellbutrin brought her out of it beautifully. However, I'm wondering about its efficacy now since what worked in the past may NOT work again in subsequent *episodes*.
> Thanks very much for your comments.
> -JanelleJ.,
Now that does change things. Now it makes me wonder if the *risperdal* might be aggravating it. I wonder if they would have put her on some Depakote with the Wellbutrin instead it could have settled her down instead of her getting worse. That almost sounds like a bipolar mixed state to me. Been there done that!
Posted by Janelle on September 3, 2001, at 16:16:35
In reply to Re: Risperdal aggravating agitation? » Janelle, posted by Mitch on September 3, 2001, at 15:27:05
Okay, so now I get the impression that Risperdal *can* cause agitation and anxiety? I thought it worked like Zyprexa (or even Depakote) in terms of calming irrational, racing, anxious thoughts, but perhaps it can do the opposite?
From what I've observed over the years, I would say yes- there IS a bipolar mixed state going on. She has had some very (almost too) *high* pperiods that last a long time, so it is hard to see that she does indeed cycle.
Thanks again, Janelle
Posted by Mitch on September 3, 2001, at 18:10:22
In reply to MITCH: help! (re: Risperdal): » Mitch, posted by Janelle on September 3, 2001, at 16:16:35
> Okay, so now I get the impression that Risperdal *can* cause agitation and anxiety? I thought it worked like Zyprexa (or even Depakote) in terms of calming irrational, racing, anxious thoughts, but perhaps it can do the opposite?
>
> From what I've observed over the years, I would say yes- there IS a bipolar mixed state going on. She has had some very (almost too) *high* pperiods that last a long time, so it is hard to see that she does indeed cycle.
> Thanks again, JanelleThanks for that information. I thought that most people that present with a mixed state (like at an ER) would be started off rapidly on Depakote with a big dose of a benzo like Klonopin or Ativan to get them settled down and then see how they respond to that first and then evaluate whether to use an antipsychotic. Oh, BTW, there have been reports of hypomania on atypical antipsychotics like Risperdal. I just saw a bulletin the other day about Seroquel causing hypomania. In general yes, they do calm people down who aren't thinking straight and are agitated. But people that are bipolar can be sensitive to any meds that can have antidepressant activity and these newer antipsychotics like Risperdal *do* have good antidepressant properties, that is why they are being used for treatment resistant depression with some success. I hope your friend gets better
soon,Mitch
Posted by Janelle on September 3, 2001, at 19:16:38
In reply to Re: Risperdal worsening bipolar mixed state? » Janelle, posted by Mitch on September 3, 2001, at 18:10:22
Thanks for returning here with more information. Years ago, when my friend was in real bad shape (worse than now) - she *was* psychotic, she was started off rapidly on Ativan, which settled her down, then the doc at that time put her on the Wellbutrin, with success back then.
At this point, I'm not sure that either the Wellbutrin or the Respirdal are helping her - she seems calm at times, but a lot of time she is *not* thinking straight, is agitated and restless (shuffling, pacing).
I guess it will be up to her pdoc what to do (she has an appointment coming up).
Thanks again for your input.
-Janelle
This is the end of the thread.
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